Almanac: September

About Joseph Breuer

Josef Breuer, sometimes regarded the grandfather of psychoanalysis, was born on January 15, 1842. Breuer was an Austrian physician and physiologist, acknowledged by Sigmund Freud and others as the principal forerunner of psychoanalysis.

Breuer’s father, Leopold (1791–1872), was a teacher of religion employed by the Jewish community of Vienna, and Breuer described him as belonging to “that generation of [Eastern European] Jews which was the first to step out of the intellectual ghetto into the air of the Western world.” Breuer’s mother died when he was about four, and he was raised by her mother. His father tutored him until he was eight, and he then entered the Akademisches Gymnasium of Vienna, from which he graduated in 1858. After a year of general university studies, Breuer entered the medical school of the University of Vienna in 1859 and completed his medical studies in 1867.

Breuer married Mathilde Altmann in 1868, and they had five children. Later, years after Breuer‘s death, his daughter Dora committed suicide rather than be deported by the Nazis. Another one of his daughters, Margarete Schiff, perished in Theresienstadt on September 9, 1942. Breuer's granddaughter, Hanna Schiff, died while imprisoned by the Nazis.

Joseph Breuer was considered one of the best physicians and scientists in Vienna. His practice was his chief interest, and although he once referred to himself as a “general practitioner,” he was that today would be called an internist. Some idea of his reputation can be gathered from the fact that among his patients were many of the professors on the medical faculty, as well as Sigmund Freud and the prime minister of Hungary. He was elected to the Viennese Academy of Science in 1894 upon the nomination of three of its most distinguished members: the physicist Ernst Mach and the physiologists Ewald Hering and Sigmund Exner.

Breuer was a skeptic in matters of religion. In espousing the views of Fechner and Goethe, he referred to himself as one of “the many intellectuals who have religious needs and find themselves utterly unable to satisfy them within the faith of popular religion.”

The picture of the reflex regulation of respiration drawn by Hering and Breuer remains in all essentials the view held today, and the underlying reflex is still known as the Hering–Breuer reflex.

After completing his work with Hering, Breuer began his long series of investigations of the function of the labyrinth, remarkable for their importance and even more remarkable because he conducted them privately, working in his own home and supported only by fees from his medical practice.

His results were by no means immediately accepted and, in particular, his work on the otoliths was not generally known or accepted as late as 1900. Yet it was correct, and toady is recognized as the foundation of our knowledge of the sensory receptors for sensations of posture and movement.

Thus, Breuer deserves the credit for two fundamental and far–reaching advances in mammalian physiology: the Hering–Breuer reflex and the elucidation of the function of the labyrinth. His scientific techniques included mastery of physiological experiment and of delicate surgery, as well as the use of histological techniques. Above all, he was a remarkably patient and accurate observer. It must not be supposed that this means he was a passive recorder of events, for observation always implies full awareness of the relation of the facts observed to their meaning for theory and interpretation, as well as the ability to suspend judgment and retain a multitude of observations pending an intellectual survey and rearrangement of them. It has been suggested that Breuer was in some ways less scientific in his psycho–analytic reporting than in his physiological research, but the same sort of active observation, active accumulation of facts, and active suspension of final judgement until the facts arranged themselves into meaningful patterns is entirely characteristic of his investigations of psychopathology.

The general impression that Breuer published little and infrequently is true in the sense that he published relatively few major scientific articles at relatively long intervals; but quite apart from the importance of these articles, it should be noted that some of them were very long and detailed. His purely physiological articles, published over a forty–year period, numbered about twenty and comprised more than five hundred pages.

In the summer of 1880, while attending a man who was seriously ill with a peripleuritic abscess, Breuer observed the onset of a serious psychological disturbance in the man’s daughter, “Anna O.,” who was also his patient. Her symptoms were later summarized by Freud as follows: "Her illness lasted for over two years, and in the course of it she developed a series of physical and psychological disturbances which decidedly deserved to be taken seriously. She suffered from a rigid paralysis, accompanied by loss of sensation, of both extremities on the right side of her body; and the same trouble from time to time affected her left side. Her eye movements were disturbed and her power of vision was subject to numerous restrictions. She had difficulties over the posture of her head; she had a severe nervous cough. She had an aversion to taking nourishment, and on one occasion she was several weeks unable to drink in spite of a tormenting thirst. Her powers of speech were reduced, even to the point of her being unable to speak or understand her native language. Finally, she was subject to conditions of “absence,” of confusion, of delirium and of alterations of her whole personality…" [The Complete Psychological Works of Sigmund Freud, XI, 10].

From his treatment of Anna O. Breuer arrived at two conclusions of fundamental importance: (1) that the symptoms of his patient were the result of “affective ideas, deprived of the normal reaction” which remained embedded in the unconscious, and (2) that the symptoms vanished when the unconscious causes of them became conscious through being verbalized. These two observations form the cornerstone upon which psychoanalysis was later built.

Breuer did not publish or publicize the results of his treatment of Anna O. He did, however, discuss them with Freud, and the cathartic treatment resumed when Freud began to use it under Breuer’s guidance. For several years Breuer and Freud jointly explored this form of psychotherapy. Only Freud treated patients, but he and Breuer continually discussed the results and implications of the treatment. Freud first used the cathartic method in either 1888 or 1889. The practical and theoretical conclusions they reached through their collaboration were published in an article in 1893 and as a book (Studien über Hysterie) in 1895.

The publication of the book very nearly coincided with the end of their collaboration—and of their friendship. The contribution of Breuer and Freud to the development of psychoanalysis may be stated as follows: (a) Breuer discovered that neurotic symptoms arise from unconscious processes. (b) Breuer discovered that neurotic symptoms disappear when the unconscious processes become conscious. (c) These major discoveries were communicated by Breuer to Freud. (d) The first serious attempt to explore the implications of these discoveries was made by Freud and Breuer working in close collaboration. (e) Breuer was not anxious to pursue these studies, and the major development must be attributed to Freud after he separated from Breuer, during a period when Breuer apparently did not seek another collaborator but dropped the subject. (f) If by psychoanalysis we mean a discipline relying on the technique of free association, psychoanalysis was solely Freud’s discovery.

Breuer, in writing theoretical chapter of the Studien über Hysterie advanced a number of very important concepts, among them one rejected by Freud but now regarded as very important: that the hypnoid state and varying levels of consciousness are of great importance in normal and abnormal mental functioning. Other theoretical concepts usually attributed to Breuer include the distinction between the primary and secondary processes, the concept of hallucination as a regression from imagery to perception, and the suggestion that perception and memory cannot be performed by the same psychic apparatus. The “principle of constancy” was first mentioned by Breuer, but he attributed it to Freud. This concept is fundamental to the development of psychoanalytic theory, and one cannot but wonder whether Breuer did not in fact play an important role in formulating it. Breuer after all, formulated the notion of “feed–back” in the respiratory cycle and studied the sense organ that plays a key role in postural balance in animals; and the homeostatic devices involved in those systems are very reminiscent of the “principle of constancy.”

Breuer’s theoretical essay in Studies on Hysteria repays close reading, as many of the observations in it are remarkably prescient. The essay is more than sixty pages long and provides a comprehensive account of the nature, cause and treatment of mental illness with astonishing clarity, rigor and depth of insight. In 1955, James Strachey, the English translator of Studies on Hysteria, described the essay as “very far from being out of date; on the contrary, it conceals thoughts and suggestions which have even now not been turned to sufficient account.” His statement is just as true today.

According to Breuer’s theory of hysteria, the illness begins when someone is exposed to psychic trauma, which he defined as any situation with a risk of serious physical or emotional injury. If the individual is unable to feel and express the emotions related to the traumatic experience, they are dissociated, that is, isolated in a separate state of consciousness that is inaccessible to ordinary awareness. Here, Breuer acknowledged and built on the pioneering work of French psychiatrist, Pierre Janet, who was the first to assert the importance of dissociation in mental illness. Breuer called this altered state of consciousness the hypnoid state, owing to its similarity to the state induced by hypnosis. Recovery and healing require accessing and expressing the dissociated emotions, through catharsis, and integrating them with the ideas in normal consciousness, a process he called associative correction.

If we compare Breuer’s theory with Freud’s formulation of psychoanalysis, there are three main differences: psychic trauma (Breuer) vs. sexual conflict (Freud) as the primary cause of psychopathology, hypnoid states (dissociation) vs. repression (defense) as the primary mechanism, and emotional expression (catharsis) vs. interpretation (analysis) as the primary means of recovery.

In his obituary of Breuer, Freud spoke with regret of the fact that Breuer’s brilliance had been directed toward the problems of psychopathology for only a brief time. Although Breuer actually dealt with that subject during a period of nearly fifteen years, he did so in a way that deserves special examination. In the first place, Breuer’s mastery of hypnosis and his readiness to use it in treating Anna O. may indicate that Breuer had more interest in psychopathology than the average internist even before the case of Anna O.; this supposition receives confirmation from the time Breuer spent on that case and from the care with which he recorded it. In the opinion of Freud it was the case of Anna O. that also caused Breuer to draw back from psychotherapy for a time, since the case had, near its end, an unexpected and disturbing result: Anna O. formed a strong attachment to Breuer, an attachment that had a definitely sexual quality. Freud believed that this upset Breuer and prevented him from again practicing “deep” psychotherapy. Breuer himself stated that after the case of Anna O. he gave up treating patients in this manner since such treatment could not be carried out by a physician subject to the demands of a busy general practice. The resumption of that sort of psychotherapy, which was to evolve into psychoanalysis, was undertaken jointly by Breuer and Freud about five years after the case of Anna O., but the treatment of patients was solely in the hands of Freud, with Breuer taking part only in discussion of the techniques and the results of treatment.

There were for a time a few “Breuerians,” i.e., physicians who used Breuer’s original cathartic therapy without Freud’s amplifications. Breuer does not seem to have been a “Breuerian” in this sense, although letters by him in the Medizinhistorisches Institut der Universität Zürich indicate that his handling of psychiatric patients remained very sophisticated. On the whole it is probably correct to say that while Breuer was persuaded intellectually of the validity and importance of the new concepts and techniques that developed from his own work and from the work he did jointly with Freud, he was equally dismayed by the recurrent intrusion of sexuality into the subject. In a sense, therefore, Breuer’s anxiety over Anna O.’s reaction to him may be taken as a symbol of the reasons for his ambivalence toward the subject, but only as a symbol, since he returned, via collaboration with Freud, to the very same subject, and did not finally split with Freud until thirteen years after the Anna O. episode. Whatever the nature of Breuer’s interest in the subject and whatever the reasons for his ambivalence, nothing can minimize the fact that his treatment of Anna O. can convincingly be regarded as the first modern example of “deep psychotherapy” carried out over a prolonged period of time.

Although they had been very close for many years, Freud, and Breuer separated in 1896 and never spoke again. Whatever the roots of this break were in the character of the Breuer and Freud relationship, the quarrels that led up to it grew out of their work on psychotherapy. It was a difficult period for Freud, who felt, among other things, that Breuer was ambivalent about the value of their work, ambivalent about publishing it, and ambivalent about publicly supporting him. Interestingly enough, their final quarrel seems to have concerned a matter in which Breuer was right and Freud only later found himself to be wrong, the question of the reality of the memoires of having been seduced in early childhood, which had occurred in many patients. Breuer did refuse to back Freud in his belief that nearly all their patients had experienced such seductions; when Freud finally realized that such memoires were memoires not of real events but of childhood fantasies, he made one of his most important discoveries.

There is no possibility of meaningfully exploring the dynamics of their relationship at this date. It may be simplest to say that for a long time Freud needed Breuer and depended upon him; he then came to need him less and to depend on him less; and eventually he had a positive need to break with him, which he did thoroughly and in a way that left bad feelings. We cannot say even that much about Breuer; all we can say is that he was very fond of Freud for a long time and deeply wounded by the break. That a relationship between an older and a younger man, first full of warm and close friendship and then of turmoil, should have accompanied the birth of psychoanalysis may have been inevitable. Several years later, after Breuer's death, Freud was deeply moved to learn, from a close relationship of theirs, that Breuer had very sympathetically followed the evolution of his life and career.

That relationship should not be allowed to obscure the brilliant intellectual and observational contributions each made to the founding of modern psychoanalysis, psychiatry, and psychotherapy, nor should it obscure the fact that their long and close collaboration was an integral part of the creation of psychoanalysis.

Breuer was friendly with many of the most brilliant intellects of his time. He sustained a long correspondence with Franz Brentano, was a close friend of the poet Maria von Ebner–Eschenbach, and was on friendly terms with Mach, whom he had met at the time of their simultaneous work on the labyrinth. His opinion on literary and philosophical questions seems to have been widely respected and often sought. His correspondence with Maria von Ebner–Eschenbach has been preserved as has part of the Brentano–Breuer correspondence. Breuer had a considerable command of languages, and its is interesting to note that his treatment of Anna O. was for a long period conducted in English. The eulogies published after his death all emphasize that the range and depth of his cultural interests were as unusual and important as his medical and scientific accomplishments.

Joseph Breuer died in Vienna, in June 20, 1925.