Hysteria Today

Anouchka Grose

• Editorial: Routledge
• Año: 2018
• ISBN:
  9780429914676
• Edición: 1
• Categoría: Psicología
• Categoría: Historia y teoría en psicología

Hysteria, one of the most diagnosed conditions in human history, is also one of the most problematic. Can it even be said to exist at all? Since the earliest medical texts people have had something to say about 'feminine complaints'. Over the centuries, theorisations of the root causes have lurched from the physiological to the psychological to the socio-political. Thanks to its dual association with femininity and with fakery, the notion of hysteria inevitably provokes questions about women, men, sex, bodies, minds, culture, happiness and unhappiness. To some, it may seem extraordinary that such a contested diagnosis could continue to merit any mention whatsoever. Hysteria Today is a collection of essays whose purpose is to reopen the case for hysteria and to see what relevance, if any, the term may have within contemporary clinical practice.

CHAPTER ONE

Hysterics today

Leonardo S. Rodríguez

A long history

Hysteria and hysterics have occupied physicians, philosophers, playwrights, and poets since antiquity. They have been a key presence in the history of psychoanalysis since its inception, and Freud credited a hysterical patient with having made a substantial contribution to the creation of the psychoanalytic method, when this was only in its gestational phase (Freud, 1895d, p. 56). Yet, having adopted them since the nineteenth century, the psychiatry of our times tends to avoid the use of the terms “hysteria” and “hysterics”, and prefers other nomenclatures to designate clinical phenomena that, from a psychoanalytic perspective, are typically hysterical. The last edition of the Diagnostic and Statistical Manual of Mental Disorders does not even mention hysteria, while the psychoanalyst will recognise hysterical phenomena (even if not exclusively) throughout that text under a diversity of headings: “Anxiety disorders”; “Dissociative disorders”; “Somatic symptom and related disorders”; “Sexual dysfunctions”; and probably under other categories (American Psychiatric Association, 2013).

The terms currently used in psychiatric nomenclature to refer to hysterical phenomena are less precise than the psychoanalytic usage of “hysteria”, “hysterics”, “conversion hysteria”, and “anxiety hysteria”: in the psychoanalytic practice informed by the works of Sigmund Freud and Jacques Lacan an effort is made to distinguish real hysterical symptoms from symptoms and signs that may resemble hysteria but which do not belong to the same clinical category.

There is a certain irony in referring to “symptoms and signs that may resemble hysteria” but which do not belong in hysteria “proper”. Until Freud, hysterical phenomena of the conversion type “resembled” physical symptoms and signs, accepted as “genuine” by a medicine oriented by the knowledge and clinical principles available at the time. But the resemblance to “true” symptoms and signs engendered the suspicion that hysterical phenomena could not be regarded as serious matters for scientific research and clinical practice. They were considered imitations, simulations of true disease, artefacts aimed at generating sympathy, at saving the sufferer from work on the grounds of sickness, at being spared from the duties and exigencies of human life: cases of fraudulent individuals, even if it was recognised that the conscious intentions of these individuals might not be deliberately deceitful, and that they might have justifiable motives to pose as ill people—disappointments in life or tragic circumstances that rendered their attempts at peculiar forms of fraud forgivable.

The words “hysteria” and “hysteric” have nevertheless survived outside psychiatric circles, in ordinary usage. They continue to be popular in English (as do equivalent terms in other languages), although they tend to be employed in a pejorative sense: “She became hysterical”, “These people have developed mass hysteria”, etc.

In psychoanalysis of the Lacanian orientation (which has always maintained its Freudian foundations), hysteria and hysterics continue to be the appropriate terms for well-established concepts that operate as clear reference-points in clinical practice. Hysteria designates different forms of neurosis—a plurality of typical neurotic formations that constitute variations of the same clinical structure—with a degree of clarity and specificity that contrast with the diffuse meanings assigned to the terms that have replaced it in the discourse of psychiatry. Furthermore, beyond what Freud first envisaged in his clinical practice and research, hysteric has become the denomination (particularly in the works of Lacan and the psychoanalysts inspired by Lacan) for first, a modality of discourse that is fundamental in the constitution of bonds between human beings, and second, an essential dimension of the complex relations that humans maintain with their own bodies, in so far as these bodies are not treated as purely natural entities but are always approached through the mediation of linguistic and cultural artefacts. This extension of the concept does not affect the precision that is required in a clinical practice: on the contrary, it has thrown further light upon hysterical clinical presentations and our orientation in their treatment—in particular, the diverse modalities in the development of the transference-relation by patients in analysis, the strategy for the handling of the transference on the part of the analyst, and the somatic manifestations of the workings of the unconscious.

The etymology of the words hysteria and hysteric illustrates the intimate links that exist between discourse, the human body, and hysterical phenomena. For a long time it was believed that these words, whose usage became frequent in medical and other circles from the sixteenth century, derived from the Greek uterós, “uterus”, and some passages of Plato’s Timaeus were interpreted as involving a pre-scientific theory of conversion hysteria, according to which the typical symptoms of this disturbance, already recognised by the Greeks of the classical period, would emanate from the activity (or hyperactivity, rather) of a “wandering womb”, itself propelled to travel in an unusual way to different locations of the internal body by a state of sexual dissatisfaction (Plato, 1961, pp. 1194, 1195, 1199, 1210). A study by M. J. Adair published years ago contests that interpretation, and argues that it is based on an incorrect translation of the original terms employed by Plato, which should be better rendered as “wandering desire” rather than “wandering uterus” or “womb” (Adair, 1997).

Not being a Greek scholar, I am not in a position to judge on the validity of Adair’s interpretation. If this author were right, Plato’s theory, without having any “solid” scientific or clinical foundation, would still be closer to the psychoanalytic findings concerning conversion hysteria than the interpretation based on a fictional account of the life of an unhappy uterus. At any rate, it is interesting to note that the two alternative interpretations of Plato’s text are based on the intuitive assumption that the mechanism of symptom-formation in conversion hysteria involves either a displacement of an organ (albeit an anatomical displacement, rather than a symbolic one) or the transposition of a mental formation on to bodily manifestations, as well as a sexual aetiology, that is, a state of lack of satisfaction of either a circumscribed sexual organ or the entire sexual desiring subject.

If hysteria has retained a prominent place in our lives and culture despite the disavowal to which it has been subjected by contemporary psychiatry, this is because it concerns the foundations of human existence, that is to say, language and the body: spoken words and their impact upon our corporeal habitat, in which, and through which, we create and destroy bonds with one another, we love and hate, we suffer and rejoice.

After Freud

A few lines of Freud’s “Comparative study” of 1893 condenses what was already known in medical circles about hysteria of the conversion type, as Freud would later call it:

[…] in its paralyses and other manifestations hysteria behaves as though anatomy did not exist or as though it had no knowledge of it […] It takes the organs in the ordinary, popular sense of the names they bear: the leg is the leg as far up as its insertion into the hip, the arm is the upper limb as it is visible under the clothing. (Freud, 1893c, p. 169)

It demanded nothing less than the clinical and epistemic revolution that Freud brought to this world to explain this strange state of affairs.

Grounded on a clinical experience rich in questions and enigmas for someone more interested in what was not known than in applying established knowledge therapeutically, Freud articulated a theory of conversion hysteria (Freud, 1894a, p. 49) and, fifteen years later, of anxiety hysteria (Freud, 1909b). Freud’s fertile clinical and theoretical production during the last decade of the nineteenth century enabled him to identify a formative, structural, and structuring link between hysterical symptoms, the modalities through which hysterical patients typically address the Other verbally, the constitutive mechanisms of the unconscious and its formations (dreams, parapraxes, jokes), and the method of free association, which has served analysands and analysts so well over the past 120 years.

It is highly improbable that the secret of the hysterical symptom could have seen the light of day outside the new discourse created by Freud, of which the method of free association is an instrument. No “objective” procedure that attempts to by-pass the patient’s subjectivity has been efficient in uncovering the causes of hysterical symptoms. “Subjectivity” is here used in a non-speculative sense: it refers to that which in the human subject remains largely unknown yet partially manifest in traces materialised by words and silences, in dreams, in peculiar expressions of the unconscious that are expressed through the body (conversion symptoms and anxiety), and in the eccentricity of obsessive ideas and compulsive acts. The method of free association created by Freud enables the analysand’s unconscious subjectivity to be revealed systematically in a way that no other human discourse has been able to achieve: poetry, the arts, and the different forms of neurotic and psychotic madness also reveal the unconscious, but they do not so systematically, and when they do the revelation is cryptic, enigmatic, and requires interpretation—the interpretation for which psychoanalysis has provided a rationale and a practical guide. The Freudian method has made it possible to develop an efficient therapeutic approach to the neuroses, the psychoses, and the perversions based on the respect for, and analysis of, subjectivity.

The essential attributes and components of human subjectivity today remain as they were in Freud’s times, in the same way as the structures of language and the human body have not changed essentially—the comparison is not accidental, as there is a correspondence between subjectivity, language, and the body, even if they belong in different levels of organisation.

What have changed, however, are the ways in which the dominant discourses define, approach, and materially deal with our subjectivity, and consequently the ways in which we, as individual subjects—subjects subjected to these discourses—deal with it. In this connection, the reference to capitalist discourse, and the ideals represented by forms of jouissance promoted by a society of consumers, has become commonplace. This reference is not incorrect, but it is insufficient to explain the contemporary modalities of human subjectivity. We have become used to hearing that the human subject has been practically abolished and has become a senseless consumer, an automaton dominated by the pursuit of useless and self-destructive forms of jouissance. Although recognising the bit of truth contained in such statements, one must nevertheless pay attention to the multiple manifestations of human subjectivity still present in the life of the arts and the sciences, in social and political movements, and in what touches us directly—neurotics and psychoanalysis. The reduction of human subjects to consumers does not result in the elimination of subjectivity: the capitalist mode of production, and its apparatuses of publicity and propaganda, still depend upon the generation of choices that, although forced and narrow, require nevertheless the enactment of subjectivity. This is not less a subjectivity for being the subjectivity of our troubled times.

The capitalist discourse and its scientific and technological supports were already dominant in Freud’s cultural milieu (cf. his Civilization and its Discontents, Freud, 1930a). The material and ideological conditions determined by capitalism, science, and technology in Western societies in the nineteenth century promoted the creation of psychoanalysis by a single man who, for ten years, worked, as he put it, “in splendid isolation”. The same conditions simultaneously favoured the resistances against psychoanalysis (cf. Freud’s “A difficulty in the path of psychoanalysis”, 1917a): this is only one among other instances of the contradictions that emerge in a dynamic culture.

If psychoanalysis has survived the many difficulties it has encountered in its path, this is because of the good work of a few psychoanalysts, but also because of the good work of neurotics (and psychotics, and perverts), whose psychopathology has served as a refuge for their subjectivity. Some of them have embarked on a psychoanalysis, thus choosing to learn something from their own psychopathology and perhaps move beyond it. For that purpose they have had to struggle against their own resistances, as well as cultural resistances. Yet these resistances are a function of the unconscious, and one can learn from them and eventually create something out of them—something modest that may well remain unnoticed, or alternatively something that represents a tangible social contribution, from the ordinary tasks of everyday life to artistic or scientific sublimations. Hysterics, too, contribute to our culture in better ways than the stereotypical figure of the histrionic and forever whining creature.

It was Freud who first linked hysteria and subjectivity in practice, and not only in theory, by listening to the hysteric qua subject and learning about hysteria from that subject—rather than attempting to deal with hysteria as an object-illness, a de-subjectified entity that could be examined as an infectious disease, a malignant tumour, or a metabolic disorder.

What is new, if anything, in the hysterics of today? Are they relatives of those that Freud treated in the last years of the nineteenth century?

Apart from the psychiatrists and other professionals who regard hysteria as something of the past, or who simply foreclose its existence, there are people (including many psychoanalysts) who believe that hysteria and hysterics do exist; yet they also believe that today’s hysterics are very different from Freud’s patients in their clinical presentation, presumably because the cultural conditions under which the hysterics of today have grown (and in particular the social habits and regulations concerning sexuality) have changed radically over the last century. From this perspective, we could still recognise the existence of hysteria as a clinical structure, but its typical symptoms would differ markedly from those presented by Elisabeth von R. and the other patients that Freud inscribed in history by making them the central characters in the pieces of the new genre that he created: the psychoanalytic case history.

This new genre, and the style of Freud’s presentation of his hysterical patients, have been as decisive as his more theoretical works in our comprehension and the clinical efficacy that we have been able to obtain in the treatment of contemporary patients. Freud’s case histories constitute substantial components of the conceptual corpus of psychoanalysis and have moulded what generations of psychoanalysts have regarded as “a case”: the narrative of the real vicissitudes of the singular psychoanalytic treatment of a unique patient by an equally unique analyst. They are vivid accounts of the discourse that Freud created, one in which the “case” (etymologically: “fall”, “chance”, “occurrence”, i.e., that which falls within a category) spoke to someone who listened—and who listened because he was interested in what the hysteric had to say, the way in which she said it, and her peculiar style of addressing the interlocutor.

None of the clinical facts of hysteria, or for that matter of any neurosis, psychosis, perversion, or other “case” hard to assign to any of the established nosological categories, would exist had Freud not invented that new form of talking and engaging with other human beings—the psychoanalytic clinical experience—which since Lacan we call the psychoanalytic discourse.

In its essence this discourse, if applied according to the rationale that Freud established for it a hundred or more years ago, has not changed to this day (Freud, 1895d, 1900a, 1905e, 1912b, 1912e, 1913c, 1914g, 1915a). This is a remarkable fact, as during the same period an extraordinary number of works published by psychoanalysts in several languages provide testimonies of the most diverse conceptual and clinical orientations within the psychoanalytic movement. Despite this diversity, all the analysts who identify with a Freudian affiliation share the same fundamental principles and rules in conducting their clinical practices, even if they explain and justify their experience and actions in very different terms.

The hysterics of today are not that different from those who lived in Vienna in the 1890s, and that is why we continue to employ the word. They are different because everybody today is different from the Viennese of those days (including the Viennese of today) in a number of significant ways: culturally, socially, linguistically, even physiologically and biochemically, if one takes into account advances in the sciences and practices concerned with human health, as well as the modern diets and the various regimes aimed at preserving the integrity of muscles and bones which hold our bodies together. The Viennese of the end of the nineteenth century, hysterical or otherwise, were different in significant ways from their contemporaries living in other places, languages, and cultures, in the same way as we are very different from our contemporaries in other continents and/or cultural environments. As the capital of the Austro-H...