Hysteria I
TEACHING NOTES
Core Concepts:
Conversion
Displacement
Erotogenic
zone
Hysterical
Identification
Perversion
Phobic
Psychical
trauma
Repression
Reproach
Sex,
sexuality, sexual excitement
Somatic
compliance
Symptom
formation
Unconscious phantasy
Required Reading
Freud, S. (1905a) Fragment
of an analysis of a case of hysteria.
Standard Edition 7: 3-122.
Supplementary
Reading
Glenn, Jules (1980) Freud's Adolescent Patients: Katharina, Dora and the
"Homosexual woman", in Freud and His Patients. Edited by Mark Kanzer and Jules
Glenn. Jason Aronson, New York,
London.
Notes from Jules Glenn regarding the Dora case
Written at the
time of the topographic theory: Cs. Precs. Uncs
Prior to the complete articulation
of the libido theory in 1905.
Refers to only the oral components, not the anal or phallic.
Aggression
was considered to be part of the libido, not a separate drive.
The
conflict was seen as occurring between the conscious and the unconscious. The task of analysis is to make the
unconscious conscious.
The
ego and self were vaguely defined and were associated with the conscious
aspects of mind.
Combines material
useful for diagnosis of hysteric neurosis with the construction of dreams and
how to analyze them.
Most defensive
activity was called repression. Conversion was identified as a defense. Other defenses are clearly present: projection,
externalization, reaction formation (reversal of affect), displacement of
sensation, regression to infantile (oral) modes of relating, identification,
identification with the aggressor, idealization/devaluation, splitting.
Does not take into
consideration features specifically linked to her being an adolescent.
Fragment of
an analysis of a case of hysteria
From introduction - Freud analyzed
Dora for 3 months, from October 1900 to December 1900. Wrote up the case in January 1901. Did not have it published until 1905,
for reasons of confidentiality. It was
originally called Dreams and Hysteria.
Real
name of patient: Ida Bauer. She was
the daughter of a Marxist philosopher who had consulted Freud.
Important
dates and ages: pp. 5-6.
Described
this as an ordinary case, a case of petite hystérie, in contrast
presumably to a grande hystérie.
Freud
said he excluded technique from the report. However, technique is implied and he said later that his
technique likely influenced the premature ending. He changed his technique after this to less forced interpretation,
more attention to the transference as resistance.
Prefatory Remarks:
1895
and 1896 – pathogenesis of hysterical symptoms and mental processes occurring
in hysteria, in Studies on Hysteria (Breuer and Freud, 1895), and The
Aetiology of Hysteria (Freud 1896c).
(Also in The Project, 1895)
Hysterical
disorders involve the intimacies of people’s lives – their sexual lives;
hysterical symptoms are the expression of their most secret and repressed
wishes. Use frankness; call the
organs and functions of sexual life by their proper names.
A thorough
investigation of the problems of dreams is an indispensable prerequisite for
any comprehension of the mental process in hysteria and the other
psychoneuroses.
A single case
cannot provide all the answers to this disorder.
The Clinical Picture
Demonstrate
the psychical processes and the organic determinants of hysteria.
Particularly in
a case of hysteria:
The history is indistinct, with gaps unfilled, riddles
unanswered; connections incoherent, sequence of events uncertain and changeable.
There is conscious disingenuousness
(holding back due to timidity, shame or discretion), unconscious
disingenuousness (part of their knowledge disappears at the time of telling),
true amnesias, paramnesias formed secondarily to fill in those gaps (e.g. alter
the chronological order of events; doubts express the first stage of
repression). Only towards the end
of the treatment do we have an intelligible, consistent, and unbroken case
history. We have repaired the
damage to the patient’s memory.
Because of the
nature of the facts that form the material of psycho-analysis, we are obliged
to pay as much attention in our case histories to the purely human and social,
especially family, circumstances of our patients as to the somatic data and the
symptoms of the disorder.
Features in the history that are typical of the hysteric
The father, who
was in his late 40’s when he brought the girl, of this 18-year-old girl was the
dominating figure in the circle, owing to his intelligence and his character as
much as to the circumstances of his life; unusual activity and talents, a large
manufacturer in very comfortable circumstances.
The daughter
was most tenderly attached to the father, and for that reason her critical
powers, which developed early, took all the more offence at many of his actions
and peculiarities.
This affection
was increased by the many severe illnesses which he had been through since her
sixth year. (E.G. tuberculosis,
which required a move to a small town in a good climate).
When the girl was 10, father had to go
through a course of treatment in a darkened room on account of a detached
retina; his vision was permanently impaired. His gravest illness was when she was 12 – a confusional attack,
followed by symptoms of paralysis and slight mental disturbances. Herr K brought him to see Freud in Vienna who diagnosed a diffuse vascular infection for which Freud prescribed an anti-luetic
treatment. Father had had a
specific infection before his marriage.
Thus, constitutionally, Dora was the daughter of a male parent with
syphilis.
Father brought
his daughter to meet Freud first when she was 16; Freud described her as “unmistakably neurotic”.
Taint of heredity: Father’s older
sister – severe form of psychoneurosis, not characteristically hysterical. Father’s older brother – a
hypochondriacal bachelor. Daughter
“took after” and was sympathetic to father’s side of the family.
Mother was
described as uncultivated, foolish, by both father and daughter, with “housewife’s
psychosis", concentrating all her interests upon domestic affairs, especially
since her husband’s illness and the estrangement to which it led. Relations between the girl and her
mother had been unfriendly for years.
The daughter looked down on her mother and criticized her mercilessly; she had withdrawn completely from mother's influence.
The patient’s
brother, 1 1/2 years older, was the model of her early ambitions, but later
their relation became distant. He
was close to mother.
Patient’s
symptoms: beginning age 8,
subject to chronic dyspnoea with occasional episodes in which the symptom was
very much aggravated.
The first
onset – after a short expedition in the mountains; put down to
“over-exertion”. Rested and looked
after for six months and it left.
Family doctor diagnosed it as “nervous”. Regarding usual childhood illness, her brother would get it
first, slightly, then she would get a severe form of it.
Age
12 – unilateral migraine headaches plus attacks of nervous coughing, tussis
nervosa, likely started originally by a common catarrh. The headaches became rare but the
coughing continued. By age 18, the
attacks lasted from three to five weeks, on one occasion for several
months. During the attack, she
developed a complete loss of voice.
All “nervous”.
During
many investigations and treatments which had no benefit, she had grown to laugh
at the efforts of doctors, to resist seeing another doctor. Only the authority of her father got
her to see Freud at 16. She declined
psychological treatment then, since the prolonged attack passed off
spontaneously.
While
17, although intelligent, with engaging looks, the patient was low in spirits
with an alteration in her character.
Fatigue, lack of concentration.
Not satisfied with herself nor her family; unfriendly to her father;
very bad terms with mother who tried to get her to share housework; avoided social
intercourse. Attended lectures for
women and tried to carry on her studies.
One day parents came across a suicide note, saying she could no longer
endure her life; then she had a loss of consciousness – subsequently covered by
amnesia – and father brought her to Freud for treatment.
A
case of petite hystérie with the commonest of somatic and mental
symptoms. No cutaneous
sensitivities, no visual field disturbances.
In all cases of
hysteria, Freud had found the psychological determinants postulated in the Studies,
namely, a psychical trauma, a conflict of affects, and, in 1896, a disturbance
in the sphere of sexuality. In
this case too were all the determinants.
Family History
Dora's family
had formed an intimate relation with a married couple, Herr K and Frau K. Frau K had nursed father during his
long illness (Dora was aged 12) and had thus earned his undying gratitude. Herr K had been most kind to Dora –
going on walks with her, giving her small presents. Dora had taken care of the K’s two little children, being
almost a mother to them.
At age
16, Dora and her father traveled to visit the K’s who were spending their
summer at a lake in the Alps. Dora
was to have spent several weeks there while father returned home after a few
days. Suddenly Dora insisted on
going home with her father. Some
days later she told her mother that Herr K had had the audacity to make her a
proposal while they were on a walk after a trip upon the lake. The father confronted Herr K on their
next meeting, but Herr K denied emphatically having made any advances which
could have been open to such a construction. He threw suspicion on the girl saying that he’d heard from
Frau K that Dora took no interest in anything but sexual matters, reading a
book on the Physiology of Love and others at the lake. Father considered that this incident
was responsible for Dora’s depression and irritability and suicidal ideas.
Dora kept pressing her father to break off
relations with Herr K and more particularly with Frau K, whom she used to
worship formerly. Father could not
do this. He believed that Dora’s
tale was a phantasy that had forced its way into her mind, and he was bound to
Frau K by ties of honourable friendship and he did not wish to cause her
pain. He was Frau K's only support; she
was nervous and disappointed in her husband. Father explained to Dora that he "gets nothing" out of his own wife. Dora had her last attack after one of
these conversations pressing him to break off with them.
Father brought Dora to Freud, wanting him to “bring her to
reason”. Freud noted that at other
times, father blamed Dora’s impossible behaviour on mother’s peculiarities.
Discussion
This experience
with Herr K would seem to be the psychical trauma that is the indispensable
prerequisite for the production of a hysterical disorder. However, it does not explain or
determine the particular character of the symptoms. Also, some of the symptoms had appeared in the patient years
before the trauma, since age 8.
Hence must look earlier for influences or impressions which might have
had an analogous effect.
Dora described
an earlier episode with Herr K, when she was 14. He arranged that the girl should be alone with him at his
place of business; he closed the shutters and just as they were to leave, he
suddenly clasped her to him and pressed a kiss upon her lips. Freud thought that this should have called up sexual
excitement in Dora, but Dora felt violent disgust, tore herself from him, and hurried
out. She continued to meet him and
neither spoke of it again. Nor did
she tell anyone else until Freud.
However, she avoided being alone with Herr K, and refused to go along
with the K’s on an expedition, which was to last for some days.
Thus, at 14,
Dora was already hysterical.
Freud considered a person hysterical in whom an
occasion for sexual excitement elicited feelings that were preponderantly or
exclusively unpleasurable, whether or not the person were capable of producing
somatic symptoms. This reversal
of affect is one of the most important and at the same time one of the most
difficult problems in the psychology of the neuroses. As well she had a displacement of sensation, from the
genital to the mucous membrane of the alimentary tract (disgust). (She had always been a poor eater and
had a disinclination for food.)
She had a sensory hallucination (during the telling) of the pressure on
her upper body of Herr K’s embrace.
Another symptom – she was unwilling to
walk past any man whom she saw engaged in eager or affectionate conversation
with a lady. Freud postulated that during the embrace, she felt the pressure of
the man’s erect member (sic) against her body; this was revolting to her, it was
dismissed from her memory, repressed, and replaced by the innocent sensation of
pressure upon her thorax – a displacement upward from the lower part of the
body. She avoided any man who she
thought was in a state of sexual excitement because she wanted to avoid seeing
for a second time the somatic sign which accompanies it.
Three symptoms:
Disgust is the symptom of repression in the erotogenic oral zone which had been
over-indulged in Dora’s infancy by the habit of sensual sucking. The excitement of the second erotogenic
zone, her clitoris, was referred by a process of displacement to the thorax and
became fixed there. She was phobic
with respect to seeing a sexually excited man.
Freud
postulated that disgust arises from the association of the genitals with the
site and smell of the excretory functions. The subject of erection solves some of the most interesting
hysterical symptoms, as does the outlines of men’s genitals as seen through
their clothing.
The patient
consciously felt finished with Herr K, but she was angry at her father for what
she took to be his love-affair with Frau K. She had detailed memories of many occasions, ever since she
was 12, that confirmed this view.
She was very critical of her father’s falseness, and, when embittered, she
used to be overcome by the idea that she had been handed over to Herr K by her
father as the price of Herr K's tolerating the relations between her father and his
wife. Her father would have been
horrified at any such suggestion, but he was one of those men who know how to
evade a dilemma by falsifying their judgement upon one of the conflicting
alternatives.
Father would have
denied that anything untoward was happening between Herr K and his
daughter. Thus it was possible for
Herr K to send Dora flowers every day for a whole year while he was in the
neighbourhood, to take every opportunity of giving her valuable presents, and
to spend all his spare time in her company, without her parents noticing
anything in his behaviour that was characteristic of love-making.
A string of
reproaches against other people leads one to suspect the existence of a string
of self-reproaches with the same content.
There is something automatic about this method of defending oneself
against a self-reproach by making the same reproach against some one else. For example, while Dora was very
critical of her father’s not wanting to look too closely into Herr K’s
behaviour to his daughter, for fear of being disturbed in his own love-affair
with Frau K, Dora had done the same thing for years – giving every possible
assistance to her father’s relations with Frau K. In spite of the affair being pointed out by a governess,
Dora remained devoted to Frau K and would hear of nothing that might make her
think ill of Frau K's relations with her father. On the other hand she readily deduced that the governess was
in love with her father. She was
amused until the time it occurred to her, because of the governess’s indifference
to her, that the governess just used her to get closer to her father. Dora had been similarly affectionate
with Herr K’s children, which had provided a bond between her and Herr K.
Dora did not at first or completely
assent to Freud’s interpretation that she had for all these years been in love
with Herr K.
Dora’s
second reproach against her father was that he exploited his illness for his
own purposes, but she did the same, for example, regarding developing gastric
pains in identification with her cousin (whom Dora thought of as a malingerer,
who developed gastric pains to be able to leave home where she felt envious of her
younger sister’s engagement). She
knew that Frau K used illness whenever her husband returned home to be able to
escape the conjugal duties which she detested. And Dora herself had developed periods of “aphonia” when
Herr K was away from home.
Hysterical
symptoms involve the participation of both somatic and psychical
functions. There must be a degree of
somatic compliance offered by some normal or pathological process in or
connected with one of the bodily organs. It cannot occur more than once unless it has a
psychical significance, a meaning.
(The capacity for repeating itself is one of the characteristics of a
hysterical symptom.) The
hysterical symptom does not carry this meaning; the meaning is lent to it,
soldered to it, as it were; and in every instance the meaning can be a
different one, according to the nature of the suppressed (unconscious)
thoughts, which are struggling for expression.
The clearing up of a symptom is achieved by looking
for its psychical significance; but also it is useful to indicate the organic
factor that was the source of the “somatic compliance” that enables the meaning
to be expressed. This factor is
essential for a hysterical symptom to take place, a conversion.
Primary gain of
illness – falling ill involves a saving of psychical effort; economically the
most convenient solution where there is a mental conflict. (flight into illness). This is the internal primary gain. There may be a desire for
self-punishment because of remorse.
Secondary
motives of illness (or external
primary gain) – serves as a resistance to recovery.
Question of malingering – a
reproach which Dora brought against her father. Freud told her that she had a motive similar to that of Frau K –
to detach her father from Frau K – either out of fear (her suicide note), or
out of pity (her fainting fits) or, if all this failed, get her revenge on him. She had reproach against father
for not believing her story about Herr K; what is the corresponding
self-reproach? Also, why did she
respond so negatively after having given him many signs of affection over the
years?
The reproach and her cough
continued.
A
symptom signifies the representation – the realization – of a phantasy with a
sexual content; it signifies a sexual situation; that is, at least one of its
meanings, because it will have many unconscious meanings. It is not necessary for the various
meanings of a symptom to be compatible with one another. A symptom may also be used to express
successive meanings over a number of years. The production of a symptom such as conversion is so
difficult, the translation of a purely psychical excitation into physical
terms, it depends on the concurrence of so many favourable conditions, that an
impulsion towards the discharge of an unconscious excitation will so far as
possible make use of any channel for discharge which may already be in
existence.
The
cough represented her unconscious picturing to herself the nature of the sexual
act between her father (whom she knew to be impotent) and Frau K.
An analyst should
be dry and direct when speaking about these things.
It is typical
of a hysteric that they know a lot about sexuality without knowing that they
know it (i.e. unconsciously) or how they came to know it. It is necessary to speak of sexual
things with a hysteric: ‘pour faire une omelette il faut casser des œufs.’ There is never a danger of corrupting
an inexperienced girl, for where there is no knowledge of sexual processes even
in the unconscious, no hysterical symptom will arise, and where hysteria is
found there can no longer be any question of ‘innocence of mind’ regarding
sexual matters.
All
psychoneurotics are persons with strongly marked perverse tendencies which have
been repressed in the course of their development and have become
unconscious. Consequently their
unconscious phantasies show precisely the same content as the documentarily
recorded actions of perverts. Psychoneuroses
are, so to speak, the negative of perversions. They continue in their unconscious the undifferentiated
sexual disposition of every child.
For example
Dora could remember a scene from her early childhood in which she was sitting
on the floor in a corner sucking her left thumb and at the same time tugging
with her right hand at the lobe of her brother’s ear as he sat quietly beside
her. The mucous membrane of the
lips and mouth is to be regarded as a primary “erotogenic zone”, which is
preserved in the act of kissing.
An intense activity of this erotogenic zone at an early age thus
determines the subsequent presence of a somatic compliance on the part of the
tract of mucous membrane which begins at the lips. At a time when the sexual object proper, the male organ, has
become known, circumstances may arise which once more increase the excitation
of the oral zone, whose erotogenic character has been retained. Substitute the sexual object of the moment
(the penis) for the original object (the nipple) or for the finger which does
duty for it, and you place the current sexual object in the situation in which
gratification was originally obtained.
In most instances a cow’s udder has aptly played the part of an image
intermediate between a nipple and a penis.
Hysteria II
Required Reading
Easser, Barbara Ruth and Stanley R. Lesser (1965) Hysterical
personality: a re-evaluation.
Psychoanal. Q. 34:390-405.
Halberstadt-Freud, Henrika
C. (1996) Studies on hysteria.
Int. J. Psycho-Anal. 77:983-996.
Reich, Wilhelm (1972 [1945]) The hysterical character, in Character Analysis. Touchstone. Simon and Schuster, New
York. 204-209.
Supplementary Reading
Bollas, Christopher
(2000) Hysteria. Routledge, London and New York.
Laplanche, J. (1974) Panel on 'Hysteria Today'. Int. J. Psycho-Anal. 55:459-469.
Nasio, Juan-David (1998{1990}) Hysteria from Freud
to Lacan: The Splendid Child of Psychoanalysis. Translated by Susan Fairfield. The Other Press, Llc.
New York.
OUTLINE
1. Review what Freud’s conclusions were –
2. Reich’s description and dynamics
3. Important additional points from the assigned
papers – Easser and Lesser, Halberstadt-Freud; dream fragment.
(4. Additional points from supplementary or other
readings)
(5. Lacan’s understanding of the dynamics – Seminars V
and XVII)
SESSION
1. Freud’s conclusions about the Dora case:
Freud interpreted her unconscious love attitudes to
Herr K. She rejected this for a
time, but finally acquiesced.
But she left the treatment prematurely.
Freud considered it was because he misunderstood the
nature of her transference (that she had the same feelings for Freud) and
therefore did not take account of it/interpret it. He thought she must have got angry at what she perceived as
his rejection of her.
Later, he came to believe that he had missed the
homoerotic aspect of her relation to Frau K, and that she was identifying with
the men in this love. This would be a
negative Oedipal configuration.
Later authors have noted that Freud did not understand
his complementary counter-transference and his enactment that supported her
transference.
Lacan thought that Dora’s interest in Frau K was not
as a sexual object but as an object for identification, to learn from her how
to be a woman.
2. Reich’s description and dynamics
Written in 1933.
No structural theory; psychosexual phases were used, first anxiety
theory. Concept of character
armour as formed by defenses against both internal and external stimuli; the
external form of this armouring is always historically determined, affected
most by the person most responsible for the child’s upbringing. Also important is the stage of
development in which the instinctual apparatus meets its most crucial frustration.
The hysteric (most often women but can be men) has an
importunate (pressing, persistent) sexual attitude.
What is apparent:
She has a physical agility, with a
sexual nuance (This disappears with successful treatment.)
She has a light step and gait; is
lilting and supple, coquettish, easily excited, with a shyness and
anxiousness. In men it is seen as
softness, excessive politeness, with a feminine facial expression, and feminine
bearing.
What is hidden: She has a fickleness in attitude, a
strong suggestibility leading to compliance, with strong reactions of
disappointment leading to devaluation.
She
has the sexual attachment of a childish nature (sweet, innocent), using
imagination and pseudologia.
Her
fantasies are experienced and grasped as real experiences.
Psychic
conflicts are expressed in somatic symptoms.
Psychodynamically: she has a fixation at the genital
phase and a genital inhibition.
She retains a strong incestuous attachment and although these ideas are
repressed, they are in full possession of their cathexis.
She
has strong genital aggression as well as anxiety.
Other
qualities (orality, anality) are allied with the genital, e.g. mouth, anus
represent to her the female genital organ.
She has severe sexual disturbance due to an acute
stasis of unabsorbed genital libido.
She is overladen with unabsorbed sexual tension. Her armouring entails an anxious ego
defense against the genital incest striving.
Her genital sexuality places itself at the service of
its own defense; that is, she uses sexuality as a defense. The more anxiety-ridden her attitude as
a whole is, the more urgent the sexual manifestations appear. She has exceptionally strong, ungratified
genital impulses that are inhibited by genital anxiety. In the transference, she does not
recognize the meaning of her sexual behaviour, being shocked by the
“insinuation”.
She always feels at the mercy of dangers that
correspond to her infantile fears.
She uses sexuality to explore for the source, magnitude, proximity of
the danger, then runs or controls it somehow. If a hysterical woman displays strong sexuality, it’s wrong
to assume she’s expressing genuine sexual willingness.
During depressive reactions, she regresses easily to
oral mechanisms. The mouth offers
stasis because it attracts genital libido in an upward displacement.
She has little interest in sublimations or
intellectual accomplishments (she is so preoccupied with her objects). Nor does she manifest reaction
formations. Her sexual energy does
not mature and become bound, as in the obsessional; rather it is discharged
into somatic innervations (e.g. conversions) or in fear and anxiety. Fully developed genital excitations are
ill-suited to purposes other than direct gratification.
3. Easser and Lesser in Hysterical personality: a
re-evaluation. Psychoanalytic Q.
1965.
Reasons for the decline of interest in hysteria –
1.Repeated
inconsistency in the ability of the psychoanalytic method to reverse the course
of the hysterical symptoms.
2.
Changed presentations of patients.
More study of the obsessive modes of dealing with neurotic conflict.
3. Shift of interest from effects of
single traumatic event to the complex methods of the psyche to cope with
anxiety; has resulted in a shift in emphasis from fantasy (the hysteric’s
preferred mode) to defense.
4.
The name is enmeshed with its popular meaning.
5.
Although hysterics are considered to have reached the highest libidinal level
for neurotic fixation, the difficulties of treating them has led to their
disparagement.
Includes diagnostic groups of conversion hysteria,
phobic reaction, fugue states, and hysterical character.
Easser and Lesser studied 6 female
patients with hysteric character.
Differences from Reich's findings:
All showed good to superior performances academically
and occupationally. Buoyant,
sprightly, lively and energetic; not flamboyant, dramatic, provocative,
seductive, exhibitionistic, highly styled. They showed concern over sexual behaviour and a real or imagined sexual
object; there had been the shattering of a romantic fantasy.
Findings of Easser and Lesser:
1.
Unconsciously motivated to compete with women, to seduce and conquer men, and
to achieve security and power vicariously through the passionate engagement of
the man with themselves. Their
fantasies usually involved an irresistible, magnetic body that was to be
exhibited to conquer the male and exclude all other women. Pure wish fulfillment, not masochistic.
2.
Social shyness and apprehensiveness were contrasted with active social
involvement. Long-term good
friendships. However, failed to
gain confidence after repeated success.
Severe feelings of humiliation and shame should rejection occur. Sense of family and friends was strong. Changed when in the presence of mother,
becoming inhibited, juvenile, inefficient, dependent, cute and lovable.
Each was profoundly involved with their father who was
dynamic and seductive, but who rejected them at puberty and/or were jealous of
their boyfriends. Their mothers
were consistent and responsible and wanted their daughters to live out mother's frustrated romantic fantasies.
Dressed them prettily.
There is major conflict when the gratification of physical
sexuality is inhibited and repressed.
Romance then preoccupies and invades every area of functioning. Remain fixated to their fathers; mother
seems uninteresting and ridiculous.
Unable to acknowledge their envy of mother’s feminine abilities. Also envious of father’s purported
physical attributes which substitutes for the forbidden sexuality.
Labile emotionality – the predominant use of feelings
rather than thought in crises and conflicts.
Direct and active engagement with the human
world. Hypersensitive to others;
afraid of any sign of rejection (e.g. criticism), affectionately interested in
their self (love analysis); egocentric need to test love results in emotional upheavals.
Responds badly to frustration but also to
over-excitability. As tension
mounts, she responds with anxiety and flight.
A close relationship between excitability and its
derivative fantasy; romantic.
Suggestibility – these have a defense against suggestibility. Rather, suggestibility occurs more
often in the object toward whom the emotionality of the hysteric is
directed. The hysteric receives
the suggestion she has already planted in the other, confirming her preference
all along.
Dislike of the exact, the rote, and the mundane. Thought of as flighty, irresponsible,
self-indulgent, rebellious. However she is capable of proficiency when the
project captures her interest and allows her to express herself. In this group superior performance was
the rule.
Maintains the self-presentation as a child-woman. Denies the unpleasant, the distasteful,
the forbidden, the actual or fantasied transgression through insouciance,
naiveté and inexperience.
Substitutes one emotion for another more painful
emotion. Uses emotional
reconnaissance; shielding the core affect, the primary underlying desire. Participates vicariously or
fictitiously.
Other patients have hysterical symptoms but are lower
level characters (more oral); call these hysteroid.
Hysterical patients in treatment.
Dreams of hysterical and hysteroid patients.
Halberstadt-Freud – Studies on hysteria one hundred
years on –
Discussion of trauma as etiology.
Series of traumas and the associated fantasies.
Chain always led back to sexuality.
Rejection of seduction theory as the only or main
cause.
Etiology in Dora case remains unclear; no subsequent
case studies by Freud featuring the female Oedipus complex. Used her case to confirm his theories;
angry when she made him powerless; did not consider the role of the mother.
Freud never developed a coherent theory of hysteria capable
of replacing the account given in the Studies. Replaced his early idea of splitting of the ego with the later
model of the drives and fantasies. He was previously more right: hysteria is
based on seduction in the sense of prematurely aroused desires that have more
to do with the adult’s than with the child’s need. “Seduction by the mother was only raised towards the end of
his life, in the context of female sexuality."
Hysteria now seen as pre-oedipal, pregenital,
specifically oral in origin.
Seen also in men.
Hysteria today: Brenman – four aspects – disavowal of
the reality of the internal and external worlds; the tendency to convince the
other that one is in the right; identification with a fantasy object;
possessive but sterile dependence.
Based on wishful thinking.
Manipulation, penetration into the other’s thinking and feeling to make
the other reality credible. A
catastrophe is feared, expressed in restrictive anxiety, phobia or conversion,
while the subject denies that anything is the matter. A hypomanic mood defends against depression. Violence hides a sense of emptiness. Not aware of his anxiety about being
unattractive and sexually inadequate.
Both frigidity and hypersexuality serve the purpose of denial of the
sexual. Dramatic victimhood is
intended to mask and disavow aggression.
Feelings
of inadequacy on the part of eroticizing patients reflect the original
interaction with a seducing parent, whose desires it was impossible for the
child to satisfy. The mother is
anxious and fears catastrophe; she suggests that there are panaceas and thus
does not present herself to the child as a realistic object for identification. Mother encourages disavowal of psychic
reality, of what is true and what is untrue; and she supplies idealizing love
and sensuous stimulation, thereby promoting both hypersexuality and dependence.
Nowadays it is generally assumed that hysteria is a
matter more of defending against depression, abandonment anxiety and
narcissistic dangers than of genital sexuality. Subtle phobic mechanisms serve for avoiding the development
of anxiety. Narcissistic problems
are circumvented by compromise formations and displacement to the field of
sexuality.
Also
homosexual conflict and fixation to bisexuality, disavowal of the difference
between the sexes, between the generations, and between subject and
object. Fixation at the phallic
level and castration anxiety still deemed important. Fantasy performs a symbolic function rather than that of
wish-fulfilment; it leads to plans that miscarry and do not lead to
satisfaction. The drives are
inhibited, leading only to ideas divorced from action or to muscular tension
and pain. Out of anxiety at the
possibility of repetition of traumas, object loss is actively courted. Possessiveness and intrusiveness are
projected and then feared by identification. Analyst may be faced with artificial transference and
irresolvable resentment and irreparable deficiencies, resulting in intense
countertransference feelings.
Hysteric conceals his wish to make an impression behind his fascination
and identification with the spectator (in his stories).
Cognitive style – tend to forget and to mystify. Poor observers. Stories are lacunary and clothed in
feelings that give an exaggerated and artificial impression.
Identifications are used as a way of relating to
others. Identifies superficially
with non-existent fantasy-objects.
He experiences through others what he cannot experience in himself; his
capacity to empathize with the other as other inevitably suffers because of
repression.
Projective identification is often used to combat
uncertainty and feelings of inadequacy; often rapidly reversible
pseudo-identifications. Attempts
to get rid of anxieties by projecting them into the object and then identifying
with it at a distance – by making the other powerless, thereby shifting the
uncertainty from the subject to the object. The practitioner is first approached with an attitude of
idealization, but then disappoints and is reviled.
Hysteria and women
Both male and female hysteria a partly a matter of the
absence of a representation of the female sex, as a result of which sexuality
takes on a powerful phallic coloration.
In hysteria, the phallic mode is a substitute for and a defense against
the dreaded femininity in both men and women. Repudiation of an excessively strong identification with the
problematic mother figure plays a part in both sexes.
Hysteria and French psychoanalysis
The French psychoanalysts lay considerable emphasis on
the anal-sadistic elements that are banished from the hysterical universe, both
aggression and guilt being repressed and projected into the other.
Hysteria in practice
Hysteria meets the expectations of the social
environment or the therapist.
In practice hysteria is frequently misleading, tending
to make the other powerless by seduction and blockage of any meaningful
dialogue. Disavowal of depression
and of mourning for lost love is converted into excitement. It is more fruitful to connect
depression with narcissistic deficiency than with erotic elements in the
transference and countertransference.
Three examples –
Making the therapist reflect her own feeling of
powerlessness, her self-image as lacking talent, worthless and a failure. Mourning for what is lost is lacking in
hysteria. Mourning for what has
not been attained, whether it be the love of the object or the high ego ideal,
is a condition for success in the treatment.
Peter had a seductive mother who could not accept her
life as it really was. He always
had to please and excite her by being her dream prince, more intelligent and
more successful than his father.
The insight concerning the importance of the technical
capacity to utilize the analysand’s message creatively in order to arrive at an
interpretation of the unique interaction seems to me to be the biggest change
in treatment in the last hundred years.
The
Studies are closer to our own time than Freud’s later work. They do not yet make assertions that
lay claim to absolute validity; various doctrines had not yet emerged
(psychosexual phases, theory of the Oedipus complex). The search was still on, just as it is in our own day, when
many axioms of psychoanalysis, as well as its theoretical structure, have lost
their stability, whereas the clinical facts remain.
FRAGMENT OF A DREAM OF AN HYSTERIC WOMAN
I had somehow got married to Peter, Susan’s husband. (Susan was her good “listening”,
advice-giving friend who died 2 years ago.) It was strange, the feeling of being married to him, but I
didn’t really know what that meant.
Were we going to sleep in the same bed, and were we going to have
sex? Peter was pretty
business-like. I thought, Well if
you get married, you have sex; so I did.
Peter said it was serious, real, not pretend, not as if…Noone asked
me. It was not as if I wanted
to. It felt outside of me. I didn’t know how I’d gotten into
this. It was like an arranged
marriage. I’d been brought in to
be the wife. There were some art
objects around. A vase – what is
my relation to this vase? Should I
be cleaning the room; is that what a wife does? Someone said, No, that is not what you should do. We have cleaners. In a bedroom; the next room was
brightly lit…