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In the course of analyses of patients with gastro-intestinal symptomatology it has repeatedly come to my attention that the symptom for which a patient entered analysis was at times replaced by another symptom or symptoms. Often a conversion symptom of hysterical nature was concurrent with and incident to at least temporary cessation of the original organ neurosis. The present paper represents an attempt to trace the transition from an organ neurosis to conversion hysteria and an analysis of the material at the time of the replacement.
It is realized that such a separation of organ neurosis from conversion hysteria cannot be considered a fixed one. However, it is customary to restrict conversion hysteria to symptoms occurring in the voluntary and sensory systems and to speak of organ neurosis in reference to function disturbances of organs whose functions are autonomic and under normal conditions not subjected to voluntary influences. It has been observed that in organ neurosis the psychological factors involved are usually very definitely pregenital in character, 2 whereas in conversion hysteria later phases of instinctual organization are prevalent, more specifically the phallic phase. I shall attempt to trace the progress of the dynamic structure during psycho-analytic treatment from early pregenital to the phallic level coincident with the change from gastric symptoms (peptic ulcer) to conversion symptom in the following case:
This patient is a forty-one-year-old female attorney who came to analysis for recurrent duodenal ulcer, agoraphobia, handwriting difficulties and a feeling of social maladjustment. She is the youngest of three children, having a brother seven years her senior and a sister five years older. Her brother is a successful attorney. The sister, who was