GUISES OF DESIRE: The story of Freud's Anna O
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Taking Occam's Razor to Bertha Pappenheim's Cough
When Dr Josef Breuer was called in to examine Bertha in November 1880, her most marked symptom was a severe cough. At some point between then and the end of his treatment in June 1882, the cough stopped. Breuer describes the origin of the cough as follows:
"She began coughing for the first time when once, as she was sitting at her father's bedside, she heard the sound of dance music coming from a neighbouring house, felt a sudden wish to be there, and was overcome with self-reproaches. Thereafter, throughout the whole length of her illness she reacted to any markedly rhythmical music with a tussis nervosa."
He claimed that Bertha had no memory of this incident until she recalled it while in a hypnotic state, after which the cough disappeared.
Cured by the 'talking cure' – or is this an example of the post hoc ergo propter hoc kind of reasoning which Breuer may have been guilty of?
By the time Breuer stopped treating Bertha in June 1882 she had become heavily addicted to morphine. When she was admitted to Bellevue Clinic the following month she was taking 100 mg/day. To attain this level of tolerance she must have been taking the drug for some considerable time.
It's not possible to establish when Bertha started taking morphine. Breuer makes no mention of it in the 1895 report published in Studies on Hysteria. However, in private correspondence with the superintendent of Bellevue Clinic, he reported that in the months before her admission she had been receiving injections of morphine, up to 200 mg/day. A report by clinic staff makes clear that they considered their main task was to wean Bertha from her morphine addiction.
One of the properties of morphine is that it acts as a cough suppressant. This was confirmed by a clinical study* at Hull University in 2007 in a double-blind placebo-controlled trial with patients suffering from intractable coughs. It came as no surprise to doctors who had already suspected as much and had for a long time been using the drug in cases of chronic coughing.
Bertha's consumption of morphine has been known since the 1970s when Albrecht Hirschmuller discovered the documents relating to it in Bellevue. It has been referred to by many of the scholars writing about the case since then, with some suggesting that her symptoms could have been partly caused by addiction to morphine and chloral hydrate. What strikes me as strange is that nowhere have I found any suggestion that her cough could have been cured by the morphine she was taking. Yet to me that seems more likely than Breuer's theory about the 'talking cure'. It's simply a matter of applying Occam's razor.
*http://www.sciencedaily.com/releases/2007/02/070215083144.htm
Hilda Reilly
I am the author of Guises of Desire, a biographical novel about Bertha Pappenheim, blogging here about the writing process. The blog on this site has now been transferred to my personal site:
www.hildareilly.com