For two years, beginning in December 1880, Breuer had treated for hysteria a Vienna-born Jewish girl, Bertha Pappenheim (1859-1936), whom he described, for case-book purposes, as 'Anna O'. She had a variety of severe symptoms, including hallucinations, speech disturbances, a phantom pregnancy, intermittent paralyses, and visual problems. In the course of her illness(es) she experienced two different states of consciousness, and also went through extended bouts of somnambulism. Breuer found that in this latter state she would, with encouragement, report stories that she made up, following which her symptoms improved temporarily. However, her condition deteriorated badly after her father died-there were more severe hallucinations and anxiety states. Again, however, Breuer found that 'Anna' could obtain some relief from these symptoms if he could persuade her to talk about her hallucinations during her auto-hypnoses. This was a process she herself called her 'talking cure' or 'chimney sweeping' ( Kaminfagen ). Breuer's next advance was made accidentally: 'Anna' started to talk about the onset of a particular symptom (difficulty in swallowing), after which the symptom disappeared. Building on this, Breuer eventually (after some considerable time) discovered that if he could persuade his patient to recall in reverse chronological order each past occurrence of a specific symptom, until she reached the very first occasion, most of them disappeared in the same way. By June 1882, Miss Pappenheim was able to conclude her treatment, 'totally cured'.28 The case of Anna O. impressed Freud deeply (he had been distinctly unimpressed by George Beard's arguments about neurasthenia). For a time Freud himself tried electrotherapy, massage, hydrotherapy and hypnosis with hysterical patients but abandoned this approach, replacing it with 'free association'-a technique whereby he allowed his patients to talk about whatever came into their minds. It was this technique which led to his discovery that, given the right circumstances, many people could recall events that had occurred in their early lives and which they had completely forgotten. Freud came to the conclusion that though forgotten, these early events could still shape the way people behaved. Thus was born his concept of the unconscious and with it the notion of repression. Freud also realised that many of these early memories which were revealed-with difficulty-under free association, were sexual in nature. When he further found that many of the 'recalled' events had in fact never taken place, he refined his notion of the Oedipus complex. In other words, the sexual traumas and aberrations falsely reported by patients were for Freud a form of code, showing not what had happened but what people secretly wanted to happen, and confirmed that human infants went through a very early period of sexual awareness. During this period, he said, a son was drawn to the mother and saw himself as a rival to the father (the Oedipus complex) and vice versa with a daughter (the Electra complex). By extension, Freud said, this broad motivation lasted throughout a person's life, helping to determine character.29 These early theories of Freud were met with outraged incredulity and unremitting hostility. The neurological institute of Vienna University refused to have anything to do with him. As Freud later said, 'An empty space soon formed itself about my person.'30 His response was to throw himself deeper into his researches and to put himself under analysis-with himself. The spur to this occurred after the death of his father, Jakob, in October1896. Although father and son had not been very intimate for a number of years, Freud found to his surprise that he was unaccountably moved by his father's death, and that many long-buried recollections spontaneously resurfaced. His dreams also changed. He recognised in them an unconscious hostility directed toward his father that hitherto he had repressed. This led him to conceive of dreams as 'the royal road to the unconscious'.31 Freud's central idea in The Interpretation of Dreams was that in sleep the ego is like 'a sentry asleep at its post'.32 The normal vigilance by which the urges of the id are repressed is less efficient and dreams are therefore a disguised way for the id to show itself. The early sales for The Interpretation of Dreams indicate its poor reception. Of the original 600 copies printed, only 228 were sold during the first two years and the book apparently sold only 351 copies during its first six years in print.33 More disturbing to Freud was the complete lack of attention paid to the book by the Viennese medical profession.34 The picture was much the same in Berlin. Freud had agreed to give a lecture on dreams at the university, but only three people turned up to hear him. In 1901, shortly before he was to address the Philosophical Society he was handed a note which begged him to indicate 'when he was coming to objectionable matter and make a pause, during which the ladies could leave the hall'. The isolation wouldn't last and in time, and despite fierce controversy, many people came to consider the unconscious the most influential idea of the twentieth century.
So much for the orthodox view. Now for the revised version. There are four main charges. In increasing order of importance they are that, one, Freud did not invent the 'free association' technique. This was invented in 1879 or 1880 by Francis Galton and reported in the journal Brain , where the new technique is described as a device to explore 'obscure depths'.35 The second charge is that it is a myth that Freud's books and theories met with a hostile reception-recent scholarship has revealed the extent of this myth. Norman Kiell, in Freud Without Hindsight (1988), reports that out of forty-four reviews of The Interpretation of Dreams published between 1899 and 1913 (which is in itself a respectable number), only eight could be classified as 'unfavourable'. Hannah Decker, herself a Freudian, in her book Freud in Germany: Revolution and Reaction in Science, 1893-1907 (1977), concludes that 'an overwhelming percent of the [published] lay response to Freud's theories about dreams was enthusiastic'.36 Though The Interpretation of Dreams may not have sold well, a popular version did do well. The history of the unconscious, reported earlier in this chapter, and the evolution of such ideas as the superego, childhood sexuality, and repression, show that Freud was not saying anything that was completely new. Why, therefore, should people have taken such exception? He never had any problems getting his views published. He never published his views anonymously, as Robert Chambers did when he introduced the idea of evolution to a wide range of readers. The third charge is that the picture Freud himself painted of one of Breuer's most famous patients, 'Anna O.', or Bertha Pappenheim, was seriously flawed and quite possibly based on deliberate deceit. Henri Ellenberger himself traced the clinics where Pappenheim was treated and unearthed the notes used by Breuer. Since some of the wording in these reports is identical with the later published paper, we can be sure that these are indeed the original notes. Ellenberger, and others since, found that there is no evidence at all that Pappenheim ever had a phantom pregnancy. This is now believed to be a story Freud invented, to counter the apparent lack of sexual aetiology in the Anna O. case as recounted by Breuer, which was completely at odds with Freud's insistence that sexual matters lay at the root of all hysterical symptoms. In his biography of Josef Breuer (1989), Albrecht Hirschmuller goes so far as to say that 'The Freud- Jones account of the termination of the treatment of Anna O. should be regarded as a myth.'37 Hirschmuller himself was able to show that many of Pappenheim's symptoms went into total or partial remission spontaneously, that she went through no catharsis or abreaction-in fact the case notes end abruptly in 1882-and that, following treatment by Breuer, she was hospitalised in the next years no fewer than four times, each time being diagnosed with 'hysteria'. In other words, Freud's claim that Breuer 'restored Anna O. to health' is false and, moreover and equally important, Freud must have known it was false because there is a letter of his which makes clear that Breuer knew Anna O. was still ill in 1883, and because she was a friend of Freud's fiancee Martha Bernays.38 The significance of the Anna O. case, or at least the way Freud reported it, is threefold. It shows that Freud exaggerated the effects of the 'talking cure'. It shows that he introduced a sexual element when none was there. And it shows that he was cavalier with the clinical details. We shall see that these tendencies all repeated themselves in important ways throughout the rest of his career. The fourth charge against Freud is by far the most serious but stems from the case of Anna O. It is that the entire edifice of psychoanalysis is based on clinical evidence and observations that are at best dubious or flawed, and at worst fraudulent. Perhaps the single most important idea in psychoanalysis is Freud's conclusion that infantile sexual wishes persist in adults, but outside awareness, and can thus bring about psychopathology. 'At the bottom of every case of hysteria,' he reported in 1896, 'there are one or more occurrences which belong to the earliest years of childhood but which can be reproduced through the work of psychoanalysis in spite of the intervening decades.' What is strange about this is that, although in 1896 he had never before reported a single case of sexual abuse in infancy, within four months he was claiming that he had 'traced back' unconscious memories of abuse in thirteen patients described as hysterical. Allied to this was his argument that the event or situation that was responsible for a particular symptom could be revealed through his technique of psychoanalysis, and that 'abreacting' the event- reliving it in talk with the associated emotional expression-would result in 'catharsis', remission of the symptom. He became convinced that this was, in his own words, 'an important finding, the discovery of a