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Hysteria”
defines the various forms of hysteria and the psychotherapeutic method which he has
evolved through his work with many patients. He argues that this therapy allows
hysterical symptoms to disappear (or be replaced by less benign symptoms) if the patient
is allowed to abreact a trauma by finding a way to put into words the passage of the
original event through the conscious and unconscious mind which hitherto had
strangulated this trauma. He describes the basic processes by which these unconscious
thoughts can be unravelled from the recesses of the mind via a three tiered system of the
human psyche. He conveys the inherent difficulties involved in this therapy and the
comes across several problems. Breuer made extensive use of hypnosis, which as a
means of treatment brought about some strong results. However Freud notes that not all
replace this technique with another more generalised form that would allow most patients
to be treated. Also, Freud wanted to clearly and explicitly define what hysteria was and
how to distinguish it from other neurosis in the hope that in doing so his specific
treatment of hysteria could be improved. He noted that this classification was difficult
when used in conjunction with real case-histories of patients. Some who had been given
an initial diagnosis of hysteria had produced scanty results upon treatment while others,
whom it was thought were not suffering from hysteria, were greatly helped by the
No direct and clear set of symptoms could be used to suggest hysteria. He also noted that
in splitting hysteria into distinct groups it did not mirror what occurred in the patient.
More often than not the neuroses were mixed. The aetiological factors that caused such
were mixed. Treatment of a single pathogenic agent would not be beneficial in healing
the entire system. Therefore, Freud advocated that all patients should be treated as
hysterical and that through treatment they would at least be helped if it were later found
Freud relates that his therapy was invaluable in cathartically removing not only
the symptoms of a noxious agent (a trauma) but also the noxious agent itself which is the
ultimate goal of the treatment. He acknowledged that his process could not prevent fresh
symptoms from occurring or if in the throws of acute hysteria allowing the patient to
break free. But if the process was allowed to flow it would enable the patient to slowly
regain their normal ego capacity for defending their mind against similar or same
infectious agents. This therapy was time consuming and would not reveal immediate
success. The patient is required to give themselves over to the analyst in their entirety, to
reveal their inner most thoughts and trust the therapist to help in the bearing of their soul.
This requires a base strength of mind and intelligence from the patient. The unconscious
resistance that the psyche builds up against this work is great and many patients will
leave rather than reveal their deepest thoughts or try to place the analyst-patient
relationship in the way of the process. However this relationship built by the difficult
work will help to work through the problems of the psyche that the patient is suffering
from.
been the cause of a hysterical symptom. Much initial work would involve convincing the
patient that they did indeed know the root of the problem and only need to concentrate
their mind on the matter to make steps towards resolving it. By making the patient a
collaborator in the work Freud propositioned that they would bring to light the many
pathogenic ideas that had been resisted and transformed into hysterical symptoms. By
means of psychical work psychical force in patients that had opposed pathogenic ideas
coming to consciousness, the same psychical force that had played a part in generation of
the hysterical symptom, could be overcome. He submitted that pathogenic ideas had been
repressed and forgotten from the consciousness. The patient had defended against
incompatible forces that had ruptured the ego. In directing a patient’s attention, through
the use of language, to such forces the psychical force that had once been resistant could
would be lessened or removed. This was difficult work, however as the ego once
provoked into exploring repellent unconscious thoughts would stir up strong defensive
psychic mechanisms. The same force that had generated the original hysteria would be
used in trying to repulse the work of the analyst. Simply put the patient would
unconsciously know the causes, and consciously resist this by declaring that they in fact
did not know the causes. This could be clearly seen as a ‘wanting to not know’, a
resistance to associate pathogenic ideas and relieve any symptoms. This resistance took
many forms from breaking initial promises of revealing all, to not wanting to know, to
distraction, to disavowal of the knowledge and many other remarkable excuses. Freud
concentrate the patient’s mind, Freud made use of a number of techniques such as the
application of pressure to the forehead and the free association of the patient’s thoughts.
The goal was to disassociate the patient from their conscious thoughts. No topic that
came to mind was invalid or not useful to the work. The patient should disclose all
thoughts that came to mind, even if they consciously perceived them as came to mind,
even if they consciously perceived them as unhelpful. Freud had already identified that in
trying to defend their own egos, the patients would try to disavow any use of thoughts
that were, in fact, most useful of all. This required a trust and strong relationship between
Freud and his patients. He needed to instil in them the sense that all that was revealed
during a session would not be judged or criticised, that the freeing of their psyche from
intentional thinking would lead them past the obstacles of resistance through the causal
set of pathogenic ideas that had not been abreacted. In following this process Freud noted
that ideas would be elucidated that were intermediate chains in a larger path from the
hysterical symptoms to the original trauma. This path is winding and without apparent
structure making it inconceivable, initially, for the patient to believe that they had any
such memories. This along with the patient’s unconscious resistance would make the
process laborious and difficult. However by carefully concentrating the patient’s mind,
by noting all conscious and unconscious ideas brought forward through speech, imagery
and bodily movements of the patient Freud could help to guide the patient down the
many paths of the unconscious by removal of the barriers of resistance and lead
ultimately to the mixture of pathogenic ideas that had caused the patient psychic harm.
Freud in ‘Studies on Hysteria’ presents many cases of perceived hysteria that were used
initial theory brought about patient work to further inform and give feedback to the
theory itself.
pathways which he must help the patient negotiate through as a three-layered system of
discussed previously Freud had noted that hysteria is typically a succession of partial
material as a structure with three parts. The nucleus contains the culmination of the
traumatic factor. Around this nucleus there exist concentric stratified themes of
memories. These have a linear chronological order with fresher, newer experiences lying
on the outer edges and older experiences lying close to the centre of the structure with the
nucleus as its centre-point. The final layer of arrangement and association is a pure
arrangement by thought content rather than purely chronological means. This allows
logical strands of thoughts to jump about from the nucleus to the outer and inner edges of
the themes of memories and collect at nodal points where several strands meet and depart
into further strands. As each layer is explored the analyst cannot simply move from the
outer to inner edge but must follow and exhaust all strands of thought to the pathogenic
nucleus. In doing so, resistance will be brought forward. It is useless to jump straight to
the nucleus of the psychogenic material as the patient would struggle to know what to do
with the information brought forward. The psychotherapist, as suggested by Freud should
slowly draw memories through the narrow cleft of the ego and in doing so piece these
together recollections of the patient gaps and imperfections can be found and probed to
extend into new and still unresolved areas. Every single reminiscence which emerges
during an analysis therefore has significance. The psycho-analyst on taking this journey
with the patient should guide but not interfere with the patient’s reproduction of
formative ideas. This journey through the threads of the psyche will seldom be straight-
forward as resistance will often block direct route to the inner nucleus of a hysterical
symptom. The intensity of the symptom will increase as the analyst draws closer to the
nucleus. This traversal of the psyche should ultimately bring to light one or more of these
inter-dependent traumas and allow the patient’s ego a path to acceptance and resolution
of such.
psychotherapy. As negotiation of the muddy waters of the mind is difficult, the time
constraints of sessions will invariably cause the patient to suffer. In between a session the
patient will, initially, be focused on the frustration of lack of overall progress and the
progress within individual sessions. This however can be channelled into ensuring
subsequent sessions are focused and concentrated, allowing the patient to feel freer in the
interim. As Freud has noted with his description of the multi-layered associations of the
psyche, progress will also not be linearly positive. Symptoms may in fact increase during
treatment as the patient tries to bring his unconscious to the foreground but is affected by
self-deception, hesitations, doubts and disavowals. During the therapy the analyst may
come up against the problem of the failing to concentrate the mind of the patient. This
can be due to the patient having exhausted all current threads of memories, having hit a
the chapter, patient’s co-operation is great. This personal sacrifice needs compensation
takes the form of transference, personal estrangement and dread of becoming too reliant
on the analyst. This transference however is noted to play a vital part in the therapy itself.
In doing so the patient is the process of transforming their hysterical misery into
commonplace unhappiness. Their ego will be strong enough to wave off further attacks of
mental instability.
relation to Breuer’s work but takes it as a starting point upon which through patient work
he builds a first theory of psychotherapy. He relates the requirements placed both upon
the patient and the therapist and the means by which the therapist should help the patient
to translate their unconscious and thereby purge and abreact the underlying trauma. The
interconnected set of memories. He points out the forms of defence and resistance put up
by the human ego and the means by which his therapy relies on the removal of such
obstacles through what is essentially known as the talking cure, the communication of the
unconscious to inform the conscious and thereby remove inherent traumas and as a side-