Meeting of the Psychoanalytic Association of New York

January 15, 1973. CONVERSION HYSTERIA AND CONVERSION SYMPTOMS: A REVISION OF CLASSIFICATION AND CONCEPTS. Melitta Sperling, M.D.

Dr. Sperling suggested that the diagnosis of conversion should be based solely on whether repressed unconscious fantasies and the affects associated with them can be recovered in analysis as the psychic contents of somatic symptoms. All conversion symptoms go back to pregenital fixations and the differential diagnosis should be based on the type of personality disorder and psychopathology of the individual patient who produces the conversion symptoms.

The author described the history and treatment of a female patient suffering from conversion hysteria. Her symptoms were similar to those of Freud's patient, Dora, and as in the case of Dora, sexual temptation reactivated unresolved Oedipal conflicts with guilt and fear of punishment. In Dr. Sperling's patient seemingly involuntary somatic behavior could be stopped by the patient during the early phases of analysis before the underlying unconscious fantasies of her symptoms were analyzed. The author felt that the explanation of this lies in the special mother-child relationship in such cases, which she refers to as 'the psychosomatic type'. In this relationship, the mother does not permit overt expression of aggression, self-assertion, and rebellion, and puts a premium on submission and dependence. Thus the child learns early in life to repress objectionable impulses and affects. Somatic compliance in these cases often results from identification with parental symptoms and preoccupations; a traumatic situation represents the danger of loss of mother and a threat to the patient's mental balance and life. Dangerous affects and impulses are converted into symbolic somatic expressions. Aggression and pregenital sexual impulses are turned against the self and the internalized objects. In the course of analysis, the analyst temporarily displaces this aspect of the internalized maternal i