Understanding Hysteria And Its Contribution To Psychoanalytic Theory

PSY3021 Psychoanalysis in Context,What is hysteria? Discuss how hysteria was important in the origins of psychoanalysis.

The History of Hysteria and Its Definition

The human mind functions in intricate mechanisms that influence behavior and interaction with the surrounding environment. Human behavior is complex and cannot be extensively explored on the basis of a single theory. These statements are supported when hysteria is put into consideration. It is a condition with a long history but there was no clarity and conclusive model about its pathophysiology and bio-mechanisms. The field of Psychology studies the mental processes and their effect on human behavior (Crawford & Krebs, 2013)). It tends to deeply understand human needs, habit formation, reaction and stimulating factors towards making specific decisions.

Psychological disorders are a common entity in the contemporary world. These disorders antedates all the way from time of Plato sweeping through a number of philosophers who made effort to experiment, study and describe them. Barlow (2014), describes a psychological disorder as a pattern of feelings, thought and actions that deviate from what is regarded normal. They are usually distressful and usually lead to a dysfunction. In this paper, I shall describe the understanding of hysteria during times of Freud and Charcot, its contribution to the development of psychoanalytic theories and perspective. In this regard, despite hysteria not being a current psychiatric diagnosis as explained by Feinstein (2011), it will be used as a model and a platform of reference due to its main role in major findings and discoveries in psychology and mental health with regard to the concept of psychoanalysis.

The timeline of history of hysteria in terms of description is traced from the work of Hippocrates and Trotula De Ruggiero in 500 and 1100BC respectively. They described it as an atypical disorder that caused dissociation for reasons which were not obvious. It is a name with a Greek origin meaning the uterus. Therefore, it was thought to arise from the abdomen/pelvis and affected normal mental function especially in women. It has a very long timeline that covers the efforts of Sigmund Freud in his follow up experiments. Literature by Rose (2013), shows that hysteria referred to a serious psychoneurotic disorder that presented with anxiety, emotional outburst, excessive fear and irritable behavior, changes in personality, anesthesia, cognitive impairment, motor control deficits, insomnia and irrational sexual desire.

Hysteria is described as not such a common disorder in the population but it is likely to occur in those with a positive history of bereavement, conflicts, personality disorders and past traumatic event or abuse (Bernheimer, 1985). There is a theory suggesting that persistent repression of aggressive and sexual behaviors could lead to hysteria. The comorbid psychological states related to hysteria are depression, anxiety and sexual disorders. Later, Breuer & Freud (2009), concurred that the occurrence mechanism should be described as a psychological reaction to unbearable situations to which the body’s resilience mechanism cannot handle.

Understanding Dissociative and Somatoform Disorders

Currently, a constellation of manifesting symptoms of hysteria are considered in the large umbrella of psychological disorders called dissociative and somatoform disorders. This was after critiques that it lacked valid reasons to qualify as a DSM diagnosis. Most of the DSM critics arrive to the conclusion that hysteria lasted for quite a long time as a psychiatric diagnosis in the ancient times due to traditional support. Therefore, this means that there is no psychological diagnosis of hysteria and its associations such as female hysteria, conversion hysteria, mass, anxiety hysteria and male hysteria in the current mental diagnostic practice. The DSM- IV states that the symptoms which were formerly relevant for the diagnostic criteria of hysteria are conclusively covered under dissociative and somatoform disorders.

Dissociative disorders refer to a group of psychopathologies characterized by a disruption in the unitary state of self or disturbances in the experience of self, resulting in a lack of connection in a person‘s thoughts, memories and feelings, actions or sense of identity. The term dissociation infers a mechanism that allows the mind to separate or compartmentalize certain memories or thoughts from normal consciousness. These split-off mental contents are not erased. They may resurface spontaneously or be triggered by objects or events in the person's environment. The DSM-4 classification of dissociative disorders include: - dissociative fugue, dissociative amnesia, derealisation, dissociative identity disorder and depersonalization disorder. On the other hand, somatoform disorders comprises a group of mental disorders characterized by a firm belief of suffering, abnormal body sensations, excessive worry and dislike of body parts. This disease cluster consists of body dysmorphic disorder, conversion disorder, somatization disorder, hypochondriasis, factitious disorder and somatoform pain disorder. Symptoms of these disorders were given the diagnosis of hysteria by early theorists in order to apply a standardized mode of therapy to the affected patients.

The psychoanalytic theory was developed by Sigmund Freud (1856-1939). This theory has a special emphasis on importance of childhood activities and experiences in shaping personality. He successfully described the structural/tripartite model which consists of the id, ego and superego. The mind changes its state depending on the pleasure principle. This is the constant drive to reduce tension and stress through expression of instinctual urges. The id is the home of instinctual drives. It is present at birth and always operates on the pleasure principle. The superego rationalizes internal morals, values and the right or wrong. It serves as a moral conscience to suppress the instinctual drives of id through shame and guilt. Development of the superego is presumed to be with socialization, identification with same-sex parent and resolution of the oedipal complex. Through socialization, one assimilates societal rules for behavior from role models. The ego component is the one which mediates between the id, superego and the external reality. It is partly conscious and uses primary process thinking. Furthermore, he described the topographical theory of the mind that consists of 3 components namely the unconscious, subconscious and conscious. The unconscious part of the mind contains repressed thoughts and feelings and shows itself in dreams and parapraxes/Freudian slips (Lapsley & Stey, 2011). It is driven by primary process thinking characterized by illogical thoughts, fantasy, immediate gratification and lack of cause effectiveness. It does not take reality into account.

Sigmund Freud and the Psychoanalytic Theory

On the other hand, the subconscious mind was described as accessible but not readily available. It always runs in the background. The conscious part is the mature type. It is fully available and readily accessible. He noted that the conscious mind does not have access to the unconscious. According to Ehrenzweig (2013), it utilizes secondary process thinking which is based on reality, logical analysis and mature ideas that are well-oriented to time. Freudian developments and contribution were related to psychic determinism/ dynamic model, topographical model of the mind, psychosexual development and ego defense mechanisms. After an approximate stay of 1 year with Charcot, Sigmund Freud’s interest in psychology developed specifically in hysteria (Arsalidou et al, 2013). He was initially a general medical practitioner and a neuropathologist. He evolved from being a neurologist to a psychiatrist. In the 1900s, Freud and Charcot were mostly involved in the treatment of signs and symptoms of what is currently related to conversion disorder. In those days, this disorder was named hysteria.

Breuer & Freud (1893), state that the symptoms that they considered were not related to any medical condition, drug or substance abuse or any close relation to cultural or religious practices and endorsements like trance. The development of full interest in psychopathology made him to study hysterical related issues such as male hysteria, effect of the subconscious mind, trauma as a factor in psychopathology and sexual aspect of psychology. Freud’s psychoanalytic theory begun to take course by experimenting on a patient, Ann O. This was a patient with classical symptoms of hysteria. Her symptoms included right-sided paralysis, cough, hearing disorder, intermittent contractures, constant visual and language deficits.

The main symptoms related to psychological instability were prolonged hallucinations and lapse in level of consciousness. When compared to the presentation of conversion disorders in the DSM-4, these symptoms tally (Yarom, 2005). On further inquiry into Anna O’s presentation, there was no history of an underlying medical condition or inappropriate substance and drug use. Freud concluded that his patient was suffering from hysteria. The roadmap to psychoanalysis unraveled through investigations and follow up on a number of patients including Fraulein Anna O (1880-1882), Frau Emmy Von N, Fraulein Elisabeth Von R and Frau Cacilie M among others. Therefore, this was ideal to Freud’s work on psychoanalysis. He together with Breuer treated Anna O for symptoms of hysteria with Breuer’s talk therapy and help of views from Charcot.

Charcot, Janet, and Moriz Benedikt's Influence on Freud's Work

Most of these work that he made theories from were borrowed and based on the primary findings of Professor Charcot, Breuer and other pioneers including Paul Richer and Janet Pierre. With a solid basis from his predecessors, he (Freud) and a colleague called Breuer came up with a hysteria theory based on known concepts developed by Janet and Moriz Benedikt. In fact, Freud was moving from known to unknown using early precedents set by his senior pioneers. Janet’s concept on fixed subconscious idea played a major role in developing the theory on hysteria. The other theory that made his work a success was using Moriz Benedikt ideas, “The pathological secret”.

Later, Freud and Breuer’s association was interrupted. On the basis of sexual hysteria, he singlehandedly managed to develop the concept of converting psychological problems to quantifiable somatic manifestations. This was through a belief that his sample patients had actually undergone the process of sexual abuse, He named this as “the seduction theory”. Later, accused his clients of deception hence he consequently developed another theory to explain this behavior. This was named “the fantasy theory”. Borch-Jacobsen, (1996a), exploits this issue and notes that this theory explained the reason behind development of sexual abuse symptoms in his sample population despite being their no actual physical or emotional abuse.

In all of Freud’s subsequent case analyses, he construed illnesses as hysteria and employed the same method of approach by investigating any traumatic incident that could have triggered the patient’s present presentation. In the earlier cases when with Breuer, Freud adopted Breuer’s hypnotic method as a mechanism to stimulate expression of repressed ideas and feelings. This worked for some time. Anna O’s case helped Freud to make a conclusion that patients who have symptoms that translated to motor manifestation had repressed feelings and ideas that are locked in the unconscious part of the mind. In repression, the patient kept any idea or feeling out of conscious awareness. Freud postulated that keeping a patient in a hypnotic state may help the therapist access the unconscious part of the mind, get the deranged part of the mind and apply the appropriate therapy to correct these manifestations. Later, Freud changed to the “pressure technique” to induce a state of concentration to his patients in order to access the repressed ideas in the unconscious mind.  Ellenberger (1970), describes this as a method where he pressed on the client’s forehead and instructed them to concentrate on their thoughts then report faithfully what was running in their head with reference to the current presentation. This was believed to evoke vivid pictures, unconscious memories and ideas. Freud believed that in this technique until it became nonfunctional due to negative attitude from patient. He then switched to “dream analysis” technique which provided patient with insight into the working of the primary process. This technique led to the discovery of oedipal complex and infant sexuality. These are concepts of psychoanalytic theory. Freud describes Oedipus complex as a child’s unconscious desire to have sexual relations with parent of the opposite sex while developing a feeling of hatred and anger against same sex. Resolution of this phase marks the end of superego development. Fixation is associated with abnormal sexual behaviors. These therapeutic techniques were used to treat and manage all patients who presented with symptoms suggestive of hysteria. This was successful and hence psychoanalysis was being brought to full maturity with subsequent patient care.

Development of psychoanalysis was further upgraded by exploration of different processes of the mind such as displacement, transference and intrapsychic conflicts and the unconscious mind. From such efforts of managing a patient named Frau Emmy Von N, Freud managed to reinforce the basis of psychoanalytic theory through inclusion of these positive techniques to the psychoanalysis. The treatment mechanism in the case of Emmy Von N was through carthatic method. Freud exploited Breuer’s technique of hypnosis to gain entry to the unconscious mind when he realized that she could be put in a state of somnambulism with ease. The carthatic method was successful in this case because Emmy Von N could get trauma out the mind by talking and releasing pent-up tensions and feelings. Brown (2009), notes that the theory of the unconscious mind was the main point of almost total emphasis in the Freudian Psychoanalytic Theory. The associated practices about the unconscious mind played a function of supportive pillars in the approval of his main theory.

Ego defense mechanisms are also exploited in Freud’s patients. These are unconscious parts of the mind that help to keep unconscious thoughts to remain unconscious. They comprise an input from the id, ego and superego. In this regard, they are used to find a leverage of meeting id’s demands while trying to remain socially acceptable. Defense mechanisms are classified as mature, immature, narcissistic and neurotic. Examples of mature defenses are altruism, anticipation, humor, suppression and sublimation. Immature defense mechanisms include; acting out, somatization, dissociation, denial, reaction formation, rationalization and projection among others. Ego defense mechanisms are a normal thought and feeling in daily life. However, constant persistence of some defense mechanisms is associated with mental conditions.

When the case of Frau Emmy Von N is viewed from another context, Freud’s findings point to employment of both mature and immature ego defense mechanisms by his subject. Freud notes that Emmy Von O was married to an extremely successful and gifted husband. He later died of stroke and left him with 2 children with nervous problem to bring up. From this event, she developed hallucinations, language and motor difficulties. From this case, there is evidence of repressed thoughts, suppression of traumatic ideas, denial, displacement, dissociation and transference as ego-defense mechanisms. She had repressed thoughts of her husband which were tucked deeply in the unconscious mind. The body mechanism of containing these thoughts was overwhelmed hence leading to somatic manifestations. Transference refers to the action of deliberately (consciously) pushing anxiety-provoking or personally unacceptable material out of conscious awareness. It is probable that she employed transference as a mode of defense by carrying forward the life experiences they had together with the deceased husband. When therapy was initiated by Freud, her symptoms improve. She could experience less episodes of insomnia and auditory hallucinations. Freud helped her rationalize the traumatic events associated with her life.

As earlier mentioned, Freud proposed that the mind was solely a collection of components that were trying to balance between internal instinctual demands and the fulfilment of external expectations. Freud explains that childhood behavior can rule our future character and personality. He explained this basing on the stages of psychosexual development in children. He even tried to probe into childhood experiences of his patients through hypnosis in order to apply the necessary therapy. These Freud's stages are based on clinical observations of his patients. The psychosexual developmental stages are: oral, anal, phallic, latency and genital. These stages occur at different phases and ages between birth and young adulthood. Each stage has a designated pleasure zone, primary activity and the conflict to solve. Failure of successfully traversing a particular stage is associated with fixation and some psychiatric disorders. The psychoanalytic theory supports the theory that the oral phase is the stage of ego development. Conflicts related to suppress ego development can lead to fixation at oral stage (Fromm, 2014). Freud associated this with symptoms that occur in hysteria such as difficulties with trust, attachment, commitment, eating disorders, smoking and drinking problems. Freud made a point that the ego and the superego have a role to subdue the unnecessary demands of the id in drive towards sexual gratification.

The psychoanalytic theory also wants us to view issues related to the conflicts at the phallic phase. Using research done by McLeod (2014), the pleasure zone is the genitalia and the primary activity is genital fondling. Failure to successfully navigate this phase leads to oedipal Conflict. The conflicts at this stage have been theorized into the psychoanalytical model to explain the Electra complex and oedipal complex as modes of fixation related to failure to navigate this stage (Crain, 2015). However, it has been discussed in many theories and models that the ego, id and superego play a major role in resolving any conflict arising from sexual gratification at this stage. In this stage boys have a feeling that they should marry their mother and kill their father. Nevertheless, the ego and superego comes into control by instilling fear of retaliation from father; the so-called castration anxiety. They ultimately resolved thru identification with father. On the other hand, girls have penis envy; they have a strong feeling of wanting to marry their father. The superego resolves this by making them identify with their mother to try to win their father’s love.

 It has been studied that once the oedipal conflict is resolved, then it is a sign that the superego is mature (Zimberoff & Hartman, 2000). In relation to hysteria, the behavior or children in this stage of development may mimic those with classic symptoms of hysteria because of rejected sexuality as described by Freud. Also, it is necessary to note that Freud clearly brings out the idea that genitalia especially in penis envy should be treated as a secondary phenomenon. Freud believed that sex and its experiences formed a platform for repressed thoughts and left a physical trace which was deeply locked away. Basing on this belief he analyzed the concepts of repression, displacement and transference as mechanisms of neuro-psychoses defense (Cramer, 2012). An idea was formulated to paint hysteria to be arising from the same common etiology of adaptive psychological defense techniques. He saw this as a confluence of related interdependent factors relating to sexual abuse and unwanted physical experience. Other theorists included heredity as a risk factor to Freud’s patients’ presentations of hysteria but as for him, he only considered physical and sexual abuse as the sole cause of such. Basing on this, Freud developed the sexual stages of development of a child. He introduced the idea that the development of hysteria and neurosis are dependent on the stage of sexual development during the abuse.

The intellectual achievements of Freud have received many critics all through the years. The seduction theory is one area where there are a number of detractors. This theory is viewed by many psychologist as a form of making the patient re-experience unwanted traumatic thought about a previous event. Many theorists also criticized him on the basis of increased doubt on validity of his findings whether they were unconscious fantasies or actual infantile abuses. His work on Anna O was criticized by a number of scholars that probably she had a brain lesion that was resulted in her physical manifestations. Bernheimer (1985), emphasizes that he probably committed medical errors by concentrating on hysteria as a primary diagnosis and his main focus was to prove that this was the case. Some even use the famous phrase “the eyes see what the brain knows”.

However, Wright (2013), explains that these critics should put into consideration that despite Freud sticking to one form of diagnosis after investigation, we see him change from one form thought and investigations across the number of patients he treated starting with Anna O to Dora and so forth. He could allow the patient to practice control over her own encounters, explain the feelings, sexual thoughts, repression and dream analysis. It is not suggested that we treat these criticism as merely petty but it is better to appreciate Freud’s contribution to psychoanalysis.

Conclusion

Despite his excellence in coining the psychoanalytic theory, it is unfortunate that Freud’s experiments were not based on a strict verifiable scientific process. His theories were more anchored to his belief evolution process with regard to psychological evolution. This was the same case with his contemporaries. Freud emphasized so much on the aspect of therapy to support his emerging ideas that arose from evolution of his belief in psychological setting.

From this kind of mannerism, it remained an unresolved challenge to get a clear picture and vision of Freud’s final theory of hysteria despite hysteria being his ultimate origin of the psychoanalytic theory. Freud saw people as passive. Gleaves & Hernandez (1999), say that Freud believed that behaviors is almost completely determined by interaction of external reality and internal drives. That all behaviors are driven by antecedent events and experiences. From the study of his patients with symptoms of hysteria, he has a strong conviction that there are no accidents in human life and that nothing happens by chance. This may not be the case in the contemporary life even if human being was to be ideal. However, it brings to conclusion that Anna O and hysteria played a major role in development of psycho analysis. It is also necessary to make a clear stand that the term hysteria is archaic and its related symptoms have been divided into the correct DSM-4 criteria of diagnosis.

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