Conversion Hysteria in a Pre-Adolescent Girl

Abstract

This paper is a case presentation of a 10-year-old girl with classic conversion hysteria symptomatology. Psychological test material as well as the ten session treatment is presented. The original Breuer/Freud conceptualization of hysteria and its linkage with trauma is considered. Current theories of trauma with the usual presenting symptoms of dissociation, abandonment fears, and repetition are also considered.     

A Preverbal Perspective on Conversion Disorder

ABSTRACT

In contrast to the vast majority of writings on hysteria that place its genesis within the Oedipal period, this article conceptualizes a preverbal, pre-Oedipal origin for the primary manifestation of hysteria—conversion disorder. Findings from infant observation research are used to support a conceptualization that includes connections to temperament, attachment strategies, Wilma Bucci’s multiple code theory, and Leslie Farber’s perspectives on will and willfulness. This article suggests an etiology that is dependent on a complexity of factors operating interactively and within the context of a relational process.     

How Managed Care Can Help Couples Cope

ABSTRACT

This article traces how managed care became a quick fix to curb out-of-control healthcare costs rather than a real effective approach to managing care. To date, the impact has been not only a negative experience, but impediment to treating couples facing relationship and related problems. The author is optimistic about how managed care will evolve to recognize the importance of couples and family treatment as we enter the future with integrated systems of healthcare. ? The future will also require significant shifts in the thinking and practice patterns of providers and an emphasis on quality and outcomes.     

On the early history of male hysteria and psychic trauma

This paper discusses the influence of Jean-Martin Charcot's views on Sigmund Freud's early theory of hysteria and the notion of psychical trauma. We consider the early history of both psychical trauma and male hysteria, for in Charcot's view traumatic hysteria and male hysteria are identical. Freud's two 1886 lectures on male hysteria, delivered after his return from Paris, are crucial to the subject because they present Freud's first impressions of Charcot and his teaching. Some of the ideas presented in the two lectures foreshadow Freud's later generalization of the etiological role of trauma and his theory of the role of psychical trauma in the genesis of hysteria; that is, each hysterical symptom is due to a psychical trauma reviving an earlier traumatic event—the so-called principle of deferred action (Nachtraglichkeit). Several arguments substantiate the thesis that Freud's notion of psychical (sexual) trauma was developed in reference to Charcot's notion of traumatic hysteria, and that the early psychoanalytic theory of psychical trauma is clearly indebted to Freud's encounter with Charcot's male traumatic hysterical patients. The discussed Freudian development points out the major role of (physical) traumata in eliciting psychopathological pictures and in this way is of definite historical relevance for the present-day discussion on the traumatic nature of the so-called multiple personality syndrome and other dissociative disorders, and post-traumatic stress disorders.     

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.     

Diagnosing a male hysteric: Don Juan-type

The aim of this paper is to provide a clinical account of a male hysteric, Don Juan-type, taken from the early stages of treatment. The patient presented with a relationship problem but there soon emerged a form of compulsive sexuality or hypersexuality in his love relations that became a central feature of the clinical picture. This hypersexuality expressed itself in a compulsive need to stage, or to stage-manage, interpersonal scenaria of a sexual or sexualised nature. These scenaria, which were repeated in different variations and with different personnel, are seen by the author as a dramatisation of the primal scene with the patient taking up the position of the oedipal father. Explanations for the disappearance of male hysteria are given, including a new theory which claims that an imbalance in psychoanalytic theory itself led to the feminisation of hysteria. This critique allows certain forms of hypersexuality in men to be promoted as a form of hysteria, the most common example being Don Juanism-a form of compulsive sexuality that encompasses normative, conversion and character features. The paper also examines the male hysteric's developmental agenda. What the patient's compulsive sexual tableaux exposed was that he had never faced a separation that was not a triangular experience. This meant that his separations were experienced as two developmental agonies telescoped into one-separation (pre-oedipal) and exclusion (early oedipal). This combination, the author suggests, is so frightening in a particular group of men as to explain the choice of hysteria as opposed to some other choice of neurosis.     

The Roles of Metaphor and Imagination in Child Trauma Treatment

ABSTRACT

This article presents developmental theory regarding the emergence and importance of metaphor and imagination to child development. The author then reviews psychotherapy research and clinical literature to identify ways that these two mental processes, as transtheoretical elements of child therapy, can be applied within trauma-specific treatment for expressing and processing difficult experiences, integrating traumatic memories, containing fears, bolstering self-efficacy, and expanding understanding of self and others. Case examples are provided to illustrate clinical applications.     

A reappraisal of medieval mysticism & hysteria

This paper examines the historical association between medieval mysticism and asceticism and the psychopathological condition of hysteria. We first review the particular forms of medieval mysticism and asceticism that seem to have inspired modern psychiatrists and reductive historians to dismiss these phenomena as indubitably neurotic behaviours. Then we review the concept of hysteria as it evolved during the last two centuries for points of convergence with mysticism. Finally, we question the validity of value-laden diagnostic formulations in the domain of personality assessment. A few highly dramatic but culturally endorsed religious behaviours occuring in an otherwise well functioning individual does not constitute a basis for any psychiatric diagnosis, let alone a condemnatory characterological one such as hysteria. We propose a perspective for looking at medieval mystical states of mind and behaviours in context that moves beyond ahistoric assumptions that employ modern Western standards as the yardstick for medieval health and illness.     

Characteristics of Male Batterers in Treatment

Abstract

This article presents information on the characteristics of a clinical population of male perpetrators of intimate partner violence (IPV) court-ordered for batterers' treatment, and how these characteristics co-varied with treatment attrition. The average demographic profile of male batterers in a midwestern treatment program that met present-day treatment guidelines was similar to that found in other studies. In addition, relationship length and status, alcohol/drug use, self-reports of past treatment and mental health issues, and self-report of witnessing or experiencing violence within the home during childhood was also similar. Batterers' self-reports of their own violent behavior were found to vary by data collection technique, with face-to-face interviews eliciting greater admission of violent behavior than paper-and-pencil questionnaires. However, the only predictors of successful treatment outcome were living arrangement at the time of treatment and racial category. Implications of these findings are discussed, and “local effects” program evaluation approaches are suggested.     

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.     

Hysteria,A Century Later: Post-Kleinian Theory and Technique

ABSTRACT

Freud developed many of his theories and technique while attempting to help hysterical patients. This article approaches hysteria not just as a syndrome consisting of a group of signs and symptoms, but primarily as an inner world configuration that fuels object relations patterns. The internal world hysterical profile informs the transference/countertransference experience and the therapeutic process. I attempt to describe some of the technical problems psychoanalysts have to deal with while working with these patients. Hysterical object relations do not necessarily manifest themselves as somatic symptoms—epileptic-like, paralysis, blindness, etc.—even in patients that show the relational hysterical patterns. These object relations modes can appear in any analysis irrespective of the primary diagnostic conceptualization.     

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.     

Rosalia H.: with Freud in a prelude to psychoanalysis

Abstract

The case of Fräulein Rosalia H. is discussed quite briefly by Freud in one of his contributions to Studies on hysteria. This case of ‘retention hysteria’ was included in another much longer case study, and it is designed to illustrate how a ‘mnemic symbol’, which operates to condense a group of memories, may be formed during the course of an analysis. A new symptom thus appears which may throw more light on the circumstances which gave rise to the presenting symptom. Despite the richness of this case, Freud does not refer to it again in his writing and there has been very little discussion of it in psychoanalytic commentaries. This paper explores how the case serves as a transition point from pre-psychoanalytic conceptions of symptomatology and clinical practice, and how it can be read as a prelude to psychoanalysis proper.     

Perceptions of self-efficacy in providing multidimensional school-age stuttering therapy among board certified fluency specialists in the United States

PurposeThe purpose of this study was to document fluency specialists’ self-efficacy beliefs for providing multidimensional treatment to children who stutter and to identify cognitive, affective, and behavioral correlates of self-efficacy.MethodSixty-six Board Certified Specialists in Fluency in the United States completed an online survey measuring self-efficacy in providing multidimensional stuttering therapy, perceived importance of multidimensional aspects of therapy, feelings of comfort in providing therapy, perceived treatment success, and employment and demographic questions. Open-ended questions were also asked for participants to describe why they chose to specialize and what benefits they received from it.ResultsParticipants reported high levels of self-efficacy (averages above 9 on a scale from 0 to 10) in speech-related, cognitive, emotional, and social domains of stuttering therapy, as well as high levels of comfort and clinical success. Higher ratings of overall self-efficacy were significantly correlated with beliefs about the importance of multidimensional treatment, τ = 0.27, treatment comfort, τ = 0.25, and self-reported treatment success, τ = .49. Responses indicated that many participants believed that their self-efficacy grew because of specialty certification.ConclusionAlthough not the same as treatment outcome data, self-efficacy among clinical service providers is an important variable to consider. Board Certified Specialists in Fluency in the United States report very high levels of self-efficacy for school-age stuttering treatment. The process of certification helps to increase self-efficacy and provides a means for advertising competence in stuttering treatment. This information could help in recruiting the next generation of fluency specialists.     

Clinical strategies to promote compliance

Abstract

This article focuses on the need for effective client management throughout the therapeutic process. The appropriate and astute use of clinical strategies can promote client compliance with treatment and counteract the possibility of client dissatisfactions and ethical/legal complaints. This article offers a systemic explanation of compliance, identifies five major clinical strategies to foster treatment adherence, and discusses the need for clinical judgments that fulfill ethical/legal obligations while promoting quality care.     

The Art of Working with Traumatized Couples

SUMMARY

In this article, the authors present a framework for treatment of the traumatized couple and also their belief in the importance of seeing such work as a process of art. Clinical illustrations are used to demonstrate their approach.     

Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens

ABSTRACT

?Background: This article provides a review and commentary on social transition of gender-expansive prepubertal youth, analyzing risks, and benefits based on a synthesis of research and clinical observation, highlighting controversies, and setting forth recommendations, including the importance of continued clinical research.

Methods: This article involved: (1) a review and critique of the WPATH Standards of Care 7th edition guidelines on social transition; (2) a review and synthesis of empirical research on social transition in prepubertal children; (3) a discussion of clinical practice observations; (4) a discussion of continuing controversies and complexities involving early social transition; (5) a discussion of risks and benefits of social transition; and (6) conclusions and recommendations based upon the above.

Results: Results suggest that at this point research is limited and that some of the earliest research on young gender-expansive youth is methodologically questionable and has not been replicated. Newer research suggests that socially transitioned prepubertal children are often well adjusted, a finding consistent with clinical practice observations. Analysis of both emerging research and clinical reports reveal evidence of a stable transgender identity surfacing in early childhood.

Discussion: The authors make recommendations to support social transitions in prepubertal gender-expansive children, when appropriate, as a facilitator of gender health, defined as a child's opportunity to live in the gender that feels most authentic, acknowledging that there are limitations to our knowledge, and ongoing research is essential.     

Indigenous Healing Practices and Asian Immigrant Women

ABSTRACT

The current article highlights the importance of indigenous psychology for Asian immigrant women. A brief overview is provided about Asian American immigration and the importance of understanding women’s experiences with the contextual lens of gender, ethnicity, and race. Key values relevant to help-seeking and service utilization are also presented. Complementary alternative approaches to Western-based mental health treatment are discussed as ways in which feminist and multicultural treatment approaches can be integrated. Given the inherent diversity of Asians and Asian Americans, which includes over 60 ethnic subgroups, the article is not meant to provide an exhaustive list of available native practices nor to reflect the experiences of Asians as a homogenous group. Instead, the goal of this article is to provide readers with an understanding of how culturally based healing practices and concepts are needed to complement and contribute to our extant understanding of help-seeking. We conclude by highlighting the ways in which Western-based healthcare would benefit by integrating indigenous practices with gender and ethnic/racial cultural perspectives.     

Beyond the representation field

Abstract

This article outlines the importance of representation and several Freudian concepts such as Vorstellung, Trieb, and word and object representations. The author refers to the division of the analytical process into two main fields: the field of representation, and the field of the Real, which is characterized by impossibility. He then states that this field is the proper field of psychoanalysis. The author presents two clinical vignettes in an attempt to demonstrate the significance of the analytical act as a tool to deal with such extreme psychic situations.