Male Hysteria: Imagining a Case Through the Lens of Contextual and Clinical Change

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Male hysteria in this article is viewed as a historical, developmental, theoretical, and clinical area of study. The article highlights the importance of contextualizing various views of male hysteria, and follows its ongoing struggle for recognition and legitimacy. Emphasis is placed on the importance of a contextually-nuanced clinical stance with the primary focus being the therapist’s listening perspective. The article describes shifts in my thinking and treatment of male hysteria over the past four decades. Conceptual shifts regarding treatment roughly parallel in time with the advances taking place in the broader field of psychoanalysis, and these shifts are illustrated in the case material provided.

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This article analyzes and critiques the construct of gender as a psychoanalytic and cultural category. Without succumbing to a nonpsychoanalytic notion of androgyny, the argument developed here challenges the assumption that an internally consistent gender identity is possible or even desirable. Beginning with the idea that, from an analytic perspective, the construct of “identity”; is problematic and implausible, because it denotes and privileges a unified psychic world, the author develops a deconstructionist critique of our dominant gender‐identity paradigm. It is argued that gender coherence, consistency, conformity, and identity are culturally mandated normative ideals that psychoanalysis has absorbed uncritically. These ideals, moreover, are said to create a universal pathogenic situation, insofar as the attempt to conform to their dictates requires the activation of a false‐self system.An alternative, “decentered”; gender paradigm is then proposed, which conceives of gender as a “necessary fiction”; that is used for magical ends in the psyche, the family, and the culture. From this perspective, gender identity is seen as a problem as well as a solution, a defensive inhibition as well as an accomplishment. It is suggested that as a goal for analytic treatment, the ability to tolerate the ambiguity and instability of gender categories is more appropriate than the goal of “achieving”; a single, pure, sex‐appropriate view of oneself.
Personality traits predisposing to hysteria are recognizable in boys as well as in girls. Youngsters who discover that hysterical manifestations bring secondary gains may use this technic throughout life to deal with stress or inner needs. Some of them will progress to true hysterical neurosis.
This paper reconsiders the case of Frau Emmy von N—Freud's first effort to treat hysteria—from the vantage point of hypnoid states of consciousness and the phenomenon of dissociation. It proposes that Freud, in ultimately repudiating Breuer's concept of autohypnosis and alterations in consciousness, led psychoanalysis for the next century towards a one‐sided emphasis on repression at the expense of dissociation. It is suggested here that Freud's inability to “cure”; Emmy was largely due to his treating her symptoms simply as pathological pieces of her past to be removed and to his failure to attend to their immediate relevance in the here‐and‐now context of their own relationship. To comprehend why, as Freud states, Emmy's cure “was not a lasting one”; is to accept that patients such as Emmy are not cured of what was done to them in the past; rather, we are working to cure them of what they continue to do to themselves and to others in order to cope with what was done to them in the past.
presents an overview of our efforts to rethink the conceptual and methodological foundations of psychoanalysis / the intellectual heritage upon which we have drawn in fashioning our "psychoanalytic phenomenology" is a very broad one, embracing the hermeneutic tradition in the philosophy of history, aspects of the existential-phenomenological movement, basic concepts of modern structuralism, and certain trends in contemporary Freudian thought that have in common the idea that psychoanalysis should be reframed as pure psychology / discuss these various influences and sketch our view of the nature of psychoanalytic investigation and knowledge / demonstrate in detail that clinical phenomena such as transference and countertransference, negative therapeutic reactions, psychopathology in general, and the therapeutic action of psychoanalysis cannot be understood apart from the specific intersubjective contexts in which they take form (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses countertransference as part of the analyst's larger experience of the patient, to capture the complexity of the analyst's involvement and correctly place it as a central guide for inquiry and interventions. The analyst's experience of the patient is shaped not only by the patient, but also by his listening perspective, models, and subjectivities. The analyst experientially can resonate with the patient's affect and experience from within the viewpoint of the patient (subject centered), or of the other person in a relationship with the patient (other centered). The analyst's listening from within and without, oscillating in a background–foreground configuration, can illuminate more fully the patient's experience of self and of self in relation to others. Case studies of 2 women and 1 man are included. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book is the first synoptic rendering of Beebe's and Lachmann's body of work. Therapists unfamiliar with current research findings will find a comprehensive and up-to-date overview of infant competencies. These competencies, as the authors demonstrate, give rise to presymbolic representations that are best understood from the standpoint of a system view of interaction. It is through this conceptual window that the underpinnings of the psychoanalytic situation, especially the ways in which both patient and therapist find and use strategies for preserving and transforming self-organization in a dialogic context, emerge with new clarity. The authors not only show how their understanding of treatment has evolved, but illustrate this process through detailed descriptions of clinical work with long-term patients. Throughout, they demonstrate how participation in the dyadic interaction reorganizes intrapsychic and relational processes in analyst and patient alike, and in ways both consonant with, and different from, what is observed in adult-infant interactions. Of special note is their creative formulation of the principles of ongoing regulation; disruption and repair; and heightened affective moments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book recapitulates and extends a unique creative odyssey in modern clinical theory. Long regarded as one of the most original writers in contemporary psychoanalysis, Bromberg here reprises some of his classic essays and offers new contributions as he continues his journey toward a relationally informed view of the clinical process. Early in these essays, Bromberg contemplates how one might engage schizoid detachment within an interpersonal perspective. He finds that the road to the patient's disavowed experiences most frequently passes through the analyst's internal conversation, as multiple configurations of self-other interaction, previously dissociated, are set loose first in the analyst and then played out in the interpersonal field. This insight leads to other discoveries. Beneath the dissociative structures seen in schizoid patients, and also in other personality disorders, Bromberg regularly finds traumatic experience—even in patients not otherwise viewed as traumatized. This discovery allows interpersonal notions of psychic structure to emerge in a new light, as he arrives at the view that all severe character pathology masks dissociative defenses erected to ward off the internal experience of trauma and to keep the external world at bay to avoid retraumatization. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
During the past 2 decades, chronic fatigue and Gulf War syndromes, tales of alien abduction and satanic ritual abuse, and recovered memories of childhood abuse have gained widespread acceptance through massive media coverage, books, and even scholars and the government. Elaine Showalter challenges the legitimacy of these claims; in fact, she argues, it's all in our heads. Showalter argues that each of these modern syndromes are all really manifestations of mass cultural hysteria—an epidemic that has been persistent throughout history, and seems to be reaching a dangerous crescendo as we approach the millennium. Plagues are spread through viruses, but epidemics of hysteria are spread through stories, which Showalter calls hystories. Hystories . . . "are elaborated in vivid and compelling autobiographies and novels, and circulated through self-help books, articles in newspapers and magazines, TV talk shows, popular films, the Internet, and even literary criticism." Surveying the causes, cures, and history of hysteria in the 20th century, Showalter discovers that hysterias are always with us, a kind of collective coping mechanism for changing times. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The diagnosis of conversion should be based solely on whether repressed unconscious fantasies and the affects associated with them can be recovered in analysis as the psychic content of the somatic symptoms, and, further, the classification of all conversion symptoms as pregenital, using as the differential diagnostic criteria the type of personality disorder and psychopathology of the individual patient who produces the conversion symptoms. The author agrees with Deutsch (1959) and with Rangell (1959) that the concept of conversion should be separated from hysteria.
PRIOR to 1618, hysteria was said to occur only in women. The writings of Hippocrates,1 Galen,2 Aretaeus3 and Celsus4 make clear their belief that the condition never occurred in men. Caroli Pisonis (Charles Lepois),5 in 1618, was probably the first to suggest that hysteria could occur in men as well as in women. Since then, many authors6 7 8 9 10 11 12 13 14 15 16 17 18 19 have reported what they term hysteria as occurring in men, although the frequency is low in men as compared with that in women.6 , 7 , 9 , 10 Briquet6 found that in 430 cases diagnosed hysteria only 1.6 per cent occurred in men; Savill,9 from a study of . . .
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