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There was a little girlAnd she had a little curlRight in the middle of her forehead.And when she was goodShe was very, very good,But when she was badShe was horrid.
This nursery rhyme must be familiar to most of you. It is particularly applicable to the analysis of those female patients whose presenting symptomatology and/or character structure overtly suggests an unresolved genital oedipal situation. This leads to a presumptive diagnosis of hysteria, a condition for which traditional psychoanalysis remains the treatment of choice. Follow-up studies of the analysis of such patients have not, however, been reassuring. In Boston, for example, we reported ten years ago:
Our reports so far tend to indicate that hysterical patients are, to put it simply, very good or very bad patients. (Knapp et al. 1960).
This conclusion was based on a review of one hundred patients evaluated as possible patients for supervised analysis. In preparing this paper I have also reviewed the initial clinical evaluation of nearly one hundred non-psychotic women. Of these, more than thirty had been in analysis, either conducted or supervised, over the past ten years. On this basis I hope to revise and explain our presumptive dichotomy and the distinction made by Easser and Lesser in a more recent paper between the hysteric and the hysteroid character.