Freud's view of hysteria in light of modern trauma research

Freud's earliest notion of the aetiology of hysterical symptoms was based on his hypothesis on the importance of trauma dissociation, upon which he began to construct his first theory of neurosis. Soon, his conception of trauma narrowed to apply only to sexual trauma, and later only to childhood experiences of sexual abuse by the father. He substituted these earliest variations on a theory of neurosis with the libido theory due to his discovery of infantile sexuality, the poor treatment results he had with hysteric patients, the frequency of hysteria symptoms, the difficulties he had in distinguishing between his patients' internal and external realities and the ambiguous nature of the reasons behind the patients' problems, presumably due to repression. Recent trauma research, however, has rediscovered trauma dissociation, which is separate from repression. This has led to a new theoretical understanding of trauma-originated dynamics and the development of corresponding treatment interventions. In this paper, the author analyzes the development of Freud's conceptions of hysteria in the social-clinical cultural context of his period, as well as the reasons which led Freud to abandon the notion that trauma dissociation was an underlying cause of hysteria symptoms.     

Women on the Couch: Genital Stimulation and the Birth of Psychoanalysis

Following Freud's emphasis on his rejection of hypnosis as leading up to the development of psychoanalysis, there has been little mention in the psychoanalytic literature of the larger context of the somatic medical treatment of hysteria within which Freud treated his hysterical patients, and which Freud himself practiced. We contend that Freud's emphasis obscured his association with massage, electrotherapy, and the procedure of genital stimulation practiced by his medical colleagues in the treatment of hysteria. We show that the history of genital stimulation—including its obfuscation, desexualization, medicalization, and co-option from traditional women healers by an exclusively male medical establishment—provides us with the background for a more sophisticated understanding of the context in which Freud developed his theories. Specifically, we examine the contribution of this understanding to Freud's theoretical emphases on autonomy and individuality, abstinence and the renunciation of gratification, penis envy, clitoral versus vaginal orgasm, mature genital sexuality, and the “repudiation of femininity” as the “bedrock” of psychoanalysis. We demonstrate that Freud's position as a Jew in an anti-Semitic milieu fueled his efforts to distance his psychoanalytic method from the more prurient practices of his day, including one his society associated with Jewish doctors and patients.     

Freud with Charcot: Freud's discovery and the question of diagnosis

Although Charcot's seminal role in influencing Freud is widely stated, although Freud's trip to Paris to study with Charcot is well recognized as pivotal in his shift from neurological to psychopathological work, a key fact of the Freudian heuristic remains largely underestimated: namely, that Freud's psychopathological breakthrough, which gave birth to psychoanalysis, cannot be separated from his ‘diagnostic preoccupation’, which is a crucial and at times the first organizing principle of his earliest writings. The purpose of this article is therefore to reopen the question of diagnosis by following its development along the path leading from Charcot to Freud. The authors demonstrate that Freud's careful attention to diagnostic distinctions follows strictly in the direction of Charcot's ‘nosological method’. More importantly, the article intends to identify the precise way in which his ideas operate in Freud's own work, in order to understand how Freud reinvests them to forge his own nosological system. If the authors trace the destiny of Charcot's lessons as they reach Freud's hands, it is the importance granted to mixed neuroses in Freud's psychopathology that allows them to pinpoint the role played by the diagnostic process in the rationality of psychoanalysis.     

The ego in Lucy R: notes on conflict in one of Freud's first cases

This paper focuses on Freud's discussion of the case of 'Lucy R' presented in Studies on Hysteria (Breuer and Freud, 1895). It is possible to see here a notion of the 'ego' being employed by Freud many years before the 1920 'turning point' in his work, and an account of the ego as a 'dominant mass of ideas' is used to explain how psychical conflicts for his patient are transformed into physical symptoms. The image of the ego defending itself against an 'incompatible' idea structures Freud's own account, and it also structures recent critical commentaries on Freud's work from within feminist writing and studies of rhetoric. Some consequences for present-day psychodynamic practice are reviewed in the course of the discussion.     

TEN SHORT ESSAYS ON HOW TRAUMA IS INEXTRICABLY WOVEN INTO PSYCHIC LIFE

The author contends that it is possible to reconcile trauma and drive theories of psychopathology if we carefully examine the general notion of trauma and reexamine Freud's ( 1919 ) theory of war neurosis and of repression itself as an elementary form of traumatic neurosis. The logic of these views follows Laplanche's reintroduction and generalization of the seduction theory in contemporary psychoanalysis.     

From the EEL to the EGO: Psychoanalysis and the Remnants of Freud's Early Scientific Practice

While numerous historiographical works have been written to shed light on Freud's early theoretical education in biology, physiology, and medicine and on the influence of that education on psychoanalysis, this paper approaches Freud's basic comprehension of science and methodology by focusing on his early research practice in physiology and neuranatomy. This practice, taking place in the specific context of Ernst Brücke's physiological laboratory in Vienna, was deeply concerned with problems of visuality and the revelation of hidden organic structures by use of proper preparation techniques and optical instruments. The paper explores the connection between such visualizing practices, shaped by a physiological context as they were, and Freud's later convictions of the scientific status of psychoanalysis and the function of its method as means to unveil the concealed structure of the “psychical apparatus”.     

Constructing the truth From ‘Confusion of tongues’ to ‘Constructions in analysis’1

The author hypothesizes that the papers Freud wrote in the period 1934‐9 constitute a fi nal turning point in his work resulting from an attempt to work through, by means of self‐analysis, early traumatic elements reactivated by the conditions of his life in the 1930s. The author emphasizes that the ups and downs of Freud's relationship with Sándor Ferenczi and the mourning which followed his death in 1933 played an important role in this traumatic situation. He suggests that through these last works, Freud pursued a posthumous dialogue with Ferenczi. This working through led Freud, in Moses and monotheism, to an ultimate revision of his theory of trauma, a revision which the author examines in full, in the light of the works of the Egyptologist, Jan Assmann. A new analytical paradigm emerges: that of constructions in analysis developed in the article of the same name. The activity of construction appears as an alternative to the mutual analysis proposed by Ferenczi and is closely bound up with the notion of historical truth. In psychoanalysis, it would mean constructing a historical truth whose anchoring in the material truth of the past is essential, though it should not be confused with it.     

Seeking double personality: Nakamura Kokyō's work in abnormal psychology in early 20th-century Japan

This paper examines Nakamura Kokyō's study of a woman with a split personality who lived in his home as a maid from 1917 until her death in 1940. She was his indispensable muse and assistant in his efforts to promote abnormal psychology and psychotherapy. This paper first explores the central position of multiple personality in Nakamura's theory of the subconscious, which was largely based on the model of dissociation. It then examines how it became a central issue in Nakamura's disputes with religions including the element of spirit possession, which invoked Western psychical research to modernize their doctrines. While both were concerned with the subconscious and alterations in personality, Nakamura's psychological view was distinguished from those spiritual understandings by his emphasis on individual memories, particularly those that were traumatic, and hysteria. The remaining sections of the paper will examine Nakamura's views on memory and hysteria, which conflicted with both the academic mainstream and the established cultural beliefs. This conflict may partly explain the limited success of Nakamura's academic and social campaigns.     

EDitorial: Identity in Change

Abstract

As we look at the evolution which has occurred in the field of psychoanalysis over the last fifty years, it is simply not possible to discuss contemporary psychoanalysis without invoking Freud. Our conference, of course, is dedicated to contemporary psychoanalysis; therefore, it is entirely appropriate for us to explore this topic.

Early contemporary psychoanalysis, I would suggest, began with the gradual evolution of the libido theory. Subsequently, contemporary psychoanalysis increasingly concerned itself with the early pre-oedipal dyadic relationship between mother and infant as well as the concomitant development of the ego. Finally, Freud's monumental and long lasting contribution to the clinical understanding of hysterical symptoms is increasingly relegated to the status of a superfluous antique. Analysts who are familiar with the ongoing contemporary significance and utility of Freud's early conceptualizations concerning the dynamics of hysteria and its treatment understand that the symptoms often represent and express an incompatible idea which has been repressed. When the analyst directly interprets the symptoms in a timely and accurate fashion, transference analysis is stimulated and enhanced.     

“sexuality and death” in freud's discovery of sexual aetiology

Abstract

The present study focuses on Freud's discovery of sexual aetiology in the period from his studies in Paris and Berlin (1885–86) to self-analysis (1897). The study gives a reassessment of both the link and the break between Freud's early works and the contemporary medical views and splits concerning sexual aetiology, which is relevant for the understanding of Freud's later developments. Freud's initial aversion toward sexual aetiology is investigated, and a significant connection between sexuality and death is found in the medical practice of female circumcision and castration in the treatment of hysteria. Finally, the relevance of the tabooed surgical operations is discussed in relation to a series of important moments for the birth of psychoanalysis (the collaboration with Fliess and the operation on Emma Eckstein, the Irma dream, the seduction theory and its abandonment, and the emergence in Freud of the memory of the death of little Julius as the “germ of guilt”).     

Fatherhood today: variations on a theme

Freud explored the concept of the unconscious in some detail in one of his papers on 'metapsychology' in 1915. But this concept is crucial to the birth of psychoanalysis more than twenty years earlier. If we look closely at one of the early cases Freud described in his 1895 book with Breuer, Studies on Hysteria, we can see how that concept was also being born. This paper focuses on the case of Elisabeth von R, to show how the distinctive psychoanalytic understanding of the unconscious was starting to be used there to make sense of her hysterical symptoms. Freud's account and the words he chooses to frame it raise a number of questions about theory and practice in psychoanalysis, which we examine here in relation to unconscious love.     

Variations on the concept of traumatism: Traumatism,traumatic, trauma1

In this paper, the author outlines Freud's fundamental hypotheses concerning the concept of traumatism, then goes on to differentiate three notions (French being a particularly apposite language for such a venture): ‘traumatism’, ‘traumatic’ (in a substantive sense) and ‘trauma’. These three terms correspond to the three turning points in Freud's theory with respect to the concept of traumatism (1895‐97, 1920, 1938). The author evokes also the developments that are due to Ferenczi, particularly in his later writings (1928‐33), where he defi ned and discussed the question of ‘trauma’ in contemporary clinical practice; the author goes on to explore the different variations on this theme as regards mental functioning. He then defi nes, from a metapsychological point of view, the differences between ‘traumatisms’ that have been ‘worked over by secondary processes’, organised and governed by the pleasure‐unpleasure principle (‘traumatism’) and ‘early’ or ‘primary traumatisms’, which interfere with the process of binding the instinctual drives (‘trauma’); states of mind infl uenced by a traumatic imprint (‘traumatic’) are looked upon as belonging to both categories of the above mentioned traumatisms. The author illustrates his hypotheses with a clinical example.     

Navigating Trauma in Joseph Conrad's Victory: A Voyage From Sigmund Freud to Philip M. Bromberg

In Victory, Joseph Conrad (1915/1924) revises his earlier treatment of trauma as a singular cataclysmic event in the life of a potentially heroic adult, usually male (as depicted in Heart of Darkness [1898], Lord Jim [1900], and Under Western Eyes [1911]), to a conception of trauma as the corrosive effect of a child's repeated exposures to emotionally invalidating caregivers. Abandoning a view of trauma that would accord with Freud's account of a single shocking incident, in Beyond the Pleasure Principle, Conrad adopts instead a view that parallels Philip Bromberg's account of trauma as a series of toxic childhood occurrences. Thus Conrad's novel Victory presciently anticipates the corrective vision of contemporary relational psychoanalytic theory, which has largely supplanted Freud's more dramatic narratives with a subtle and nuanced understanding of trauma as a long-term lack of validation in childhood that forecloses adult possibilities. In Victory's portraits of two characters whose lives are constricted by pathological dissociation, Conrad presents literary examples that confirm and illumine Bromberg's clinical and theoretical explications of this pervasive psychological phenomenon.     

THE WIDENING SCOPE OF INDICATIONS FOR PERVERSION

Much has changed in clinical practice and theory that bears on the diagnosis and treatment of perversion since Freud's Three Essays on the Theory of Sexuality (1905). Definitions of perversion have been freed from assumptions of a heterosexual normality and from moralistic interpretations. The authors endorse the current emphasis on aggression and early narcissistic problems and include the notion of splitting and sexualized scenarios in their definition of perversion. They present several vignettes of male and female patients to demonstrate the debts owed to Freud's theories and the way in which their thinking differs. They emphasize the understanding of the transference‐countertransference picture and the patient's management and control of excitement.     

A practitioner's notes on the free-associative method as existential praxis

Freud's pre-1914 texts demonstrate why he consistently asserted that his free-associative method was the sine qua non of his discipline. Prior to 1914, Freud's theorizing was intimately and inextricably connected to his lived experience with the discovery of this method. After 1914, he became more speculative in this thinking and writing; his models of the “mental apparatus” and its functioning drew increasingly on conceptual sources other than his experience with free association. The four fundamental coordinates of his discipline (the methodical disclosure that self-consciousness is repressive, the nonlinear “time of the mind,” the significance of our sensual embodiment or libidinality, and the formation of the repression barrier by the incest taboo) are all closely tied to free-associative experience. By contrast, post-1914 theoretical preoccupations (from object relations to the structural-functional model, and other formulations generated after Freud's life) are comparatively divorced from such experience. These conceptual edifices imply a conventional depiction of the theory–practice relationship, which is radically challenged by free-associative discourse. The notion of praxis is introduced as contesting the prevailing depiction of practice as an application of theory, and as serving to rescue psychoanalysis from the somewhat “sterile debates” over its scientific status and over the relevance of metapsychological speculation to clinical treatment. Against the normative ideology of theory and practice, the lived experience of free-associative discourse, with its potential for change and healing, can only be understood in terms of this notion of praxis, and this justifies Freud's claim to have initiated “a critical new direction in science.”     

The Retentional and the Repressed: Does Freud's Concept of the Unconscious Threaten Husserlian Phenomenology?

This paper investigates the claims made by both Freudian psychoanalysic thought and Husserlian phenomenology about the unconscious. First, it is shown how Husserl incorporates a complex notion of the unconscious in his analysis of passive synthesis. With his notion of an unintentional reservoir of past retentions, Husserl articulates an unconscious zone that must be activated from consciousness in order to “come to life.” Second, it is explained how Husserl still does not account for the Freudian unconscious. Freud's unconscious could be called, in phenomenological terms, a repressed retentional zone that differs from both near and far retention. Finally, an analysis is offered for the significance of this psychoanalytic argument for phenomenology. Does phenomenology provide a complete account of the psychical life of the subject without the Freudian unconscious? Does phenomenology suggest, as is often done, that Freud's “discovery” of the unconscious is a fantastical invention? Or, does the Freudian unconscious represent a true stumbling block for phenomenology?     

Hysteria and Self Psychology

ABSTRACT

The article uses a self psychological lens to explore the notion of hysterical personality from our earliest understanding of it as the root of all psychogenic disorders, as discovered by Breuer and Freud, to its present elimination in the DSM-V. Can hysteria still be considered an applicable diagnosis or character style in the modern time? Or is it a culturally and historically limited phenomenon that no longer holds validity? Considering the case of Dora from Heinz Kohut’s revolutionary view, which privileges the subjective and empathic stance in treatment, one can infer that Dora’s own hysterical symptoms were not pathological, as Freud thought, but rather healthy attempts to bolster an enfeebled self. Nevertheless, both Kohut and his followers conclude that from a self psychological perspective both object-instinctual understandings, and self-object transferences, are essential for successful analytic treatment.     

Winnicott's rejection of the basic concepts of Freud's metapsychology1

In this paper, the author attempts to show how Winnicott rejected the basic concepts of Freud's metapsychology, namely the concepts of Trieb(instinct/drive), psychical apparatus and libido. To that purpose, he first elucidates what metapsychology is, according to Freud. Freud describes metapsychology as a speculative superstructure of psychoanalysis in which the aforementioned concepts correspond to the dynamic, topographical and economic viewpoints. The author then presents an explanation of what metapsychology means in Winnicott's view, and examines his criticism of this kind of speculative theorization in psychoanalysis, as well as his suggested substitute for each of those basic concepts. Subsequent analysis shows that Winnicott replaced the main concepts of the metapsychological theory, which have no correlation whatsoever in the phenomenal world, with a set of other, non‐speculative concepts, thereby favouring a factual theorization.     

WITHSTANDING TRAUMA: THE SIGNIFICANCE OF EMMA ECKSTEIN'S CIRCUMCISION TO FREUD'S IRMA DREAM

The author considers the medical rationale for Wilhelm Fliess's operation on Emma Eckstein's nose in February 1895 and interprets the possible role that this played in Freud's dream of Irma's injection five months later. The author's main argument is that Emma likely endured female castration as a child and that she therefore experienced the surgery to her nose in 1895 as a retraumatization of her childhood trauma. The author further argues that Freud's unconscious identification with Emma, which broke through in his dream of Irma's injection with resistances and apotropaic defenses, served to accentuate his own “masculine protest”. The understanding brought to light by the present interpretation of Freud's Irma dream, when coupled with our previous knowledge of Freud, allows us to better grasp the unconscious logic and origins of psychoanalysis itself. 1