Josef Breuer

Austrian physiologist

• Born: January 15, 1842
• Birthplace: Vienna, Austria
• Died: June 20, 1925
• Place of death: Vienna, Austria

Breuer was one of the foremost physiologists of the nineteenth and early twentieth centuries and made major contributions to the understanding of the process of respiration and the function of the inner ear. However, he is remembered primarily for his discovery of the cathartic or “talking out” method of treating neurotic disorders, a discovery that led, through Sigmund Freud, to the development of psychoanalysis.

Early Life

Josef Breuer (YOH-zehf BROY-ehr) was born at a time when the Jews of Eastern Europe were beginning to reap the fruits of their emancipation from years of social and political oppression. Breuer felt deeply indebted to his father, Leopold, and others like him who, through replacing Yiddish with standard German and the customs of the Eastern ghettos with the culture of the Western world, effected the assimilation of the Jewish population. Leopold, a teacher of religion who also wrote a much-used religious textbook, obtained an appointment from the official Jewish Community of Vienna in 1836. Breuer was born into this milieu in the year 1842.

Breuer’s mother died during the birth of his younger brother, so the role of mother was assumed by his grandmother. He did not attend public school but was tutored at home by his father and was able to read perfectly at the age of four. When he was eight, he entered the gymnasium and enjoyed his eight years of study there, especially the higher grades, in which intellectual curiosity and critical thinking were encouraged. Breuer’s critical or skeptical turn of mind would become evident later in his departure from orthodox Judaism and his adoption of more liberal Jewish views.

For quite some time prior to his graduation in 1858, he had been planning to become a physician, and in 1859 he entered the medical school of the University of Vienna. Breuer’s interests during his first year of medical studies centered on chemistry and anatomy, but during his second year he discovered his lifelong love, physiology. The emerging interests and skills of the budding physiologist blossomed under the tutelage of Ernst Brücke, in whose laboratory Sigmund Freud would also spend formative years in physiological and histological research. Breuer received his medical degree in 1867 and in the following year married Matilda Altmann; they had five children.

Life’s Work

Immediately after his graduation from medical school, Breuer became an assistant in the clinic of Johann Oppolzer, a Viennese internist whom Breuer came to admire and to emulate. When Oppolzer died in 1871, Breuer resigned his position and went into private practice. During this period, Breuer also made his first historic contribution to the study of physiology. He had been conducting research on the self-regulation of respiration at the Josephinum, the military medical school of Vienna, with professor Ewald Hering, and they published the results of their work in 1868. They had discovered that there are receptors in the lungs that sense the degree of expansion. Thus, when the lungs are inflated during inhalation, these receptors send impulses along the vagus nerve to the brain, which then triggers a reflex for exhalation. Following exhalation, other receptors stimulate impulses that trigger inhalation, and so on in an alternating cycle. This automatic regulatory process of respiration, one of the first biological feedback mechanisms discovered in mammals, is known as the Hering-Breuer reflex.

Breuer’s other major contribution to physiological research arose from a series of investigations into the fine structure and function of the inner ear. He first focused his attention on the semicircular canals, which are filled with a fluid called endolymph. He theorized that the control of head movements is based on impulses generated by the flow of the endolymph in the canals, and he presented the theory and supporting evidence, which had been arrived at independently and almost simultaneously by Ernst Mach and Crum Brown, in 1874 and 1875. Breuer also showed that sensations of bodily posture are connected to another inner ear structure called the otolith. Although his findings were not accepted immediately, they have come to be considered basic for modern physiological research on the perception and control of bodily equilibrium and movement.

Breuer was appointed lecturer in internal medicine at the University of Vienna in 1875 but resigned in 1885 following a disagreement with the medical faculty concerning teaching policies; he also declined an offer to be nominated as an extraordinary professor. Yet his knowledge and expertise as both a scientist and a clinician were well known, as evidenced by his election in 1894 to the Viennese Academy of Sciences and by the fact that many influential citizens of Vienna, including not only Brücke and numerous other medical faculty members but also Freud, chose him as their personal physician. His humanitarian impulses are revealed by the fact that he offered his services free of charge both to the poor and to his colleagues and their families.

In 1880, Breuer began treating a twenty-one-year-old female patient who was suffering from severe hysteria. Her name was Bertha Pappenheim, but she is known in the annals of psychiatry as “Anna O.” This patient, after becoming physically and mentally exhausted through months of nursing her seriously ill father, began to suffer from a variety of troubling and remarkable symptoms. These included occasional paralysis and loss of sensation in the extremities on the right side, and sometimes on the left side, of her body, disturbances in eye movement, restrictions in visual perception, difficulties with the posture of her head, a severe nervous cough, and aversion to nourishment. She would also lose her ability to speak her native German language from time to time and was subject to daily periods of “absence” or clouded confusion associated with alterations of her entire personality.

When Anna O. was in her more normal psychological state, she was typically unable to remember the disturbances and hallucinations of her confused state. Breuer discovered that if, while his patient was under hypnosis, he repeated to her words she had said during her periods of delirium, she was enabled to remember and to relate the content of her hallucinations. This process, which Anna O. termed the “talking cure,” was found to alleviate her symptoms and calm her mind. Breuer also discovered that if she would methodically relate her memories of a particular symptom back through time until she unearthed her memory of the traumatic circumstances surrounding its first appearance, the symptom would quite dramatically disappear. Breuer referred to this therapeutic method as catharsis, and he employed it in the successful treatment of each of Anna O.’s symptoms.

Breuer conducted regular sessions with Anna O., often for several hours each day, for a two-year period ending in June, 1882. In November of that year, he told his close friend Freud, whom he had met a few years earlier in Brücke’s laboratory, about this intriguing case. Freud was extremely interested, and Breuer shared with him many of his detailed and systematically recorded case notes. Although Breuer abandoned psychotherapy at that time, at least in part because of his concern over the strong sexual attachment Anna O. developed toward him near the end of her treatment, Freud revived the cathartic method in his own practice, in consultation with Breuer, some seven years later. Freud repeatedly confirmed the therapeutic effectiveness of the cathartic method during the following four years, and the insights and experiences shared by Breuer and Freud during the twelve years from 1880 to 1892 form the foundation upon which psychoanalysis was built. They published their findings in article form in 1893, and in a much expanded book form in 1895, as Studien über Hysterie (Studies in Hysteria , 1936).

Based on his treatment of Anna O., Breuer had concluded, first, that neurotic symptoms arise when emotions or “affective ideas” are deprived of normal expression and thus remain unconscious, and, second, that these symptoms disappear when their sources are uncovered and consciously verbalized. Breuer and Freud then hypothesized that the basic process underlying these psychodynamics is the effort of the nervous system to keep its overall quantity of excitation at a constant, and preferably low, level a process they claimed is governed by the “principle of constancy.” When psychic pressures grow and normal outlets or avenues to consciousness are not available, these unconscious conflicts erupt through inappropriate channels into a diversity of symptoms. In this way, the overexcitation or imbalance of the nervous system is at least temporarily alleviated. Since Breuer and Freud considered an overly or suddenly excited nervous system to be the source of unpleasant sensations and the discharge of this energy to be the source of pleasure, the constancy principle is intimately tied to the pleasure principle. The method of catharsis thus came to be understood as functioning in the service of these principles.

For almost two decades, beginning in the late 1870’s, Breuer and Freud were firm friends. Breuer, fifteen years Freud’s senior, served as fatherly adviser, cherished companion, and, sometimes, financial supporter of his less-established colleague. However, their close collaboration on the personally and professionally sensitive issues relating to their research on hysteria put a severe strain on their relationship, which was thus severed, rather sadly and bitterly, in 1896.

Significance

Breuer’s research on the reflex regulation of respiration and on the labyrinth of the inner ear were sterling achievements in the field of physiology. Yet these accomplishments have sometimes faded from historical consciousness, and Breuer’s subsequent fame has centered primarily on his seminal studies of psychopathology. This has occurred partly because, although Breuer’s published articles on purely physiological subjects span forty years and total more than five hundred pages, he had no permanent institutional affiliation and no intellectual disciples. The fact that Breuer is recognized first for his relatively brief research and publications on hysteria is also the result of the enormous historical impact of Freud and psychoanalysis. Although Anna O.’s cure was not complete during the two years she spent with Breuer (she continued to suffer relapses for several years thereafter), the systematic “talking out” of her unconscious conflicts can be regarded as the first instance of a sustained attempt at deep psychotherapy, a form of treatment that has flourished during the twentieth century.

Breuer’s training and research in physiology cannot, however, be separated from his study of psychopathology. On the contrary, his early insights into physiological processes apparently had a major formative influence on the theory of hysteria that he and Freud developed, an influence particularly evident with regard to the principle of constancy. This principle, used to describe the self-regulatory activity of the nervous system, is strikingly similar to the self-regulatory reflex of respiration and the mechanisms of bodily equilibrium that Breuer had discovered in his early physiological research. The fact that he and Freud (who was trained for years in neurology) thought that the psychological processes of neurosis could be described adequately by reference to an essentially physical principle, based on quantities and currents of energy, is evidence of the influential role that mechanistic and materialistic explanations, which excited the psyches of so many nineteenth century scientists, played in the creation and evolution of psychoanalysis.

Bibliography

Breuer, Josef. “Autobiography of Josef Breuer (1842-1925).” Edited and translated by C. P. Oberndorf. International Journal of Psychoanalysis 34 (1953): 64-67. Brief autobiographical comments, first published in Vienna in 1925, on Breuer’s family, cultural background, inspirational acquaintances, and major professional achievements.

Breuer, Josef, and Sigmund Freud. Studies on Hysteria. Vol. 2 in The Standard Edition of the Complete Psychological Works of Sigmund Freud, edited by James Strachey. London: Hogarth Press, 1955. The standard English translation of the authors’ 1895 book. This edition also contains the 1893 article known as the “Preliminary Communication” and an informative introduction by the editor dealing with the publications’ historical background and their influence on psychoanalysis, as well as the scientific differences between Breuer and Freud. Freud’s numerous references to Breuer, scattered throughout the twenty-four volumes of this set, can be located via the index.

Cranefield, Paul F. “Josef Breuer’s Evaluation of His Contributions to Psychoanalysis.” International Journal of Psychoanalysis 39 (1958): 319-322. An analysis of the contributions that Breuer and Freud made to the creation of psychoanalysis, containing a letter from Breuer evaluating his own contributions.

Ellenberger, Henri F. The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books, 1970. A substantial and detailed study of the development of dynamic psychiatry. Deals (in various locations indicated in the index) with Breuer’s life, his work with Freud, and his formative cultural influences. Also contains many illustrations of the major players in this drama.

‗‗‗‗‗‗‗. “The Story of ’Anna O.’: A Critical Review with New Data.” Journal of the History of the Behavioral Sciences 8 (1972): 267-279. Ellenberger provides a thorough examination of this famous case, gives biographical information about Anna O., and discusses two previously unknown case histories of her, one written by Breuer in 1882, discovered by the author.

Freud, Sigmund, and Josef Breuer. Studies in Hysteria. Translated by Nicola Luckhurst. New York: Penguin Books, 2004. An updated, one-volume edition of the 1955 work of the same name by Breuer and Freud. Includes an introduction by Rachel Bowlby.

Jones, Ernest. The Life and Work of Sigmund Freud. New York: Basic Books, 1953. This classic, three-volume biography of Freud, written by one of his leading disciples, is noted for its richness of biographical data, although it also suffers from some factual inaccuracies. Volume 1 describes the personal relationship between Breuer and Freud and includes references to Freud’s expressions of delight at being in Breuer’s “sunny” presence.

Skues, Richard A. Sigmund Freud and the History of Anna O.: Reopening a Closed Case. New York: Palgrave Macmillan, 2006. Skues reappraises Anna O’s case, presenting an analysis that contradicts previous interpretations.

Sulloway, Frank J. Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend. New York: Basic Books, 1979. A groundbreaking book that not only deals with the details of Freud’s and Breuer’s lives and work but also places it all in the context of nineteenth century science. Chapter 2 discusses the evolution of the theory of hysteria; chapter 3 examines the reasons for the estrangement of the two men.