(1996).

International Journal of Psycho-Analysis, 77:983-996

tu!ies "n #ysteria "ne #un!re! $ears "n: A %entury "f Psychoanalysis
#enri&a %. #al'ersta!t-(reu!
In this )a)er the author sho*s ho* +tu!ies on #ysteria, ushere! in a ne* century of )sychiatry.
-hile hysteria as a clinical entity re.ains as !ifficult as e/er to !efine, the entire theoretical e!ifice
of )sychoanalysis rests u)on it, as it allo*e! the !isco/ery of the la*s of conscious an!
unconscious thou0ht an! fantasy an! there'y .a!e it )ossi'le to e1)lain sy.)to.s an! !rea.s.
2he author )oints out that .any of the 'asic conce)ts of )sychoanalysis are alrea!y to 'e foun! in
the tu!ies an! that, althou0h so.e i.)ortant i!eas *ere thereafter for0otten, these ha/e no* co.e
to 'e re0ar!e! as essential a0ain. 2he notions of s)littin0 an! !issociation feature! )ro.inently in
that se.inal *or& an! ha/e no* 'een reinte0rate! into .ainstrea. theory. Present-!ay
)sychoanalysis is consi!ere! to ha/e returne! to its roots as e.'o!ie! in the tu!ies, .uch less
e.)hasis no* 'ein0 lai! on the later conce)ts of !ri/es, )hases an! li'i!o theory. (e.ale
!e/elo).ent an! the *o.an3s "e!i)us co.)le1 are, in the author3s /ie*, as )ro'le.atic as in
(reu!3s !ay, )erha)s 'ecause of his countertransference )ro'le.s an! ne0lect of the role of the
.other, as e1e.)lifie! in the 4ora analysis. As the author sho*s, only the (rench analysts ha/e
re.aine! consistently faithful to the conce)t of hysteria, *hereas in other countries it no lon0er
e1ists as a !ia0nosis. $et the conce)t is state! to 'e i.)ortant 'oth historically an! for clinical
)ractice to!ay.
Introduction
"/er a hun!re! years a0o Josef 5reuer an! i0.un! (reu! )u'lishe! tu!ien 6'er #ysterie (5reuer
7 (reu!, 1898), *hich ushere! in a ne* century for )sychiatry. 9o*, ho*e/er, hysteria as a clinical
)icture:the .o!el of )sychoanalysis an! the )rototy)e of neurosis:see.s to ha/e all 'ut
!isa))eare! an! has 'een 'anishe! fro. !ia0nostic .anuals (A.erican Psychiatric Association,
199;).
-hat is the si0nificance of hysteria for )resent-!ay )sychoanalysis< A historical re/ie* of the
!e/elo).ent of the conce)t o/er the last hun!re! years .ay hel) us to ans*er this =uestion.
History
It *as only to*ar!s the en! of the ei0hteenth century that hysteria an! hy)ochon!ria *ere lin&e! to
the ner/ous syste. ((oucault, 1961> ?eith, 1968). 2his !e/elo).ent )a/e! the *ay for the science
of )sychiatry. @i&e Janet, 5reuer an! (reu! sou0ht a )sycholo0ical e1)lanation for hysteria, a
!ia0nosis that *as har! to !efine e/en in those !ays: as (reu! )ut it, +hysteria is not an in!e)en!ent
clinical entity, (5reuer 7 (reu!, 1898, ). A89). 9o*a!ays *e !istin0uish a ran0e of )ersonality
!istur'ances:for e1a.)le +'or!erline, an! +narcissistic,:*hich .ay or .ay not ha/e hysterical
characteristics (Bern'er0, 1978, 1976). 2he structure of the hysterical )ersonality, *ith its ty)ical
co0niti/e style an! its !yna.ic, econo.ic an! a!a)ti/e features, has 'een !escri'e! in !etail
(Brohn, 1978> CentDos, 1993> #oro*itD, 1991).
:::::::::::::
2ranslate! 'y Phili) lot&in, CA, CI2I.
(C. recei/e! AEF6F98)
(Ge/ise! C. recei/e! 1EF1F96)
(2ranslate! C. a))ro/e! 1EF6F96)
%o)yri0ht H Institute of Psycho-Analysis, @on!on, 1996
9ot*ithstan!in0 his )ole.ical tone, (reu! (5reuer 7 (reu!, 1898) sho*s a closer relationshi) to
Janet (Illen'er0er, 197E> Jay, 1988> JK!!e, 199;) than to %harcot (1886), *ho, after all, *as first
an! fore.ost a so.atist.
tu!ies on #ysteria can 'e seen as the startin0 )oint of )sychoanalysis, as (reu! *as to call the ne*
!isci)line in 1896. 2he trau.a *as !ee.e! to 'e )sychic, consistin0 of un)leasant .e.ories or
re)u0nant thou0hts that ha! to 'e e1clu!e! fro. consciousness (5reuer 7 (reu!, 1893). +#ysterics
suffer .ainly fro. re.iniscences, (5reuer 7 (reu!, 1898, ). 7). 9ote that the *or! use! is
+re.iniscences, an! not +.e.ories, (tein, 1986).
The importance of the studies for
psychoanalysis
(reu!3s i!eas a'out hysteria resulte! in a theory of the unconscious> this *as certainly the .ost
i.)ortant )hiloso)hical re/olution 'rou0ht a'out 'y the tu!ies (@i/in0stone .ith, 199A). 2he
%artesian !ualis. of 'o!y an! .in! *as re)lace! 'y a .aterialistic unity consistin0 of t*o &in!s of
(un)consciousness. 4issociation an! s)littin0:the latter then still 'ein0 !escri'e! as an +act of *ill,
((reu!, 189;):*oul! only later 'eco.e +re)ression,.
Janet !i! not in/o&e only )sychic forces to e1)lain ho* un*elco.e thou0hts, such as se1ual
fantasies, *ere &e)t out of consciousness. 9or *as the unconscious ne* (Ja.es, 189E> Illen'er0er,
197E). 5reuer an! (reu! also consi!ere! the unconscious to 'e +s)lit off,, +!issociate!, fro.
consciousness ('ut not yet +re)resse!,). )littin0 (the ter. ha! 'een intro!uce! 'y Janet) le! to
!issociati/e !istur'ances ((reu!, 1896). )littin0 of the e0o *as !escri'e! 'y @e %oultre in the
9etherlan!s as the central .anifestation of neurosis (@e %oultre, 1993). 2he )heno.enon has
al*ays 'een at the heart of the Bleinian conce)tion (5ell, 199A). Bern'er0 a!o)ts the notion an!
uses it, for e1a.)le, to e1)lain the hysterical )ersonality (Bern'er0, 1978). 2he a))roach of the
tu!ies )ro/es consistent *ith 'oth .o!ern co0niti/e )sycholo0y an! )resent-!ay )sychoanalysis.
A re/olution too& )lace also on the thera)eutic le/el. 5oth (reu! an! 5reuer listene! e/ery !ay for
hours to (.ostly fe.ale) )atients, *ho at that ti.e *ere seen .ore as un!er-a0e chil!ren than as
a!ults (4ec&er, 1991). I1)lanations such as here!ity, !e0eneration an! constitution *ere as far as
)ossi'le rele0ate! to the 'ac&0roun! in fa/our of )sycho0enesis. 5reuer an! (reu! at first use!
+catharsis, to o/erco.e hysterical sy.)to.s (usually con/ersions). 2o0ether *ith the 'rilliant
5ertha Pa))enhei., alias Anna ", 5reuer !e/elo)e! the +)ri/ate theatre, an! the +tal&in0 cure,
(#irsch.6ller, 1989).
It ha! not yet 'een !efinitely esta'lishe! that the source of hysteria lay in )sychose1ual
!e/elo).ent. "nly in the last cha)ter of the tu!ies !i! (reu! conclu!e that se1uality *as the
un!erlyin0 cause of all co.)laints an! that 5reuer ha! )erfor.e! a isy)hean tas& *ith Anna "
(5reuer 7 (reu!, 1898, ). A63). (or all (reu!3s assertions to the contrary, the tu!ies *ere not 'a!ly
recei/e! (Illen'er0er, 197E, ). ;86> Jay, 1988, ). 77).
After a'an!onin0 techni=ues such as hy)nosis, )ressure on the forehea! an! .assa0e, (reu!
increasin0ly allo*e! hi.self to 'e 0ui!e! 'y his )atients3 free associations. #e *as fascinate! 'y
such )heno.ena as +!efence, an! +resistance,. Pro'le.s of +counter*ill, an! +transference,,
inclu!in0 +transference lo/e, :*hich *as not to 'e na.e! until later:*ere !iscusse! for the first
ti.e in the tu!ies. It *as only su'se=uently, *ith 4ora, that (reu! *as to realise fully that
)sychoanalysis coul! not succee! *ithout a thorou0h ela'oration of the action of the .utual
thera)eutic relationshi), the +transference, ((reu!, 19E8). In his cha)ter on the )sychothera)y of
hysteria (5reuer 7 (reu!, 1898), ho*e/er, (reu! !oes alrea!y .ention the nee! to analyse the
transference.
#ysteria le! hi. to +free association,, a .etho! *here'y transference is )ro/o&e! an! satisfaction
is rule! out. 2his )ara!o1 of .utual se!uction is itself a for. of +hysterical interaction, (4onnet,
1986). (in!in0 hi.self no .ore ca)a'le than the sorcerer3s a))rentice of stan!in0 u) to *hat he ha!
unleashe!, the in/entor )ut the 'la.e for it on to his hysterica (Juillau.in, 1988).
The concept of trauma
At the ti.e of the tu!ies, trau.a coul! still assu.e a *i!e /ariety of 0uises:for instance, lon0-
ter. nursin0 of a sic& father, !istress o/er an unha))y lo/e relationshi), or the *itnessin0 of an
erotic scene. Althou0h the si0nificance an! e1)erience of se1uality *ere a.)ly ac&no*le!0e! 'y
)sychiatry at the en! of the nineteenth century, the su'Lect !i! not yet feature )ro.inently in the
tu!ies. 2his .ay ha/e resulte! fro. the t*o authors3 !ifferin0 /ie*s. 5reuer )resu.a'ly hel!
(reu! 'ac& (Casson, 198;, ). 181), 'ecause se1uality *as a &ey e1)lanatory ele.ent for (reu! 'oth
'efore the tu!ies ((reu!, 189;) an! i..e!iately after the 'rea& 'et*een the t*o .en. #e hi.self
has the follo*in0 to say a'out it:
-hen I 'e0an to analyse the secon! )atient, (rau I..y /on 9., the e1)ectation of a se1ual
neurosis 'ein0 the 'asis of hysteria *as fairly re.ote fro. .y .in!. I ha! co.e fresh fro. the
school of %harcot, an! I re0ar!e! the lin&in0 of hysteria *ith the to)ic of se1uality as a sort of
insult:Lust as the *o.en )atients the.sel/es !o (5reuer 7 (reu!, 1898, ). A89f.).
Psychic trau.a calls for .ore !etaile! eluci!ation 'ecause the conce)t has 0i/en rise to
.isun!erstan!in0s a'out the role of the internal an! e1ternal *orl!s. I/en 'efore 1898, (reu! ha!
note! that an i!ea *as al*ays in/ol/e!, *hether or not lin&e! to a trau.a that ha! 'een actually
e1)erience!. 2he !ecisi/e ele.ent *as not the o'Lecti/e e/ent 'ut the si0nificance assi0ne! to it 'y
the in!i/i!ual. A for'i!!en *ish coul! also act as a trau.a. econ!ly, it *as not a .atter of Lust one
trau.a 'ut of a series of trau.as an! the associate! fantasies. (reu!3s treat.ent trace! this chain
'ac& to se1uality, *hich, 'ein0 for'i!!en 'y the e0o an! su)ere0o, *as trau.atic.
5efore (reu! reLecte! the +se!uction theory,:*hich *as first so calle! 'y Bris (198;) :he ha!, as
it ha))ens, alrea!y entertaine! a succession of !ifferent trau.a theories (5lass 7 i.on, 199A,
199;). (or a fe* years (reu!3s attention *as focuse! on +trau.a, in the sense of chil! se1ual
se!uction or a'use, *hether or not 'y a )arent (usually the father).
(reu!3s self-analysis follo*e! aroun! 1897, after the !eath of his father an! a0ainst the 'ac&0roun!
of his increasin0 !e)ression. +Psychic reality,, the )ara.ount i.)ortance of the su'Lect3s o*n
e1)erience an! the su'Lecti/e ele.ents in 'oth his theorisin0 an! his clinical )ractice increasin0ly
force! the.sel/es u)on hi.. #o*e/er, contrary to so.e co..only hear! assertions, the
a'an!on.ent of the so-calle! se!uction theory *as 'oth a 0ra!ual an! a )ainful )rocess1. (reu!
!isco/ere! the factor of se!uction in his o*n treat.ents an!, as re)orte! in a letter *ritten in Cay
1897 ((reu!, 1988, ). A;9), notice! that he felt attracte! to his !au0hter Cathil!e. Puttin0 the 'la.e
on the father is no solution, 'ecause the )atient is not .erely a )assi/e /icti., 'ut hi.self )lays an
i.)ortant )art in the for.ation of his o*n history. (reu! !isco/ere! the neuro)atho0enic effect of
the chil!3s fantasies.
:::::::::::::
1 %ritics such as Casson an! Alice Ciller are Lust as *ron0, an! Lust as re!uctionistic an! 'iase!, as
the )sychoanalysts *ho ta&e the /ie* that (reu! a'an!one! the so-calle! se!uction theory
su!!enly. 2he for.er asserts that he !i! so out of !eli'erate calculation an! the latter that the sole
reason *as the !isco/ery of the "e!i)us co.)le1. #o*e/er, the historical )rocess in (reu!3s .in!
*as .ore co.)licate!, .ore su'tle an! .ore 0ra!ual, as 5lass 7 i.on ha/e e1)laine! in a
nu.'er of )a)ers, *hich constitute a fascinatin0 account of their historical research (see also
chi.e&, 1987). 2hese authors sho* ho* (reu! stru00le! *ith his o*n *ishes an! )roLections an!
ho* these interacte! *ith his scientificar0u.ents.
Dora
2he i.)ortance of the e1ternal *orl! is e/i!ent fro. the se!uction trau.as e1)erience! 'y 4ora
((reu!, 19E8), an a!olescent *ith *ho. (reu! sho*e! little sy.)athy (5lass, 199A). 2he theory of
the 0irl3s "e!i)us co.)le1 here )ro/es, on closer ins)ection, to 'e less central an! also less *ell
foun!e! than is an! has al*ays 'een assu.e!. 2he aetiolo0y in 4ora3s case re.ains unclear: is it a
.atter of .astur'ation, of the se!uction 'y #err B, or of se1ual !esires for her father< 2here are no
su'se=uent case stu!ies 'y (reu! featurin0 the fe.ale "e!i)us co.)le1.
-hen (reu! consi!ere! that he ha! foun! *hat he *as loo&in0 for:na.ely, the central i.)ortance
of se1uality:he /ery .uch *ante! to see his hy)otheses confir.e!. Partly for this reason, he ha!
less )atience than at the ti.e of his colla'oration *ith 5reuer for listenin0 to the )atient *ithout
)reconcei/e! notions. "*in0 to the 0ro*in0 e.)hasis on se1uality, an! not*ithstan!in0 the
a'an!on.ent of hy)nosis, (reu!3s .etho! 'eca.e .ore su00esti/e an! .ore coerci/e. #e coul!
scarcely control his an0er at 4ora3s ten!ency to .a&e hi. )o*erless:*hich he sa* as her
hysterical !ri/e to assert herself. 2he treat.ent *as ulti.ately 'ro&en off )re.aturely 'y 4ora.
9e/ertheless, (reu!3s !escri)tion of the transference an! the .utual se!uction in the interaction
*ith this 0irl, inco.)rehensi'le an! unco.)rehen!e! as she re.aine!, constitutes a 'rilliant
account of all the ele.ents that )lay a )art in the conce)t of hysteria, *hich re.ains as .ysterious
as e/er to!ay.
2he fantasies a'out the other-se1 )arent in (reu!3s self-analysis ha! le! to the !isco/ery of the .ale
"e!i)us co.)le1. At the ti.e of the 4ora analysis, (reu! *as tryin0 to e1ten! this theory to the
0irl. 2he tas& of har.onisin0 fe.ale !e/elo).ent *ith *hat he !eclare! to 'e the uni/ersally
a))lica'le "e!i)us co.)le1 of the 'oy )ursue! (reu! throu0hout his career (i.on, 1991> i.on
7 5lass, 1991). 2he fact that he !i! not !isco/er the i.)ortance of the .other as the central fi0ure
until the en! of his life cause! hi. )ro'le.s an! for a lon0 ti.e )re/ente! hi. fro. 0ainin0 insi0ht
into the !e/elo).ent of the 0irl an! the 0enesis of the )er/ersions (#al'ersta!t-(reu!, 1991).
Hysteria after the studies
5y 19EE, interest in hysteria ha! alrea!y !ecline! .ar&e!ly. 2his *as )artly !ue to the unsol/e!
)ro'le.s of the transference an! countertransference. A)art fro. his )a)er on the )ho'ia of @ittle
#ans (19E9'), (reu! )u'lishe! a fe* .ore short contri'utions an! scattere! re.ar&s, 'ut ne/er
!e/elo)e! a coherent theory of hysteria ca)a'le of re)lacin0 the account 0i/en in the tu!ies
(Gan0ell, 1989> 5lac&er 7 2u)in, 1977, 1991). 2his *or& re.aine! fun!a.ental for the
un!erstan!in0 of hysterical )sychic functionin0, 'oth in (reu!3s self-analysis an! in the analyses of
his )atients.
(reu!3s =uest for the source of hysteria le! hi. to )sychoanalysis an! the !isco/ery of the la*s of
unconscious thou0ht. y.)to. for.ation, the structure of !rea.s, )ara)ra1es an! Lo&es there'y
'eca.e accessi'le. (reu! also o*e! the for.ulation of )heno.ena such as re)ression, transference
an! !efence to his trou'leso.e hysteria )atients.
-hen re/olutions 0o too far, they are follo*e! 'y a restoration. Cany early (reu!ian conce)ts an!
i!eas are no* 'ac& in /o0ue 'ecause they so.eti.es )ro/e! to 'e .ore ser/icea'le than (reu!3s
later theories. 5oth Jrotstein (199A) an!, 'efore hi., (air'airn (198;) re0ret that (reu!3s later
.o!el of the !ri/es re)lace! s)littin0 of the e0o. 2he internalise! o'Lect relations *ere ne0lecte! as
a result. (reu!3s later li'i!o theory, 'ase! on eroto0enic Dones an! )hases, *as not an a!/ance.
%oncernin0 the con/ersion of 'o!ily Dones, the conce)t of hysteria is .ore a))lica'le than the
lan0ua0e of !ri/es an! )hases. 2he anus as an +eroto0enic Done, e1)lains little *ithout the
associate! o'Lect relations. Jastro-intestinal co.)laints as hysterical con/ersion sy.)to.s can
'etter 'e inter)rete! as a .eta)hor for an unsatisfyin0 o'Lect relationshi). Iarly (reu! *as ri0ht:
hysteria is 'ase! on se!uction in the sense of )re.aturely arouse! !esires that ha/e .ore to !o *ith
the a!ult3s than *ith the chil!3s nee!. (reu!3s successors ha/e !el/e! .ore !ee)ly into the role of
the .other, *ho. he !i! not connect *ith hysteria. (reu! .entione! se!uction 'y the .other only
to*ar!s the en! of his life, in the conte1t of fe.ale se1uality ((reu!, 1931, ). A38).
A nu.'er of conce)ts fro. the early !ays of )sychoanalysis that *ere =uic&ly rele0ate! to the
'ac&0roun! !urin0 the course of its hasty !e/elo).ent:such as hy)nosis, trau.a an! se!uction:
ha/e no* once a0ain 'eco.e the focus of attention. +Post-trau.atic stress syn!ro.e, is a fre=uent
!ia0nosis to!ay. 2here is also rene*e! interest in the ill-treat.ent of chil!ren, se1ual a'use an!
incest. #y)nothera)y is a .o!ern /ersion of the a))roach of 5reuer an! (reu!. %atharsis *as use!
'y Jano/ an! transfor.e! into +)ri.al-screa., thera)y. 2he s)littin0 of consciousness is no*
uni/ersally acce)te! in 'oth )sychoanalysis an! )sychiatry. 2he !issociati/e !istur'ance, an ol!
!ia0nosis fro. the tu!ies, is currently )o)ular in the for. of .ulti)le )ersonality !istur'ance
(CP4), co.)lete *ith the +hy)noi! state,. 2he ter. !issociation is 'ac&, !enotin0 a .ore ri0orous
for. of !efence: total re)ression as a reaction to serious e1ternal trau.a (5renner, 199;).
An1iety hysteria, a ter. intro!uce! 'y te&el (198E), is still the .ost co..on neurosis. In chil!ren,
it is in!ee! a nor.al, al'eit te.)orary, state (@e'o/ici, 1979). #ysteria is an! re.ains the )rototy)e
an! the first for. of neurosis, Lust as 'o!y lan0ua0e is the first lan0ua0e. A)art fro. (enichel3s
+encyclo)ae!ia, (19;6), *hich !istin0uishes an1iety hysteria, )ho'ia an! con/ersion, an! -ilhel.
Geich3s character analysis (19;9), hysteria is no* 'ac& on the a0en!a .ore fun!a.entally than at
any ti.e since (reu!3s !ay. Gan0ell (1989), ho*e/er, !oes fin! that con/ersion an! hysteria occur
se)arately fro. each other an! are therefore not synony.ous, *hile -is!o. (1961) inte0rates a
nu.'er of Celanie Blein3s i!eas that hel) to clarify the aetiolo0y of hysteria (that is, con/ersion
hysteria).
As it ha))ens, hysteria constantly follo*s in the footste)s of )sychoanalytic theory an! chan0es
*ith it. Its 0enesis is no* .ore often !escri'e! as )re-oe!i)al, or rather )re0enital, i.e. s)ecifically
oral. 2he so-calle! rea!ily treata'le hysteria of the ol! !ays (MetDel, 1968) is no* increasin0ly
re0ar!e! as an archaic !istur'ance that is !ifficult to cure. 2he eroticisin0 as)ect is foun! to 'e
)seu!ooe!i)al, 'ase! on an oral fi1ation acco.)anie! 'y )oor a))reciation of reality. -e .ay
!isre0ar! hysterical )sychosis 'ecause it features relati/ely infre=uently in the )sychoanalytic
literature, althou0h *e coul! characterise the )atholo0y of (reu!3s )atients fro. the tu!ies as such.
2he 5ritish )sychoanalyst Iric 5ren.an inclu!es the follo*in0 =uota'le re.ar& on the first )a0e of
his )a)er: +A fe* collea0ues sai! they !i! not &no* *hat hysteria *as 'ut they &ne* an hysteric
*hen they .et one, (1988). #e then tells of a .an *ho .ani)ulates hi., .a&es hi. )o*erless an!
*ants to .a&e hi. 'elie/e in a s)urious reality. It *as, inci!entally, alrea!y 0enerally &no*n in the
last century that hysteria also occurs in .en. 2he 4on Juan fi0ure is the usual e1a.)le 0i/en.
As at 1998, it is still the case that no one &no*s *hat hysteria as a !isease in/ol/es> the !ia0nosis
has 'een re)lace! in 4C-I? (A.erican Psychiatric Association, 199;) 'y +!issociati/e )ersonality
!istur'ance, (con/ersion) or +histrionic )ersonality !istur'ance,. 2he latest historical stu!y on the
su'Lect calls it a +state of .in!, (Jil.an et al., 1993).
Back to the seduction theory?
2he .ain )ro'le. *ith *hich (reu! *as stru00lin0:*hether the .e.ory reconstructe! in
treat.ent is fantasy or reality:re.ains unsol/e! to this !ay 'ecause it is a s)urious )ro'le.. 2he
!ialectic of fantasy an! reality is, after all, characteristic of e/ery life story.
-hat is true is that )sychoanalysis for a lon0 ti.e ten!e! to close its eyes an! ears to )sychic
trau.a. 2his inclu!es the a'use of )o*er, for e1a.)le 'y a!ults a0ainst chil!ren, as *ell as social
terror an! /iolence. 2he co.)laints of sur/i/ors *ho suffere! )ersecution an! *ere threatene! *ith
e1ter.ination *ere for too lon0 attri'ute! to neurotic .echanis.s !atin0 fro. chil!hoo! (4e -in!,
198;). Ill-treat.ent of chil!ren, se1ual a'use an! incest *ere fre=uently o/erloo&e! (i.on, 199A).
-e no* o'ser/e e1cesses in the o))osite !irection: thera)ists *ho )ersua!e their clients that they
ha/e +re)resse!, .e.ories of se1ual a'use. 2hey seiDe once a0ain u)on (reu!3s ol! se!uction
theory, e1)lain all !istur'ances 'y se1ual trau.as, an! i0nore his *arnin0 that these are often
fantasies (torr, 1998). 2hese +reco/ere!-.e.ory, thera)ists .a&e the =uestion *hether a trau.a is
a .atter of .e.ory or fantasy rele/ant a0ain to!ay (@oftus, 1993). An often ill-te.)ere!
contro/ersy ra0es a'out +false-.e.ory syn!ro.e,, in *hich early (reu! is re/ere! an! the later
(reu! is )resente! as a /illain (%re*s, 1993, 199;, 1998).
o.e critics of )sychoanalysis ta&e the re)resse!-.e.ory thera)ists as li/in0 )roof that (reu!
tal&e! his )atients into the i!ea that they ha! e1)erience! a se1ual trau.a. "thers, such as Ciller
(1981) an! Casson (198;), .a&e )recisely the o))osite assertion, clai.in0 that (reu! 'o*e! to
criticis. of his *or&, ha/in0 a'an!one! the se!uction theory a0ainst his 'etter Lu!0e.ent, althou0h
he &ne* that chil! a'use *as the cause of hysteria.
Hysteria today
5ren.an .entions four as)ects of hysteria: !isa/o*al of the reality of the internal an! e1ternal
*orl!s> the ten!ency to con/ince the other that one is in the ri0ht> i!entification *ith a fantasy
o'Lect> an! )ossessi/e 'ut sterile !e)en!ence. #ysteria in his /ie* is 'ase! on *ishful thin&in0.
Cani)ulation, )enetration into the other3s thin&in0 an! feelin0, is necessary in or!er to .a&e the
+other reality, cre!i'le. At the sa.e ti.e a catastro)he is feare!:this 'ein0 e1)resse! in the
restricti/e an1iety, )ho'ia or con/ersion:*hile the su'Lect !enies that anythin0 is the .atter. In .y
e1)erience, too, the hy)o.anic .oo! ser/es to !efen! a0ainst a !e)ression that often lies conceale!
'ehin! hysteria. 2he /iolence hi!es a sense of e.)tiness, occasione! 'y s)littin0 an! re)ression
(!issociation). 2he intense an! )ersistent transference lo/e cries out to 'e ans*ere! in the sa.e
coin. 2he hysterical )atient is not conscious of his an1iety a'out 'ein0 unattracti/e an! se1ually
ina!e=uate. Atte.)ts at se!uction are .a!e 'ut !o not lea! to the !esire! (or un!esire!) ai.
'ecause they ha/e little or nothin0 to !o *ith se1uality. 5oth fri0i!ity an! hy)erse1uality ser/e the
)ur)ose of !enial of the se1ual. 4ra.atic /icti.hoo! is inten!e! to .as& an! !isa/o* a00ression
(see @a)lanche, 197;).
(eelin0s of ina!e=uacy on the )art of eroticisin0 )atients reflect the ori0inal interaction *ith a
se!ucin0 )arent, *hose !esires it *as i.)ossi'le for the chil! to satisfy.
A clearer /ie* of the 0enesis of hysteria has no* e.er0e!. 5ren.an .entions the follo*in0
characteristics of the (hysterical) .other-chil! relationshi): the .other is an1ious an! fears
catastro)hes> she su00ests that there are )anaceas an! thus !oes not )resent herself to the chil! as a
realistic o'Lect for i!entification> she encoura0es !isa/o*al of )sychic reality, of *hat is true an!
*hat is untrue> an! she su))lies i!ealisin0 lo/e an! sensuous sti.ulation, there'y )ro.otin0 'oth
+hy)erse1uality, an! !e)en!ence (see @a)lanche, 197;> 5ren.an, 1988).
9o*a!ays it is 0enerally assu.e! that hysteria is a .atter .ore of !efen!in0 a0ainst !e)ression,
a'an!on.ent an1iety an! narcissistic !an0ers than of (0enital) se1uality ()erlin0, 1973). u'tle
)ho'ic .echanis.s ser/e for a/oi!in0 the !e/elo).ent of an1iety. 9arcissistic )ro'le.s are
circu./ente! 'y co.)ro.ise for.ations an! !is)lace.ent to the fiel! of se1uality.
Al.ost all authors .ention the ho.ose1ual conflict an! fi1ation to 'ise1uality, as *ell as !isa/o*al
of the !ifference 'et*een the se1es, 'et*een the 0enerations (a son .ust 'e ca)a'le of satisfyin0
the .other an! a !au0hter the father) an! 'et*een su'Lect an! o'Lect. (i1ation at the )hallic le/el
an! castration an1iety are still !ee.e! i.)ortant. In hysteria, fantasy )erfor.s a sy.'olic function
rather than that of *ish-fulfil.ent. It lea!s to )lans that (ine/ita'ly) .iscarry an! !o not (or cannot)
lea! to satisfaction. 2he !ri/es are inhi'ite!, 0oin0 no further than i!eas !i/orce! fro. action an!
fro. their o'Lect, )ossi'ly resultin0 in .uscular tension an! )ain (Jeanneau, 1988). "ut of an1iety
at the )ossi'ility of re)etition of trau.as, o'Lect loss is acti/ely courte! (attraction an! re)ulsion).
Possessi/eness an! intrusi/eness are )roLecte! an! then feare! 'y i!entification. 2he analyst .ay 'e
face! not only *ith an artificial transference 'ut also *ith unresol/a'le resent.ent an! irre)ara'le
!eficiencies, resultin0 in intense countertransference feelin0s (Bhan, 1978). Innocent an! infantile
.anifestations or sa!o.asochistic accusations .ay arouse anti)athy. 2he hysterical )ersonality
li&es to s)in a thrillin0 yarn, in the ho)e of recei/in0 attention, lo/e an! a!.iration. #e conceals the
*ish to .a&e an i.)ression 'ehin! his fascination an! i!entification *ith the s)ectator (!e CiLolla,
1986).
Another characteristic is the co0niti/e style, e1)resse! in o'ser/ation an! thou0ht. 2he ca)acity to
re)ress an! to !issociate .ay 'e !ee.e! to 'elon0 to the co0niti/e style of the hysterical !efence.
If, li&e (reu!, *e !i/i!e neurotics into t*o .ain ty)es:o'sessional an! hysterical:the for.er can
rea!ily re.e.'er, o'ser/e an! re)ort )recisely on *hat is re.e.'ere! an! o'ser/e!, 'ut cannot
con/ey the associate! feelin0, *hereas the latter ten! to for0et an! to .ystify> they are )oor
o'ser/ers, *hose stories are lacunary an! clothe! in feelin0s that 0i/e an e1a00erate! an! artificial
i.)ression.
(inally, i!entification .ay 'e use! as a .eans of relatin0 to others. 2he hysterical )ersonality
i!entifies su)erficially *ith none1istent fantasy o'Lects. In his fantasy, he e1)eriences throu0h
others *hat he lac&s internally hi.self, *hile at the sa.e ti.e his ca)acity to e.)athise *ith the
other as other ine/ita'ly suffers 'ecause of re)ression.
As state!, )roLecti/e i!entification is use! to co.'at uncertainty an! feelin0s of ina!e=uacy. (ain 7
5N0oin (198;) )oint out in this connection that the )roLecti/e i!entifications concerne! are in fact
ra)i!ly re/ersi'le )seu!o-i!entifications.
2he hysterical )ersonality atte.)ts to 0et ri! of an1ieties 'y )roLectin0 the. into the o'Lect an!
then i!entifyin0 *ith it at a !istance. 2his is !one 'y .a&in0 the other )o*erless, there'y shiftin0
the uncertainty fro. the su'Lect to the o'Lect. 2he chaos an! !es)air that the hysterical )ersonality
can 0enerate in his or her )artner *as e1)erience! 'y 5reuer *ith Anna ", *ho rule! o/er hi. an!
le! hi. u) the 0ar!en )ath *ith her illnesses an! hel)lessness. -e are all fa.iliar *ith the
)heno.enon of sho))in0 aroun! fro. thera)ist to thera)ist or )hysician to )hysician, a for. of
'eha/iour e1hi'ite! 'y se/eral of the )atients in the tu!ies. 2he )ractitioner is first a))roache!
*ith an attitu!e of i!ealisation, 'ut then !isa))oints an! is re/ile!.
Hysteria and women
2he /ie* that 'ise1ual as)irations:in )articular, re)resse! .asculine, )hallic fantasies:cause
*o.en to 'e hysterical .ore fre=uently than .en )ersists un!i.inishe! in (reu!3s later
)u'lications on hysteria ((reu!, 19E8, 19E9a). A *o.an3s s)ecial relationshi) *ith her constantly
chan0in0 'o!ily state an! the s)ecific characteristics of the fe.ale ha/e to 'e consi!ere! as another
)ossi'le factor in the 0reater fre=uency of hysteria in *o.en. (e.ale se1uality is e1)erience! as
.ore !iffuse an! less rea!ily localisa'le than that of .en. 2he co0niti/e characteristics of hysteria,
*hich are foun! in 'oth se1es, are /a0ueness of o'ser/ation an! of narration (ha)iro, 1968).
(e.ale se1ual e1)erience is nor.ally !irecte! less to*ar!s the or0an than to*ar!s fusion an! the
a'an!on.ent of control. Cen, on the other han!, cannot easily i!entify *ith the total surren!er an!
!e!ication of *hich *o.en are ca)a'le. In )articular, the internal re)resentations:re)resentation
'ein0 such a central conce)t in hysteria:are clai.e! to 'e less clearly !elineate! in *o.en, *ith
their .ysterious internal 0enitals. 5oth .ale an! fe.ale hysteria is )artly a .atter of the a'sence of
a re)resentation of the fe.ale se1, as a result of *hich se1uality ta&es on a )o*erful )hallic
coloration (chaeffer, 1986). In hysteria, the )hallic .o!e is a su'stitute for an! a !efence a0ainst
the !rea!e! fe.ininity in 'oth .en an! *o.en. Ge)u!iation of an e1cessi/ely stron0 i!entification
*ith the )ro'le.atic .other fi0ure )lays a )art in 'oth se1es.
Hysteria and french psychoanalysis
2he (rench )sychoanalysts lay consi!era'le e.)hasis on the anal-sa!istic ele.ents that are
'anishe! fro. the hysterical uni/erse, 'oth a00ression an! 0uilt 'ein0 re)resse! an! )roLecte! into
the other.
(rench )sychoanalysis has re.aine! faithful to hysteria o/er the years. In 1973, 198;, 1988 an!
1986, the Ge/ue (ranOaise !e Psychanalyse !e/ote! entire issues an! e/en /olu.es to )a)ers on
hysteria. @a)lanche 7 Pontalis !eal at len0th *ith hysteria in 2he @an0ua0e of Psycho-Analysis. 5y
contrast, the su'Lect har!ly features at all in the In0lish-lan0ua0e Lournals. 2his !ifference is
connecte! *ith the (rench tra!ition of the +return to (reu!,, intro!uce! 'y @acan an! others. A0ain,
follo*in0 !e C3PDan, Joyce Cc4ou0all !etache! )sychoso.atic illness fro. hysteria an! turne! it
into an analytic the.e in its o*n ri0ht (Cc4ou0all, 1989).
2he .ost ele0ant co.'ination of the t*o /isions, the In0lish an! the (rench, is !ue to @a)lanche
(197;). e!uction, )assi/ity, hel)lessness an! se1uality are state! to 'e the nucleus of hysteria an!
of neurosis in 0eneral. @a)lanche consi!ers that orality in (reu!3s conce)tion also 'elon0s to
se1uality in the *i!er sense an! that the )ri.al-scene fantasy that arises in the first year of life
relates to oe!i)al trian0ulation. 5y usin0 the *or! +)re0enital, rather than +)re-oe!i)al,, he lin&s
Blein an! (reu! to0ether, Lust as -innicott an! Bern'er0 !o.
Hysteria in practice
2he i!ea that hysteria no lon0er occurs is .ista&en. In!ee!, nothin0 coul! 'e further fro. the truth.
5oth an1iety hysteria an! con/ersions are still foun! in relati/ely une!ucate! su'Lects. 2he +)roto-
)rofessionalise!, classes, *ho ha/e ac=uire! a s.atterin0 of )sychoanalytic &no*le!0e fro. its
*i!es)rea! )o)ularisation, use .ore su'tle for.s that are less trans)arent. #ysteria /aries
accor!in0 to ti.e an! )lace an! follo*s in the *a&e of the )rocess of ci/ilisation. #ysteria .eets
the e1)ectations of the social en/iron.ent or the thera)ist. 2hese currently co.)rise e1istential
co.)laints that are often !ifficult to classify nosolo0ically (@a)lanche, 197;).
In )ractice, hysteria is fre=uently .islea!in0, ten!in0 to .a&e the other )o*erless 'y se!uction an!
'loc&a0e of any .eanin0ful !ialo0ue. 4isa/o*al of !e)ression an! of .ournin0 for lost lo/e is
con/erte! into e1cite.ent ("!y, 1986). It is .ore fruitful to connect !e)ression *ith narcissistic
!eficiency than *ith erotic ele.ents in the transference an! countertransference. 2he thera)ist .ust
'e a'le to *ithstan! se!uction to choose the se1ual or 0enital le/el as a the.e, *hereas the
an1ieties o)erate in a .uch .ore )ri.iti/e e1)eriential layer of the )ersonality.
Three examples
Crs Q is a *o.an in her late forties *ho suffers fro. !e)ressi/e feelin0s, intense .i0raines,
hy)er/entilation an! )anic attac&s. Althou0h she has 'een ha))ily .arrie! to a fa.ous .an for ten
years or so, she su!!enly *ee)s *hen I as& her ho* she feels a'out ha/in0 no chil!ren. he has
co.e to .e 'ecause she has hear! that I a. +so s)ecial, an! )ro'a'ly +the only )erson *ho can
hel), her. I a. the latest in a lon0 line of !octors, )hysiothera)ists, acu)uncturists an! other
)ractitioners.
Crs Q is s*eet, innocent an! se!ucti/e, 'ut has little to say a'out herself. he lea/es it entirely to
.y creati/ity to !isco/er *hat the .atter is. he re0ularly infor.s .e that she has still 'een ha/in0
se/ere hea!aches. I su00est that it .ust a.use her to see .e toilin0 a*ay. he cannot hel) lau0hin0
:al*ays a si0n of ac&no*le!0e.ent. Ca&in0 .e )o*erless ta&es us 'ac& to her o*n feelin0 of
)o*erlessness, her self-i.a0e as lac&in0 talent, *orthless an! a failure. he *oul! ha/e li&e! to 'e
+intelli0ent, an! +*ell !e/elo)e!,. he a!.ires .e an! *oul! li&e to 'e a!.ire! herself. Instea!,
she feels that she has nothin0 to offer. 5oth her )arents *ere *or&in0-class an! cli.'e! u) the
social la!!er. #o*e/er, she ha! little 0ui!ance fro. the. an! nothin0 *as !ealt *ith o)enly at
ho.e. -hat *as clear *as that she ha! to ha/e a 0oo! e!ucation, .a&e a res)ecta'le i.)ression
an! 'eha/e )resenta'ly. All this .et *ith stu''orn resistance on her )art. As a refractory teena0er,
she .isse! al.ost all her schoolin0. he has +ne/er achie/e! anythin0 s)ecial, an! also e1)eriences
the fact of not ha/in0 ha! any chil!ren as a .isera'le failure. (inally, after .any .onths, she tells
.e a'out an a'ortion an! feels !istresse!. Cournin0 for *hat has 'een lost is lac&in0 in hysteria
("!y, 1986). Cournin0 for *hat has not 'een attaine!, *hether it 'e the lo/e of the o'Lect or the
hi0h e0o i!eal, is a con!ition for success in the treat.ent. After a year of conceal.ent an! the
s)innin0 of yarns, the )ho'ic nature of her co.)laints, stee)e! in the fear of failure, 'eco.es
clearer. I/erythin0 she !oes is for her a )erfor.ance, the sta0in0 of a )lay that has to 'e a hit. I/en
her /isit to .e in all her finery is a sho* inten!e! to occu)y .e a0reea'ly. "nly to*ar!s the en! of
the treat.ent !oes she a!.it her an0er to*ar!s her .other.
Peter, a .an in his forties, not*ithstan!in0 his +0oo! .arria0e, an! a youn0 son *ho. he lo/es,
&e)t elo)in0 *ith other *o.en. 2hese lo/e affairs en!e! 'ecause the *o.en in =uestion !i! not
*ant an e1clusi/e or lastin0 relationshi) *ith hi.. #e al*ays ca.e 'ac& to his *ife, .o/in0 out of
the house an! 'ac& three ti.es.
Peter *as an1ious in the transference an! *orrie! a'out the *ay I .i0ht see hi.. #e felt *orthless
an! *as sure I loo&e! !o*n on hi.. I !i! not fin! hi. interestin0 enou0h or ta&e his a.'itions
seriously. #e often !rea.e! a'out 'ein0 )o*erless, not in control, losin0 hol! of the steerin0 *heel.
#e *as fri0htene! a'out e.)ty holes, cre/ices an! tunnels. 4urin0 the analysis he fell in lo/e a0ain
an! left his *ife to li/e an a!/enturous life a*ay fro. ho.e. #e *as constantly /ery e1cite! an!
felt li&e an a!olescent a0ain, youn0, /ital, not nee!in0 .ore than a fe* hours3 slee) each ni0ht. #e
&e)t tellin0 .e ho* thrillin0 his a!/entures *ere, ho* !ee)ly in lo/e he *as, an! ho* *on!erfully
ro.antic it all *as.
I listene! to his lo/e stories an! his .oo! s*in0s *ith a .i1ture of e.)athy an! sur)rise,
*on!erin0 ho* the *hole thin0 *or&e!. -here !i! he 0et the ener0y to !e/ote to his *ife an! chil!
as *ell< -e *on!ere! to0ether *hy he *as not .ore successful in his affairs an! *hat he *as
really after. -hat !i! it .ean in the transference< 4i! he *ant to .a&e .e Lealous, to e1cite .e, to
ca)ti/ate .y attention< "n se/eral occasions he threatene! to lea/e the analysis an! !i! in fact !o
so, stayin0 a*ay a fe* !ays or *ee&s, 'ut each ti.e he returne!. I/entually I notice! that his
stories 'e0an to 'ore .e li&e )enny-!rea!fuls. I *as no lon0er i.)resse! 'y his *il! out'ursts of
an0er an! his scenes of lea/in0 .e, an! I felt there *as enou0h .utual trust to tell hi. as .uch, in
full earnest, e1)osin0 the seriousness of the situation as I sa* it. 2his resulte! in cal.er ti.es an!
after three years of analysis he hi.self *on!ere! *hether he ha! e/er seriously *ante! to lea/e his
*ife:or .e, for that .atter. A year later he finishe! his treat.ent. Cean*hile he ha! 'eco.e
content *ith his se1 life, for the first ti.e o/erco.in0 his ti.i!ity *ith his *ife.
@i&e .ost hysterics, Peter ha! a se!ucti/e .other, *ho coul! not acce)t her life as it really *as. #e
al*ays ha! to )lease an! e1cite her 'y 'ein0 her !rea. )rince. #e ha! to 'e .ore intelli0ent an!
.ore successful than his father, as her hus'an! *as too .e!iocre for her taste. Peter ha! trie!
unsuccessfully to satisfy his !isenchante! .other e/er since he *as a chil!. #e still felt that his
house *as not lu1urious enou0h to )lease his Cu., that his career la00e! 'ehin! her e1)ectations,
an! that his 0irlfrien!s (*ho *ere )resente! to her for tacit a))ro/al) *ere not sufficiently
0la.orous. In short, he lac&e! the resources to .a&e his .other feel full an! co.)lete, Lust as he
.ust ha/e felt as a chil!: inco.)etent an! utterly failin0 her.
A thir! )atient, Caria, *ho *as a'out 38 years ol!, suffere! fro. a fear of se1uality, as *ell as
a'!o.inal an! 'ac& )ains. I *as sure she *as lyin0 to .e *hen she clai.e! se1ual e1)erience,
)reten!in0 that she ha! ha! her first coitus Lust 'efore the analysis starte!. -hen the transference
situation felt safe enou0h, I tol! her a'out .y !ou'ts an! her nee! to )reten! out of sha.e. he
!enie! this an! little chan0e ensue!. #er co.)laints re.aine! the sa.e or increase!. he often ha!
'outs of an0er a0ainst .e, as the re)resentati/e of her .other she coul! not for0i/e. he )lace! this
an0er in the conte1t of reality rather than 0ainin0 insi0ht an! seein0 .e as a sy.'olic o'Lect in her
re)resentational *orl!. After four years I !isco/ere! to .y sur)rise that she *as in 0rou) thera)y
t*ice a *ee&. he ha! starte! this thera)y lon0 'efore co..encin0 her analysis *ith .e an! ha!
continue! it *ithout e/er tellin0 .e. In the su'se=uent crisis I tol! her I felt too an0ry an! 'etraye!
an! that in .y /ie* the in!is)ensa'le trust 'et*een us *as .issin0, so that I si.)ly coul! not
continue.
Conclusion
2he tu!ies ca.e into 'ein0 at the ti.e *hen (reu!, *ho ha! not yet entirely free! hi.self fro.
classifyin0, 'e0an to listen. 2he !ia0nosis of hysteria can ser/e as a caricature or a ter. of a'use. It
is ina))ro)riate *hen o'ser/e! fro. the /anta0e-)oint of the )sychoanalytic situation, in *hich,
after all, *e oursel/es are in/ol/e! (!e CiLolla, 1986). $et there is surely no lac& of tellin0
e1a.)les in our !ay-to-!ay clinical )ractice. 9o*a!ays *e co.)lete the +)ure )icture,, *hich has
ne/er e1iste!, *ith a .ore su'tle !ia0nosis (CentDos, 1993).
(reu! still ha! little i!ea ho* to use either the ne0ati/e or the )ositi/e transference as an instru.ent.
2he countertransference ha! an e1clusi/ely ne0ati/e si0nificance, in!icatin0 ten!encies that ha! to
'e su))resse!.
2he insi0ht concernin0 the i.)ortance of the technical ca)acity to utilise the analysan!3s .essa0e
creati/ely in or!er to arri/e at an inter)retation of the uni=ue interaction see.s to .e to 'e the
'i00est chan0e that has ta&en )lace in the last hun!re! years. #ysterical an1iety is still rele/ant, in
'oth analyst an! analysan!.
2he stu!y of hysteria an! its history .a&es it )ossi'le to un!erstan!, on 'oth the intellectual an!
e.otional le/els, )heno.ena that *oul! 'e o/erloo&e! *ithout this &no*le!0e. In the !ia0nosis of
chil!ren in )articular, a hysterical or o'sessional-neurotic tren! in character-!e/elo).ent can
so.eti.es 'e !iscerne! at an early sta0e. 2he hysterical co0niti/e attitu!e is also often i!entifia'le
in a!ults, e/en if the e/entual !ia0nosis is !ifferent. Psychoanalytic !ia0nosis, li&e the )ractice of
)sychoanalysis, has 'een e1ten!e!, refine! an! .ore su'tly !ifferentiate! in the last hun!re! years.
9e/ertheless, the )ersonality structure *e co..only call +hysterical, is in!is)ensa'le to it. 2he
ori0inal !isco/eries affor!e! (reu! 'y hysteria not only are of 0reat historical i.)ortance 'ut also
furnish clinical &no*le!0e.
In!ee!, in a nu.'er of res)ects the tu!ies are closer to our o*n ti.e than (reu!3s later *or&. 2hey
!o not yet .a&e assertions that lay clai. to a'solute /ali!ity> the !octrine of the )hases of the
se1ual !ri/es ha! not yet e.er0e!> nor !i! the theory of the "e!i)us co.)le1 e1ist. 2he search *as
still on, Lust as it is in our o*n !ay, *hen .any a1io.s of )sychoanalysis, as *ell as its theoretical
structure, ha/e lost their sta'ility, *hereas the clinical facts re.ain.
(reu!3s *arnin0 to his fiancNe, to the effect that the )resent cannot 'e un!erstoo! *ithout a
&no*le!0e of the )ast, a))lies Lust as .uch to the theory as to the in!i/i!ual. 2o un!erstan! the
!e/elo).ent of )sychoanalysis, that entity, no* cele'ratin0 its centenary, .ust 'e stu!ie! fro. its
'e0innin0s.
Psychoanalysis as 'oth theory an! science is currently teeterin0 on its foun!ations. A certain *ay of
thin&in0 an! o'ser/in0 is )erha)s all that *ill re.ain of it in the lon0 ter.. An! this )sychoanalytic
attitu!e *as alrea!y fully )resent in the tu!ies.
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