On June 30, the psychotherapist wrote for the magazine an interesting and certainly controversial essay about the relevance of Josef Breuer’s work in modern psychotherapy, but which have been practically ignored and are only briefly mentioned in psychology classes. Sandhu also writes about Breuer’s relationship with Freud and the well-known Anna O. The whole text is very interesting and offers us much to think about and discuss.
The article was translated by David Aparicio and Maria Fernanda and you can read the original version at .
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The Viennese physician Josef Breuer (1842-1925) has a unique and prominent place in the history of psychotherapy. He developed the cathartic method, or healing through speech, as a treatment for nervous disorders, while treating a patient known as Anna O., between 1880 and 1882. As a result of that treatment, Breuer formulated many of the concepts of modern psychotherapy. This month marks the 90th anniversary of his death and offers us the opportunity to reflect on the value of his contributions.
Breuer is best known for his collaboration with Sigmund Freud, when he introduced him to the case of Anna O. (whose real name was Bertha Pappenheim). The ideas that came out of that case fascinated Freud so much that he dedicated the rest of his career to developing them and they shaped what we know as psychoanalysis. The two men co-wrote the book Studies on Hysteria, published in 1895, which is considered the founding text of psychoanalysis. However, the importance of Breuer’s contributions go beyond his role as Freud’s mentor and collaborator. In fact, Breuer laid the foundation for modern therapy; for example, he took into account all aspects of his patients’ lives and personalities and focused on their emotional expression, as opposed to the Freudian emphasis on the insight and interpretation.
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I discovered Breuer early in my training as a therapist, after becoming aware of helping my patients achieve insigth of their problems, as the main focus of treatment, was rarely effective. And I found Freud’s technique of free association to be useless, because many clients who are anxious or depressed have a lot of difficulty free associating. On the other hand, the most therapeutic sessions were those that provoked an emotional response in my patients. If I was able to guide them to access their relevant feelings and memories, then they reported that something had changed in them and that dramatically accelerated the process of change and growth.
I wanted to learn how to obtain these results and experiences in therapy and began to explore techniques such as hypnosis, mindfulness and focusing, all of them involve subtle changes in the client’s state of consciousness. While studying the literature to understand the nature of these changes, I learned of Breuer’s description of the cathartic method and his work with Anna O. in Studies on Hysteria. Breuer’s ideas are surprisingly relevant to modern therapy and to my work with my clients, and I was surprised that they were not widely known.
Breuer’s theoretical essays in Studies on Hysteria They require careful reading. His essay is more than sixty pages long and provides comprehensive observations on the relationship between the nature, cause, and treatment of mental illness with astonishing clarity, rigor, and depth. In 1955, James Strachey, English translator of the Studies on Hysteria, describing the essay, said that it was “very far from being out of date; on the contrary; Grant thoughts and suggestions to those that have not been given enough importance. His statements are very valid today.
In image: Bertha Pappenheim / Credits: Wikimedia Commons
According to Breuer’s theory of hysteria, mental illness begins when a person is exposed to psychic trauma, which he defined as any situation with a risk of serious physical or emotional harm. If the individual is unable to feel and express the emotions related to the traumatic experience, then they are dissociated, meaning that it is a separate state of consciousness that is inaccessible to ordinary consciousness. Here, Breuer recognized and built his theory on the work of the French psychiatrist, Pierre Janet, who was the first to recognize the importance of dissociation in mental illness. Breuer called this altered state of consciousness the “hypnoid state,” due to its similarity to the state induced by hypnosis. Recovery and healing then requires the ability to access and express associated emotions through catharsis, and their integration with ideas in normal consciousness, a process he calls associative correction.
If we compare Breuer’s theory with Freud’s formulation of psychoanalysis, we will find three main differences: psychic trauma (Breuer) vs. sexual conflict (Freud) as the main cause of psychopathology; Hypnoid states (dissociation) vs. repression (defense) as the main mechanism; and emotional expression (catharsis) vs. interpretation (analysis) as the main means of recovery. Ironically, on each of these points, the modern view of psychotherapy has been increasingly in Breuer’s favor.
A significant body of evidence, compiled by researchers such as , points out the central role of trauma in the origin of psychopathology. Understanding the effects of trauma is now a major focus of medical research, postulated by the urgent need to find effective treatments for post-traumatic stress disorder (PTSD). Breuer’s work is also very relevant to clinical practice. His concept of the hypnoid state, for example, It is very similar to (and provides a unifying link between) techniques such as mindfulness, focusing, neurofeedback and EMDR, which are of importance in current therapy.
The publication of theStudies on Hysteria¨marked the end of the collaboration between Breuer and Freud. Freud increasingly focused on sexuality, as an essential role in all cases of hysteria. Breuer recognized the importance of sexuality, but considered it only one of many factors, and instead affirmed the phenomenon of dissociation due to trauma, which was implicit in his theory of hypnoid states.
In a letter to Swiss psychiatrist Auguste Forel in 1907, Breuer wrote, “this theoretical and practical immersion in the sexual is not to my taste,” and continued, “Freud is a man given to absolute and exclusive formulations: it is a necessity.” psychic, which in my opinion, leads to excessive generalization.¨ Freud, for his part, was skeptical of the entire concept of hypnoid states. InFive Lectures on Psychoanalysis,¨ wrote: “Breuer’s theory of hypnoid states turned out to be unnecessary and obstructive, and was abandoned today by psychoanalysis.”
Freud also promoted the idea that Breuer was too cautious and conservative to recognize the true importance of sexuality. To support his argument, Freud claimed that Breuer had abruptly ended his work with Anna O., and never returned to work with hysterical patients, because she developed strong sexual feelings toward him. This view was stated as fact by Freud’s biographer, Ernest Jones, and came to define popular belief about it.
However, there is no reliable basis for Freud’s claim. The psychoanalyst and biographer of Freud wrote: “Freud’s version of what happened is simply not true. It is an example of the “resistance” argument that he would later use to remove all those who questioned his theory of sexuality: they could not accept the theory because it was too threatening. “Freud later used a similar argument with many of his followers who disagreed with him, including Carl Jung, Alfred Adler, Sando Ferenczi and Otto Rank. Breger goes on to say: “The truth is that Breuer did not run away from Bertha, he remained involved with her treatment for several years.”
In image: Sigmund Freud /Credits: Wikimedia Commons
In “The interpretation of dreams”, Freud wrote: “A close friend and a hated enemy have always been the necessary requirements in my emotional life. I always knew how to provide myself with both over and over again…sometimes both were united in the same person.¨ This statement is very descriptive of Freud’s relationship with Breuer.
It is notable that Breuer had been more than a collaborator with Freud, who was 14 years younger, lending him money, referring patients, and taking him into his home. The Yale historian, in his biography of Freud, wrote: “His unpleasant snarl toward Breuer in the 1890s is a classic example of the ingratitude and resentment of a proud debtor against his benefactor.”
Breuer never publicly challenged Freud or responded to his criticisms, instead choosing to withdraw from the field of psychology to focus on his medical practice. Freud had the field to himself and his writings shaped public opinion of Breuer, which persists to this day.
Personal data aside, the key question is: which ideas are most valid? In that sense history is on Breuer’s side. Freud’s emphasis on sexuality as the dominant factor in shaping human development and as the cause of psychopathology is no longer taken seriously today. Instead, the role of dissociation due to trauma is increasingly recognized as fundamental. Furthermore, most therapists today realize the importance of helping clients access and integrate painful emotions due to past trauma, which is the essence of Breuer’s cathartic method.
Breuer made radical changes when he developed the cathartic method for the treatment of Anna O. First, Breuer changed the focus of therapy from suggestion to the patient’s self-discovery. Second, he expanded the scope of therapy from a narrow focus on treating symptoms to considering all aspects of patients’ lives and personalities, thereby founding psychotherapy as a distinct discipline.
Finally, he was the first person to treat mental illness through long-term exploration of unconscious conflicts, and invented what is known as “the talking cure,” the central treatment approach for all forms of mental illness. psychotherapy. While popular belief assigns all the credit to Freud for these achievements, the fact is that all of this was already in Breuer’s treatment with Anna O., before he began their collaboration…