The Analysis of the Hysterical Patient: Limitations?

Hysterical patients were the ones around whom both the theory and the therapy of classical psychoanalysis came into being, and for a long time they were considered the patients most amenable to, and with the best prognosis for this treatment. These considerations stemmed centrally from Freud's original conceptualization

of the phallic-Oedipal nature of the salient psychosexual developmental fixation points and conflict loci in patients with hysterical symptoms; this conceptualization was later extended to the hysterical character formation as well. It was Marmor (1953) who, in a widely noted paper, so strongly underlined the often equally strong oral-level fixation points in the hysterical personality organization. Zetzel (1968) then elaborated these considerations of the range of developmental fixation levels and concomitant neurotic conflict that characterized the array of hysterical character organizations into prognostic and therapeutic prescriptive counsel. Zetzel distinguished patients with truly excellent prognoses, from the “so-called good hysterics,” with much more problematic treatment prospects. This whole field of the diagnostic understanding of the phenomena of the hysterical personality, as well as of the technical prescriptions for therapy, has thus grown considerably in complexity (and, alas, also in ambiguity) since the original Freudian conceptualizations, For one overview of present-day psychoanalytic thinking on these various diagnostic, prognostic, and therapeutic issues—one that is at the same time linked firmly to the empirical experiences with the PRP sample—see a discussion of mine (Wallerstein, 1980-1981).

The PRP experiences had to do with a cluster of patients with certain marked similarities in personality structure and in the nature of their illnesses; incidentally, all of these were thought originally to be among those with the best prognosis for thoroughgoing neurotic conflict resolution in psychoanalysis. T