Psychiatry Professor M. Sagman Kayatekin of the Department of Psychiatry and Behavioral Sciences of Baylor College damns me with florid praise but misses the heart of my article on hysteria as histrionics and sees it as “a revolt”—part of a mixed bag of all kinds of revolts, including Thomas Szasz, allegedly a representative of anti-psychiatry. But I did not bring up Szasz, even though I knew him personally and co-authored a book about him: “Thomas Szasz: The Man and his Ideas.”
Breuer and Freud clearly stated their intention in the title of their introduction to The Studies on Hysteria: “On the psychical mechanism of hysterical phenomena: preliminary communication.” Mark well: hysterical phenomena. They first used the adjective hysterical and not the noun hysteria, and there was a good reason for that: hysterical phenomena applied to a wide range of observations, from “hysterical epileptoid convulsions” to “vomiting and anorexia” to “visual hallucinations”; “…what we are accustomed to find in traumatic neuroses” (Standard Edition, 2:6). True, their synonym for “traumatic neurosis” was “traumatic hysteria,” but the main phenomenon was “the affect of fright—the psychical trauma… Any experience which calls up distressing affects—such as those of fright, anxiety, shame, or physical pain—may operate as trauma” (p. 6). However, hysterical phenomena occur in everyday life, no matter whether the patients do or don't end up in the hothouse of a psychiatric hospital. David Shapiro also made this clear in his 1965 book Neurotic Styles, in which he defined neurotic styles as “a form or mode of functioning—the way or manner of a given area of behavior—that is identifiable, in an individual, through a range of his specific acts” (p. 2). True, Shapiro also meant “the characteristics of various neurotic conditions” (p. 2). But ‘neurotic’ is also used in common parlance to refer to an “emotionally unstable person” and ‘hysterical’ to mean “unrestrained emotionalism” (both in the Third New International Dictionary). There
was no noun ‘hysteria’ in the Hippocratic canon, only the adjective hysterike, as in hysterike pnix, a uterine strangulation probably referring to the retention of the placenta. The famous British doctor Sydenham translated it as suffocations of the mother. The adjective hysterical was coined as a noun in the 19th century (Oxford English Dictionary On Historical Principles), a cause of many sins of reification, including those in diagnostic classifications. In DSM-5 the word hysteria is gone and replaced with “Dissociative, Conversion, and Somatoform Disorders.” But all this is meant to prove an even more important fact: the most revolutionary consequence of Breuer and Freud describing traumatic reactions was the further extension of the concept of a traumatic neurosis to PTSD, as I stated: “Today we have a different label for a reaction to trauma: post-traumatic stress disorder. Therefore, I submit, there is good reason to cancel the use of the convenient cliché hysteria, one can instead speak of traumatic reactions.” In fact, we see PTSD in war and in civilian accidents, with or without bodily traumas, and in the survivors of the genocide of the Jews called the Holocaust and in a variety of individual metaphorical holocausts, at times called soul murder, who come to speak with us.
The other major miss of Professor Kayatekin is misunderstanding my concept of dramatology. In fact, he sums up his lengthy discussion of dramatic phenomena as follows: “All of which are in sync with drama, theater, acting and enacting and the concept of dramaturgy” (the italics are mine). Clearly, he did not take the trouble to read my paper on dramatology in which I distinguish dramatology from dramaturgy: the former referring to hysterical phenomena in real life events or dramas, the latter referring to those depicted in stage dramas created by the great dramaturgs like Sophocles or Shakespeare, showing how art imitates life. This I can forgive. But I cannot forgive without getting a retraction of this statement by him: “In sum, it is an impression, perhaps ill-founded, that the author has chosen for the sake of this paper, to remove himself from experience-near clinical practice and has instead emphasized a literary critique perspective on “hysterical/histrionic” phenomenon as it is depicted in various texts” (I added italics). Yes, Professor Kayatekin, this impression is ill-founded: I did not remove myself from anything experience-near, I practice interpersonal drama therapy (IDT)—not psycho-drama which is also an invention situation—and confront my patients
with the drama happening between them and me during the session and which we are both witnessing, and make them aware of their resistances, transferences, and neurotic habits. It is not transference that explains the here-and-now drama, it is the dramatic here-and-now drama that helps us understand transference as a compulsion to repeat and as neurotic character styles and habits.