Year1 PS181 Summary of Hysteria

8/14/2019 Year1 PS181 Summary of Hysteria

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Summary of The Psychotherapy of

Hysteria

Student: Alan Cummins

Student No: 1165236

Course: BA Psychology (HBAPY1F)

Module: Introduction to the Work of Freud (PS 181)

Lecturer: Rik Loose


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Alan Cummins - 1165236

BA Psychology - PS 181 - Intro To The Work of Freud - Rik Loose2

In Psychotherapy of Hysteria Freud discusses his evolving theory of the

treatment of hysteria. He elucidates the shortcomings with Breuers method of treatment,

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

reasons the patient tries to resist the work of the analyst.

In discussing Breuers method for the treatment of hysterical symptoms, Freud

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

patients can be hypnotised. Either the patient is physically unable to be hypnotised or is

putting up a conscious or unconscious resistance to the act of hypnotism. Freud wished to

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


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treatment as if hysterical. Hysteria also had no physical mechanism by which it worked.

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

that hysteria was not the root problem.

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.


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The therapy itself required the patient to try to remember what had originally

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 patients attention, through

the use of language, to such forces the psychical force that had once been resistant could

be slowly turned to playing a part in overthrowing the incompatible ideas or in

understanding those incompatible forces. The side-effects of these incompatibilities

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


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explained that his task was to simply overcome this resistance to associate. To try to

concentrate the patients mind, Freud made use of a number of techniques such as the

application of pressure to the forehead and the free association of the patients 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 patients unconscious resistance would make the

process laborious and difficult. However by carefully concentrating the patients 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


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to produce his first theory on such. This gives rise to an inter-dependent reliance on an

initial theory brought about patient work to further inform and give feedback to the

theory itself.

In creation of his first theory of hysteria, Freud illustrates the psychical

pathways which he must help the patient negotiate through as a three-layered system of

interconnected and associated memories barricaded by disassociation, repulsion and

resistance. To add further to this complicated interconnected set of pathways, as

discussed previously Freud had noted that hysteria is typically a succession of partial

traumas, partly inter-dependent, linked and partly independent. He describes psychical

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


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back together into a coherent form for the patient psyche to understand. In piecing back

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 patients 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 patients ego a path to acceptance and resolution

of such.

Freud goes on to discuss the various drawback and problems of his

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


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large layer of resistance which can only be solved by filling in gaps at a alter stage of by

the patient-analyst relationship becoming disturbed. As Freud had surmised previously in

the chapter, patients 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.

In summary, Freuds Psychotherapy of Hysteria reveals the short-comings in

relation to Breuers 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

theory is then further expounded to describe the human psyche as a multi-tiered,

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-

product unwanted symptoms.

Documents

Year1 PS181 Summary of Hysteria