Do we owe Psychoanalysis to Hysteria?

I would like to propose that we think about the idea that Freuds clash with the realities of hysterical phenomenology brought about within him an intellectual crisis the resolution of which gave birth to Psychoanalysis. Given what we now know about such apparently intellectual crises, we need also consider the emotional crisis component which no doubt accompanied it.

The intellectual component of the crisis was experienced by Freud - I assume - in ways which today we might think of in terms of thinking about a philosophy of mind: how could he reconcile his positivistic, medical-model education with what he newly encountered clinically with his patients suffering with hysteria, symptoms of which he was discovering to have meaning and to possibly have resulted from psychic trauma.

Fairbairn, in 1954, put it succinctly:

The essential and distinctive problem [of Hysteria] is the substitution of a bodily state for a personal problem_._

Perhaps this whole episode might itself be conceptualized as an episode of trauma for Sigmund Freud in itself, and, perhaps, even to contain what we now understand to be some of the associated features of traumatic states. This is the aspect which I am suggesting comprised the emotional crisis.

His own thoughts and behaviour as revealed in his many letters to Fliess and the biographies written about him, reveal to us the personal struggles he underwent to develop his ground-breaking ideas.

If Freud has given us any enduring legacy at all, it must surely lie in the concept of the importance of the role of memory in neurotic illness and in personality disorder: both memory retained albeit perhaps distorted - and memory lost.

Memory retained as either true or distorted and memory lost, but still psychically active in some form or another.

Freud after all, gave us the aphorism Hysterics suffer from reminiscences.

Implicit in this aphorism is that a psychical phenomenon: retained memory influences a somatic phenomenon: expression of illness behaviour.

The problem is to understand how memories of experiences and the private meanings ascribed to those experiences retain their influence over the mental lives of human beings and so often in a disabling manner.

The actual mechanisms of this phenomenon remain a mystery - but we are making some progress toward resolving it.

Memory and the unconscious are inseparable says Italian psychoanalyst/neuroscientist Mauro Mancia [Mancia, 2006, IJP, Vol. 87 p.87]

and Freud has shown us that mental disorder and the unconscious are inseparable.

**If hysterics have trouble with their memory as to the origins of their disorder, how clear are we about the origins of our discipline and profession: psychoanalysis itself?
**
Let me now ask, what would you my audience consider to be the origin of Freuds discovery of what would become Psychoanalysis?

If we were at this point to have a free floating discussion of what each of you might be thinking, I am sure there would be a fair degree of consensus among you but, I imagine, also a fair degree of difference.

I am sure that Freuds encounter with his patients with hysteria would feature strongly; the role played by Josef Breuer and Anna O.; the shift from hypnosis to the talking cure; the formulation and subsequent rejection of the Seduction Hypothesis; and so on.

Hysteria, hypnosis traumatic experience, fantasy.

Perhaps some of you have other significant issues or even definitive moments of Freuds own life in mind at this point.

We know that ONE HUNDRED and TWENTY-FOUR YEARS AGO, IN NOVEMBER, 1882, Joseph Breuer gave to his then 26 year-old colleague, Sigmund Freud, a detailed account of his successful treatment of a case of hysteria. The treatment had lasted two years and had been completed in June of that year. The patient is now known to us as Anna O. and in most histories of psychoanalysis she is accorded the honor of being the first proto-psychoanalytic patientthe inventor of "chimney sweeping" as she called it [Breuer and Freud, 1893-1895, p. 30], or free association, as we call it.

We also know that Freud wrote to Wilhelm Fliess, informing Fliess of the pending publication of the precursor to the now famous joint paper with Breuer, on Studies in Hysteria which was to be on January 1st 1893 some 10 years later.

In our interests in trying to date the birth of psychoanalysis, one might consider that conception occurred when Breuer planted the seed in Freud's mind in 1882 and psychoanalysis was born after a ten-year gestation - an appropriately long pregnancy for such a complex child.

Thus: conception in late 1882 with Breuers problems with Anna O. and birth in early 1893 of the definitive paper on Studies in Hysteria, after a 10 year gestation.

Ron Britton, in a 1999 paper to which I will refer more definitively later, recorded the following of which many of us may not be fully aware of some details:

In November 1882 Freud, when he was a newly qualified doctor of 26, heard clinical details [of the case which was to become Anna O.] from Breuer, five months after the treatment ceased. If this had remained the only knowledge of the case it would have provided him with the material that he needed for his early theories of unconscious mental life, repression and conversion. However, we now know that on one hot summer evening of 1883 and while he and Breuer dined alone together in relaxed mood he was told another much more unbuttoned, informal and intimate account of the case. This revealed the erotic psychodrama that took place within Breuers treatment of Anna O. and potentially gave Freud raw material for his theories of the Oedipus Complex, identification, transference, countertransference, repetition compulsion and acting out.

Ilse Grubrich-Simitis in a 1997 paper records Breuer writing in 1907 that he vowed never again to subject himself to such an ordeal as he had suffered in his treatment of Anna O. actually, Bertha Pappenheim.

Thinking further about trying to date conceptions and gestations, perhaps we have to be more specific with the language of our quest in search of the birthday of Psychoanalysis.

Some historians of the development of psychoanalysis have nominated moments of Freuds enlightenment his dreams, his intellectual crises, for example while others nominate significant works The Studies in Hysteria, The Interpretation of Dreams, The Project for a Scientific Psychology, The Unconscious clearly each of these have required a significant period of gestation themselves.

Our psychoanalytic minds might well register this evident intimation of intercourse in this case, between two men: Breuer inseminating Freuds fertile mind-womb.

Richard Friedman [in Psychoanal. Q.], in reviewing a book by Christine Downing, writes the following interesting paragraph:

[Downing] notes that psychoanalysis was born in the context of the intensely eroticized relationship between Freud and Fliess, a relationship that was followed by the troubled, but also eroticized, relationship between Freud and Jung. Freud's theory of bisexuality was influenced by his own bisexual fantasies mobilized by these intense relationships.

Although the Downing book Myths and Mysteries of Same-Sex Love could lead us off into an altogether different direction, the interesting point here is the idea that it was Freuds relationship with Fliess that was important in the gestation of the psychoanalytic baby in the context of the suggested intensely erotized relationship between these two men: Freud and Fliess, - not Freud and Breuer.

Conception with Breuer or was it Anna O. ? and gestation with Fliess.

We know from the history of events at the end of the 19th Century, that Breuer was NOT a suitable partner for Freud in the procreative relationship which was needed to bring Psychoanalysis to life that relationship partner was Fliess.

It was in the very many letters to Fliess that Freud bounced around his new ideas as well as admitting his blocks and lamenting his disappointments.

Nevertheless, he did use his struggle with Hysteria to elucidate a significant number of concepts which would become central tenets of Psychoanalysis.

What was central to Freuds encounter with Hysteria?

We would have to include the bizarre symptomatology inexplicable on organic grounds (and remember especially the bizarre posturings of many of Charcots dramatic cases, bringing to mind sexually provocative positions and actions) and the histories he elicited of sexual trauma, often, at the hands (so to speak) of the young womens fathers or other significant males of their acquaintance.

Even though the question of real or fantasied trauma is a topic in its own right, the central place of infant sexuality was established by Freud.

The _relationship _of the hysterical patient and her father is always of special significance.

The centrality, therefore, of sexuality itself as a central concern of psychoanalysis was established in the course of the seminal encounter with Hysteria and Hysterics. [The pun is intended to continue to make the point that it is relationships which give birth to ideas].

Subsequent developments in psychoanalysis, wherein a focus on the pre-genital has predominated over issues to do with sexual conflicts, have led Andr Green to question in 1995 Has Sexuality anything to so with Psychoanalysis?. This now well known paper was interestingly presented as a Freud Birthday tribute some 11 years ago.

I will refer to this apparently disappeared attention to sexual conflicts later in this paper.

Turning now to another of the contenders for origin status .

In a 2000 paper in the International Journal of Psychoanalysis, historian of psychoanalysis, Ilse Grubrich-Simitis deals extensively with The Interpretation of Dreams, which she refers to as Freuds Book of the Century.

She minutely details Freud's conflicted relations with his Book of the Century.

Grubrich-Simitis takes the centenary of The Interpretation of Dreams at the turn of the twenty-first century as the occasion for a reconstruction of the metamorphoses of Freud's magnum opus, as revealed in his changing and conflicted relations with the book in the course of his life. She tracks the vicissitudes of this relationship from the period of the work's gestation at the end of the nineteenth century through the editions published in Freud's lifetime, distinguishing various phases of revision and demonstrating connections with some of his other key writings and the development of psychoanalytic theory.

She says that Freud himself considered psychoanalysis to have originated with the publication of The Interpretation of Dreams, and that he felt, in his last years, that his colleagues interest in dreams and their interpretation was flagging. She quotes Freuds own well known words

Psychoanalysis, wrote Sigmund Freud in 1923, may be said to have been born with the twentieth century; for the publication in which it emerged before the world as something newmy Interpretation of Dreamsbears the date 1900 (1924, p. 191).

Although he had, in a letter written almost a quarter of a century before, had to apologise to his friend Wilhelm Fliess for the failure of the book to appear on Fliess birthday table punctually on 24 October 1899 on account of deficiencies in the parcel delivery service (1985, p. 380), this letter of 27 October 1899 nevertheless allows [us] to imagine the solemn moment when Freud, the author of Die Traumdeutung, finally held the first two advance copies in his hands, even before the work was despatched from the Viennese publishing house of Franz Deuticke on 4 November 1899its paper cover and title page bearing the date 1900 and thus pointing the way to the future.

Moreover, as late as in 1931, he declared straight out in the preface to the third English edition: It contains, even according to my present-day judgement, the most valuable of all the discoveries it has been my good fortune to make. Insight such as this falls to one's lot but once in a lifetime (1900, p. xxxii).

Well, so far, hysteria and the hysterics and the interpretation of dreams.

A third major strand of exploration of what actually gave birth to psychoanalysis is well summarized in a paper in 2000 by Mauro Mancia and Luigi Longhin in it they say this:

Psychoanalysis was undeniably born in the neurological and psychiatric scientific context of nineteenth-century Europe, within which the personal position of the mature Freud after his experience with von Brcke at the Institute of Physiology and with Meynert at the Institute of Psychiatry can easily be discerned.

Mauro Mancia and Luigi Longhin speak in modern terms of mind culture and brain culture. Their paper is located in the work of the philosopher Kant and the psychoanalysts Bion and Money-Kyrle. Both of these latter analysts had more modern and up-to-date other authors to draw upon than did Freud.

They highlight what I think is the intellectual level of the crisis faced by Freud when faced with his empirical experiences with this group of patients:

How was he to reconcile what all around him were convinced was a neurological, biological disorder merely awaiting further biological research that is, a strong brain culture with his growing awareness that he needed to conceptualise new models of mental processes in order to explain the symptomatology with which he was confronted that is, he needed to develop a new kind of mind culture.

Nevertheless, many of the philosophy of science issues faced by Freud remain largely unresolved to this day.

There are any number of papers addressing these issues in the modern literature both psychoanalytic and (even more so) non-psychoanalytic.

Freud was perhaps the first with his feet hitherto so firmly planted on the brain culture side of the mind/brain divide to grapple with the mind culture issues so intensively and so publicly especially in light of his own personal struggles as evidenced in reporting of his own dreams, his own personal history as well as snippets of observations of his own family [e.g. was it Max Halberstadts son who played with the cotton-reel ?].

Oftentimes, Psychoanalysis is criticized for its speculative adventures proceeding to make huge constructions on the basis of minimal evidence often only indirectly connected to the mind of the subject-in-question.

Perhaps it is now time for me to try to glean some more statements from Freud himself as to what he considered to be the birth or origin of the psychoanalytic science.

There is at least one rather famous statement and one rather less well known one.

First, the less well known one, is the one I quoted earlier:

In 1924, in his paper, A Short Account of Psycho-Analysis, he begins:

Psycho-analysis may be said to have been born with the twentieth century; for the publication in which it emerged before the world as something new my Interpretation of Dreams bears the date 1900. But , I can now add, [Freud himself writes] it did not drop from the skies ready-made. It had its starting point in other ideas, which it developed further; it sprang from earlier suggestions, which it elaborated. Any history of it must therefore begin with an account of the influences which determined its origin and should not overlook the times and circumstances of its creation.

The better known statement of Freuds relates to the plaque Freud proposed to be installed to announce his successful interpretation of the Irma dream is a birth announcement calling to mind the shared completion of Walther's Prize Song in Wagners Die Meistersinger, about which Hans Sachs proclaims, Ein Kind ist hier geboren.

Again, the child of a nourishing and supportive relationship.

Psychoanalysis is the child fathered by Wilhelm Fliess, born to Sigmund Freud on July 23-24, 1895.

Thus, on 6 June 1900, Freud envisioned glory arising from his discovery of the secret of dreams. He fancied a festive celebration of his achievement and imagined a marble tablet commemorating the place where he had the Irma dream. The plaque would read: 'Here on July 24, 1895 the secret of the dream revealed itself to Dr. Sigmund Freud' [Freud, 1895, p. 417].

His wish was finally fulfilled more than three quarters of a century later when such a plaque was actually placed there on 6 May 1977.

**TRYING NOW to TIE THIS ALL TOGETHER then
**
Freuds medical, initially neurological, career suffered a trauma when he encountered the problems of hysterical disorders.

Having developed his professional mind in a medical positivistic and philosophically romantic tradition he experienced what we might call trauma: some form of intellectual crisis.

His effort in writing his Project for a Scientific Psychology in one fevered sitting may be understood to have been an attempt to work through his trauma by retaining his neuro-scientific underpinnings and to couch what he was encountering in neuro-physiological terms albeit by needing to postulate some new notions some proving to be fanciful and others perhaps prescient.

His philosophical forebears at that time were notably von Brcke and his school.

Faced with the crisis, Freud admirably becomes able to free himself from these shackles and is able to begin to think along what Mauro Mancia identifies as Kantian lines the development which later is taken to greater heights by Bion and Money-Kyrle.

The Interpretation of Dreams book clearly becomes a great pre-occupation for Freud, undergoing at least eight revisions before reaching its final version in 1930 !

The Grubrich-Simitis paper goes into fine detail tracking the course of these revisions and the reasons for them.

I offer the idea that this revision of the Traumdeutung book represents something akin to what we now recognize as the plasticity of memory its constant revision in the light of new experience what Freud himself came tocall Nachtrglichkeit.

Grubrich-Simitis historical effort in tracing the additions, subtractions and revisions may be somewhat similar to the clinical work involved in exploring the vicissitudes of our patients own memories of childhood events.

Freuds own paper A Short Account of Psycho-Analysis, some 20 pages long in Volume 19 of the Standard Edition, does in fact, in his usual masterly fashion, refer to all the issues I have been mentioning.

As I quoted earlier, the paper begins with his assertion that the beginning of the twentieth century coincided with the publication of _The Interpretation of Dreams.
_
He acknowledges psychoanalysis initial single aim the understanding of the nature of the functional nervous diseases, which had hitherto rendered medical treatment of them impotent.

Physicians did not know what to make of these so-called neuroses and so left them to philosophers, mystics and the quacks. It was considered unscientific to concern oneself with these disorders.

Accordingly [writes Freud] they could find no approach to the secrets of the neuroses, and in particular of the enigmatic hysteria, which was, indeed, the prototype of the whole species.

This lack of understanding compromised the treatment of these disorders.

Freud asserts that a decisive turn came with the attempt to re-introduce hypnotism into medical science.

It is not easy to over-estimate the importance of the part played by hypnotism in the origin of psychoanalysis. [he wrote].

He credits Charcts experiments with hypnosis in being able to demonstrate that striking somatic changes could be brought about solely by mental influences.

He even acknowledges the work of Pierre Janet Charcots pupil, but says:

Psycho-analysis, however, was not in any way based on these researches by Janet. The decisive factor [in the case of psychoanalysis] was the experience of [Breuer with his patient Anna O. in 1881].

Freud refers to his own experience with many further hysterics and the eventual establishment of the catharctic method.

The catharctic method was the immediate precursor of psychoanalysis; and, in spite of every extension of experience and of every modification of theory, is still contained within it as its nucleus. But it was no more than a new medical procedure for influencing certain nervous diseases, and nothing suggested that it might become a subject for the most general interest and for the most violent contradicition.

In describing the important shift from medical model conceptualization of the neurotic disorders to a more psychical appreciation of mental processes, Freud implicitly acknowledges the body-mind conflict. He does not refer to his own attempted resolution through his Project for a Scientific Psychology, but he does allude to the forced realization that the unconscious [his inverted commas] now has become something actual, tangible and subject to experiment

Here ends Part I of his Short Account in which Freud uses the pronoun I on many occasions.

In Part II, he refers to himself in the third person:

After hypnosis was replaced by the technique of free association, Breuers catharctic procedure turned into psycho-analysis, which for more than a decade was developed by the author (Freud) alone.

He goes on to enumerate many of the important early phenomena which engaged his fertile attention as economical a summary of the early discoveries as one could wish for.

For our purposes here, the next highlight in his account is this:

From the date of The Interpretation of Dreams psychoanalysis had a twofold significance. It was not only a new method of treating the neuroses but it was also a new psychology; it claimed the attention not only of nerve-specialists but also all those who were students of a mental science.

The rest of his short account deals with the stormy reception received by psychoanalytic theories with which we are only too familiar. It reads well and would be worthwhile for anyone who has not so far done so to peruse.

However, I cannot resist one last quote from this interesting historical summary by Freud himself, referring to the dissemination of psychoanalytic ideas throughout the world:

As early as in 1911, Havelock Ellis was able to report that analysis was studied and practiced, not only in Austria and Switzerland, but also in the United States, in England, India, Canada and, no doubt, in Australia too.

HYSTERIA THEN AND NOW

Given that Psychoanalysis birth in one way or another is intricately connected to the phenomenon of Hysteria, it might be possible to very briefly trace some of the developmental trends in Psychoanalysis itself through developments in the understanding of Hysteria.

Hysteria at Freuds time was clearly regarded from the perspective of a _conversion symptom. _Any consideration of specific hysterical personality structure was only to develop later.

I did a study of the percentage of papers in the electronically accessible journal literature which refer to hysteria in one way or another:

From a high of over 16% in the 1920s and 30s, dropping to less than 10% in the 1950s and rising to around 13% in the 70s, 80s and 90s.

This does suggest a cyclical level of interest, which could be a topic for another day.

But perhaps, Andre Greens lament about the disappearance of sexuality from clinical psychoanalysis might have something to do with it.

Green in fact argues that the apparent disappearance is rather a defensive resistance to the intensity of the presence albeit perhaps in disguise of the sexual drive in many of the presenting phenomena encountered in a psychoanalytic relationship.

To make his point, he quotes Guntrips account of Guntrips own analysis with Fairbairn. Green expresses surprise to learn that Fairbairn conducted the analysis from behind his desk and also allowed discussions to take place outside of the session time itself.

Green interprets this as evidence of the everpresent need to distance oneself from the intensity of the erotic aspect of any analytic intercourse.

This observation of Greens permits us to hark back again to the earliest origins of psychoanalysis.

Did not Breuer have to flee the erotic intensity of Anna Os attachment to him?

Freud at a distance from Anna O herself was in a safer situation to begin to conceptualise the intensity of the first observed transference-based set of enactments in the Breuer-Anna O relationship.

But what of Freuds own reactions to the likely transference impact of Dora? perhaps too, Emmy non N. and others?

This is not to criticize Freud, but to acknowledge that the pressure from sexual states of mind originating in the dynamics of infantile developmental struggles are a constant force to be contended with by analysts.

Otherwise, we would likely have fewer boundary transgressions let alone violations to plague our professional efforts both as individuals and as a professional discipline.

Psychoanalysis has been the butt of popular jokes about it alleged obsession with matters sexual. The irony is that it is true that at the core of Freuds great discoveries lies his insight that the vicissitudes of infantile sexuality contribute to the production of psychosexual manifestations of psychopathology BUT Greens point, and mine, is that this very same insight is the one toward which we expend so much energy defending against both in some of our more recent theories and in our day-to-day work.


SUBSEQUENT DEVELOPMENT OF THE CONCEPT OF HYSTERIA

As is well known, in Freuds time, Hysteria was classified as _Conversion Hysteria _or Anxiety Hysteria.

__

The Conversion Hysterias were the emotionally theatrical outbursts, the non-organic blindnesses, aphonias, anaesthesias and paralyses, lumps in the throat and so on.

The Anxiety Hysterias are what we would today regard as the anxiety disorders and phobias.

The meaning and aetiology of these disorders were originally thought to lie in the arena of sexual trauma later to be understood to be _either _real or phantasied.

Nevertheless, as we have kept emphasizing, the whole arena of OEDIPAL PSYCHODYNAMICS was opened up by the progressive understanding of this psychopathology.

It fell to Fairbairn and Melanie Klein to formulate these issues in terms of internal objects: as Fairbairn wrote specifically exciting and frustrating objects.

Fairbairn cites clinical material to support his notion that emotional conflict occurring in crucial libidinal phases can result in the relevant erotogenic zone being converted to a body part or tissue which would, ordinarily, otherwise not be so endowed with erotic significance. This, together with Fairbairns developing notions of internal objects, seems to provide a bridge to subsequent Kleinian thinking about the internal world and its associated models.

I now select but one representative of Kleinian and Post-Kleinian thinking to provide a very modern view of Hysteria:

Ron Britton, one of the most highly regarded modern day psychoanalysts certainly by analysts here in Sydney - wrote a paper titled Getting in on the Act: the Hysterical Solution, published in the I.J.P in 1999.

In it he reviews what is now known of the treatment experience of _Anna O. _and the subsequent life course of _Bertha Pappenheim _ who she was in reality.

Brittons paper is well worth reading in its own right for its corrections of some misconceptions of the relevant aspects of the history of psychoanalysis which many of us probably share as well as additions offered by detailed historical research subsequent to, say, the Jones biography of Freud.

He then goes on to outline his own very modern view of the distinctive aspects of Hysteria by discussing a case of his own, with striking similarities to Anna O.

Brittons notion of the other room which he spoke about on his last visit to Sydney, and about which he writes, and its relation to the imagination are among his many unique contributions to our understanding.

This represents Brittons very modern take on the issues we refer to in a shorthand way as the Oedipal Complex and especially his modern conceptualization of the relevance of fantasies about parental sexuality and the various ways projective identification can be used by a given patient to insert him or herself into the sexually alluring other other place, other relationship, other person, other mind.

A flavour of his understanding of hysterical mental processes is afforded by these excerpts from his paper:

When we locate our phantasies in this other room, a room defined by our physical absence from it, we say we are imagining something. This Anna O. did prior to her illness in what she called her private theatre of her day-dreams; a place where she spent a great deal of time.

About his own patient, he wrote:

The young woman had an unconscious phantasy of herself watching the primal scene between her parents; this was transformed by a phantasy of her taking her mothers place by projective identification.

This probably equally is true of Anna O., as he suggest and of all hysterics.

Britton acknowledges the current-day problem of differentiating _hysteria _from the borderline syndrome with which there are no doubt features in common.

Britton says that in hysteria, priority is given to the claim to possess the object in the realm of love whereas in the borderline syndrome the claim is to possess it in the realm of knowledge. . in hysteria the insistence is on possessing exclusively the analysts love, leading to a transference illusion that ignores the importance of any other reality than love and annihilates the analysts erotic bonds with anyone else.

In the borderline transference [by contrast] the insistence is on complete intersubjective understanding with the annihilation of anything that might hint at the analyst having derived knowledge from or shared knowledge with anyone else.

This different manifestation of projective identification experienced in the countertransference by the analyst - permits a potential diagnostic distinction to be made:

Britton characterizes the experience of being with the borderline as predominantly one of feeling constrained or even tyrannized (as in his missing link paper) while in the case of the hysteric, the predominant feeling is of being especially important with the attendant risks of being seduced into collusion.

Psychoanalysis has brought us to be able to distinguish states of mind from enduring character structures.

Thus, while any given person may be affected by a hysterical, narcissistic, autistic, psychopathic or even psychotic state of mind, to be enduringly dominated by any of these states of mind reflects more an enduring character structure, diagnosable as pathology.

Current diagnostic dilemmas faced by clinicians often involve trying to distinguish between hysterical, narcissistic, psychopathic and borderline personality disorders.

I have also to include the special form of diagnostic dilemma encountered as so-called Multiple Personality Disorder. While most regard it as a variant of Borderline Personality Disorder, it is noteworthy that Freud and Breuers clinical account of Anna O. includes mention of dual personality phenomenology.

Freud himself, was quite casual in referring to split personality on a number of other occasions.

I consider that nowadays, we do not often enough consider the Hysterical Personality Structure in our clinical discussions.

I would even venture to say that the all-too-common clinical group of **_Eating Disorders _**is but the modern day extreme form of presentation of what was Hysterical Conversion Disorder.

Remember Fairbairn:

hysteria is the substitution of a bodily state for a personal problem

Psychiatry does not seem to regard patients with eating disorder to be as ill as they are at least in the psychoanalytic sense.

Modern Psychiatry seems to regard eating disorders as a socio-culturally determined disorder leading to distorted body imagery and treats it accordingly.

**Could we consider hysterics with eating disorders to be presenting in a way that is intended to convey that they are physically sicker than they really are in order to conceal that they are really _psychically sicker _than they would like to admit they are. **

Sadly, families, physicians and indeed society, all collude in this deception.

A very well known and highly regarded psychoanalyst who laments the eclipse of Hysteria from our clinical consciousness is Christopher Bollas.

He developed a series of seminars in the mid-1980s to address this very point. These seminars resulted in the slim volume hysteria published in 2000.

I would highly recommend this treatise on Hysteria.

Any attempt to summarise his views could only fail to do them justice. I might offer but a taste to whet your appetites for a fuller meal by reading him yourself:

Hysterics are intensely ambivalent about imagining and delivering genital sexuality, as they believe that it is sinful and that they will lose their innocence. The great moments of the body in the selfs life the sexual epiphanies of the 3-year-old and the 13-year-old make the body a type of villain for hysterics. When they repress their repudiated sexual mental contents, it is fitting that they are converted into a body ailment to which they seem blithely indifferent: the body, agent of their demise, shall in turn suffer pain and unlove.

. surely, modern day Eating Disorders in a nutshell.

Bollas places more emphasis on the internal relationship with the mother than, certainly, did Freud and, probably, most others.

It is always sobering to read ones own interesting ideas succinctly summarized in someone elses paper written some years before.

In writing this paper, only recently did I come to read the final chapter of Bollas book. There I read:

true to the nature of all intellectual movements, psychoanalysis progresses in swings and roundabouts, and in the early 1990s conferences on sexuality and hysteria sprang up, new and interesting books on hysteria were written and psychoanalysis not only rediscovered hysteria, but may well have recovered from its own forgetting.

He concludes his book with the following sentence:

Next time we think hysterics have disappeared, lets ensure someone asks after us and calls for help.


After all this, . which, then, of our original contenders for the moment or the issue have prevailed as having given birth to Psychoanalysis ?

Well, all of them!

Perhaps we can arrange them all in some meaningful relationship to each other:

First, Freud was confronted with the at the time bizarre and mysterious phenomenology of the so-called hysterics.

Second, through developing his novel talking cure approach, he was given privileged access to the inner worlds of these troubled individuals and this in turn led to his awareness of the importance of dreams, and in turn, his developing notions of the unconscious mind. His preparedness to devote honest and uncompromising attention to _his own inner world _was no doubt an essential aspect of this part of his struggles.

Lastly, and as background to this whole process, his intellectual struggle with brain culture and mind culture issues, in the context of the influential figures of his times on each side of the divide influenced the development of and revision of his successive theories and models of mind.

BUT, were it not for Freuds encounter in the first place with hysteria itself, we would probably have no PSYCHOANALYSIS at all.

We may well then have Hysteria to thank for Psychoanalysis but, were it not for Freud and Psychoanalysis, we would have little real understanding of the richness and depth of the internal world of Hysteria at all nor indeed the richness and depth of other minds which might prefer to think of themselves as **not **hysterics at all.