Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrian-Jewish feminist, a social worker pioneer, and the founder of the Jewish Women's Association (Jüdischer Frauenbund). Under the pseudonym Anna O., she was also one of Josef Breuer's best-documented patients because of Sigmund Freud's writings on Breuer's treatment of her.
Bertha Pappenheim was born on 27 February 1859 in Vienna, the third daughter of Recha Pappenheim and Sigmund Pappenheim. Her mother Recha, née Goldschmidt (1830–1905), was from an old and wealthy family in Frankfurt am Main. Her father Sigmund (1824–1881), a merchant, the son of an Orthodox Jewish family from Preßburg, Austria-Hungary (today's Bratislava, Slovakia), was the cofounder of the Orthodox Schiffschul in Vienna; the family name alludes to the Franconian town of Pappenheim. As "just another daughter" in a strictly traditional Jewish household, Bertha was conscious that her parents would have preferred a male child. Her parents' families held traditional Jewish views on marriage and had roots in Orthodox Judaism. Bertha was raised in the style of a well-bred young lady of good class. She attended a Roman Catholic girls' school and led a life structured by the Jewish holiday calendar and summer vacations in Ischl.
When she was eight years old, her oldest sister Henriette (1849–1867) died of galloping consumption, now known as a form of tuberculosis. When she was 11 the family moved from Vienna's Leopoldstadt, which was primarily inhabited by poverty-ridden Jews, to Liechtensteinstraße in the Alsergrund. She left school when she was sixteen, devoted herself to needlework and helped her mother with the kosher preparation of their food. Her 18-month-younger brother Wilhelm (1860–1937) was meanwhile attending a high school, which offered in those days prestige and status, and which made Bertha intensely jealous.
Illness and treatment as Anna O.
Between 1880 and 1882, Pappenheim was treated for a variety of symptoms that began when her father suddenly fell seriously ill in mid-1880 during a family holiday in Ischl. His illness was a turning point in her life. While sitting up at night at his sickbed she was suddenly tormented by hallucinations and a state of anxiety. At first the family did not react to these symptoms, but in November 1880 a friend of the family, the physician Josef Breuer, began to treat her. He encouraged her, sometimes under light hypnosis, to narrate stories, which led to partial improvement of the clinical picture, although her overall condition continued to deteriorate. Breuer kept his then-friend Sigmund Freud abreast of her case, informing his earliest analysis of the origins of hysteria.
Starting on 11 December, Pappenheim was bedridden for several months. When her father died, on 5 April 1881, she became fully rigid and did not eat for days. Her symptoms continued to get worse and on 7 June she was admitted against her will to the Inzersdorf sanatorium, where she remained until November. After returning she continued to be treated by Breuer. She returned to this sanatorium several times over the course of the following years (sometimes at her own wish).
The slow and laborious progress of what Breuer called her "remembering work", in which she recalled individual symptoms after they had occurred, thus "dissolving" them, came to a conclusion on 7 June 1882 after she had reconstructed the first night of hallucinations in Ischl. Breuer concluded his case report with the words "She has fully recovered since that time".
Anna O. was the pseudonym given to Pappenheim by Breuer while she was his patient, in his descriptions of her as a case study. The pseudonym was constructed by shifting her initials "B.P." one letter back in the alphabet to "A.O." Aspects of the Anna O. case were first published by Freud and Breuer in 1893 as preliminary communications in two Viennese medical journals. The detailed case history appeared in 1895 in his book Studies on Hysteria, written in collaboration with Freud.
Pappenheim was treated by Breuer for severe cough, paralysis of the extremities on the right side of her body, and disturbances of vision, hearing, and speech, as well as hallucination and loss of consciousness. She was diagnosed with hysteria. Freud implies that her illness was a result of the resentment felt over her father's real and physical illness that later led to his death.
Throughout the two years of her illness, she developed a wide spectrum of symptoms:
Language disorders (aphasia): on some occasions she could not speak at all, sometimes she spoke only English, or only French, or Italian. She could however always understand German. The periods of aphasia could last for days, and sometimes varied with the time of day.
Neuralgia: she suffered from facial pain which was treated with morphine and chloral and led to addiction. The pain was so severe that surgical severance of the trigeminus nerve was considered.
Paralysis (paresis): signs of paralysis and numbness occurred in her limbs, primarily on only one side. Although she was right-handed, she had to learn to write with her left hand because of this condition.
Visual impairments: she had temporary motor disturbances in her eyes. She perceived objects as being greatly enlarged and she squinted.
Mood swings: Over long periods she had daily swings between conditions of anxiety and depression, followed by relaxed states.
Amnesia: when she was in one of these states she could not remember events or any of her own actions which took place when she was in the other state.
Eating disorders: in crisis situations she refused to eat. During one hot summer she rejected liquids for weeks and lived only on fruit.
Pseudocyesis: there are some accounts that during her final meeting with Breuer she exhibited symptoms of a false pregnancy. Freud later claimed that she accused Breuer of impregnating her, but admitted that this was a guess.