Hysterical Identification in An Eleven Year Old Girl Sherick PDF

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HYSTERICAL IDENTIFICATION
IN AN ELEVEN-YEAR-OLD GIRL
Ivan Sherick
The concept of hysterical identification was reviewed and illustrated in

child analytic process material obtained in the treatment of a latency-
age girl. It is the author’s contention that “hysteria” and its dynamics,
for example, hysterical identification, have fallen into disuse, to the
disservice of our child patients. This contribution is aimed at getting
child analysts to reconsider the merits of this outcome.
The concept of identification has been a difficult one for psycho-

analytic theory, perhaps because the end product is often blurred
with the process (Widlocher, 1985). Identification is a product of
a process of internalization and can serve to promote ego growth.
Identifications sometimes, however, can be the outcome of a mal-
adaptive dynamic attempt at conflict resolution. While a metapsy-
chological clarification of the concept would be helpful, my in-
tention is not so ambitious, but rather, more narrowly, to focus on
hysterical identification. This is a clinical concept that currently
appears to be almost absent in the psychoanalytic literature. In a
PEP (Psychoanalytic Electronic Publishing) web search of the lit-
erature for article titles that included the term “hysterical identifi-
cation,” its presence suggesting the paper’s focus, no articles were
found since the early 1980s. The concept may be considered
“quaint” by some, but I would contend it is a “psychoanalytic an-
tique” that is valuable, not to be dismissed as “junk,” and a con-
cept that needs to be resurrected. Hysterical identification has
been neglected partly because of the reduced importance placed
on libidinal motives, particularly oedipal ones, in contemporary
psychoanalytic clinical theory, yet such motives are part and par-
cel of our daily work with analysands. Some theorists have sug-
gested the modification of theory so that all wishes need not be
Psychoanalytic Review, 101(5), October 2014 © 2014 N.P.A.P.
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676 IVAN SHERICK
viewed as derivative of sexual or aggressive instincts (e.g., Sandler,

1981). I believe that although it is not necessary to reduce all mo-
tivation to sexual and aggressive instincts, the pendulum has gone
way too far in the other direction.
Furthermore, modern analysts have also relegated the thor-
ough analysis of symptoms to the “psychoanalytic antique shop,”
and hysterical phenomena are of reduced interest. Yet in child
analysis we see numerous children with assorted aches and pains
that are usually dismissed by parents and pediatricians because
the causes are not obvious or are explained as due to a physiolog-
ical event. Many professionals do not take the time to talk to the
patients or to the family, listening with an “analytic ear.” Surely,
some of the “complaints” have symbolic meaning (conversion
symptoms), especially in children who developmentally are transi-
tioning from the “body to the mind.”
In The Interpretation of Dreams, Freud (1900, pp. 149–151),
comments that “identification is a highly important factor in the
mechanism of hysterical symptoms.” Freud thought it only de-
scriptive to speak of “hysterical imitation” when attempting to ex-
plain why it is that hysterics were able to express in their symp-
toms not only their own experiences but also those of other
people. He preferred the concept of identification. To support
his view, Freud pointed to the common occurrence of a hysterical
attack of a patient on a ward followed by similar attacks of other
patients. He rejected the notion that imitation could explain this
phenomenon. He believed, instead, that sympathy was aroused in
the observers after they drew an unconscious inference that they
had the same reasons for having such an attack, and that if this
were conscious they might develop in lieu of the symptom, fear of
it. In such instances of hysterical identification there need be no
object relationship with the identificatory object (cf. Freud’s
[1921, p. 107] similar account of hysterical fits in school girls).
Freud (1900) believed the common element underlying hys-
terical identification most often to be a sexual one. “A hysterical
woman identifies herself in her symptoms most readily—though
not exclusively—with people with whom she had had sexual rela-
tions or with people who have had sexual relations with the same
people as herself” (p. 150). Freud suggested it is enough for pur-
HYSTERICAL IDENTIFICATION677
poses of identification that the sexual relations take place in

thoughts and not in actuality.
In Freud’s “Fragment of a Case of Hysteria” (1905, pp. 75,
82–83), we learn that Dora’s cough was a hysterical identification
with her beloved father’s cough, and unconsciously it had links
with ideas about her father’s venereal disease and his “evil pas-
sions.” When Dora once again directed libidinal wishes toward
her father she identified with the woman to whom father was at-
tracted, Frau K., and Dora’s hysterical attacks of coughing and
hoarseness obtained the symbolic meaning, among others, of rep-
resenting sexual intercourse with father.
The idea that identification could occur under the influence
of guilt feelings and the suggestion that this was characteristic of
hysterical identification, therein implicating hostile motives along
with libidinal ones, was suggested as early as 1897 in Draft N,
where Freud (1892–1899) anticipated a formulation which he was
to elaborate upon twenty years later in “Mourning and Melancho-
lia” (1917).
Hostile impulses against parents (a wish that they should die) are
also an integral constituent of neuroses. . . . They are repressed at
times of their illness or death. On such occasions it is a manifesta-
tion of their mourning to reproach oneself for their death (what is
known as melancholia) or to punish oneself in a hysterical fashion
(through medium of the idea of retribution) with the same states of illness
that they have had. The identification which occurs here is, as we can
see, nothing other than a mode of thinking and does not relieve us
of the necessity for looking for the motive. (Freud, 1917 [1915], p.
240, emphasis added)
At a later date, in Group Psychology, Freud (1921) again re-

ferred to identification when the motive is one of retribution, this
time specifically in hysterical symptom formation.
Supposing that a little girl . . develops the same painful symptom as
her mother. . . . This may come from the Oedipus complex; in that
case it signifies a hostile desire on the girl’s part to take her moth-
er’s place, and the symptom expresses her object love towards her
father, and brings about realization, under the influence of a sense
of guilt, of her desire to take her mother’s place. “You wanted to be
your mother, now you are—anyhow as far as your sufferings are
678 IVAN SHERICK
concerned.” This is the complete mechanism of the structure of a hysterical

symptom. (p. 106, emphasis added)
In “Mourning and Melancholia” Freud (1917) contrasts nar-

cissistic and hysterical identification. With regard to the latter he
pointed out that the object-cathexis persisted, whereas in the for-
mer it was abandoned (p. 250). Hysterical identification was un-
derstood to be a “partial” identification (cf. Freud, 1921, p. 107).
In summary, Freud understood hysterical identification to be
the expression of retribution (superego) and a common element to
be a sexual one, often colored by hostile competitive feelings.
Fenichel (1945), in his encyclopedic review of the psychoan-
alytic theory of neurosis, reviews Freud’s concept of identification
in hysteria. He writes, “Hysteria, as is well known, may imitate any
and every disease, a circumstance that makes the clinical picture
of conversion hysteria so very multiform. This ‘hysterical identifi-
cation . . . expresses the wish to be in the place of another person”
(p. 221). He distinguishes several types of hysterical identifica-
tion: with one’s rival (see the case presented later in this paper),
identification with a relinquished object as compensation for
their loss, identification on the basis of identical etiological needs
with someone with whom there is no object relationship, and
multiple identifications (as in seizures representing “the enact-
ment of a whole drama,” and,“hysterical identification with one-
self “(with a past ego state) (pp. 222–223). In some hysterical
pains there is an anticipation of desired events, for example, ab-
dominal pains expressing a wish to be pregnant.
It is interesting and somewhat puzzling why Anna Freud in
both her book on ego defenses (1937) and on normality and pa-
thology in childhood (1965) does not discuss hysterical identifica-
tion. My understanding of why Miss Freud did not is that in the
book on defenses she was aiming to bring to psychoanalytic think-
ing revolutionary ideas about the significance of the ego in the
tripartite theory of psychodynamics. Therefore, she attended to
the most commonly utilized ego defenses to raise our conscious-
ness about the ego’s role in neurotic conflict. Hysterical identifi-
cation was not one of those commonly employed by the ego. In
her 1965 work, she was attempting to juxtapose normality and pa-
thology in childhood development and to emphasize that the

childhood expression of psychopathology and adult expressions
were not identical. Her focus was not comprehensive. Therefore,
regarding the bodily self she was more focused on elucidating a
developmental line that led to taking ownership of one’s body.
Again, hysterical identification was not a commonplace experi-
ence in this evolution so it was not raised.
Anna Freud (1965) does comment about children’s’ reac-
tions to physical illness. She highlights that they misunderstand
the helpful ministrations of a doctor or nurse because of their
limited cognitive abilities to comprehend the vicissitudes of their
illness, and that regression is typical. Furthermore, Anna Freud
(1952) highlights how parents become much more indulgent of
the ill child; how some children resist the necessary passivity called
for during convalescence while others readily give into it; how re-
stricted mobility often leads to reactive heightened aggression;
how surgical intervention can have anxiety-laden meanings attrib-
uted to it based on regression and on the child’s level of instinct
development; how pain is interpreted by many boys to be passive
feminine castration, denied, or genuinely “discarded” by boys
who are very invested in masculinity; and how during illness libi-
do is withdrawn from the external world and redistributed onto
the body and its needs.
Max Schur (1955) is a pioneer who has written about somati-
zation. While hysterical phenomena are not his focus, he has rel-
evant thoughts for us about the maturational changes in reactions
to anxiety. At an early age reactions to anxiety are a diffuse dis-
charge leading to a somatic response. His hypothesis is that as the
ego matures it develops the capacity to utilize secondary processes
and to neutralize energy during its response to anticipated dan-
ger. When there is a neurotic response that is directed by a regres-
sive evaluation of danger, then the reaction will be regressive. Re-
somatization can result from a usurpation of primary processes
after failure of secondary processes, along with a “simultaneous”
failure of neutralization. He particularly considers dermatological
symptoms, and remarks on the libidinal conflicts that give rise to
aggression and anxiety making it difficult to tease out compo-
nents of the symptoms. I surmise that my young patient, reported
680 IVAN SHERICK
on in detail in the case that follows, was also having a regressive

reaction to anxiety due to intensified aggressive and sexual wish-
es, and that primary processes gained ascendency. This was ac-
companied by a failure to neutralize these intensified drive ener-
gies so that resomatization resulted, in her case in the form of
hysterical symptoms. Schur (1967, p. 95) underscores Freud’s un-
derstanding of the principal role of condensation in hysterical
symptom formation.
In a summary of a review of the “hysterical child,” Anthony
(1981b) writes: “We began these presentations portraying hysteri-
cal children through Freud’s eyes as the beautiful double flowers
of mankind, and we now end with a picture of them as globules of
mercury. It is this attractive but elusive quality that continues to
haunt the clinician” (pp. 123–124). Perhaps this elusiveness is one
reason we rarely see published accounts of detailed child analytic
material as it emerged. Evans’s article (1975) is an exception and
earlier, Bornstein’s (1946) and Waelder-Hall’s (1946). Another
reason may be the difficulties in distinguishing hysterical symp-
toms expressed on the body from psychosomatic and medical
ones, especially before puberty. Anthony and Gilpin’s edition
(1981) contains psychoanalytic articles about hysteria by Coppo-
lillo (1981) and Paulina Kernberg (1981). While these contribu-
tions deal with examples of childhood hysteria they do not focus
on hysterical identification. Coppolillo aims mainly to deal with
the issues of differential diagnosis, and Paulina Kernberg consid-
ers the development of hysterical character in children. Kernberg
views hysterical character etiology as attributable to endowment,
familial, and cultural factors. While, undoubtedly, cultural factors
may be a determinant in the diminished frequency of diagnoses
of hysteria (Satow, 1979–1980) and may also play a role in the eti-
ology of hysteria, my focus is on psychodynamic determinants,
and it is beyond the limited focus of this paper to review this lit-
erature. It is accepted that a lack of sophistication, minimal edu-
cation, and strong religious observance contributes to hysterical
phenomenon. Young children in rural areas are a demographic
group more likely to satisfy these parameters.
I provide brief summaries of those published cases of child
analytic treatment of childhood hysteria so as to give the reader a
context for my clinical presentation. Evans (1975) gives a detailed

illustration of his child analytic work with an eight-year-old girl
who complained of many physical ailments. While he does not
focus on hysteric identification, he does believe this girl’s anal
fixation expressed itself in “hysterical materialization,” borrowing
a term proposed by Ferenczi (1926) to illustrate how a hysteric
creates a stimulus (increased innervation) that is then given un-
conscious meaning by him or her. His patient, among other
things, desired a phallus and created a fecal one, and then uti-
lized melted wax in her sessions to materialize first an anal baby,
then breasts, a phallus, culminating in the whole “messy” analytic
process.
Bornstein (1946) presents the case of an eight-year-old sexu-
ally molested girl who would experience hysterical twilight states
wherein she would leave the house and beckon coquettishly to
men in cars to give her a ride; she would respond when called by
name but did not recognize her father. An uncle who reneged on
a promise to give her a ride in a car had molested her. Later she
contracted gonorrhea, and part of the treatment was to be given
baths by mother while held down by her father. The twilight states
seemed to be prompted by temptations to revisit the sexual satis-
faction of the molestation and subsequent masturbation and
served as punishment.
Waelder-Hall (1946) presents the analysis of a seven-year-old
boy who suffered from night terrors. He was referred after pierc-
ing heart pains that upon medical investigation turned up no evi-
dence of something physically wrong. The sleeping arrangement
for this boy was to sleep between his parents. His fantasies in-
volved crime, arrest, and punishment. The boy’s pavor nocturnus
was primarily motivated by a wish to prevent parental intercourse,
to protect mother from father’s “attack,” and to have father re-
moved so he could be alone with mother, leading to the arousal
of castration anxiety, and an attempt to flee.
Campanile (2012) writes about how adolescents anticipate
the integration of a sexualized body, with hysterical symptoms
representing “the best possible attempt, at a given point, to sym-
bolize what is taking place” (p. 412). But as a symptom it is a failed
attempt; it “can hint at new solutions, but that can also become
682 IVAN SHERICK
entrenched if better ones are not found or furnished.” Here Cam-

panile is addressing continuity and discontinuity (transformative
events) in development. In two commentaries on this paper, Bal-
sam (2012) addresses the old mind–body integration issue, and
Imber (2012) focuses on cultural factors and on identity forma-
tion.
In what follows, I focus on the clinical paradigm of hysterical
identification using analytic material obtained years ago from a
latency girl’s analysis. Regretfully, I do not have a recent child an-
alytic case to illustrate the concept of hysterical identification that
I am focusing on. However, I believe they exist, although likely go
unnoticed (see Discussion section of this paper). I hope to illus-
trate the value of this clinical concept to our contemporary clini-
cal work with children. The analytic process material I present is
detailed, in order to illustrate the oedipal dynamics of hysteria, in
general, and of hysterical identification, in particular, in a latency-
age girl. As mentioned earlier, detailed child analytic process of
childhood hysteria is almost never presented in recent literature
(cf. Evans, 1975). This case is intended to help fill this gap. I also
wish to illustrate the unfolding of the child’s dynamic conflicts in
response to my interventions. A detailed presentation of the pro-
cess will demonstrate the value of interpretations as a technique
in dealing with childhood hysterical phenomena. Perhaps the de-
tailed content will be reminiscent to readers of cases of their own
that they may not have heretofore considered as “hysterical.” If
this occurs I will achieve one of the aims of writing this paper. I
concentrate herein on my patient’s hysterical identification with
her mother’s gynecological pains.
Why is it important to distinguish “hysterical identification”
from “identification” in general, and what are the consequences
for understanding psychopathology and for treatment if this dif-
ferentiation is or is not made? Identification, in general, involves
a modification of a self-representation to be like an object-repre-
sentation. Envy is involved in hysterical identification. There is a
wish to possess what another person has and to obtain it at what-
ever imagined cost to the envied other. The patient may not be
aware of its insidious presence. Much nonhysterical identification
involves, instead, emulation. Here there is a wish to be like an ad-
mired person and not to harm the exalted other. Fear, too, can
motivate a child to establish identification, as in identification with
a perceived aggressor. A specific kind of identification, a “hysteri-
cal” one, involves adopting a perceived physical symptom(s) of an
object. What is involved for the subject is a compromise that in-
cludes retribution (pain or discomfort of the symptom[s]) along
with an underlying unconscious gratification of forbidden sexual
wishes that are part of a hostile competition with the object. The
presumed presence of such a compromise has diagnostic signifi-
cance insofar as it suggests that a child patient has achieved a rela-
tively high degree of psychic structuralization. This knowledge
will guide a clinician in making interventions. If one does not give
sufficient attention in a treatment on the occasion of an inferred
hysterical identification, the underlying superego retribution,
feelings of guilt, and drive aspects (sexual/aggressive, often oedi-
pal) can be deemphasized or even go unnoticed. Treatment in-
terventions will miss potentially important dynamic areas of en-
gagement between the patient and the therapist/psychoanalyst.
An opportunity for the patient to lessen suffering and for the
therapeutic work to be deepened will be missed.
The case that I am presenting was treated in an era when
child analytic cases were treated in a manner similar to the ana-
lytic treatment of adults. Parents were seen infrequently and pri-
marily to ensure their support for their child’s analytic treatment.
The child analyst, like the adult analyst, depended only on mate-
rial presented by the analysand within the consultation room. In-
terpretation was the major technical intervention. Contemporary
child analysts know that children are not diminutive adults but
unique in their own right and need to be treated differently from
adults. However, while child analysis has beneficially added to its
armamentarium of technical interventions, to devalue and/or to
absent interpretative work is to “throw out the baby with the bath
water,” especially with children whose development has pro-
gressed to the oedipal level.
The reader may be impressed with how dismissive this girl
was of my interpretive remarks, yet the analytic material deep-
ened. It may puzzle a reader that I proceeded on despite my anal-
ysand’s protests. Because of this deepening, I took it as confirma-
684 IVAN SHERICK
tion of my interventions. It was as if her protests were mandatory

but superficial, followed by her allowing herself to communicate a
little more. Her rejection of my comments was a characteristic of
her often-contentious personality, which I was familiar with from
the earlier part of her analysis (Sherick, 1981). But her nonaccep-
tance of my interventions also reflected the nature of her resis-
tance. What I was conveying aroused anxiety, but the level presum-
ably was tolerable insofar as she communicated further. Her
resistance was expressed in a manner not uncharacteristic of
many latency-age children (e.g., see Evans’s [1975] description of
his analysis of a latency-age girl). Latency-age children commonly
may shout down their analyst’s words, and in extreme cases physi-
cally lash out. Nevertheless, despite such rejections they often
“hear” what is said, and in action or words communicate more
essential thoughts and feelings. In these instances, the resistance
is not unremitting. Additionally, the nature of hysterical psychopa-
thology is such that a hysteric invites your attention only to reject
it. This is evident in the behavior of some adult hysterical women
who can be coquettish and then defensive when responded to.
CASE PRESENTATION
Background
Laura was nine years old when she first came to our atten-
tion.The parents’ presenting complaint primarily had to do with
Laura’s reluctance to separate from mother. She was beginning
to hesitate about entering into afterschool activities. School re-
fusal never occurred, although Laura was very slow in readying
herself in the morning. Other complaints had to do with Laura’s
pervasive interest in animals1 to the neglect of other activities, her
shyness, her sulking or obstinate silence when angry with her
mother, her suspiciousness of strangers, her inability to learn
math, and her “messy” eating habits. Laura and her mother were
involved in a relationship having sadomasochistic overtones, such
as struggles about getting ready for school, choosing clothes, and
so forth, which had its antecedents in feeding and toileting
(mother assisted her with toileting into mid-latency). At age three
there was a one-week separation from the parents who were on

vacation, and at nearly six years of age she had a tonsillectomy
and was reported to have loved the nurses’ attention and to have
cried when she had to go home.
Laura was the younger child of a middle-class family. She had
a brother three years her senior. Father was an athletic, robust
businessman, and mother was an attractive, demonstrative wom-
an who used to model clothes and once aspired to be an actress.
Mother expressed guilt about Laura’s suspiciousness with strang-
ers insofar as she believed she had used excessive words of cau-
tion. Both parents thought that Laura was overshadowed by her
brother’s superior intelligence. Mother told me she empathized
with her daughter about having an older brother since she had
one, too. Intelligence testing suggested that Laura was within the
bright normal range.
Laura was doing well in school except for math, and she par-
ticipated willingly in horseback riding and, with her parents’ en-
couragement, in ballet. She had numerous pets, was knowledge-
able about animals, and wanted to become a veterinarian. She
had a friendly and enduring friendship with only one girl who was
a classmate.
Treatment
In order that we may get a clinical picture of Laura, as it ex-
isted at the time when her hysterical identification with mother’s
physical symptoms was evidenced, I summarize the two and a half
years of analysis leading up to this point. The following issues were
dealt with during this period, often within our treatment relation-
ship and accompanied by ample resistance and focus on defenses:
(1) her use of externalization, displacement, and reaction forma-
tion with regard to sadistic wishes; (2) her feelings of castration
and penis envy, and resultant depressive feelings; (3) her retreat to
a sadomasochistic stance as a defense against positive oedipal wish-
es and feelings; (4) her hostile feelings toward her mother, both
preoedipal and oedipal, which contributed to her separation anxi-
ety (fear of loss of the object and its love); (5) her use of daydream-
ing as a way of dealing with disappointing reality (e.g., disappoint-
686 IVAN SHERICK
ed positive oedipal wishes); (6) her retreat to thinking she could

win father’s favor as a boy (active, masculine aims); and (7) how an
eye exam revived fantasies and anxieties connected with a tonsil-
lectomy at age six, and how the surgery was experienced as a pun-
ishment for anal messiness, oral greed, and oral aggressiveness.
In the middle of the third year of treatment, analysis was in-
terrupted for a two-week period due to my absence. Laura was
told that my sudden, unexpected absence was connected with the
death of a relative. In the time intervening between my return
and the Christmas holiday the analytic material centered around
the themes of feeling uncared for and vulnerability to dangers,
the accusation against herself that she was unworthy to be cared
for because of unimportance, untidiness, and the like, and the
theme of death. It was the clinical material that follows which first
alerted me to possible fantasies of oedipal triumph over mother
with the tummy aches as a hysterical form of retribution.
In the second week after the Christmas holiday, Laura had
tummy aches and a slight fever and consequently missed a couple
of sessions. The family doctor advised a consultation with a pedia-
trician. In our sessions, Laura spoke about the family cottages—
her parents owned four attached cottages. There were two elderly
ladies occupying two cottages, and Laura said they had to die
sooner or later and then it would be all theirs. A little later she
spoke about a television serialization about Henry VIII’s six wives.
She liked Ann Boleyn’s life (the second wife) better than Cathe-
rine of Aragon’s (the first wife). Ann’s life was more “exciting.”
Laura told me her father was going into the real estate business—
he would like to buy a chapel to be used for funerals and mar-
riages and sell it at a profit. Laura looked out the window and re-
marked about the increased daylight. She said, “Poor little winter
left behind,” and claimed that she liked winter best of all the sea-
sons. Laura’s mood was pleasant. When I next saw her she spent
the entire session silently reading a comic book. I was impressed
by the change of mood and the apparent resistance but could not
engage her. She missed the next session because she attended a
rescheduled ballet class.
The following week, she said she did not feel very well and we
spoke a bit about her physical symptoms. I suggested that togeth-
er we could try to understand what her body was expressing via

the pains. After a long silence Laura asked me if I saw the televi-
sion program about Ann Boleyn. Then she resumed her silence.
After a while, I said I wondered if somewhere in her mind she saw
herself like Ann Boleyn, rivaling mother for father’s love and at-
tention, as I imagined Ann felt about Catherine.2 While we played
the game Chutes and Ladders, I thought aloud that if I was cor-
rect about Laura feeling guilty and anxious about being competi-
tive with Mother and triumphant about obtaining father’s love, by
having tummy aches she made mother a caretaker rather than a
rival. Laura said I was “crazy” and threw the counters at the waste-
paper basket, and at the end of the hour she refused to clean up.
I commented that she was having me be a caretaker mother who
cleaned up her mess, like mother used to wipe her bottom. (I
thought anality was used defensively against oedipal-level con-
tent). The next day she saw a pediatrician.
I learned from Laura the pediatrician suspected she might
have a stomach ulcer; he was doubtful but would have her X-
rayed. Laura told me mother had had a stomach ulcer when she
was seventeen years old. Laura pointed to a cartoon of a man with
a big tummy and said it (the tummy) was “ugly.” She told me next
that mother met a woman she had not seen for years and learned
that the woman was adopting a baby. I wondered if Laura imag-
ined being pregnant like a mother and felt this was bad, and the
tummy aches were self-inflicted punishment for such wishes. She
said this was rubbish, that if it were an ulcer then it had nothing to
do with “worries.” Immediately after this she spoke indirectly about
noticing boys. She favored a particular secondary school ostensi-
bly because it taught ballroom dancing rather than ballet. It was
also across from a boy’s school which her brother attended, so she
could walk with him to school. She added that the boys and girls
used a common sports field. The next session Laura brought her
pet dog and she played like a loving mother with her infant.
Laura had her X-ray and I saw her later in the day. She si-
lently read a girl’s magazine. After a while I said it was “interesting
and surprising” that she said nothing of her experience earlier in
the day. She misheard me and said, “What do you mean, ‘excit-
ing’?”
688 IVAN SHERICK
The next day there was material that suggested a wish to have
a baby, partly to undo feelings of loneliness. I conjectured to my-
self that there were two sources to such feelings, preoedipal and
positive oedipal disappointments. She began by saying she might
get a puppy. Her brother intended to get a girl parakeet. Her boy
parakeet was “lonely” and having babies would counteract this
feeling. She said her parakeet was “regurgitating,” a sign that he
wanted to mate. She would like a cat; there was one at the cottage
that was fat and waddled. After this she read jokes to me. The first
one that she chose to relate had to do with a boy and girl who vis-
ited a museum and saw a mummy with a sign underneath saying
“200 B.C.” The boy said to the girl that it must be the license num-
ber of the car that killed the mummy. I thought silently of her
hostile competitive feelings toward mother. She then showed me
some money in her wallet that would go toward buying something
that had to remain a secret. Finally, she told me that she would
buy a “baby racehorse” (horse racing was an interest of father’s).
She complained about a female receptionist who asked her to
bring her pet rabbit only on Fridays and asked me to intercede on
her behalf. I compared the receptionist to a mother and how un-
fair she may feel it to be that mothers have baby companions but
she is not permitted to have companion pets. Early in the next
session there were several comments about wishing to adopt stray
and poorly treated animals. I suggested that pets were like adopt-
ed babies. Later she complained more about the receptionist’s
restrictions and called her a “bitch,” and wished she would die. I
said she was very angry because her rabbit, “Sooty,” was special, a
pet she obtained since the time we started to work together, may-
be even like a pretend baby. She became embarrassed and said
Sooty belonged to her. If it were ours, she said, I owed her money
for its hutch, harness, and so on. Father had given her money to
purchase a hutch to be kept at the cottage. I wondered if she were
trying to give me such an idea by bringing in money the previous
session. She embarrassedly said, “I did . . . did not.” Laura brought
her pet dog to the next session.
The next week Laura went into the hospital for observation
and tests to determine the cause of her tummy aches. When we
met she spoke of the several days in hospital as if it were a tea
party. She became annoyed with me when I pointed this out, say-
ing it was not a “dungeon.” She liked her doctor, a surgeon who
talked sense, unlike the pediatrician who talked psychological
rubbish like me. The surgeon wanted to rule out a physical prob-
lem. I told her I supported that; if there were a physical cause,
what it meant to her was important for our analytic work. Her
mood mellowed and she admitted that her hospital stay was not
all that great. She seemed to suppress any thoughts that she had
about what might be causing the tummy aches. Reluctantly, while
playing with water at the sink, she volunteered she might have
something wrong with her kidneys but did not know what.
She sat down in a soft chair and commented once again
about her wish that the wooden frame of the chair be “white
wood.” I said it would be similar to the cottage’s beams that were
painted white. Laura looked embarrassed and said she had a se-
cret. She changed the subject and said she was busy and ought to
come less often to see me. At the window she claimed her aunt
and uncle were walking by, pushing their baby in a carriage. She
wondered where I lived. She noticed a cat in the street and re-
marked, “There’s that cat again . . . it must be dead.” Without
commenting on the absurdity of her statement, she flipped a pen-
ny and had me guess whether it landed heads or tails. I guessed
“wrong” each time and she “won,” excitedly jumping up and down
with glee, “I’m the winner.” Then she announced the “final flip.”
The coin rolled under the couch and she retrieved it. Before an-
nouncing which side it had landed on, she intended to make the
sound of fanfare, but there was a slip of the tongue and instead
she hummed “Here comes the bride,” and changed the tune mid-
way. I wondered aloud if she thought the reason I went to Ameri-
ca unexpectedly was because my wife died and now she felt like a
“winner.” Laura said I was “crazy” and “pitied” me. She indicated
she was going to be a “robber” but refused to elaborate and sat
flipping the coin. I said perhaps she felt like Ann Boleyn, like a
robber who has “stolen” another woman’s husband and feels anx-
ious and guilty. Laura said she was not listening to my “rubbish.”
She said she was reading a story about a “secret garden” in a mag-
azine. It was about a princess and the death of the lady of the
manor where the secret garden is. She thought I’d make a big
690 IVAN SHERICK
deal about it. After this she wondered how old I was. At the end of
the session she seductively said, pretending Sooty was present,
that I should not get up immediately because I know how excited
he gets.
The following week Laura brought her record player and we
listened to classical music and talked. She intended to come in
one session less. She had no worries. Her tummy aches were due
to her being “high-strung” and “walking on a tightrope.” I com-
mented about her guilt, anxiety, and denial as underlying her
consideration to come less frequently. She challenged me to give
her one reason why she should come as often as she does and I
said, “to understand why she gets tummy aches.” She wanted me
to guess the age of her record collection, emphasizing that they
had no scratches. I commented on her wish to be older and more
sophisticated so that she would be more pleasing to me. I also
equated “scratches” with “angry feeling” and reconstructed her
inability to show anger toward mother, turning it against herself
instead in the form of tummy aches. Later in the session she was
able to speak about the pains, which most recently had occurred
the evening before, while she watched The Six Wives of Henry VIII
on television. The pains were intense, subsided, then reappeared,
the interval being a matter of seconds. At the end of the session
she noticed an ambulance in the street below and wondered why
it was outside every day at this time. She denied worries that her
tummy aches might be due to some physical problem.
I met with mother the next day at her request. She said Laura
had had the tummy pains for about a year (only occasionally men-
tioned by Laura), but they had become frequent since the Christ-
mas holiday. The pains began with “pricks” on the tummy, sub-
sided, and reappeared, the intervals being a matter of minutes
(Laura said “seconds”). All of the medical tests were negative. In
speaking about the etiology of the pains, we spoke about Laura’s
inability to show anger toward her. Laura apologized repetitively
if she expressed minimal anger. She would say to her mother, “I
love you so that it hurts me.” At this point, I learned that mother
had had gynecological problems for a period of one year, the se-
verity also having heightened since Christmas. She had trouble
urinating (recall that Laura speculated that she [Laura] had a
kidney problem) and might have to have a partial hysterectomy. I

learned that Laura was aware of all this.3 I said I thought Laura’s
tummy aches were her “gynecological” problems, and how by be-
ing like mother, Laura defended against angry feelings toward
her mother and punished herself for competitive thoughts.
I met with Laura later that day. She began by asking if my
name was “Ivan”—she had looked me up in the telephone direc-
tory. She asked what mother and I spoke about, and in a general
way I told her. She was annoyed with mother for not having said
anything about her pets. Laura then displaced her anger onto a
woman in the waiting room—“Why does she look so old and have
bags under her eyes?”—and onto a friend’s mother whom she
called “crazy.” She angrily wanted to know why I had to meet her
mother. After I commented about her jealousy, she told me about
teasing boys and hating them. Later, Laura asked me if my wife
visited a gynecologist. She was anxious and defensive, and, in a
confused way, indicated that a woman visited one when about to
have a baby, and that her mother had not visited one for eleven
years (around her birth) and should have done so each year.
The next session, in the context of talking about babies, I re-
constructed her rivalry with mother, her wish to have a baby with
father, her considerable resultant anxiety and guilt, and her identi-
fication with mother’s physical pains as a punishment. I said she
had reexperienced these wishes and feelings with my wife and me.
As usual, she said I spoke rubbish, but then spoke about becoming
a “brilliant” veterinarian once again (suggesting relief from super-
ego tension?). The next day, Laura brought Sooty and cuddled
him to her breast like a mother holds an infant. She “hated” people
who did not care properly for pets. She emphasized how healthy
Sooty was. There was some apprehension about taking him home
because she was afraid a dog would notice him. This reminded me
of mother’s worry about encountering a drunken male on the
street, a concern told to me by Laura earlier in our work together.
The next week there was a suggestion of a loosening of de-
fenses against hostility felt for mother, although Laura still relied
upon displacement. She decided to “smuggle” her rabbit into the
clinic—the receptionist had suggested she bring it only on Fridays
because there was a boy with an animal phobia who came to the
692 IVAN SHERICK
clinic at the same time on other days. It was my decision to let

Laura take the initiative in proposing an alternative set-up for
bringing her pets to the clinic. While sitting in the waiting room
with Sooty concealed in a carry case, she noticed another of my
patients who, coincidentally, had openly brought his hamster.
She was furious with the receptionist—“an old cow”—whom she
accused of lying, being stupid, showing favoritism, and so on. I
told Laura I appreciated her anger and her current wish to bring
Sooty in whenever she wanted to since he was something special
between us. Laura accepted this. She hated the receptionist for-
ever and then attacked hamsters and my other patient (a boy).
The next day Mother telephoned to report how “emotional”
and angry Laura was when she returned from her session yester-
day. She was angry with the receptionist but afterwards calmed
down and said she felt as if she had gotten a “big lump” from out
of her chest. Mother was very pleased to see how calm Laura could
be after expressing anger. I explained to mother that I thought
Laura had taken a big step forward by bringing the rabbit the way
she did and by permitting herself to get angry, and now I thought
I could intercede between Laura and the receptionist. I also
pointed out how Laura’s comment that she had gotten a “big
lump” from out of her chest was significant, since it showed how
Laura somatized her feelings. Mother went on to report her good
news that she would not need a partial hysterectomy after all,
though she would require some gynecological surgery connected
with her bladder. Laura was aware of this news. After the tele-
phone call my impression was that unconsciously mother felt the
anger Laura displaced from herself (mother) and, being genu-
inely concerned about her daughter’s welfare, she welcomed its
expression at one level and was surprised to see the positive after-
effects of its expression. Knowing mother’s health was not in jeop-
ardy may have been a factor in Laura’s expression of anger, albeit
in a displaced form.
When I saw Laura later I told her I had learned that the child
with the animal phobia was much less fearful and that the only
restriction was that her dog be on a leash in the waiting room. She
continued to express anger at the receptionist. I said she was tell-
ing me that the receptionist was like a bad “mommy” who is not
fond of animals. We spoke about her mother’s telephone call.

Laura smiled and said, “You may think so,” when I spoke about
the significance of her comment that expressing her anger was
like getting a lump out of her chest. She said she wrote a curse
about the principal of a secondary school she was interested in at-
tending and meant it for the receptionist, too.
From this point onwards, Laura no longer complained of tummy
aches, nor missed sessions on this account. Laura gradually accepted
that her tummy aches were psychological in origin. Whereas she
had portrayed her internalized conflict via her physical compli-
ance and symptoms of tummy aches (autoplastic solution), she
externalized her conflicts once again (alloplastic solution) by
bringing content having to do with her respective pets: her dog,
which mainly symbolized her “bad” self-representation, and her
rabbit, which mainly stood for her “ideal” self-representation.
DISCUSSION
The clinical material presented in the preceding section is in-

tended to illustrate the dynamics of hysterical identification in a
latency-age girl, and, hopefully, to reinvigorate our interest in an-
alyzing such dynamics. Chused (2007) has indicated, in a reex-
amination of the case of Little Hans, that contemporary child ana-
lysts know childhood sexuality exists, so that they can feel free to
investigate other motives in their child cases. While I agree with
this, I believe that there is neglect among contemporary child an-
alysts of sexual instinctual derivatives while they focus on other is-
sues.
The core of Laura’s problems was intersystemic tension be-
tween her ego and superego, stemming from death wishes direct-
ed at mother. These intolerable wishes had a contribution from
all levels of instinctual development. Oral-aggressive derivatives
were expressed in a displaced way via her pets. From the anal lev-
el, aggressive derivatives were contained within the sadomasochis-
tic relationship that she engaged her mother in. From the phallic
level, there was the hatred for mother for denying her the penis
that she envied so much in her brother. Last, from the positive-
oedipal level was the wish to do away with mother as a rival for
694 IVAN SHERICK
father’s affection. My conjecture is that there were two currents

running together which her defensive structures were unable to
contain, namely, the contribution from the fantasized actualiza-
tion of triumph over the transference or displaced rival—the
imagined death of my wife—and the contribution from reality
having to do with mother’s gynecological problems and prospects
of a partial hysterectomy that also allowed Laura to feel trium-
phant over her real oedipal rival. The psychic reality of oedipal
triumph—my wife was “dead” and her mother might die—aroused
intense feelings of guilt, and the need for retribution presented
itself. Here we have the motive that Freud thought characteristic
of hysterical identification and an etiological agent in hysterical
symptom formation. Recall, too, that Laura wondered why there
was an ambulance outside the clinic every day at the same time
she attended her session. (There actually was one that transport-
ed another patient to the clinic.) Laura’s probable underlying
anxiety of a personal catastrophe was also a feared retribution for
the psychic realization of her death wishes. In my meeting with
mother I was left with the impression that she worried about a
malignancy, a worry probably conveyed to Laura.
Laura’s tummy aches can thus be understood to have a su-
perego contribution, but we can also conceptualize an id compo-
nent. My conjecture is that she had an intense unconscious desire
to have a baby from father. The pain served as unconscious proof
of a baby growing inside of her, and the site of the pains, the ab-
dominal area, probably was a displacement in fantasy from the
organ of reproduction, the uterus. Of course, this is based on our
theory, but also on inferences drawn on the derivative analytic
data. Laura was knowledgeable about reproduction from her in-
terest in animals, and she knew how female dogs and cats were
spayed or “doctored,” so it is likely that a similar idea passed
through her mind in connection with mother’s possible partial
hysterectomy, although this was never verbalized. Furthermore,
the description of the pains caused me to have an association of
“labor pains.” Ferenczi (1926), in this regard, has written about
what he called “hysterical materialization.” By this he means that
repressed hysterical fantasies find plastic or concrete representa-
tion in somatic dysfunction; for introverted hysterics it is a form of
accentuated trial action (cf. Fenichel [1945, p. 217]). For Laura,

we speculated that the wish to have father’s baby, experienced in
the transference, materialized in her tummy aches.
We must not forget that Laura’s identification with mother’s
physical problem was also a means of defense against hostile feel-
ings for mother, which were antagonistic to her loving feelings.
Freud (1921) wrote that one effect of an individual’s identifica-
tion is in “limiting his aggressiveness towards those with whom he
has identified himself, and in his sparing them and giving them
help” (p. 110, n.2). In this connection we might wonder about a
magical reparative or protective element in Laura’s hysterical
identification, that is, a wish to “cure” her mother. Lastly, the tum-
my aches resulted in secondary gains for Laura as well as in a tem-
porary regression in object relationships insofar as mother be-
came a caregiver, instead of an oedipal rival—in this way Laura’s
considerable oral dependency needs were satisfied. Laura was
well aware of her mother’s anxiety about any indication of mal-
functioning of her (Laura’s) body. Anna Freud (1952) has writ-
ten about how “some mothers find it difficult to resign themselves
to the fact that their children, even after the toddler stage, cannot
really be trusted to take care of their own bodies and to observe
the rules serving health and hygiene” (p. 276). While Miss Freud
was writing here about how it is normal for children to entrust
their bodies to their mother’s care, in Laura’s case we suspected
that she colluded with mother’s anxiety about physical dysfunc-
tion. Recall how mother was excessively concerned with Laura’s
anal region and was intrusive with regard to Laura’s body in this
respect, as well as being concerned with Laura’s “messy” inges-
tion. (Mother suffered from gastrointestinal symptoms.)
For Laura to identify with mother’s physical suffering and to
develop her own physical pain suggests somatic compliance. Con-
sidering mother’s concern about Laura’s ingestion and elimina-
tion, it is not surprising in Laura’s case that somewhere along the
alimentary canal would be the site for somatization. Ludwig
(1959) has written about the subtleties involved in the choice of
conversion symptom sites and his comments have some applica-
tion with regard to Laura’s choice of site of her hysterical symp-
tom.
696 IVAN SHERICK
The erotization and cathexis of an organ function in a parent

seems to lead to special awareness of this particular function and
perhaps to special stimulation in the same organ in the child. It
may pave the way for choice of this particular organ for identifica-
tion with the parent and later to its utilization by the conversion
process as well as by the symptoms which are designed to deal with
conflicting impulses towards the identification figure. Instead of
outward expression toward the object, both the impulses and the
defense against them become internalized and disturb the func-
tion of the organ which has been so utilized. (p. 108)
Ludwig underscores the interactive dynamic between the parents’
and child’s unconscious fantasies. These comments by Ludwig re-
late to my patient’s dynamics in terms of her site of symptom and
the unconscious meaning attributed to the symptom, as well rep-
resenting her wish, defense, and guilt (punishment).
Somatic compliance plus the sexual symbolism involved in
Laura’s symptom (so that one could translate the body-language,
the pains, to word-language—“the pains are proof of the baby
growing inside me”) make the pains a hysterical conversion symp-
tom.
As mentioned earlier, we see many children who present
physical complaints. A microscopic evaluation as obtained in a
child analytic treatment will reveal differences, for example, in
the dynamic and genetic aspects of physical symptoms that have a
psychological origin. Hence, we understand some physical symp-
toms to be due to turning aggression at the self following arousal
of guilt feelings; there are some patients where the physical symp-
tom appears to be due to a regressive ego response to anxiety
(Schur, 1955); in some instances hypochondriacal complaining is
a consequence of a shifting of libidinal aims from object-repre-
sentations to the self-representation, such as following the loss of
an object; and there are occasions when there is a symbolic mean-
ing to the physical symptom, as in a hysterical conversion symp-
tom, or when the physical complaint is a result of a hysterical
identification. It is beyond the scope of this paper and its inten-
tion to compare and contrast various psychogenic physical com-
plaints, but worthy of future psychoanalytic inquiry.
Freud meant hysteria and hysterical phenomena to reflect
the pathological vicissitudes of the oedipal stage. That there are
prephallic elements and fixation points in neurotics that are pre-

dominantly hysteric—Marmor (1953) has written on this topic—
does not obviate that hysterical pathology is intimately related to
difficulties with oedipal instinctual wishes and their derivatives.
The attainment of at least the oedipal level would suggest that the
patient has reached a relatively high level of drive and ego develop-
ment, that a particular type of object relationship has been attained
and accompanied by specific kinds of fantasies, that the personality
is well structured or differentiated, and that there is a fair degree
of internalization. That this is so is implied in Freud’s implication
that retribution due to a sense of guilt is a motive that is character-
istic of hysterical identification, as well as his comments that it is
only a “partial” identification. Some child patients presenting psy-
chogenic physical symptoms do not appear to have reached so
high a level of drive and ego development. This has technical and
prognostic significance. Perhaps another reason for reduced inter-
est in hysterical phenomena is that less importance is attributed to
the Oedipus complex in modern psychoanalytic theory.
In contemporary child analysis the mutative power of inter-
pretation is less respected than in the past (e.g., Chused, 2007).
Instead, the experience of play and the here-and-now emotional
relationship between analyst and child is believed to contain the
most mutative power (Frankel, 1998; Solnit, Cohen, & Neubauer,
1993). Undoubtedly, both are important. Play and an emotional
relationship with an analyst that is a so-called “new object” (Abrams,
2001) can both be transformative. Transference interpretations
now are made less frequently. Genetic (reconstruction) interpre-
tations now are rarely made. I think we lose something with some
children in this deemphasis.4 It is the emotional relationship that
is the context for one kind of understanding that can come with
words contained in a timely interpretation. It is not a question of ei-
ther/or, but a balance that is different for each child. I contend that
children who are dealing with the dynamics of hysteria particu-
larly have sufficient ego and superego development (Cf, Zetzel,
1968) to benefit from transference and genetic interpretations,
especially in the latter part of latency and onward. I believe my
analysand Laura is a good illustration of the validity of this pro-
posal.
698 IVAN SHERICK
It may be more apparent than real (Anthony, 1981a), for the

reasons mentioned earlier, that there is a decreasing incidence of
hysterical phenomena. To alert child analysts to reconsider such a
diagnostic judgment has been a major aim of this paper (cf. An-
thony & Gilpin, 1981; Coppolillo, 1981; Evans, 1975; P. Kernberg,
1981). Perhaps our clinical landscapes can be looked at with
clearer diagnostic vision so that we can more clearly see the “flow-
ers of mankind” (Anthony, 1981a).
NOTES
1. For an earlier report on this child, see Sherick (1981). I am grateful to the
late Ms. Agi Bene for her valuable insights into my patient.
2. I was hesitant about being so direct, but I contextualized my comment with
recent material, and I also felt a sense of urgency because I anticipated she
might experience scary and intrusive medical diagnostic procedures. The way
the material continued to unfold, however, increased my confidence on the
validity and timing of the intervention. My interpretations were based on my
accumulated understanding (Sherick, 1981) of Laura’s conflicts as well as on
my clinical theory.
2. With the privilege of hindsight many years later, I think countertransfer-
ence was present. I wanted to protect my patient from unnecessary intrusive
medical procedures; recently I had experienced helplessness dealing with the
premature death of my wife’s mother, which necessitated our unplanned trip
to the United States.
3. At the time that I was seeing Laura I did not meet with parents of children in
analysis on a regular basis. As mentioned earlier in the text, parents were seen
irregularly, mainly to ensure their continued support of their child’s analysis.
With this particular patient, Father was never seen, although he tacitly sup-
ported her analysis. I think this was regretful. There was never any analytic
material from Laura to suggest that he acted inappropriately with her. I have
since changed my technical stance about seeing parents. I now believe it es-
sential to see both parents regularly insofar as parenting issues can support or
undermine a child analyst’s efforts with a child or adolescent.
4. I do not mean to diminish the current importance of mutuality in an analysis,
for example, of countertransference, enactments, co-constructed resistance,
and so forth. Had Laura been seen by me more recently, I likely would have
paid more attention to contemporary technical ambitions than I did at the
time.
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220 Riverview Drive The Psychoanalytic Review

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E-mail: isherick@umich.edu
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Hysterical Identification in An Eleven Year Old Girl Sherick PDF

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The concept of hysterical identification was reviewed and illustrated in

The concept of identification has been a difficult one for psycho-

676 IVAN SHERICK

viewed as derivative of sexual or aggressive instincts (e.g., Sandler,

poses of identification that the sexual relations take place in

At a later date, in Group Psychology, Freud (1921) again re-

678 IVAN SHERICK

concerned.” This is the complete mechanism of the structure of a hysterical

In “Mourning and Melancholia” Freud (1917) contrasts nar-

thology in childhood development and to emphasize that the

680 IVAN SHERICK

on in detail in the case that follows, was also having a regressive

context for my clinical presentation. Evans (1975) gives a detailed

682 IVAN SHERICK

entrenched if better ones are not found or furnished.” Here Cam-

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tion of my interventions. It was as if her protests were mandatory

there was a one-week separation from the parents who were on

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ed positive oedipal wishes); (6) her retreat to thinking she could

er we could try to understand what her body was expressing via

688 IVAN SHERICK

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kidney problem) and might have to have a partial hysterectomy. I

692 IVAN SHERICK

clinic at the same time on other days. It was my decision to let

fond of animals. We spoke about her mother’s telephone call.

The clinical material presented in the preceding section is in-

694 IVAN SHERICK

f­ather’s affection. My conjecture is that there were two currents

accentuated trial action (cf. Fenichel [1945, p. 217]). For Laura,

696 IVAN SHERICK

The erotization and cathexis of an organ function in a parent

prephallic elements and fixation points in neurotics that are pre-

698 IVAN SHERICK

It may be more apparent than real (Anthony, 1981a), for the

Anthony, E.J. (1981a). The flowers of mankind. In E. J. Anthony & D. G. Gilpin,

700 IVAN SHERICK

Sandler, J. (1981). Unconscious wishes and human relationships. Contemp. Psy-

220 Riverview Drive The Psychoanalytic Review

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father’s affection. My conjecture is that there were two currents

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220 Riverview Drive The Psychoanalytic Review