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Bertha Pappenheim was, so far as we know, the first patient to be treated with cathartic psychotherapy as described by Joseph Breuer. It was not psychoanalytic treatment as no interpretation was given; in 1880 interpretation was not yet known as a therapeutic tool. The patient, called Anna O, suffered from severe hysteria, bordering on a psychotic state, which some psychiatrists would label schizophrenia. The patient did not recover until years after the termination of the treatment. The cathartic treatment should not be given credit for that recovery. It deserves, however, high credit for its great influence on the scientific development of Freud.
The publication of this case history by Breuer and the first publication of Freud's views on the role of sexual conflicts in hysteria occurred in the years 1893, 1895, and 1896. These publications may explain why Miss Pappenheim developed during those years from housemother for orphans to antisexual suffragette. She had escaped from nursing her father, Sigmund Pappenheim, by herself becoming sick. She then suffered a disappointment in transference with her psychotherapist, Breuer. After these experiences she was not ready to accept the implications of another Sigmund (Freud) that she had a sexual conflict. Such an assumption may have seemed to her a manifestation of masculine designs on pure and innocent girls. She did not attack Freud in her published work, but displaced her accusations from Freud onto the 'traders' of girls.