Freudian Doctrine of Hysteria

   (1892 and after)

   The word "hysteria" accompanied Freud throughout his career. For him, it always meant physical symptoms having a psychological causation, yet his conception of the mechanism changed greatly during the years. In one of his earliest articles, "A Case of Hypnotic Healing" ("Ein Fall von hypnotischer Heilung") in the Journal of Hypnotism and Suggestive Therapy (Zeitschrift für Hypnotismus, Suggestionstherapie) (vol. 1, 1892–1893), he spoke of hysteria as involving "dissociation of consciousness." Freud considered "conversion disorders" a particular form of hysteria. In his 1894 essay on the "Defensive Neuropsychoses" Freud explained that, in contrast to phobias and obsessions, in hysteria the intolerable memories of past events are detoxified in the mind by transmuting the sum total of their excitability into physical symptoms, "for which process I should like to propose the term ‘conversion’ " (see "CONVERSION") ("Die Abwehr-Neuropsychosen," published in the Neurologisches Zentralblatt) (Gesammelte Werke, I, p. 63.)

   Then in 1895, in Studies in Hysteria (Studien über Hysterie), which he co-authored with Viennese family doctor Josef Breuer (1842–1925), Freud argued that "traumatic hysteria" was caused by remote traumatic events and was treatable with cathartic therapy. It was here that Freud dilated upon the term "conversion symptom": "The hysterical nature of the defense [against intruding past memories] . . . consists in the conversion of the agitation into a somatic innervation, the benefit of which is that an unbearable idea is repressed from consciousness" (Gesammelte Werke, I, p. 181). In 1905, in his "Fragment of an Analysis of Hysteria" ("Bruchstück einer Hysterie-Analyse") in the Monatsschrift für Psychiatrie und Neurologie, Freud showed in a case study that hysteria was intimately linked to the patient’s underlying sexual life. "The psychopathology is, to put it bluntly, the patient’s sexual life" (Gesammelte Werke, V, p. 278). Freud also said that sexuality in and of itself possessed biological components. Finally in 1926, toward the end of his most productive theoretical years, in The Problem of Anxiety (Hemmung, Symptom und Angst) that appeared as a book, Freud called hysteria "the necessary defense against the libidinous demands of the Oedipus complex" (Gesammelte Werke, XIV, p. 146). Thus hysteria had become an intrapsychic mechanism for coping with anxiety, and subsequent psychoanalytic writing would see conversion symptoms as a way of binding anxiety.