Wednesday, April 09, 2008

The Exceptional Josef Breuer (1842-1925) and Sigmund Freud

Perhaps Josef Breuer is the most underestimated of influences on the thought and work of Sigmund Freud.  Another Jew, Breuer was born in Vienna, Austria, in 1842. His father, Leopold Breuer, taught religion in Vienna's Jewish community. Breuer's mother died when he was quite young, and he was raised by his maternal grandmother and educated by his father until the age of eight. He graduated from the Akademisches Gymnasium of Vienna in 1858 and then studied at the university for one year, before enrolling in the medical school of the University of Vienna. He passed his medical exams in 1867 and went to work as assistant to the internist Johann Oppolzer at the university.  He was not only a brilliant physician who had a large private practice but also a psychiatrist and a physiologist of note.  He used any extra money he earned from his practice to engage in his physiological and psychiatric studies and researches.   He is famous for the following discoveries: (i) The Hering-Breuer reflex, that is the reflex reactions originating in the lungs and mediated by the fibres of the vagus nerve: inflation of the lungs, eliciting expiration, and deflation, stimulating inspiration, (ii) Mach-Breuer theory which was a theory to explain the reactions of the vestibular organ in the ear.  But it is for a third theory that is most widely known in psychiatric and psychological circles, namely the eponymous Breuer's theory which influenced Freud considerably.  This theory states that the symptoms of built-up or suppressed affections and psychic traumas not dealt with can be eliminated through recalling and working on one's feelings in conversations.

I have already given a fulsome description of hysteria in my last post.  Suffice it to say, this condition, which was strangely and culturally diagnosed in women only, had a broad array of symptoms like paralyses, tremors, losses of feeling in limbs and other sundry assorted symptoms which as far as any doctor could say had absolutely no apparent physical or physiological base.  Needless to say, then, most of Freud's contemporaries in the medical world dismissed hysterical patients as malingerers or con artists or fakers.  However, Freud, who had studied under Charcot and also at the famous Nancy School under Hippolyte M. Bernheim believed otherwise.  To Freud's great credit he took these "strange characters" seriously in their suffering.  The researchers at Nancy had been somewhat successful in treating hysteria by hypnotizing patients and then suggesting while they were in this state that their symptoms would disappear.  Sometimes, though not always I hasten to add, they did.

When Freud returned to Vienna he reported a certain small amount of success with his patients using hypnosis.  It is at this stage that our man Josef Breuer enters the picture.   Breuer, as we've said, was an amazingly versatile physician with a private practice, but who, in his spare time, did original research into physical and mental phenomena that interested and intrigued him.   Enter also, the famous "Anna O" or Bertha Pappenheim (1859-1936)  While nursing her terminally ill father this poor girl developed a host of debilitating and socially awkward hysterical symptoms.  Let us return to Professor Fancher's magisterial work for a lucid description of Breuer's then newly discovered cathartic method for the treatment of hysteria:

Gradually, and working together virtually as collaborators, doctor and patient devised a cathartic method that removed her symptoms... In this treatment, Breuer hypnotized Pappenheim and then asked her to try to recall the first time she had experienced a physical sensation like one of her symptoms.  Often the "hypnosis" facilitated the recall of a previously "forgotten"  but highly emotion-laded memory associated with the symptom.  Upon remembering such an incident, she would give vent to its previously suppressed emotion.  Following this emotional "catharsis" the symptoms would disappear. (Pioneers of Psychology, 367)

In short, then, when Anna or Bertha could recall the first moment at which a particular hysterical symptom appeared and then re-experience the accompanying emotion, the symptom disappeared.  Breuer called his famous treatment catharsis.  Breuer and Freud went on collaborate on a book called Studies on Hysteria (1895) wherein they made the very famous statement "hysterics suffer mainly from reminiscences." (Fancher, op.cit., 368)  Needless to say, these reminiscences were invariably painful and were pushed deep down and well away from consciousness.    Hence, Freud theorised that there must be a mechanism in the psyche which tended to banish these memories from consciousness.  Freud was to call this first mechanism of defence Repression.  This latter defence mechanism would go on to become one of the cornerstones of the psychoanalytic theory of neuroses.  Of course, Freud and Breuer in our above short quotation did not mean mere memories by their term "reminiscences" but rather memories of fraught and emotionally charged instances or experiences.  These over-wrought experiences are very painful and are pushed as far away from consciousness as possible.  Thereby, these repressed experiences become disease-producing pathogenic ideas.  To return briefly once more to Fancher, we read:

Thus Freud and Breuer referred to many hysterical symptoms as conversions (of emotional into physical energy).  With hypnotic assistance, however, patients could regain conscious access to their pathogenic ideas, and thus to the normal expression of their stragulated emotional energy.  The causes of their symptoms could thus be removed. (Ibid., 368)

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