Introduction and a paper on Hysteria

Dear Forum,

For the past year, I have been in a nearly lethal roller-coaster relationship with my HPD. The boards have been one of my lifelines and I've turned to it more times than I'd care to admit. I'm pretty sure that I've read most every post since the beginning of the list. You have all become very important to me. The amount of thanks and gratitude I hold towards everyone on the boards, every fighting Non and every brave HPD is beyond description. Thank you. Truly.

So I felt the time had come to step out the closet and join the discussion more fully. I'm looking forward to telling my story in juicy, sickening detail (we've all heard it before... it's uncannily, even precisely the same story as everyone here) in a future post.

But in the meantime, I wanted to share a paper I just wrote on hysteria (see below) which I hope will resonate. I'm currently a psychoanalytic candidate at a New York-based institute. And believe me, being in the process of getting a doctorate and a license in this field is no help whatsoever when it comes to one's personal life. If anything, the same obsessive, codependent, narcissistic, and counterphobic defenses that attracted me to the mental health profession in the first place, made my relationship with my HPD much, much worse... I really must have had the fantasy that I could save her. I couldn't.

Love and peace to you guys. You are wonderful.

Windowpane



The Life/Dream of the Hysteric

If you think of the psychoanalytic imagination as a dream play with a bill of characters, no one in the dramatis personae is more complex in their suffering and breakdown than the hysteric. More than any other, she (or he, as I strongly identify with this personality style) humbles and frustrates, as she demands that the other produce knowledge about her. Sphinx-like, she says, “Look to my body, there you will find the answer to this riddle of hysteria… tell me who I am, I am who you say I am.” But when we gaze with desire at her, playing at interpreting a symptom, an ache or a pain, she laughs it off as if to say, “Nice try, buster! But no cigar.” In this analytically castrative moment, the hysteric’s body and mind seduces us, as though she is one big question mark to be solved or saved. And we shrug our shoulders, study up, try again, only to come to the truest description ever given of a riddle: it’s a riddle.

As I mentioned, I both personally identify with this character and am deeply fascinated by people like this. Being hysterical or being in an on-again-off-again relationship (believe me, this is symptomatic) with another hysteric is one big experience of saying: “What just happened?” The strung-out experience of sudden lack, of hollow absence that leaves one filled with nostalgia and primal longing is the defining transference and counter-transference quality of an hysterical encounter. As Lacan pointed out, the hysteric was born to run. It’s true.

But what is hysteria—or, perhaps, a better question would be what on Earth isn’t hysteria? Today, it seems to have disappeared… almost as though the mental health establishment and the larger culture repressed it. Is it so versatile and shape-shifting that it’s stealthily assimilated itself into everything and therefore nothing? A friend of mine, who informed her CBT-oriented therapist that she thought she might be an hysteric, was told in reply: “What do you think this is, the nineteenth century?”

According to Elaine Showalter, author of Hystories, hysteria has all but been subsumed under the popular diagnoses of conversion, histrionic and borderline personality disorders. However, she believes the rumors of its demise are greatly exaggerated. Showalter contends that, actually, hysteria is alive and well, albeit masquerading as ADHD and chronic fatigue syndrome; it’s also hiding in conspiracy theory and alien abduction communities, political and religious nutjoberry, anorexia and bulimia, and even multiple personality disorder (now called disassociative identity disorder). However, Showalter is not a clinician, she’s a literary critic.

Despite this, experienced psychoanalyst Christopher Bollas offers Showalter his unswerving support for her theory and goes even further. Bollas brilliantly argues in his book, Hysteria, that the condition’s well-known features (i.e., repressed sexuality; indifference to conversion [la belle indifference]; and over-identification with the other) are just outermost symptoms. Bollas instead directs our attention to what he believes is at the heart of this character: “The hysteric elects to perpetuate a child innocent as the core self, endeavouring to be the ideal boy or girl throughout a lifetime.”

As such, above all else, the hysteric unconsciously wishes to gratify the parent figure of the mental health professional (or, for a time, the girl/boyfriend) and to wonderfully and elaborately represent clinical desire back to them. So when the psychoanalytic community became hysterically interested in early childhood preoedipal conditions, such as borderline, the hysterics correctly intuited this desire for the return to the primitive. They then “became borderline” long before the mental health establishment was manifestly obsessed with this diagnosis.

As if this unconsciously stage-managed descent into madness isn’t confusing enough, Bollas contends that hysterics are such expert performers that they can literally portray other clinical objects of desire such as schizophrenia! They can accurately reproduce schizophrenic symptoms. So it’s no use to say that just because a patient has delusions, has cognitive disorders, hears voices, and cannot distinguish between fantasy and reality, that they must be a schizophrenic. If the patient is an hysteric, then nothing is off limits in their theatre.

In this frightening and radically overdetermined hall of mirrors, the unconscious life of this character has understandably seduced the fascination of people interested in the mind. Historically, the hysteric took center stage in modern psychology before the most famous hysteric of them all: Anna O. The real debut came earlier, when Freud’s mentor, Jean-Martin Charcot, published a series of articles on hysterical somatic manifestations. Charcot maintained that hysteria was a neurological disorder. He hypothesized that patients were vulnerable to this condition due to constitutional hereditary traits of their nervous system. “Incidental” and “accidental” cues in the patient’s environment were all that was needed in order to fire off the symptoms.

Freud, also a neurologist by training, did not disagree with this view. In fact, he supported the idea that environmental factors triggered hysterical somatic manifestations. However, he became suspicious when he started noticing that some very specific external cues were influencing hysterical behavior. He cites: “…mollycoddling, premature awakening of mental activity, frequent and violent excitements…trauma, intoxication, grief, emotion, exhausting illness, anything in short, which is able to exert a powerful effect of a detrimental kind.”

In these words, one can sense that Freud was beginning to suspect a traumatic event of some kind or another lay at the etiology of hysteria. As he explored with his patients further, Freud discovered that they had stories to tell of abuse, rape and incest. Freud believed these reports and he began to construct a theory of hysteria. His clinical observations testified to the long-lasting damage that comes from early boundary violations and untimely sexual experiences. Such events can cause violent repressions, compromise formations, and symbolic symptoms, which get “converted” into the body through somatization.

Freud maintained that these symptoms function as an elaborate defense to protect the psychic apparatus from excessive stress. In a way, hysterical symptoms actually demonstrate a primary gain in which the symptom directly reduces tension. For example, the patient may persistently scratch an “imaginary” itch (the symptom is not factitious, it is experienced as real) as a way of symbolically protecting herself from realizing some forbidden and threatening knowledge. So Freud believed that hysteria is a very dynamic way for a patient to maintain and cultivate elaborate repressions.

As the hysterical disorder persists, Freud noticed that there are also significant secondary gains. For example, a somatized “imaginary/real” itch may provide an independent advantage, such as protecting the hysteric from being caressed by potential lovers because she’s feeling “too sensitive.” At its core, hysteria almost always serves to protect the sufferer from adult genital sexuality and bonding. It manages this by converting the libido into earlier developmental stages and diffusing this excitation into various parts of the body.

The result is a distinctively libidinal body language and style of dress, which has been autoerotically over-invested with sexuality that has nowhere to go. As a result, the contemporary diagnosis of histrionic personality disorder (though not exactly the same thing as hysteria) is the only category in the DSM that actually uses the clinician’s subjective visual impressions as diagnostic criteria. If someone comes into the consulting room in six-inch stilettos at ten in the morning, it gets noted. Obviously, it is incredibly difficult and dangerous to define over-flirtatiousness, as this is so culturally dependent and contextual. But most analysts I’ve interviewed say if it walks like a duck and quacks like a duck…

A much more reliable red flag usually comes up when we assess the patient’s sexual history: often, hysterics have trouble consolidating libido into their genitals in orgasm. Orgasm, though consciously desired, is often unconsciously avoided, as this event would release unacceptable realizations and forbidden knowledge about themselves. It would also be a strong symbol of growing up. Depending on the degree to which one believes in emotionally contagious inductions and the mechanisms of projective identifications, one could also say that hysterics enact the desire of others and polymorphously spread it throughout their whole body. To bind this desire in an orgasm, would symbolize the end of the other’s fascination with them so the climax is often deffered indefinitely. In fact, Lacan believed that this is the essence of hysteria; namely, that the hysteric’s desire is always for the desire of the other. At her core level, she takes on and somatizes the other object’s desire as a way of bolstering her own flagging self-love.

According to Dr. Hendrika Freud (no relation), this as if performance of the hysteric—playing at being a lovable person in order to get love in return—is basically a narcissistic problem of poor self-esteem. Dr. Freud says that, fundamentally, the hysterical character has roots in preoedipal, preverbal experiences with mothering that failed to mirror the infant. So, in a conversion situation, where the hysterical patient frequently presents with hypochondriacal complaints, she may be demonstrating a significant other object’s desire to keep her docile and helpless for his own satisfaction. This may echo her infantile experience with her primary objects.

So the hysteric’s dilemma is that life is lived like a dream; a mimetic, as if, performance. Naturally, “intimate” human relationships are foreclosed by this kind of imaginary and dissociated coping. And many hysterics do feel this as a loss but are compelled to repeat their behavior. Secretly, unconsciously, the hysteric believes that adult sexual rapport is cold comfort and a sad attempt at compensation for the failure of their parent’s love. They hopefully enact romantic relationships again and again as ongoing rehearsals for an idealized performance of erotic redemption that never comes.

Their mirror is meant to capture the lover’s internal world and reflect it back to them as illuminated art in the hopes that the preoedipal mother will come around eventually. In essence, the hysteric idyllically dreams up the romantic partner and acts out their desire but doesn’t commit to any real relation. Their body may be on erotic loan to this world, but their true self is safely tucked away as a covert sacrifice and offering to ideal sublime love. In fact, many hysterics romanticize death and casually announce their suicidal dreams as though they were describing a vacation to the Bahamas (la belle indifference). Bollas points out that when an hysteric commits suicide in a mental institution, the staff is struck down by counter-transferential grief. They feel powerless (just like the victim) because they’re convinced that the patient hasn’t really understood what death is and she innocently acted out the fantasy that she would attend her own funeral!

This is probably why the hysteric can suddenly leave and run away from apparently intense involvements with people in their life. It’s as though they’re moving on from a previous, now devalued dream, and merely waking up to another exciting dream; a bit like absent-mindedly and drowsily flipping channels with a TV remote in the hopes of finding a program that will take one out of existential boredom.

What can be done to help the hysteric find a point of balance and address their very sad internalized memories of primary lack? I get the sense that the psychoanalytic perspective is in a unique position to treat hysteria. As a treatment technique and a therapeutic discipline, analysis enacts a “cure” through “saying everything.” In fact, the psychoanalyst’s intervention is based on returning the clinician’s focus to “the talking cure.” Very interestingly, this description of the process of analysis originally emerged from an encounter between Dr. Joseph Breuer (Freud’s mentor and predecessor) and Anna O.

Anna O. was a pseudonym for Bertha Pappenheim, a woman suffering from “paralysis of her limbs, and anaesthesias, as well as disturbances of vision and speech.” In other words, Anna O. was a classic hysteric. When she began describing her symptoms to Breuer, they disappeared as though swept away by words. Anna O. subsequently coined the term for this therapy: “her talking cure.” Freud and Breuer recorded their analyses of Anna O., in their collaborative 1895 book, Studies on Hysteria. These discussions formed the basis of psychoanalysis, as a discourse and a discipline. Therefore, in a way, all forms of contemporary therapy owe the evolution of their techniques to the mother figure of hysteria.

In psychoanalysis, we enter a dream-like and somewhat undifferentiated narcissistic transference with the patient. We do more—perhaps more than any other school of therapy—to accommodate the patient, to make them comfortable, to let them build the frame. In other words, we become hysterically receptive and appeasing to the other’s unconscious. We allow ourselves to be caught in the desire for the desire of the other.

For 50 minutes, we mirror the patient, join them, and participate fully in their enactment of life as a dream. The whole analytic situation becomes an as if play, a moving association of the patient’s efforts to make love to an idealized maternal absence. The analyst, out of sight, just far enough away to recapitulate the patient’s preoedipal longing, links his or her own unconscious to the patient’s unconscious. The analyst’s art is, then, to be a better hysteric than the hysteric—to outdream the dreamer. On occasion, and where therapeutically appropriate, the analyst echoes the patient’s words, images and feelings. In the unconscious empathy of transference, the hysteric has finally come home.

In this imaginary and mirrored dream world on a fainting couch, we make the one single demand that cuts the hysteric’s reveries and induces emotional maturation: “say everything.” In sending out signals of analytic desire to the hysteric we have her temporarily identify with the mother tongue of language, which separates and individuates the infant from the imaginary order and initiates them into the symbolic order. In this push towards progressive communication, the hysteric is asked to symbolically communicate in words, not just somatically act out her desire. Literally, this opens new pathways, new choices.

I’m speaking from my own experience here. In as much as I have some hysterical characteristics myself, I can vouch for my analysis as having spurred on a waking up from the repetitive dreams (nightmares, actually) of deferring away real life in the hopes of getting back to the “bigger, better deal,” the transcendently obscur objet du désir.

So to sum up, hysteria is what happens when you don’t wake up from the dream of an arrested childhood. The repressions necessary to keep one asleep as a perpetual Peter Pan or Lolita results in some of the most dramatic and mysterious qualities of this disorder. These elusive and surreal symptoms have led many—even within the psychoanalytic community—to dismiss it as a catchall junk diagnosis, particularly due to its long list of potential manifestations. But I think they’re just resisting this most versatile and complex of all characters—the one who insists on colorfully and inconveniently returning the repressed to manifest waking life through the associative anti-logic of dreams.



Sources

Abraham, G. "The Psychodynamics of Orgasm." International Journal Psycho-Analysis 82 (2002): 325-38. Print.

Bollas, Christopher. Hysteria. London: Routledge, 2000. Print.

Breuer, Josef, and Sigmund Freud. Studies on Hysteria. New York: Basic, 1957. Print.

Dor, Jöel, Judith Feher. Gurewich, Susan Fairfield, and Jöel Dor. The Clinical Lacan. Northvale, NJ: J. Aronson, 1997. Print.

Dorland, W. A. Newman. Dorland's Illustrated Medical Dictionary. Philadelphia, PA: Saunders, 2007. Print.

Gregory, R. L., and O. L. Zangwill. The Oxford Companion to the Mind. Oxford [Oxfordshire: Oxford UP, 1987. Print.

Kretschmer, Ernst, and Oswald Herman Boltz. Hysteria. New York: Nervous and Mental Disease, 1926. Print.

Micale, Mark S. "On the ‘Disappearance’ of Hysteria: A Study in the Clinical Deconstruction of a Diagnosis." Isis 84 (1993): 496-526. Print.

Rixon, Christopher Hugh Leete, and David Matthew. Anxiety Hysteria; Modern Views on Some Neuroses. New York: P.B. Hoeber, 1923. Print.

Showalter, Elaine. Hystories. New York: Columbia UP, 1997. Print.

Window wrote: So to sum up, hysteria is what happens when you don’t wake up from the dream of an arrested childhood.

Interesting paper and thanks for sharing it! Welcome to the forum.

So do you want to share your story and what you learned here? The practical side? or just look through the window?

Thanks for sharing! I am a bit troubled that claims of delusions would be simply swept under the rug as being simply a transference of someone else's desire, as if the hysteric was only a mirror.

Sometimes the analysis doesn't probably work because we love the attention too much.
Also, I had erotic transference and that must have messed everything up.
Anyway, my analyst left town and I miss him terribly and feel like it set me way back.

@ herewego. Thanks! Absolutely, I'd really like to share in detail what went down and some of the lessons learned (though I'm still figuring this part out). As soon as time allows I'll share the story.

@oneliner. I think the hysteric is absolutely there as a person too. No one is just a mirror. But the hysteric's sense of boundaries, even their sense of self, is so diffuse and vague. They tend to get their ego functions from other people. So a person with hysteria can get pretty enmeshed with the man or woman of the moment. However, once the "moment" passes (whatever that means to them), it's on to the next thing. So, in a way, their delusion is that this kind of behavior has no consequences. That's pretty much the definition of an empathy failure.

@nowheregirl. It totally sucks when the analyst goes on vacation. It's like a mini-abandonment. I usually just try to talk myself out of missing them by telling myself that if they don't take care of themselves then they'll be no good at all for this work. Also, re: the patient who basks in attention and has an eroticized transference--these kinds of resistances are like gold nuggets in the treatment. Without resistance there is nothing for the analyst and you to study together. If your analyst is good at what they do, then these feelings are fantastic grist for the mill.

windowpane wrote:@oneliner. I think the hysteric is absolutely there as a person too. No one is just a mirror. But the hysteric's sense of boundaries, even their sense of self, is so diffuse and vague. They tend to get their ego functions from other people. So a person with hysteria can get pretty enmeshed with the man or woman of the moment. However, once the "moment" passes (whatever that means to them), it's on to the next thing. So, in a way, their delusion is that this kind of behavior has no consequences. That's pretty much the definition of an empathy failure.

Sorry, I may not have been clear enough about the word "delusion", I meant the psychosis and schizophrenia claims; I think those are serious symptoms and having a diffuse sense of self seems also to indicate that there might be something more than just a desire to please momentarily.

Absolutely, hysteria is a very serious and emotionally disregulated condition. Intermittent psychoses (usually induced by stress) and disassociations are very common. It's certainly possible that someone who is a full-blown hysteric is not just responding to other people's desire but also has constitutional elements as well. The thing is, we haven't figured out a drug or really any kind of medical intervention with personality disorders. So the best bet is still to try to understand how they experience their own personality on a relational level (desire, mirroring, etc.) and make the therapy be about that.

It's a very good paper and I most certainly like to read your story.

Hi Windowpane,
Would you possibly be able to elaborate more on the differences between hysteria and hpd? I read over your paper a few times and that is the main question I had. Thanks. Jean

windowpane wrote:So the hysteric’s dilemma is that life is lived like a dream; a mimetic, as if, performance. Naturally, “intimate” human relationships are foreclosed by this kind of imaginary and dissociated coping. And many hysterics do feel this as a loss but are compelled to repeat their behavior. Secretly, unconsciously, the hysteric believes that adult sexual rapport is cold comfort and a sad attempt at compensation for the failure of their parent’s love. They hopefully enact romantic relationships again and again as ongoing rehearsals for an idealized performance of erotic redemption that never comes.

Their mirror is meant to capture the lover’s internal world and reflect it back to them as illuminated art in the hopes that the preoedipal mother will come around eventually. In essence, the hysteric idyllically dreams up the romantic partner and acts out their desire but doesn’t commit to any real relation. Their body may be on erotic loan to this world, but their true self is safely tucked away as a covert sacrifice and offering to ideal sublime love. In fact, many hysterics romanticize death and casually announce their suicidal dreams as though they were describing a vacation to the Bahamas (la belle indifference). Bollas points out that when an hysteric commits suicide in a mental institution, the staff is struck down by counter-transferential grief. They feel powerless (just like the victim) because they’re convinced that the patient hasn’t really understood what death is and she innocently acted out the fantasy that she would attend her own funeral!

This is probably why the hysteric can suddenly leave and run away from apparently intense involvements with people in their life. It’s as though they’re moving on from a previous, now devalued dream, and merely waking up to another exciting dream; a bit like absent-mindedly and drowsily flipping channels with a TV remote in the hopes of finding a program that will take one out of existential boredom.

Thanks for this paper. I particularly identify with much of the above that i witnessed for myself (much to my own dismay and pain). Concerning suicide, in my experience, and accroding to what I have also read on the topic, the HP shall talk about suicide, romanticize it, but rarely do it. In fact my understanding is, that suicide is relatively close to zero. However, to add to what you say, i am convinced that Hysterical personalities don't "feel" in the same way as the majority of the population. They "act" feelings based upon what they have intellectually learned from others to be an appropriate response in this or that scenario. Careful, I am not saying that HP don't have feelings, just that they deviate from the majority based upon reason for feeling and intensity of the feeling felt.

Here is an example that confimed my doubts. It happened during the relationship:

We were driving to a party at a friends. My ex was at the wheel. A cat ran across the road and she hit it. She did not stop, and I had to ask her several times to turn around and go back. When we got there, the car that was travelling behind us had stopped and the couple were attending to the cat. The cat was near death, but still alive, yet unconscious. With the couple I got down next to it, and i ran my finger on its face and said "shhhhh". This was an automatic reaction my side. She got down next to me, became red in the face and a tear rolled down her cheek. 15 seconds later (me still on my hunkers with the couple and the cat), she was on her way back to the car and calls me..."****, come on, we shall be late for the party". I thought about the cat all the way there, and felt upset throughout the party. She never mentionned it again and had a great evening.