Belief, hope and faith

A case of hysteria is presented in order to create a frame of reference for the author's approach to the concepts of hope, belief and faith. A difference between hope as a 'sad passion' (which is here called regressive hope) and hope as a principle of mental functioning is established. The concept of hope will at first always be based on beliefs--either beliefs organised in the paranoid-schizoid position (called here fragmented and delusional beliefs)--or those organised from the depressive position (complex systems of beliefs, which end up being dogmatic); the latter typically occur in neurotics. It is suggested here that there is another possibility for hope, which is based on faith. The meaning of faith is considered here externally to the religious sense. The solid establishment of hope as a principle--based on faith--can be viewed as responsible for the opening up of creative potentials and as one of the main aims of analysis. Such an aim, however requires the establishment of a deep relationship, both in theory and in clinical practice, between the Kleinian question of the depressive position and the Freudian question of the Oedipus complex.

Existential Analysis and Psychoanalysis: Specific Differences and Personal Relationship between Ludwig Binswanger and Sigmund Freud

The concise curriculum vitae of the founder of existential analysis is followed by an exact comparison of the polarity (homo natura versus homo cultura) between Binswanger and Freud. Then the five stages in the development of (Existential Daseinsanalysis Analysis) are described: the stage of learning, of practice, of criticism, of the alternative to psychoanalysis, and of reconciliation. The criticism is aimed especially at Freud's naturalism and at the concept of drive. These concepts are opposed by ontoanalytic doctrines derived from Heidegger's ontoanalysis. The differences are further exemplified by the comparison of the existentialanalytical and the psychoanalytical view of the unconscious. A presentation of the treatment of a "hysterical phobia," which is first explained in psychoanalytic terms and later in existentialanalytic terminology (mainly concerning the world-projects) makes the difference between the two schools of thought explicit.

Pierre Janet and Félida Artificielle: multiple personality in a nineteenth-century guise

In the wake of the recent epidemic of multiple personality phenomena, it is important to get a clear idea of what similar phenomena looked like in previous centuries. Pierre Janet's detailed description of his discovery, made during the 1880s, that he could cure hysteria by creating a healthy second personality offers a close look at a form of multiple personalities very different from what has recently been described. His description of the factors that influenced his discovery allow one to see his work in a historical context and to appreciate his confrontation with the paradoxes that this discovery revealed.

[Treatment of hysteria in the 19th century--in which way did German psychiatrists view castration?]

Until the late 19 th century treatment of hysteria, this inhomogeneous group of somatic, neurological and psychiatric symptoms, hardly differed from the methods of the Greco-Roman epoch. Dietetics, physical applications, and smaller surgical operations made up the standard forms of intervention for this illness which was regarded as belonging to the field of gynecology. Thus, it is not astonishing that oophorectomy (ovariectomy) was included into the therapeutic spectrum for hysteria both in Germany and beyond at the end of the 19 th century. It was above all gynecologist Alfred Hegar (1830 - 1914) who tried to extend the application of this method to nervous illnesses. This therapeutic alternative did not, however, meet with an unanimously positive response among psychiatrists. Richard von Krafft-Ebing (1840 - 1902) as a follower of the degeneration theory as well as Paul Flechsig (1847 - 1929) supported it, applying it as the ultima ratio. But since these operations produced no lasting curative impact, functional neurological disorders were regarded more important. From Emil Kraepelin (1856 - 1926) then, psychiatrists began to understand the psychological component of this illness, for which Leipzig neurologist Paul Julius Möbius (1853 - 1907) had made major contributions. Thus, surgical interventions were rejected and conservative methods of treatment were developed further considering psychological aspects. It was Adolf Strümpell (1853 - 1925) who had laid the basis for this postulating a "psychic trauma" as the cause for hysteria as early as in 1884. On the other hand, Möbius had developed a psychotherapeutic concept for the treatment of these disorders long before Sigmund Freud (1856 - 1939) came out with his psychocathartic method.

Hysteria. Pretending to be sick and its consequences

Hysteria, as it involves the medical profession, is a form of sickness that is defined as being without disease or illness. This lack of a biomedical explanation has limited progress in its understanding. In this essay we propose that hysteria might be better thought of as a form of pretending, elaborated in transaction with the medical system. In medicine, to pretend usually means to deceive. From the perspective of play, however, pretend is a state more akin to acting, magic, belief, and hypnosis. We provide a number of reasons why sickness is an attractive focus for pretending. We show how enactments of sickness can be scripted by a group of involved persons, each contributing from their own perspective, as occurs in the parlour game of 'Consequences', except in hysteria the consequences are often dire.

Distinguishing the drama from the histrionics in a case of hysteria with multiple tics

The author describes a clinical experience with a hysterical patient with multiple tics, an upper-middle class, married woman, who when she started analysis at the age of 30 was in a state of profound tension and anxiety. The first eight years of this analysis are presented in order to describe how the analyst came to identify the dynamics of unconscious phantasies in a situation where analyst and patient found themselves involved in several roles of a drama dominated by theatrics. The insights and therapeutic benefits suggested that this patient unconsciously experienced her oral needs as intensely destructive and cruel, an experience she felt to have been exacerbated by her mother's lack of response to her emotional needs. This primitive cruel orality was accompanied by a split-off experience of a secret, mystical union with the primitive idealised mother. The author considers that this split experience of cruel and idealised orality suffused the patient's genital sexuality, hindering the evolution and realisation of her adult sexuality, giving her a distorted view of the primal scene as an impenetrable fused amalgam acting as an omnipotent, self-sufficient, excluding phallus. Gradually analysis enabled the patient to transform her bodily theatrics into thoughts and to broach the difficult task of relating to others instead of being either fused with them or totally excluded by them.

Follow-up study of hysterical psychosis, reactive/psychogenic psychosis, and schizophrenia

The present study was undertaken to learn more about the longer-term course of nonaffective functional psychoses, including hysterical psychosis. A group of 48 female patients diagnosed with hysterical psychosis, nonhysterical reactive/psychogenic psychosis, and schizophrenia at their first admission were reassessed after an average follow-up period of 11.6 years. Seventy-five percent were receiving outpatient treatment; less than half were on neuroleptics, and only 35% were rehospitalized. The patients suffered from a few, mostly unspecific, symptoms and were relatively well adjusted socially. No differences were found between original diagnostic categories regarding all variables studied. Hysterical psychosis does not appear to be a special clinical entity, distinguishable from other reactive/psychogenic psychoses in the short term and from other nonaffective functional psychoses in the longer term. The symptomatology and clinical presentation of nonaffective functional psychoses at first admission do not allow any prognostic longer-term forecast, and the initial differences between individual psychoses tend to disappear over time.

Mass psychogenic illness: role of the individual physician

Mass psychogenic illness is characterized by symptoms, occurring among a group of persons with shared beliefs regarding those symptoms, that suggest organic illness but have no identifiable environmental cause and little clinical or laboratory evidence of disease. Mass psychogenic illness typically affects adolescents or children, groups under stress and females disproportionately more than males. Symptoms often follow an environmental trigger or illness in an index case. They can spread rapidly by apparent visual transmission, may be aggravated by a prominent emergency or media response, and frequently resolve after patients are separated from each other and removed from the environment in which the outbreak began. Physicians should consider this diagnosis when faced with a cluster of unexplained acute illness.

'My bad diagnostic error': once more about Freud and Emmy v. N. (Fanny Moser)

The author examines two aspects of the case of Fanny Moser (Emmy von N. in the 'Studies on Hysteria'): first, a hitherto unknown letter written by Sigmund Freud to Fanny Moser's daughter in 1935, in which he revises his diagnosis of half a century before, describing it as 'a bad diagnostic error' and apologising to the daughter; second, the dates of Fanny Moser's treatment. All previous attempts have failed to date it consistently. The author combines all the information about the case of Fanny Moser and the circumstances of Freud's life in that period and shows that Freud took over the case in 1888, not in 1889. In addition, he suggests that Emmy von N. has had a significant influence on Freud's papers on 'Hysteria' and on his comparative study 'Organic and hysterical motor paralyses'.

Getting in on the act: the hysterical solution

The author recounts the case of Anna O from a contemporary psychoanalytic viewpoint, incorporating the additional information now available to us about Breuer's treatment of Bertha Pappenheim. Now the erotic transference and Anna O's 'oedipal illusion', which culminated in her hysterical pregnancy and labour, is evident to us, as it was to Freud, who did not publicly share his knowledge of Breuer's unhappy experience with this patient. Ernest Jones, in whom Freud did confide, wrongly dated the conception of the Breuer's baby in his biography of Freud describing it as a sequel to Anna O's treatment. In fact Mrs Breuer's pregnancy was concurrent with the treatment and the author suggests that it significantly influenced its course. Using the case of Anna O and one of his own the author postulates that a feature of hysteria is the use of projective identification by the patient to become in phantasy one or other member of the primal couple. A symbolic version of the primal scene between patient and analyst may then be enacted in the context of the erotic transference-countertransference that characterises these cases.

Disguised hysteria in a child psychosis?

In this paper the stages are presented in the psychoanalysis of an eight-and-a-half-year-old boy consulting with a worsening symptomatology that has been evolving for more than one year. The trigger element seems to have been the birth of a brother. During the analysis the relation was clear between this brother's birth, the mother's abortions, and the previous death of a brother. The interpretation of the homicidal omnipotent fantasies and the analyst's reception of projective identifications, destructive anxieties, and castrating anxieties of the patient produced, apparently, an unimagined fast improvement of the psychotic symptoms. This took the authors retrospectively to raise the hypothesis that this patient's psychosis could be a disguised child hysteria.