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It is commonly held that hysteria, in terms of full conversion syndromes, is much less frequently observed today at least in the ‘developed’ world and, although many have seriously questioned the value of the continued use of the diagnosis, it seems that the term, as Lewis (1975) remarked, will long outlive its obituarists.
Patients who come for analysis today tend to have less flamboyant symptomatology. They are preoccupied with feelings of emptiness and alienation and we understand them as suffering from narcissistic disorders or borderline conditions. I will contend, however, in this paper, that the basic psychopathology and central preoccupations of these patients are not essentially different from those patients studied by Freud and Breuer. It is the manifestations of this psychopathology which have altered although, in the privacy of the analytic consulting room, transient conversion syndromes, hysterical identifications, indeed the full gamut of ‘hysterical’ symptoms are, I think, less uncommon than is sometimes held.
In the famous ‘Preliminary Communication’, Breuer and Freud (1893) draw conclusions from their consideration of hysterical phenomena which formed the foundations of the theory and technique of psycho-analysis: the concept of repression makes its first appearance and elsewhere in ‘Studies on Hysteria’ the terms ‘unconscious’ and ‘transference’ are used for the first time in a psycho-analytic sense. For the purposes of the present paper, I wish firstly to draw attention to an essential component of Freud and Breuer's conceptualisation of hysteria which in contemporary psycho-analytic thinking has been extraordinarily fruitful.
They state:
… we have become convinced that the splitting of consciousness which is so striking in the well-known classical cases under the form of ‘double consciousness’ is present to a rudimentary degree in every hysteria and that a tendency to such a dissociation, and with it the emergence of abnormal states of consciousness