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Patients who do not seem to have a psychotic character structure sometimes develop overt psychoses. Such psychoses are especially unsettling if they are connected with treatment. These have been studied under many overlapping designations: transference psychosis, hysterical psychosis, delusional transference; and, earlier in this century, hallucinatory confusion and amentia. Yet a well-integrated explanation has not emerged. Pankow (1974) describes hysterical psychosis as one of those “unrewarding areas of psychiatry which attract the interest of neither practitioners nor theoreticians” (p. 408).
Freud (Breuer and Freud, 1895) linked such psychotic symptoms with childhood sexual trauma as early as 1881. Anna O. was treated for “a psychosis of a peculiar kind” (p. 22), complete with vivid hallucinations and gaps in her thinking and sense of time, and Frau Emmy von N. for symptoms including delirium and hallucinations. In “The Neuro-Psychoses of Defence,” Freud (1894) concludes:
For these patients whom I analysed had enjoyed good mental health up to the moment at which an occurrence of incompatibility took place in their ideational life.…
In females incompatible ideas of this sort arise chiefly on the soil of sexual experience and sensation [p. 47].