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The Chairman opened the proceedings by asking two questions: (1) had hysteria disappeared or did we simply not know how to diagnose it, and (2) what in our view were the factors that predisposed to hysteria?
On diagnosis, the first panellist, Janine Chasseguet-Smirgel, pointed out that Freud had stated already in the Studies on Hysteria that the term hysteria could cover the worst and the most contradictory of phenomena. Pure forms were very hard to find in the clinical situation; mixed configurations made up of an amalgam of symptoms were the most common, so that diagnosis was difficult.
Hysteria had often been explained and treated as a severe narcissistic pathology calling for the working through of archaic nuclei of the patient's psyche. Many authors of the British school, such as Rosenfeld and Brenman, considered that powerful psychotic anxieties underlay hysteria. Other authors, such as Kernberg, placed hysterical personalities in the borderline category. By contrast, representatives of the French school, such as Green and Laplanche, distrusted and were concerned about the desexualisation of psychoanalysis.
The diagnosis of hysteria was impeded by the fragmentation of psychic structures, the lack of repression and the incompleteness of the oedipal organisation, which meant that hysterics were often seen as borderline personalities.
For this contributor, the hysterical nucleus lay in neurosis, psychosis or a borderline state according to the relevant level of regression. In her view, although some felt that this work was too simple and ineffective, it was important in hysteria to interpret oedipal conflicts, guilt at attacks on the mother and siblings, and projection on to the infantile penis of possible revenge for the subject's destructive fantasies.
She noted the difficulty of tolerating the existence of such an amorphous and indeterminate clinical entity, which could encompass hallucination, somnambulism, multiple identifications, acts of absorption rather than