Chapter 6 Hysteria

We generally regard as health, a capacity to meet the realities of life (external and internal), and that this capacity is capable of growth. In illness, excessive defences are employed as a way of dealing with the vicissitudes of life, stunting development and increasing the fears of negotiating reality. In this paper, I explore a psychic organization which we tend to call hysteria. I hope to show how the ‘hysteric’ feels held together by his defences and faulty object relationships and simultaneously mutilates and is terrified of reality.

At first I thought I had very little use for the concept of hysteria and regarded it as an obsolete diagnosis which was part of the history of psychiatry and psychoanalysis, yet at the same time I felt I could not ignore it, as something like hysterical features occurred so frequently and so pervasively in clinical work. I think that many features which are regarded as hysteric have now been refined and understood in more detailed ways – such as the studies of narcissism. Freud himself had a great deal to say on the subject in his early writings (1893-1895) but seemed to depart from the theme as more knowledge was acquired about psychopathology.

I wondered if the diagnosis of ‘hysteria’ was meaningful and when I discussed this with colleagues, I found many who shared this view. A few colleagues said they did not know what hysteria was but they knew an hysteric when they met one. This view is not without its value because it indicates that there is a concept of a ‘hysterical character’ who affects one in a way that produces antipathy, and I hope to show reasons for this in the course of the paper.

I also looked at the problem from the point of view of hysteria as a defence against psychosis and thought it might be valid to talk of an ‘hysterical defence’. At the same time, in clinical work I have come across extremely ‘mad’ behaviour and found that I was saying to myself ‘this is not

psychotic, this is hysterical’. I believe I was