Histeria

Panel Report: Hysteria One Hundred Years On. Int. J. Psycho-Anal., 77:75-78 (IJP)
Panel Report: Hysteria One Hundred Years On
Chaired by EDWARD NERSESSIAN, New York
Reported by
Joana M. Tous

The Chairman opened the proceedings by asking two questions: (1) had hysteria disappeared or did we simply not know how to diagnose it, and (2) what in our view were the factors that predisposed tohysteria?
On diagnosis, the first panellist, Janine Chasseguet-Smirgel, pointed out that Freud had stated already in the Studies on Hysteria that the term hysteria could cover the worst and the most contradictory of phenomena. Pure forms were very hard to find in the clinical situation; mixed configurations made up of an amalgam of symptoms were the most common, so that diagnosis was difficult.Hysteria had often been explained and treated as a severe narcissistic pathology calling for the working through of archaic nuclei of the patient's psyche. Many authors of the British school, such as Rosenfeld and Brenman, considered that powerful psychotic anxieties underlay hysteria. Other authors, such as Kernberg, placed hysterical personalities in the borderline category. By contrast,representatives of the French school, such as Green and Laplanche, distrusted and were concerned about the desexualisation of psychoanalysis.
The diagnosis of hysteria was impeded by the fragmentation of psychic structures, the lack of repression and the incompleteness of the oedipal organisation, which meant that hysterics were often seen as borderline personalities.
For this contributor, the hystericalnucleus lay in neurosis, psychosis or a borderline state according to the relevant level of regression. In her view, although some felt that this work was too simple and ineffective, it was important in hysteria to interpret oedipal conflicts, guilt at attacks on the mother and siblings, and projection on to the infantile penis of possible revenge for the subject's destructive fantasies.
Shenoted the difficulty of tolerating the existence of such an amorphous and indeterminate clinical entity, which could encompass hallucination, somnambulism, multiple identifications, acts of absorption rather than internalisation, lack of ego boundaries, and so on. She concluded that as psychoanalysts we had to face up to the profusion and wide range of the phenomena concerned.
The hallucinations ofhysteria were mostly visual and differed in character from those of psychosis. What was specific to hysteria was the patient's interest in her hallucinatory state, which made her produce an abundance of hallucinations for the analyst; this the psychotic never did.
Recent literature no longer saw hysteria

Panel held at the 39th Congress of the International Psychoanalytical Asociation, SanFrancisco, 31 July 1995.
Panellists: Eric Brenman (London), Janine Chasseguet-Smirgel (Paris), Carlos Sopena (Madrid).
Translated by Philip Slotkin, MA, MITI.
Copyright © Institute of Psycho-Analysis, London, 1996
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as a pathology of gender and identity, although the hysterical patient's central question was still whether he or she was a man or a woman. In this connection Chasseguet-Smirgelnoted that fantasies of pregnancy featured prominently in the only case of male hysteria described.
On the basis of Anna O's remark that she was going to have Breuer's child, Chasseguet-Smirgel related hysteria to what she called the ‘kingdom of the mothers’, namely the uterus and pregnancy. Hysteria was connected with the uterus both in fantasy and through biology. In a psychic pathology whosetheatre was the body, the biological factor could not be underestimated.
The wish to incorporate the penis predated the acquisition of genital potency. Masturbatory activities, erections and coital movements surely existed from the beginning of life. The primal nucleus of conversion hysteria was the wish for pregnancy with the two-fold connotation of fertilisation and unlimited penetration by a...