Fact, Fiction and Phenomenology

Novelist Hilda Reilly discusses biographical fiction as a research method into the patient experience — and the unexpected questions raised in her exploration of Bertha Pappenheim, aka ‘Anna O’.

Medical historian Roy Porter (1985) draws attention to a ‘patient-shaped’ gap in medical history, pointing out that while histories of epilepsy and hysteria exist there are none by epileptics and hysterics. But how are we to fill this gap in the case of patients who are no longer alive to speak for themselves?

For an MA in Creative Writing I set out to explore the illness of Bertha Pappenheim, the ‘Anna O’ of Studies on Hysteria (Breuer and Freud, 1974), by writing a novel about her. My aim, in fact, was as much investigatory as creative. I wanted to find out what kind of picture would emerge if the account provided by her doctor, Josef Breuer, was brought to life. I was also curious to see if this picture would be credibly consistent with the ideas which Dr Breuer and his friend Sigmund Freud developed on the basis of that account. According to Breuer and Freud, Bertha’s hysterical symptoms were caused by repressed memories of negative incidents, and the symptoms were removed by bringing those memories into consciousness via the ‘talking cure’.

My primary sources for the case were reports and letters written by Dr Breuer, and were thus physician based. In addition to this I undertook the usual socio-cultural-historical research which a biographical novelist would normally carry out.

In the event the novelising process proved to be a research tool in itself: it forced me to consider matters of practicality and daily life which might otherwise never have been thought of. This threw up a number of inconsistencies, inaccuracies and quasi-impossibilities which have been elevated to the status of fact and influenced the development of Freudian theory ever since.

Here are just a few of these issues.

The presenting symptom was a severe cough, one which lasted during Bertha’s illness until the precipitating incident (allegedly hearing dance music while she was caring for her sick father) was discovered. This cough, diagnosed as hysterical, was reportedly triggered every time Bertha heard strong rhythmic music. But given that she was housebound for much of this period, in a home where her father lay dying, and in a pre-gramophone/radio era, it is difficult to see how she could have been exposed to the sound of such music at all, apart perhaps from the occasional military band or barrel organ in the street. How, I wondered, could the cough have occurred with such frequency in these circumstances that it was judged severe and requiring medical attention?

Again in relation to the cough, while researching the effects of morphine, which Bertha started to take during this period, I discovered that it is a cough suppressant. Could that have been the explanation for her cough being cured? I have not found any mention of this possibility in any of the literature relating to her case.

The history of psychoanalysis has proved fertile ground for the generation of myths and the most notorious of the myths relating to Bertha Pappenheim is that of the pseudocyesis, or ‘phantom pregnancy’. Shortly after Dr Breuer stopped treating her, so the story goes, he was called back urgently to find her in a state of hysterical labour, imagining that she was giving birth to his child.

The pseudocyesis first made its appearance in a letter from Freud to a friend in 1932. In it, Freud outlined the story as something he had reconstructed on the basis of what he had guessed as a result of something he had remembered Breuer telling him in a different context. So already the links in the chain of reasoning are looking tenuous. Freud went on to say that he had been so convinced of the truth of his conjecture that he had published it somewhere. There is, however, no record of any such account ever having been published by Freud. Yet the story of the hysterical pregnancy is still widely subscribed to, particularly by therapists and academics who find in it a rich seam of interpretations to be mined according to their own particular school of thought.

Anna O: Fourteen Contemporary Reinterpretations (Rosenbaum and Muroff, 1984) provides some interesting examples. There we find:

• a psychiatrist puts forward the theory that the pseudocyesis was a re-creation by Bertha of the recent pregnancy of Breuer’s wife;
• a psychoanalyst claims that it would not have occurred with a female analyst as Bertha’s sexual fantasies would have been explored;
• a psychopharmacologist speculates that it would probably have been prevented with medication;
• an MD suggests that it may have signified ‘the enactment of what she most feared – that a man would seduce, impregnate, and abandon her’.

All those hypotheses developed from a story which had no foundation in evidence-based reality, only in the imagination of Sigmund Freud.

A further question mark hung over the diagnosis of hysteria itself. I considered various attempts at retrospective diagnosis which had been made of Bertha’s case before realising that for the patient herself what mattered was not the label but the subjective experience: what it was like, in Nagel’s sense (1974), to be Bertha Pappenheim.

This realisation highlighted for me the primacy of the patient’s phenomenology and the need for patient-authored research sources in undertaking any work of pathography, which brings me to the subject of my PhD research – one of Freud’s most important patients, Anna von Lieben (Freud’s Cäcilie M.).

I felt that my approach to the von Lieben case should be a more academically rigorous one and it was my quest to identify a suitable approach which led me to Interpretative Phenomenological Analysis (IPA), a qualitative research methodology which is used to interpret text in its own terms rather than by applying an existing analytical framework (eg, feminist, psychoanalytic). For Bertha Pappenheim we have nothing in her own words relating to that stage of her life – so my interpretation of her subjective experience must remain ‘my best guess’ –  but in von Lieben’s case we do have autobiographical material: a volume of poems relating to her health, her state of mind and her relationships. This is what I will be analysing with an adapted form of IPA in the hope that it will illuminate her psyche. There is also a substantial corpus of family archival material which will provide additional contextual data. Overall the study will permit a re-imagining of the case from the perspective of von Lieben herself, set within her own life-world.

For many people biographical fiction is anathema, a hi-jacking of another person’s reality. But do the historians, academics and physicians fare any better?

Hilda Reilly is a PhD candidate in Medical Humanities at Glasgow University. Further information about her research and her writing can be found on her website: www.hildareilly.com

References

Breuer, Josef, and Sigmund Freud. 1974. Studies on Hysteria. Translated by James and Alix Strachey. London: Pelican.
Nagel, Thomas. 1974. “What Is It Like to Be a Bat?” The Philosophical Review 83, no. 4 (October): 435-450.
Porter, Roy. 1985. “The Patient’s View: Doing Medical History from Below.” Theory and Society 14, no. 2 (March): 175-198.
Rosenbaum, Max and Muroff, Melvin, eds. 1984. Anna O: Fourteen Contemporary Reinterpretations. New York: Free Press.