Recovering Hysteria (a historical / conceptual essay)

Depth Psychology, Track K, Fall 2005

Submitted February 26, 2006
Freudian Psychology DP-760
Instructor: Erik Craig, Ed.D

The concept of hysteria undergirds depth psychology like the sands of the ocean floor lay beneath the sea. Sigmund Freud was a psychological diver of great depth, he is the patriarch of psychoanalysis and, like a father who seeds new thought, he moved the concept of hysteria in a new direction. He altered the causes of hysteria from sexual trauma to those of hidden wishes, tailoring his ideas to be acceptable to the mainstream of the day while describing the patriarchy he helped to propagate. This essay is not an indictment of Freud, rather it is a historical review of the concept of hysteria.

The first systematic study of hysteria was by the French physician Briquet in 1859, titled Traite de l’Hysterie. The definition Briquet provided was “neurosis of the brain, the manifestations of it consisting chiefly in a perturbation of those vital acts which are concerned with the expression of emotions and passions” (Ellenberger, 1970, p. 142).  Briquet established that hysteria was more common among lower social classes, but did not attribute it to erotic frustration, rather he said it is violent emotions, prolonged sorrow, family conflicts, and frustrated love by predisposed and hypersensitive persons that led to hysteria. If we look at modern day symptoms of anxiety and depression so prevalent in our culture today, we could say very much that same thing.

The French neurologist Jean-Martin Charcot next investigated the difference between epileptic convulsions and hysteria in 1870. Later he used hypnosis to recreate paralysis thus removing it from the hypothesis that it was caused by an organic lesion (Ellenberger, 1970, p. 91). He then went on to investigate faith healing and gained prestige healing hysterics at the Salpetriere, making the hospital famous.  Freud audited Charcot’s seminars towards the end of 1885 and afterwards devoted his time to developing case studies of hysteria and the use of hypnosis. He translated Charcot’s lectures into German and gradually disagreed with Charcot that hysteria was hereditary (Brunner, 2001, p. 13-14). He was sensitive to the race issue since Jews were thought to have more hysteria than among “German races,” (Brunner, p. 10) and subsequently he avoided the idea of heredity and degeneracy. I believe he was fighting against anti-Semitism and race biology as factors of disease, in light of the fact that Jews actually did have a higher ratio of degenerative psychosis and degenerative neurosis, according to the data (Brunner, p. 11). Freud (1957) stated that “in carrying out this work we must of course keep free from the theoretical prejudice that we are dealing with the abnormal brains of ‘dégénérés’ and ‘déséquilibrés’ (p. 294) or degenerate and unbalanced persons. Still, he did not completely deny that heredity or constitution could play a role in the etiology of hysteria as a predisposing factor (Brunner, p.15).

Unlike the French psychopathologists, Freud shared an understanding with Josef Bruer, his Viennese mentor, which differed from them. Freud and Breur understood that ”hysteria of the severest type can exist in conjunction with gifts of the richest and most original kind — a conclusion which is, in any case, made plain beyond a doubt in the biographies of women eminent in history and literature” (Bruer &  Freud, 1957, p 103). I recognize in Freud’s writing a sympathetic and discerning view that does not condemn women even though he expresses ignorance about the desires of women. I feel a thread of hope that alhough women were objectified as failed boys, he helped to open the door of women’s liberation through attentively listening to them.

Consider the women that Freud worked with to develop his theories.  They were middle-class German women and he “blamed their illness on moral rigidity which did not even allow them to become aware of sexual wishes which were incompatible with their high-minded self-image” (Brunner, p. 15). Unlike the French, German moral rigidity led to an exaggeration of passivity and increased submissiveness to the culture. I feel it is significant that hysteria was viewed differently in Germany than in France, because my impression of the French from my travels there are that as a people they are sexually more honest, and naturally passionate.

Brunner (2001) reminds us that in the late 1870’s and 1880’s, the French State used hysteria as a medical category in their “attempt to use science against the Church.” (p. 9) The medical historian Jan Goldstein (Brunner, 2003) says that religious phenomena such as mystical reveries, ecstasies, and possession were reinterpreted as hysteria to appeal to the secular and popular spirit of the time, thereby making hysteria a political construction in France. (p. 9) The move away from religion towards science actually served a useful purpose in the development of psychology, still today religious conversion carries with it the same phenomenon. You might say that religious conversion brings disorder to the psyche, and I think it is interesting that today we call hysteria by the name of “conversion disorder.” My own experience with religious conversion at the age of 16 led me to out-of the-body experiences (that I still regard highly to this day!) and a vast opening of the unconscious to my awareness through visions, voices, and coincidences that I likened to miracles. In contrast, the process of conversion that is discussed here is the somatization of psychic symptoms such as medically unexplainable physical pains, paralysis, etc. These might be called migraines, fibromyaliga or chronic fatigue syndrome today.

Freud (1955) wrote that intentional repression of an idea from consciousness is essential to hysteria. (p. 116) Repression is the basis for conversion of the psychic symptom to a bodily symptom. Freud re-introduced the concept of conversion to explain hysteria, since the term was already in use years before Freud used it. He writes,

 If, for the sake of brevity, we adopt the term ‘conversion’ to signify the transformation of psychical excitation into chronic somatic symptoms, which is so characteristic of hysteria, then we may say that the case of Frau Emmy von N. exhibited only a small amount of conversion…There are cases of hysteria in which the whole surplus of stimulation undergoes conversion, so that the somatic symptoms of hysteria intrude into what appears to be an entirely normal consciousness. (Breur & Freud, 1957, p. 86)

Chris Mace (2003) writes that John Ferriar, an English physician, introduced conversion a century before Freud as the mind’s versatile means of reconciling contradictions (p.2). This was to remove it from the action of ‘animal spirits’ since Ferriar was agnostic. In addition, hysteria was “triggered by emotional responses” according to Brudenell Carter in 1853, usually fear, passion, or jealousy and the idea of libido was used by Benedikt in 1868 to speculate that “spinal action allowed sexual energy to have psychological form.” (p.4) Freud (1957) described in Studies of Hysteria how libidinal energy is converted into somatic symptoms when repression is present and the energy is displaced into the body as a physical symptom. He added to the idea of conversion by uniting four themes in medical accounts of the pathogenesis of hysteria: the neurological; the gynaecological; the erotogenic; and the psychogenic (p. 3), in other words related to nervous impulses, women’s reproductive system and sexual sensitivity originating in the mind or from mental or emotional conflict. I appreciate Freud to a great extent, but let us remember that historically men are not excluded from symptoms of hysteria as I explain further on.

For Freud, hysteria was based upon a split of consciousness, when one part of consciousness cannot accept a thought, idea or situation. He added “passive sexual experience prior to puberty” but switched from “actual sexual trauma to early sexual fantasy as the key pathogenic factor in all cases of conversion” (p. 3). Instead of antagonizing his Victorian audience with evidence of sexual trauma, he focused his explanation on the splitting of the mind as the cause of hysteria. This was brilliant in that it loosened up the moral judgment against hysteria, and instead made morality itself the problem. Freud admitted, though, that some cases of hysteria could be organic and could have more than one cause and, likewise, that there could be more than one kind of hysteria (p.5).

So we see that hysteria has not disappeared from society although the word is seen as politically incorrect. The medical diagnosis of conversion disorder in the DSM-IV (300.11) is

  1. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.
  2. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.
  3. The symptom or deficit is not intentionally produced or feigned.
  4. The symptom or deficit cannot, after appropriate investigation, be fully explained by general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience.
  5. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
  6. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of Somatization Disorder, and is not better accounted for by another mental disorder.

This does not take into account war based hysteria and the first case of shell shock in the Greek story of the blinding of Epizelos, written by Herodotus. Epizelos was fighting with bravery when he suddenly lost vision in both of his eyes without any physical injury. He was blind for the rest of his life. Apparently Epizelos said he was opposed by a warrior of great stature that appeared to be a phantom which passed him by and killed the next man. For medical writers, this became known as a case of conversion hysteria and Helen King (2003) writes how the label was applied to men in a less feminine way to explain how men became paralyzed during war, or lost their sight suddenly. (p. 37) Today we might use the term “traumatic stress disorder” to describe the neurosis associated with war, and likewise with sexual abuse, I would think. My attention was alerted when I read that “the mechanism which produces hysteria represents on the one hand an act of moral cowardice and on the other a defensive measure which is at the disposal of the ego” (Freud, 1955, p. 123) Imagine the trauma that the battlefield must place on those “sensitive” individuals who cannot reconcile the conflict, much like some (not all) women who are sexually abused. Hysteria requires a greater amount of moral courage to “shake off” somatic symptoms, in other words, courage to unite the repressed idea with the conscious ego. (p. 124)

So the term ‘hysteria’ has a varied and rich history which my feminist side has to rethink. Looking past the practice of performing hysterectomies as a cure for female hysteria, and accepting the label, what symptoms of hysteria can I allow myself to be conscious of? As I write this essay, I am aware of subtle hysteria that is anything but dramatic.  Where Miss Lucy R. smelled burnt pudding, I have been known to have a hypersensitive sense of smell accompanied by migraine headaches. But after a CAT scan showed no known organic cause, I truly wondered if I could have imagined the peculiar smell that I associated with a house and a relationship that I was not happy in.  I began to think that if I could exercise “moral courage” in the face of my symptoms, I could overcome the pain (and I was successful, but it is hard to maintain).  After he moved out I was still experiencing sinus pain and my hallucination (!) of the smell diminished. I was struck by Miss Lucy R.’s case and how my own symptoms differed little.

Still I am not convinced that ‘moral courage’ is the answer, because it sounds like an oversimplification. My choice of responses is to acknowledge the hysteria I feel, and address it directly.  That is, talk to the Hysteria instead of the other person (even under the guise of talking to the other person) using the sound of my voice as therapy. This objectification could be a division of personality, but it would seem to be effective. I am open to exploring it with an open mind and feel that if it is true that hysteria undergirds the foundation of psychoanalysis, then we should discuss our splits of consciousness without fear or prejudice, men and women both owning that they have symptoms of hysteria.

A better example from my family may suffice, I think. My nephew developed facial neuralgia after several months of living with his father after his parents divorced. His face would twist and contort into the most painful expression and then it would disappear. Conversations were horrifying because he seemed not to know that these contortions came and went randomly. Eventually the symptoms grew milder as he got older and they manifested as twitches, which he still has to this day. He has learned to control them for the most part, yet the twitches are discernable. At the time it manifested, it would seem to have been a temporary paralysis, as his face would freeze in a grimace.

Freud’s treatment of this conversion of energy from the psychic to the physical was to reverse its direction. Memories of trauma and the feelings associated with it could be brought to consciousness with the use of free association, one of the basic techniques of psychoanalysis.

Yet, the current object-relations approach to the treatment of hysteria as described by Nick Temple (2003) is that,

the dynamics of the therapeutic relationship in psychodynamic psychotherapy today are not primarily concerned with repressed traumatic memories, but with the human issues of the present relationship between the patient and the therapist.  This is influenced and affected by the patient’s internal world as a modified and distorted memory of the past.  This has to be resolved and worked through in the psychotherapy. (p. 286)

The object-relations approach replaces the instinctual model and can be applied to more seriously disturbed patients with personality disorders (p.294). Nevertheless, abreaction (according to Webster defined as the expression and emotional discharge of unconscious material by verbalization especially in the presence of a therapist) and catharsis (defined as elimination of a complex by bringing it to consciousness and affording it expression) could still be used as modern treatments of hysteria, although they are probably used less frequently.

Symptoms may be caused by the same mechanisms that we discussed in class, which included four characteristics of Freudian theory: 1) painful patterns that repeat themselves, called repetition, which is at the center of Freud’s thinking and led him to all of his other ideas; 2) transference during the practice of psychoanalysis when the patient transfers painful feeling or shows “irrational” feelings of love towards the therapist; 3) the idea that what is hidden and repeated represents a contradiction that exists in the psyche; and 4) our ambivalence to the human condition, that is, we want to know or feel at the same time that we avoid knowing or feeling (class notes).

In conclusion, depth psychology is like a root canal of the mind, best performed under the anesthesia of transference, where painful memories can be transferred to the doctor who will make the patient aware of resistances and help to find their origin in the patient’s past. Also, I see depth psychology as deeply rooted in the future that we are moving towards, which is reflective of the cyclic nature of life itself. A root canal is probably not the best metaphor to explain it to others, but it suits me. Obviously all creative process is an expression of depth psychology. The writing of poems involves abreaction and is as cathartic as dream tending.

On a final note, Jose Brunner on Freud and the Politics of Psychoanalysis is the one book that did more than anything else to help me fall in love with Freud. As I breathe deeply and reach to feel my soul, I realize with fear and excitement that it is possible for a woman to claim great intelligence, and yet I face the contradiction that to possess it creates fear of the way that society resists the intelligence of women, people of color, and poor people. It seems the masculine, in actuality my real father and patriarchy, has to push feminine intelligence down until women learn to do this to ourselves out of fear of pain, punishment, or lack of positive regard. I believe that Freud understood this and I think he may have smiled to himself when he listened to the premature mainstream analysis of hysteria that was popular in his day.


Breur, J. & Freud, S. (1957).  Studies of Hysteria. (Trans. J. Strachey). NY: Basic Books.

Brunner, J. (2001). Freud and the Politics of PsychoanalysisI.  New Brunswick, NJ: Transaction Publishers.

Craig, E. (2005).  Freudian Psychology. Unpublished lecture presented at Pacifica Graduate Institute, Carpinteria, CA.

Diagnostic Criteria from DSM-IV (1994). Washington DC: APA

Ellenberger, H.F. (1970). The Discovery of the Unconscious. Cambridge, MA: Basic Books.

Freud, S (1955). Studies on hysteria. In J. Strachey (Ed. & Trans.) The standard edition of the complete psychological works of Sigmund Freud (Vol. 2, pp. 106-124). London: Hogarth Press.

King, H. (2003). Recovering hysteria from history: Herodotus and the first case of ‘shell-shock’.  In P.W. Halligan, C. Bass & J.C. Marshall (Eds) Contemporary approaches to the study of hysteria. (pp. 36-48).  NY: Oxford University Press.

Mace, C. (2003).  All in the mind? The history of hysterical conversion as a clinical concept. In P.W. Halligan, C. Bass & J.C. Marshall (Eds). Contemporary approaches to the study of hysteria. (pp. 2-11).  NY: Oxford University Press.

Temple, N. (2003).  Psychodynamic psychotherapy in the treatment of conversion hysteria. In P.W. Halligan, C. Bass & J.C. Marshall (Eds). Contemporary approaches to the study of hysteria. (pp. pp. 283-297).  NY: Oxford University Press.