Exploring Techniques for Emotional Access

Keen to learn how to facilitate such transformative experiences consistently, I began exploring techniques like hypnosis, mindfulness, and focusing—all of which involve nuanced shifts in the client's state of awareness. While delving into the literature to grasp the nature of these changes, I was drawn to Breuer’s description of the cathartic method and his work with Anna O. in "Studies on Hysteria." I found Breuer’s insights remarkably relevant to contemporary therapeutic practices, yet I was surprised by their limited recognition.

Breuer’s theoretical essay in "Studies on Hysteria" merits careful analysis, as many of its observations are strikingly ahead of their time. This comprehensive work, spanning over sixty pages, meticulously details the nature, causes, and treatment of mental illness with remarkable clarity, thoroughness, and depth. In 1955, James Strachey, the English translator of "Studies on Hysteria," remarked that the essay is “very far from being out of date; on the contrary, it conceals thoughts and suggestions which have even now not been turned to sufficient account.” This assertion remains valid today.

Breuer theorized that hysteria begins when an individual encounters psychic trauma, which he defined as any circumstance posing a significant risk of physical or emotional harm. If the person cannot express the emotions tied to the traumatic event, they become dissociated, trapped in a separate state of consciousness that is not accessible to normal awareness. Building on the pioneering work of French psychiatrist Pierre Janet, who highlighted the importance of dissociation in mental illness, Breuer termed this altered state the "hypnoid state" due to its resemblance to hypnosis. Recovery hinges on accessing and expressing these dissociated emotions through catharsis and integrating them into normal consciousness, a process Breuer called associative correction.

Comparing Breuer's theory with Freud's psychoanalytic framework reveals three significant differences: Breuer emphasized psychic trauma as the primary cause of psychopathology, while Freud focused on sexual conflict; Breuer identified hypnoid states (dissociation) as the main mechanism, contrasting Freud’s concept of repression (defense); and Breuer prioritized emotional expression (catharsis) over interpretation (analysis) as the primary means of recovery. Ironically, contemporary psychotherapy increasingly aligns with Breuer’s views.

A substantial body of evidence from researchers like Bessel van der Kolk underscores the central role of trauma in the onset of psychopathology. Today, understanding trauma's effects is a primary focus of medical research, driven by the urgent need for effective PTSD treatments. Breuer’s concepts remain pertinent in clinical practice; for instance, his idea of the hypnoid state resonates with modern techniques such as mindfulness, focusing, neurofeedback, and EMDR (Eye Movement Desensitization and Reprocessing).

The Divergence of Breuer and Freud

The publication of "Studies on Hysteria" marked the conclusion of the collaboration between Breuer and Freud. Freud increasingly believed that sexual conflicts were central to all cases of hysteria, while Breuer acknowledged sexuality's significance but viewed it as one of many contributing factors. Breuer posited that dissociation due to trauma, implicit in his hypnoid state theory, was more fundamental.

In a letter to Swiss psychiatrist Auguste Forel in 1907, Breuer expressed his discomfort with Freud's focus on sexuality, stating, “this immersion in the sexual in theory and practice is not to my taste.” He further commented on Freud’s tendency for “absolute and exclusive formulations,” which he believed led to excessive generalization. Freud, for his part, dismissed the concept of hypnoid states, claiming in "Five Lectures on Psychoanalysis" that it was “impeding and unnecessary,” ultimately discarding it in psychoanalysis.

Freud also suggested that Breuer's reluctance to acknowledge sexuality's critical role stemmed from his overly cautious and conservative nature. To support this narrative, Freud claimed that Breuer had abruptly ceased his work with Anna O. due to her developing strong sexual feelings for him. This account was perpetuated by Freud's biographer, Ernest Jones, and has largely influenced the prevailing view.

However, Freud's assertion lacks credible evidence. Psychoanalyst and Freud biographer Louis Breger argues: “Freud’s version of what happened is simply not true... It exemplifies the ‘resistance’ argument Freud later used to dismiss critics of his sexual theory.” Breger contends that Breuer maintained involvement in Anna O.'s treatment for several years rather than abandoning her.

In "The Interpretation of Dreams," Freud wrote about his emotional life, stating, “An intimate friend and a hated enemy have always been necessary requirements... sometimes the two were united within the same person.” This description aptly encapsulates the complex relationship between Freud and Breuer.

It's important to recognize that Breuer was more than just a collaborator to Freud, who was 14 years his junior. Breuer lent Freud money, referred patients to him, and welcomed him into his home. Historian Peter Gay noted in his biography of Freud that his complaints about Breuer in the 1890s represent a classic case of ingratitude, reflecting the resentment of a proud debtor toward his benefactor.

Breuer chose not to publicly challenge Freud or respond to his criticisms, opting instead to withdraw from psychology and concentrate on his medical practice. Freud monopolized the field, and his writings significantly shaped public perception of Breuer, which endures to this day.

Ultimately, the pivotal question is whose ideas hold more validity, and in this regard, history favors Breuer. Freud's emphasis on sexuality as the primary driver of human development and psychopathology has lost credibility. In contrast, the role of dissociation due to trauma is increasingly acknowledged as fundamental. Furthermore, most therapists today recognize the importance of assisting clients in accessing and integrating painful emotions stemming from past trauma, which is the essence of Breuer’s cathartic method.

Revolutionizing Therapeutic Approaches

Breuer's development of the cathartic method to treat Anna O. instigated several groundbreaking changes. Firstly, he shifted the therapeutic focus from therapist suggestion to patient self-discovery. Secondly, he broadened therapy's scope from merely addressing symptoms to considering all facets of the patient’s life and personality, thereby establishing psychotherapy as a distinct discipline. Finally, he was the first to treat mental illness through prolonged exploration of unconscious conflicts, creating the talking cure that remains central to all forms of psychotherapy today. While conventional wisdom attributes these achievements to Freud, they were all present in Breuer’s treatment of Anna O. before his collaboration with Freud began.

Breuer's brilliance lay in his intelligence and openness to learn from his patient, valuing her experiences over his authority as a physician. Over ninety years since his passing, Breuer's insights continue to enrich my practice, reminding me to learn from my clients' perspectives, recognize the impact of trauma, and prioritize emotional experience over mere insight.

Further Reading

• "Studies on Hysteria." Josef Breuer and Sigmund Freud. Translated from the German and edited by James Strachey. Hogarth Press, 1955.
• "The Life and Work of Josef Breuer." Albrecht Hirschmüller, New York University Press, 1978.
• "Freud: A Life For Our Time." Peter Gay, Macmillan, 1988.
• "A Dream of Undying Fame: How Freud Betrayed His Mentor and Invented Psychoanalysis." Louis Breger, Basic Books, 2009.
• "The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma." Bessel van der Kolk, Viking, 2014.