freud's case study of Anna O, Little Hans and Ratman

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more information please on Freud's studies on Anna O, Little Hans and ratman

-- marieta de villiers (dvillcm@unisa.ac.za), October 04, 2004

Answers

Anna O. was actually Breuer's case, and can be found in Breuer & Freud's _Studies in Hysteria_. You can find the cases of Little Hans and the Ratman in Freud's _Two Case Histories_ (v. 10 of the _Complete Psychological Works_)

-- Christopher Green (christo@yorku.ca), October 04, 2004.

To get a full appreciation of the case of Anna O., you should read the work of Henri Ellenberger regarding her. One source is: Micale, M. (Ed.) (1993). Beyond the unconscious: Essays of Henri Ellenberger in the history of psychiatry. Princeton University Press. It contains a chapter devoted to Anna O.

-- John D. Hogan (hoganjohn@aol.com), October 04, 2004.

Anna O. was a twenty-one-year-old woman who had fallen ill while nursing her father who eventually died of a tubercular abscess. Her illness began with a severe cough. She subsequently developed a number of other physical symptoms, including paralysis of the extremities of the right side of her body, contractures, disturbances of vision, hearing and language. She also began to experience lapses of consciousness and hallucinations. Breuer diagnosed Anna O.’s illness as a case of hysteria and gradually developed a form of therapy which he believed was effective in relieving her symptoms. He came to the conclusion that when he could induce her to relate to him during the evening the content of her daytime hallucinations, she became calm and tranquil. Breuer himself saw this as a way of ‘disposing’ of the ‘products’ of Anna O.’s ‘bad self’ and understood it as a process of emotional catharsis. The patient herself described it as ‘chimney sweeping’, and as her ‘talking cure’. Breuer went on to extend this therapy. At one point in her illness, for a period of weeks, Anna O. declined to drink and would quench her thirst with fruit and melons. One evening, in a state of self-induced hypnosis, she described an occasion when she said she had been disgusted by the sight of a dog drinking out of a glass. Soon after this she asked for a drink and then woke from her hypnosis with a glass at her lips. In his published account of the case, written some twelve years later, Breuer treated the story which Anna O. had related in a trance as a true account of an incident which had given rise to her aversion to drinking. He said he had concluded that the way to cure a particular symptom of ‘hysteria’ was to recreate the memory of the incident which had originally led to it and bring about emotional catharsis by inducing the patient to express any feeling associated with it.. The sudden disappearance of one of Anna O.’s many symptoms thus became the basis for what Breuer later described as a ‘therapeutic technical procedure’. According to both Freud and Breuer, this method had been applied systematically to each of Anna’s symptoms and as a result she was cured completely of her hysteria.

-- cw (pringel@juno.com), October 14, 2004.

The above analysis is correct as of the publication of the Anna O. case study, but Freud later revisits the case and finds that he was utterly wrong. Brauer, for understandable reasons, did not publish the entirety of the case study. Before terminating treatment, after concluding that Anna O. was completely cured, new symptoms began to surface. She experienced a hysterical pregnancy. Though not pregnant, she began feeling morning sickness, and at their last session, under hypnosis, began experiencing labor and screamed something like: "Here it comes - Brauer's baby!" Brauer was so freaked out that he left psychoanalysis, never to return.

Freud rethinks this event, saying that the answer was in front of them all along. First, Anna o.'s propensity to latch onto everyday experiences and to distort them into ever new neurotic symptoms suggests that the cathartic cures were themselves hysteric symptoms. Just as her treatment was drawing to a close, a new onset of symptoms distorted the feelings of loss and attachment to Brauer into a mess of meanings. It's tempting to think of Anna O. as merely a fake, since her symptoms appear tactical. Yet, taking them seriously, Freud concludes that neurotic symptoms serve strategic, though not deliberate, psychological functions. They are protective but maladaptive, a subset of defense mechanisms gone terribly wrong.

In the initial formulation, the events (e.g. the dog drinking out of the glass) produced the symptoms (feeling too disgusted by water to drink any, however thirsty). Thus their initial approach: Cure the disease by targetting these experiences. Now apparent, the experiences were more or less arbitrary, where it was Anna's diseased imagination unable to cope with everyday stresses. The dog elicited revulsion, but rather experiencing this unpleasant feeling, her psyche blocked it. But blocked experiences don't dissappear. Everytime an experience reminded her of the initial incident, she had to reapply the repression.

Second, Anna's hysterical pregnancy displayed transference in the libinal-sexual association with Brauer. Since dealing with neurosis at the level of events did not work (the neurotic just finds more events), Freud needed a method to influence the way that the neurotic's imagination responds to events. A person must feel comfortable enough to go through with the experience. This is done by reworking the event in an artificial and safe (play) space, allowing the person to experiment with different styles of response (and so hopefully learn how to deal with realworld experiences better).

-- Tom Jacobs (lyingmime@netscape.com), October 26, 2004.


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