
After Hysteria: How Anna O. Became Bertha Pappenheim
In Buenos Aires there is a neglected, overgrown cemetery for Jewish pimps and prostitutes. It’s one physical trace of the “Mädchenhandel,” the “girl business”—sex trafficking, especially in the late 19th century, by Jews, of desperate, poor, young Jewish women. They were trafficked from Poland, Russia, and Germany to Jaffa, New York, Paris, and São Paulo.
Growing up, I never heard of this. I think it’s fair to say this history has been repressed. It was repressed even at the time, for fear that it would fuel growing anti-Semitism—indeed, Der Stürmer, the Nazi newspaper, published articles pinning the “white slave trade” on Jews.
This is a history that, when it comes to light, makes the world look different. I learned it from the new book The Secret Mind Of Bertha Pappenheim: The Woman Who Invented Freud’s Talking Cure by Gabriel Brownstein, which shows us power of speaking the truth. Pappenheim might be happy to know this; making sure people cared about those women was her life’s work.
But like a hidden cemetery, locked behind a gate, this book doesn’t give up its secrets easily. It’s about grief, repression, trauma, the mystery of the mind, and that of illness and healing. It’s also, ironically, about the pitfalls of men telling women’s stories.
Brownstein is excavating an inherited Freudian obsession in two senses of the word. His father was a doctor and psychiatrist whose “dominant emotion is a loving, protective rage.” The night before his father dies, he stands over Brownstein, clad in only his underwear, haranguing him about Pappenheim. He hands him a “fat padded envelope” full of research, calling it “my masterpiece.” After he dies, Brownstein delves in, and the result is this book.
Who was Bertha Pappenheim? It depends who you ask, and when.
In her first life, she was Anna O., the most famous case study in Josef Breuer and Sigmund Freud’s Studies on Hysteria. A dutiful, accomplished, upper-class young Viennese Jewish woman of “considerable intelligence, remarkably acute powers of reasoning, and a clear-sighted intuitive sense…her will was energetic, tenacious and persistent…one of her principal traits was a sympathetic kindness.” She was also a close friend of Freud’s wife.
Given a decent education, she was basically confined to her home to sew her trousseau until marriage. Bored out of her mind, she called daydreaming “her private theater.”
Anna O. started suffering while caring for her father, who was dying of tuberculosis. She developed a cough, facial neuralgia, paralysis in her limbs, periodic inability to speak her mother tongue, a squint, suicidal tendencies, visions of black snakes, skeletons. She would fall asleep in the afternoons and wake up in a twilight state, spinning fanciful tales. That’s when Breuer would come to listen to her. She, not Freud, coined the term “the talking cure.”
It’s fair to say Freud, like Brownstein’s father, was obsessed with Anna O. It’s the case he referred to most often in his life. These descriptions became more and more sexual over the years, culminating in Freud’s “suddenly remembering” that Anna O. suffered from a “hysterical pregnancy,” calling out “Dr. B’s baby is coming”— a story that, Brownstein says, is of “questionable authenticity.’”
Freud told another story in gossipy letters to his fiancée. He writes that Dr. Breuer stopped seeing Bertha because “his happy marriage threatened to come unstuck on account of it.” Martha replies that Bertha could “turn the head of the most sensible man.”
Studies on Hysteria pronounced Anna O. fully cured by Dr. B. But Bertha Pappenheim spent most of the next decade in and out of sanatoriums, where she was “tortured, dosed with arsenic, and electric eels were applied to her face.” She was addicted to chloral hydrate and morphine—drugs Breuer gave her, which many speculate contributed to her symptoms and her visions.
Pappenheim did eventually get better. In fact, she became formidable. Around 29, as she aged out of marriageability, she and her mother moved to Frankfurt, where they had a wealthy, well-connected, philanthropic family. She volunteered at a soup kitchen, taught sewing to refugee children, ran an orphanage. She published a German translation of Mary Wollstonecraft’s A Vindication of the Rights of Women, dozens of articles, even a book of fairy tales. She founded and ran the Judischer Frauenbund—the largest Jewish women’s group in the German-speaking world.
In this role, Pappenheim crisscrossed the globe, raising the alarm about the Mädchenhandel. She traveled to Russia, Romania, Jaffa, London, New York, and Toronto. Education and trades for women, she said, would bring redemption and respectability. Her work supported the schools for religious girls—the Bais Yaakov schools, now numbering 250, with over 38,000 students, as well as a home for girls and unmarried pregnant women that cared for 1500 girls over 30 years.
She was a feminist Torah critic, once writing: “from the unjust position that the Bible assigns to women, it follows that it was composed by a brilliant but male human, and not divine dictate.” And in 1907, causing a scandal with a speech that charged: “And the woman in the Jewish community? She doesn’t count, she’s worth nothing. She learns nothing…she has to mutilate or at least disfigure herself. In the eyes of the Jewish law a woman is not an individual,” concluding that the law reduces us to “sexual beings”—something she had experienced personally, through Freud’s successive embellishments of the life of Anna O.
Through the Weimar Republic and the rise of Nazism, Pappenheimer labored to raise enough money for the girls under her protection. In 1936, one of the developmentally disabled girls at her home apparently said of a newspaper photograph of Hitler, “He looks like a criminal.” An employee denounced Pappenheimer to the Gestapo. They interrogated her, and let her go. A few weeks later she was dead of cancer.
She was eulogized by her close friend Martin Buber: “There are people of spirit and there are people of passion, both less common than one might think. Rarer still are people of spirit and passion. Rarest of all is a passionate spirit.”
Right now we’re having a loud, urgent cultural conversation about the intersection between individual trauma and systematic injustice. Somehow it’s still men, like Bessel van der Kolk and Gabor Mate, that everyone seems to be listening to when it comes to the meaning of trauma and the mechanics of healing.
It’s unfortunate that this new book is yet another example of a man telling a woman’s story.
Brownstein doesn’t have a compelling explanation for how, exactly, Pappenheim was able to recover and go on to lead such an extraordinary life. He doesn’t seem all that interested in the question. This may be, in fairness, because as Brownstein tells us, he wrote the book during the “worst years of my life,” comprising the loss of his father, then his wife to pancreatic cancer, and the Covid pandemic. He’s shuffling through a labyrinth of grief with his sheaf of yellowed notes. At one point he compares Bertha to Sleeping Beauty, surrounded by “the thorny field of impenetrable narration.”
But despite the thorns of all these men and their ideas, Bertha’s passionate spirit leaps off the page. Her insistence on uncovering hidden truths about the world and forging a life of purpose, outside of shame, hiding and secrecy, points toward an entirely different story we might tell about trauma.
Pappenheim also appears in the psychiatrist Judith Herman’s foundational 1993 work Trauma and Recovery. Herman reminds us that the history of trauma itself has been buried and unburied.
In 1896, Freud told an appalled audience that his “hysterical” patients were almost all victims of childhood sexual abuse: “It seems to me certain that our children are far more exposed to sexual assaults than the few precautions taken by parents in this connection would lead us to suspect.” (Brownstein talks to patients, primarily women, suffering from the equivalent of hysteria, known today as functional neurological disorder; they are roughly twice as likely to have been sexually abused as the general public.)
For speaking up, Brownstein writes, Freud was “despised and universally shunned.” So he backed off and came up with a new theory: the women were all fantasizing.
In other words, Herman writes, “for a brief decade, men of science listened to women with a devotion and a respect unparalleled before or since.” They listened, they learned the truth about rampant sexual trauma, and then they nailed it back under the floorboards.
It fell to feminist researchers like Herman, nearly a century later, to uncover the truth again. As a psychiatric resident, her first paper on incest, in 1976, circulated for a year as samizdat before it was published. She and her co-author started receiving letters, “and witnessed firsthand the creative energy that is released when the barriers of denial and repression are lifted.”
Pappenheim didn’t recover by telling her own story. As far as we know she never spoke of herself as the famous patient to anyone. And she vowed to keep the talking cure away from the girls under her care: “As long as I live…psychoanalysis will never penetrate my establishment.” (Interesting choice of words; not sure what it was in the original German).
She did dedicate herself to dispelling denial and repression in the culture at large, and that did seem to release her creative energy. And, there’s the power she found in caring for others.
Trauma and Recovery and its 2023 follow up, Truth and Repair, are about healing, particularly the healing that comes from “restoring the connection to community.” In support groups, as Herman describes them, people learn self-compassion by awakening their compassion for others with similar circumstances.
In Trauma and Recovery, Herman quotes Pappenheim’s final wish: In her “last will,” written in 1930, she hoped that people who visited her grave would leave a small stone, “as a quiet promise…to serve the mission of women’s duties and women’s joy…unflinchingly and courageously.” Her sense of duty is abundantly clear. But what does it mean to serve the mission of women’s joy? That’s more mysterious, like a poem, or a rose growing in a forgotten graveyard.
Anya Kamenetz writes about climate, well-being, and parenting at thegoldenhour.substack.com.