Hysterical Trends in a Male Patient with Obsessive Ideas

FAILURES OF LOVE HAVE ALWAYS PLAYED a prominent role in prompting individuals to seek psychoanalytic psychotherapy. Contemporary theorists (e.g., Kernberg, 1974) regard the inability to fall in love as a sign of severe character pathology. Dr. Walter Spear's patient, Jack, entered therapy because he feared that he is incapable of remaining in love with and maintaining a commitment to a woman. My discussion seeks to further our understanding of this young man's perceived deficiencies in loving. I will organize the "facts" of the case to highlight issues relevant to the patient's character traits and character pathology. My working assumption is that paying closer attention to the "hysterical" aspects of Jack's style would pave the way for a constructive exploration of the core conflicts and themes that are dramatically enacted in the manifest content of the dream that is at the center of Dr. 'Spear's case report.

When you think of an obsessive do you tend to think of a male, just as when you think of a hysteric do you tend to think of a female? Existing theories and research support this gender bias (Warner, 1978). We have far less information regarding the manifestations of the hysterical personality disorder in men than in women (Luisada, Peele, and Pittarel 1974). Not surprisingly, a common diagnostic error is the failure to recognize the presence of hysterical trends in men. I believe that substantial hysterical trends can be discerned in the expressive, cognitive, and interpersonal aspects of Jack's style.

In comparison to the protypical male obsessional patient, Jack is not exclusively devoted to work and productivity to the exclusion of pleasure (Salzman, 1968) ; (Shapiro, 1965). His life structure is not achievement-dominated (Levenson et al., 1978). He is not driven by the wish to win respect and avoid failure at all costs. Rather, his outlook on "reality, " broadly conceived, is primarily "romantic" (Schafer, 1970