An Hysterical Psychosis in Statu Nascendi1

It is a very rare thing for a psycho-analyst who is not actually working in a mental hospital to have the chance of observing hysterical psychoses, especially hysterical dissociations. And psycho-analytical literature contains no special study on this subject, except for the cases dealt with by Breuer and Freud (Studien ueber Hysterie) in particular those of Anna O. and Emmy v. N—, and a few brief remarks in other analytic works. It therefore needs no apology if I bring forward a case of this kind. The few theoretical remarks which I shall make in connection with my account of the analysis are intended to throw open to discussion certain problems of a theoretic and technical nature to which the material gave rise.

The patient was a young woman aged nineteen, a hysteric. She had begun an analysis with a member of the Vienna Psycho-Analytical Society in April, 1923, and had continued it with me three months later. The whole analysis lasted six and a half months, and had then to be broken off on account of the appearance of a state of continuous psychotic dissociation. The patient had suffered from sleeplessness for more than five years and from a hysterical abdominal pain for the last year. This pain was felt in the region of the appendix, was very definitely delimited, and she described it as having a stabbing and 'boring' quality. It used to come on almost every day, as a rule in the afternoon, and to last from two to five hours. It ran a regular course, beginning very gently and gradually increasing to the greatest intensity, then to die down as gradually as it had arisen. During menstruation it tended to be more intense and to last longer.

Besides this the patient had suffered from abnormal states for the last three years. She herself knew nothing about them, and used always to believe afterwards that she had been asleep. According to the accounts of others it used to happen, often several times in the course of the day, that she would suddenly, in the