Book Review: ‘The Secret Mind of Bertha Pappenheim,’ by Gabriel Brownstein

THE SECRET MIND OF BERTHA PAPPENHEIM: The Woman Who Invented Freud’s Talking Cure, by Gabriel Brownstein

Bertha Pappenheim stopped eating and sleeping. She lost her language and ability to move. Her eyes crossed and her muscles spasmed.

She suffered, her doctors said, from the prevailing diagnosis afflicting primarily well-to-do women in fin de siècle Vienna: hysteria.

What this meant was and is a source of debate: Did her facial paralysis emerge from a biological condition? Was her intermittent deafness psychological — or something more metaphysical?

Her physician, Josef Breuer, taken with the engaging and beautiful young woman, began visiting her daily. Sometimes Pappenheim made up fairy tales, sometimes she spoke of her hallucinations. Together they traced the source of her trauma to her father’s sickroom and with the repressed unearthed, Pappenheim began to improve.

There was catharsis in this exchange. Pappenheim herself described the process, which came to be known as “the talking cure,” as “chimney sweeping.”

More than a decade later, Sigmund Freud included Pappenheim’s story under the name “Fraulein Anna O.” — a case in “Studies On Hysteria.” Later, Freud added apocryphal details to the case, including a pseudo-pregnancy that illustrated his theory of transference. Embellishments aside, Anna O. — psychiatry’s most famous inconvenient woman — entered the annals of history as a success story that helped birth psychoanalysis.

The trouble is, as Gabriel Brownstein writes in his fascinating “The Secret Mind of Bertha Pappenheim,” it was all a lie. Pappenheim was not cured. She continued to suffer long after Breuer gave up her case and ended up in a sanitarium, subjected to untold horrors, and addicted to the drugs that Breuer had prescribed her.

Her true triumph came long after she quit analysis. She emerged from this crucible in middle age, reinvented herself as an advocate and philanthropist and never again spoke of her time under Breuer’s care. She advocated on behalf of Jewish girls exploited by the sex trade, and opened institutions to house and educate them.

But “The Secret Mind of Bertha Pappenheim” isn’t just about one woman — not entirely. This is a memoir nestled in an investigation, hidden inside a mythology. And it’s really about the limits of knowledge: not just about what we know about Pappenheim, but about medicine specifically and about nonfiction in general.

Fittingly, Brownstein’s interest in Pappenheim began with his father, Dr. Shale Brownstein, a respected psychiatrist and psychoanalyst with a longstanding grudge against Freud. The night before he died, Dr. Brownstein gave his son an essay he had written about Pappenheim. And despite Freud’s warnings about burdening ourselves with our parents’ desires, the father’s obsession became the son’s.

Brownstein could have written a much easier book than the one he did. I haven’t even mentioned his third layer: examining Pappenheim’s case through new research on the diagnosis of functional neurological disorder — the modern equivalent, he argues, of hysteria.

F.N.D. is a controversial diagnosis, despite being taken more seriously in recent years. This is not a rare condition; it is the second most common reason for outpatient neurology visits. Yet for some doctors it’s a scarlet letter, a signifier that the patient may be difficult or malingering.

Brownstein argues persuasively that F.N.D. is as “real” as the defect that necessitated open-heart surgery in his childhood, an experience he chronicled in his lovely “The Open Heart Club.”

Like hysteria, this diagnosis predominantly affects women; Brownstein profiles several. One loses her ability to walk; another shakes uncontrollably. Each seems to struggle with profound traumas — incest; years of grooming by a teacher; the horror of a mother who watched her baby get crushed under the wheels of a truck.

Tests are clean; there are no lesions. No M.R.I. scan can pinpoint the cause. But emerging studies show that F.N.D. seems to be a breakdown in the systems of the brain. “Brain networks have become tangled, messages are not getting through,” Brownstein writes.

Brownstein’s passages about F.N.D. are the book’s strongest. “In cases of F.N.D., the distinctions between ‘mind,’ ‘brain’ and ‘body’ seem imprecise,” he writes. “They have lost their ability to perform. They are violating the script the rest of us follow, a script that says consciousness is separate from the flesh.”

I feel it’s important — and so does he — to relay the context surrounding the “horrible three years” in which the author wrote this book. After his father died, Brownstein’s wife, Marcia, was diagnosed with pancreatic cancer. He wrote the book in hospital hallways, in the moments between tending to their children.

When she died, he found himself writing the book for her. “Her death revealed my life as unstable, and her loss made the world seem unreal.” He related to the way the feminist literary critic Elaine Showalter defines hysteria as a “narrative incoherence.”

Of course, this incoherence is present within the book, too. We are left with so many questions: Did Pappenheim have F.N.D.? What would it mean if she did? Does the talking cure actually have a place in medicine?

Brownstein is allergic to answers. He likens himself to a “conscientious archaeologist” and leaves it to his readers to draw their conclusions based on the specimens he places before us.

“I do not claim to have solved any great mysteries here,” he writes, “to have discovered what Anna O. really suffered, or to be able to tell you what F.N.D. really is.”

As frustrating as this can feel to the reader, perhaps the impossibility is the point. Real life, after all, is rarely clear-cut.

THE SECRET MIND OF BERTHA PAPPENHEIM: The Woman Who Invented Freud’s Talking Cure | By Gabriel Brownstein | PublicAffairs | 326 pp. | $32