Saturday, January 29, 2011

Deal with the cause.

Josef Breuer (1842 –1925) was an Austrian physician whose works laid the foundation of psychoanalysis. Breuer is perhaps best known for his work with Anna O. (the pseudonym of Bertha Pappenheim), a woman suffering from 'paralysis of her limbs, and anaesthesias, as well as disturbances of vision and speech.

Until Breuer's time, hypnosis had primarily been used for the alleviation of pain in surgery, and according to Liebeault's method, the simple suggesting away of symptoms. However, circa 1880, Breuer made an accidental discovery that changed the methods of hypnotherapy. As a matter of fact, it not only changed the methods of hypnotherapy, but actually introduced an entirely new art in itself as it was Breuer's work which attracted Freud and led him into methods of psychoanalysis which are so common to psychiatrists today.

In any case, Breuer had been treating a patient whom he called Anna O. [Anna O. being the pseudonym used for Bertha Pappenheim, an Austrian-Jewish feminist and the founder of the Jüdischer Frauenbund (League of Jewish Women).] The case is a long and involved one, and is well known to all students of psychiatry. During one portion of therapy, they found however, much to her distress, (and Anna O. was a hysterical patient with many, many different problems) that she could drink no water. In fact, no matter how intense her thirst became, she felt it was a physical impossibility for her to swallow water. Thereupon, she subsisted for a number of months on watery fruits and melons until, during a hypnotic session, she revealed in a fit of anger, how to her great disgust, a former governess had permitted a dog to drink water out of a glass in her presence. As soon as she awoke from the trance she immediately asked Breuer for a drink of water, emptying the glass with ease.

This led Breuer to the realization that the simple recalling of the traumatic experiences from the past of the dog drinking the glass of water was responsible for removing the symptoms. After coming to this conclusion, Breuer then attempted to associate all of the patient's symptoms with traumatic experiences in the past. After working with Anna O. for over a year, Breuer was able to remove her symptoms of blindness, paralysis, deafness, the contracture of her right arm, her anesthesia's, cough, trembling, and all of her other symptoms, merely by repeated trances which revealed more and more of her previous experiences, which contained damaging traumatic incidents.

The importance of Breuer's work lies in the change of emphasis in hypnotic therapy, from the direct removal of symptoms to the dealing with the apparent cause of these symptoms.

Breuer described his final methodology as follows: In the morning he asked Pappenheim under light hypnosis about the occasions and circumstances under which a particular symptom occurred. When he saw her in the evening, these episodes—there were sometimes over 100—were systematically "reeled off" by Pappenheim in reverse temporal order. When she got to the first occurrence and thus to the "cause", the symptoms appeared in an intensified form and then disappeared "forever".

Anna's/Bertha's case also shed light for the first time on the phenomenon called transference, where the patient's feelings toward a significant figure in his/her life are redirected onto the therapist. By transference, Anna imagined to be pregnant with the doctor's baby. She experienced nausea and all the pregnancy symptoms. After this incident, Breuer stopped treating her.

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