CATHARTIC METHOD

The so-called "cathartic method" was a treatment for psychiatric disorders developed during 1881-1882 by Joseph Breuer with his patient "Anna O." The aim was to enable the hypnotized patient to recollect the traumatic event at the root of a particular symptom and thereby eliminate the associated pathogenic memory through "catharsis." The term was derived from Aristotle's use of it to describe the emotionally purgative effect of Greek tragedies.

Reading the case history of Anna O., one sees that the method developed gradually. At first, Breuer limited himself to making use of the patient's self-induced hypnotic states in which she would strive to express what she preferred to avoid talking about when normally conscious. Later on, Anna O. began inventing stories around a word or words she heard, at the conclusion of which she awakened serene and improved. After the death of her father, such stories evoked diurnal fears and hallucinations. The cathartic effect, linked to the emotional state that accompanied these fears, required the doctor to listen without actively seeking etiological clues. Anna O. aptly described this procedure, speaking seriously, as a "talking cure", while she referred to it jokingly as "chimney-sweeping" (1895d, p. 30). At this juncture Breuer began to more systematically employ a technique by which, while Anna O. was in a trance, he repeated to her a few words that she herself had muttered while in a self-induced "absence."

It was probably in August 1881 that the method acquired its definitive form. This was when Anna O., after refusing to drink water and suffering near-hydrophobia during hot weather, remembered the disgust she felt when she happened upon her English lady-companion's dog while it was drinking from a water glass. As soon as she described the event, she asked for water and "thereupon the disturbance vanished, never to return" (p. 35) Other examples provided Breuer with evidence that "in the case of this patient the hysterical phenomena disappeared as soon as the event which had give rise to them was reproduced in her hypnosis" (p. 35), and that systematic application of what she called "chimney sweeping" would put an end to one after another of such morbid phenomena. To move the treatment along faster, Breuer began use hypnosis, which he had not regularly employed previously.

Freud and Breuer filled out the notion of catharsis with the concept of "abreaction"—a quantity of affect that was linked to memory of a traumatic and pathogenic event that could not be evacuated through normal physical and organic processes as required by the "principle of constancy" and so, thus blocked (eingeklemmt ), was redirected through somatic channels to become the process at the origin of the pathological symptoms (1893a).

Tired of poor results and of the monotony of hypnotic suggestion, by 1889 Freud appears to have decided, in treating Emmy von N., to employ "the cathartic method of J. Breuer." But failure to regularly induce hypnotic states inclined him by 1892 to give up hypnosis, which his patient Elisabeth von R. disliked. He asked her to lay down and close her eyes but allowed her to move about or open her eyes as she wished, and he experimented with a "pressure technique": "I placed my hand on the patient's forehead or took her head between my hands and said: 'You will think of it [a symptom or its origin] under the pressure of my hand. At the moment at which I relax my pressure you will see something in front of you or something will come into your head. Catch hold of it. It will be what we are looking for.—Well, what have you seen or what has occurred to you?" (Freud 1895d, p. 110). This procedure "has scarcely ever left me in the lurch since then," (p. 111) Freud added, claiming that this was the case to such an extent that he told patients that it could not possibly fail but invariably enabled him to "at last [extract] the information" (p. 111).

Breuer's method little by little thus became an "analysis of the psyche" which prefigured "psychoanalysis," a term that first appeared in print in 1896. The technique would be developed progressively over the course of a dozen years.By 1907, when Freud undertook analysis of the "Rat Man," he no longer actively demanded that patients produce material, but asked only that they verbalize what spontaneously came to mind.

Freud's thesis, according to which trauma at the root of displaced energy towards the soma is invariably sexual in nature, led to a rupture in his relationship with Breuer, but it also determined the future course of psychoanalysis. His explanation of the difficulties that patients experienced during treatment to defend themselves against pathogenic memories would come to be known as "resistance," while the concept of "transference" would emerge from his understanding of Breuer's sudden termination of Anna O., or the time that a patient, upon waking from hypnosis, threw her arms around his neck.

Catharsis and abreaction, even while still observed during psychoanalytic treatment, no longer constitute therapeutic aims as in 1895. However, they remain prominent in several psychotherapeutic techniques, such as in "Primal Scream" therapy and certain types of psychodrama.

Alain de Mijolla

See also: Dynamic point of view; Economic point of view; First World War: The effect on the development of psychoanalysis; "Instincts and their Vicissitudes"; "Repression"; Topographical point of view; "Unconscious, The"; Witch of Metapsychology, the.