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What is hysteria? Discuss how hysteria was important in the origins of psychoanalysis.

| February 1, 2017

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Introduction

Throughout the history of psychology, the term Hysteria was used to describe symptoms of illness that were atypical to already established diseases (Feinstein, 2011). Neuropsychiatrists of the 1800-1900s described Hysteria as an illness where dissociation occurs for reasons that are not obvious. The symptoms shown in a hysterical patient are those such as anaesthesia, amnesia, abulia, motor control disorders and changes in personality (Haule, 1986). These symptoms are known today as a type of psychoneurosis which causes emotional excitability, provoking emotions such as fear or panic. Disturbance of the sensory, motor and cognitive functions of humans are also a result of this particular neurosis (Patel, 2012). It has been argued by critics of the DSM that the condition, Hysteria, lacks validity and that the only reason why it lasted as a category of disease throughout history is due to tradition (Feinstein, 2011). Thus, in 1994, the DSM-IV removed ‘hysteria’ as an established disease and divided the symptoms of the disease into two sections now known as Somatoform Disorder and Dissociative Disorder. The issues under these two umbrella terms covered the symptoms that were accepted by the original term ‘hysteria’ (Feinstein, 2011). The DSM-IV stated that the diagnoses for the conditions which lie under the umbrella terms Somatoform Disorder and Dissociative Disorder are particularly relevant to the formerly known diagnostic categories of hysteria. These conditions are Somatisation Disorder, Conversion Disorder and Dissociative Amnesia (Feinstein, 2011).
Conversion Disorder was the most closely associated to the disorders that were treated by Charcot and Freud in the 1900s, and refers to symptoms that mimic neurological disorders such as motor and sensory deficits, pseudo seizures and mixed presentations. These symptoms should not relate to any organic source of illness, nor be associated with substance use/abuse or the patients participation in culturally endorsed behaviours such as trances during religious ceremonies in order for them to be and have been diagnosed as hysteria (Feinstein, 2011). The aim of the present essay is to outline what hysteria was, and how it related to psychoanalysis. So, although the symptoms of hysteria are now represented through separate categories of mental disorders in the Diagnostic and Statistical Manual in the present day, for the purpose of this essay, the term hysteria will be used to encapsulate all of the symptoms, and in order to embody the historical and contextual term whilst discussing the relevance of the condition to the origins of psychoanalysis.
The literature suggests that the causes of hysteria are linked to past traumas, conflict, undue stress such as bereavement and a history of abuse (Patel, 2012). It has also been theorised that repression of sexual or aggressive behaviours could trigger hysteria. This concept was best conveyed through Freud’s work on patient Anna O, where psychoanalysis had begun to take form. Freud had treated Anna O for symptoms of Hysteria by joining Breuer’s talk therapy and Charcot’s view of hysteria (Webster, 2004). Anna O’s symptoms represented the typical manifestation of hysteria. Physical symptoms consisted of a cough, paralysis on the right side of the body, contractures, and disturbances in vision, hearing and language. Psychological symptoms consisted of lapses in consciousness and frequent hallucinations. These symptoms are similar to the modern day indicators of Conversion Disorder. Doctors found no organic cause for Anna O’s symptoms, so as a result of this, she was diagnosed with hysteria. Through the work on Anna O, an outline for psychoanalysis had begun to emerge (Webster, 2004). Freud continued to use the same therapeutic techniques on other patients who displayed the symptoms of hysteria, consequently bringing psychoanalysis into full bloom (Webster, 2004). The process of exploring concepts such as the unconscious, repression and intrapsychic conflict in hysterical patients aided the development of psychoanalysis. Hypnosis, directive and abreactive techniques, and an early form of free association were used with these patients. Through these experiments Freud was able to strengthen the foundation of his psychoanalytical theory by adding these techniques to his practice of psychoanalysis (Krohn, 1978).
Freudian psychoanalytic theory, and its associated practice, psychoanalysis, placed emphasis on the theory of the unconscious mind. Freud had proposed that the mind was composed of three components: the id, ego and superego. These components were suggested to play a significant role in the development of hysteria and are best explained through their association to the psychosexual stages of development (Yarom, 2005). The psychosexual stages of development encompass the Oral, Anal, Phallic, Latent and Genital phases. The theory holds the standpoint that the ego develops during the Oral phase, and the superego develops during the Phallic phase. The subject of hysteria has widely been studied in ego psychology and its understanding was enhanced in the more recent studies throughout the literature, as a personality disorder related to conflicts within the ego (Yarom, 2005).
Psychoanalytic theory had proposed that the ego and the superego were developed by the psyche in order to put into effect some control over the libido during psychosexual development and throughout adult life, so that need for gratification is directed into socially acceptable ways. Freud had stated that need for gratification is associated with the different parts of the body during each stage of psychosexual development, thus the conflict between the id, ego and the superego is associated with whichever psychosexual stage the individual is at (McLeod, 2008). The conflict within the psyche at the Phallic stage is what has been theorised to bring about the Oedipus and Electra Complexes in individuals (McLeod, 2008). The suggestion made by Freud was that hysteria was associated with rejected sexuality. Freud put forward strong references to the female sexuality. This connection was made through the theory of the Electra complex in which females are said to have unconscious incestuous wishes and envy the penis of their male caregivers. For this reason, hysteria was a disease strongly related to women (Yarom, 2005) On the other hand, neo-Freudian approaches, such as that of Horney’s (1967) suggested that penis envy should be considered as a secondary as opposed to primary phenomenon, in the sense that women’s sexual identities are more focused on aspirations to bear children rather than achieve orgasm. However, it may be suggested that this still provides a sexist standpoint against women as it portrays women as only being interested in bearing children. Nonetheless, sexism was slowly overcome as history progressed and this was evident through the fact that hysteria gradually became a disorder that was associated with males as well as females (Yarom, 2005). Yet contradictory literature shows studies during the 1970s which still insisted that hysteria was more prevalent among women than men, with a high comorbidity evident between sociopathy and hysteria, especially in women (Cloninger & Guze, 1971). These findings are supported by Lerner (1974) who stated that hysteria is a disease frequently applied to women and less frequently, if never, to men. However, despite these studies showing evidence in the literature that hysteria is a female only disease, it may be suggested that the chauvinistic and patriarchal nature of society throughout history may have influenced the findings that although males may exhibit hysterical behaviours, it does not necessarily mean that they have the condition hysteria. It may be the case that male researchers did not want to associate this ‘weakness in character’ to the male population, therefore put it forth as a female only illness, maintaining the ‘strong’ image of men. Secondly, since the majority of the researchers in this area of interest were males, it may also be suggested that they lacked empathy and understanding of the emotions and behaviours that females were exhibiting, thus interpreted these as more hysterical than those which the males were exhibiting. Conversely, the paper by Lerner (1974) does indicate that hysterical symptoms such as conversion reactions and dissociative phenomena were been observed in men, but that these patients did not display the cognitive and personality characteristics of the hysterical individual, therefore they did not have hysteria. Yet, in any case, when social and contextual factors are taken into consideration, it brings one’s attention to the fact that the doctors and researchers involved in studies of Hysteria were mainly male, reinforcing the notion that the literature was also dominated by observations influenced by patriarchal males. To lend additional support to this view, it was advocated that the explanation of the prevalence of Hysteria among women on the part of psychoanalysts was focused on preoedipal and oedipal developmental tasks that must be mastered by males and females, yet the libidinal development of the two sexes only offers a partial explanation of the alleged sex differences in Hysteria, therefore it is more rational to hold the belief that social and cultural factors play a major role in the issue (Lerner, 1974).
With reference to conflict within the psyche during each psychosexual stage, the purpose of psychoanalysis was to aid the patient in bringing forward to consciousness the repressed thoughts and emotions that were associated with these phases. Resolving these conflicts would strengthen the ego (Zimberoff & Hartman, 2000).. In accord, the likelihood of developing hysteria would lessen. This is supported by the notion that tension during each phase relies on the way in which the ego deals with anxiety, and that hysteria is a result of manifested repression of an incompatible idea on the ego’s part (Vaillant, 1992). Therefore, the evidence based on the relationship between the id, ego and superego in psychosexual stages and the development of hysteria, played a cruicial role as a catalyst in bringing the theory of psychoanalysis into practice. This is evident through the demonstration of how resolving psychosexual conflicts strengthens the ego, therefore avoiding the development of hysteria.
Although the role of Hysteria in the development of psychoanalysis is clear, it must be noted that the patriarchal approach taken by Freud and other researchers during the studies of Hysteria had also reflected on the theory and practice of psychoanalysis (Bernheimer & Kahane, 1985). Freud’s writings were based mainly on male development (McLeod, 2008). This could imply one of two things: Either that he held the belief that female development mirrored male development, or that it was inferior to male development. Hence, it is appropriate for one to question the theory that if hysteria was a female only disease, was it a mirror of male hysteria? This could in turn imply that males were also prone to developing hysteria, therefore weakening the literature throughout history that hysteria was limited to females. On the other hand, it may also be suggested that if only the ‘hysterical symptoms’ that were limited to men, were mirrored by women and were manifested in women as full blown hysteria, that hysteria was in fact a disease in full bloom in males as well as females. If women mirroring the behaviour of men was the case, this would suggest and further reinforce the idea that psychoanalysis the product of a patriarchal foundation, as hysteria was the catalyst which had patriarchal influences attached to it. As a consequence, one is left in a position to question whether studies on hysteria had influenced psychoanalysis, or whether psychoanalysis had influenced the findings and history of hysteria, as they both appear to be partners in crime when the issue of sexism has been mentioned throughout the literature.
In summary, hysteria is a set of symptoms known in the modern day as three different categories of mental disorder, classified by the DSM-IV as: Somatisation Disorder, Conversion Disorder and Dissociative Amnesia. These three categories include the indicators of hysteria such as anaesthesia, amnesia, abulia, motor control disorders and changes in personality. Modern psychology suggests that hysteria is brought on through past traumas, conflict, undue stress such as bereavement and a history of abuse. However, throughout the history of psychology, it was believed that hysteria was the ego’s reaction to suppressed sexual or aggressive behaviours. Freud, Charcot and Breuer played significant roles in the establishment of the term hysteria, and Anna O had been the first patient to be treated for the symptoms of hysteria. Through the practice of talking therapy and free association, Freud began to establish the theory of psychoanalysis as he worked with Anna O. Theories of the unconscious mind and its components, the id, ego and superego began to emerge as Freud established their roles in the development of the human psyche. Later, hypnosis, directive and abreactive techniques, were used with Freud’s patients. It was through the founding of the psychosexual stages of development that psychoanalysis began to blossom in full bloom. Many doctors in the 1800-1900s had associated hysteria with females, considering it to be a women’s only disease and suggesting that men merely showed symptoms of the disease – not a complete case (Lerner, 1974). For this reason, Freud had suggested that the conflict of the psyche during the Phallic stage, especially for females, whom struggled with penis envy, was what manifested as Hysteria at a later stage in life (Yarom, 2005). However, subsequent and more recent speculation highlighted the fact that these findings were discovered during a highly patriarchal time in history, where the medical field was widely dominated by men. Thus, it became evident that hysteria was, and still is a mental disorder found to be equally as prevalent in both men and women (Tucker, 2009).
In conclusion, with respect to the essay question at hand, it was considered that hysteria was a significant foundation and catalyst for the development of psychoanalysis. However, due to the fact that hysteria itself was a flawed phenomenon in the way it was reflected throughout the literature at the time, psychoanalysis also became a skewed theory, based on patriarchal and chauvinistic theories. Nonetheless, this does not change the fact that Hysteria, and Anna O played a major role in the founding of psychoanalysis. Moreover, it should be considered that Hysteria is now an outdated term. The symptoms have been revised and the categories for the symptoms have been divided by the DSM, reflecting the progression that psychological literature has made since the time of Freud and psychoanalysis.

References

Bernheimer, C. and Kahane, C. (1985). In Dora’s case. 1st ed. New York: Columbia University Press.

Clonninger, C. and Guze, S. (1970). Psychiatric Illness and Female Criminality: The Role of Sociopathy and Hysteria in the Antisocial Woman. American Journal of Psychiatry. 127(3), pp.303-311.

Feinstein, A. (2011). Conversion disorder: advances in our understanding. Canadian Medical Association Journal. 183(8). 915-920.

Haule J.R. (1986). Pierre Janet and dissociation: the first transference theory and its origins in Hypnosis. Am J Clin Hypnosis. 29: 86-94

Horney, K. (1967). Feminine psychology. 1st ed. New York: W.W. Norton.

Krohn, A. (1978). Hysteria, the elusive neurosis. 1st ed. New York: International Universities Press.

McLeod, S. (2014). Psychosexual Stages | Simply Psychology. [online] Simplypsychology.org. Available at: http://www.simplypsychology.org/psychosexual.html [Accessed 24 Apr. 2014].

Patel, M. and Patel, M. (2012). An Introduction to Hysteria: Causes Symptoms and Treatment. [online] mDhil. Available at: http://www.mdhil.com/an-introduction-to-hysteria/ [Accessed 24 Apr. 2014].

Psychologistworld.com, (2014). Sigmund Freud – Psychology Issues – Psychologist World. [online] Available at: http://www.psychologistworld.com/psychologists/freud_1.php [Accessed 24 Apr. 2014].

Webster, R. (2014). Anna O and Hysteria: Charcot and the origins of psychoanalysis. [online] Available at: http://www.richardwebster.net/print/xfreudandcharcot.htm [Accessed 24 Apr. 2014].

Vaillant, G.E. (1992). Ego Mechanisms of Defense: A Guide for Clinicians and Researchers. Washington, DC: American Psychiatric Press.

Yarom, N. (2005). Matrix of hysteria. 1st ed. London: Routledge.
Zimberoff, D. and Hartman, D. (2000). Ego Strengthening and Ego Surrender. Journal of Heart-Centered Therapies, 3(2), pp.3-66.

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