‘Physicality’ and Conversion Hysteria: Developmental Considerations

Psychoanalysts and psychiatrists are repeatedly intrigued by the rare and the unfamiliar. Apart from the intrinsic interest of cases of this kind, it has long been recognized that unusual clinical presentations and psychopathologies may teach us a great deal about more widespread conditions and even cast light on ‘normal’ psychological development. But it is easy to take for granted that conditions which have been widely studied in depth over a great many years are well understood, and it is often said, if not always believed, that there is little more to be learned about them. In the case of the obsessional neurosis, few would be so complacent; but other symptom neuroses still present many unsolved problems. If, for example, we ask ourselves why, in conversion hysteria, the symptoms take a particular physical form, we know that this cannot be adequately explained simply on the grounds of ‘somatic compliance’.

In revisiting conversion hysteria, many matters which are already well known will have to be restated. But it is hoped that a short discussion of the role of ‘physicality’ in this condition will help to stimulate further clinical enquiry and perhaps promote further theoretical formulations.

The symptom neuroses have always occupied a special place in psychoanalytic thinking. Freud's exposition of the process of dream formation, arising out of his self-analysis, paved the way for the firm foundation of the new psychological discipline and provided a key to the understanding of such disturbances as conversion hysteria, anxiety hysteria, and obsessional neurosis. In all these conditions, comparable processes were shown to be involved in their formation. Both dreams and symptom neuroses are regressive phenomena; both show admixtures of primary and secondary process; both show compromise formations between derivatives of the id and defensive aspects of ego functioning which are normally uncon-scious;