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Reichard, S. (1956). A Re-Examination of 'Studies in Hysteria'. Psychoanal Q., 25:155-177.

(1956). Psychoanalytic Quarterly, 25:155-177

A Re-Examination of 'Studies in Hysteria'

Suzanne Reichard, Ph.D.

SUMMARY

Re-examination of the five cases reported in Breuer and Freud's Studies in Hysteria makes clear that they are not a diagnostically

homogeneous group. Application of Bleuler's criteria for schizophrenia, bearing in mind his warning that the presence of neurotic symptoms does not preclude this diagnosis, leads to the conclusion that the first two cases, Anna O and Emmy von N, were schizophrenics suffering from a psychosis at the time of treatment. The diagnosis of hysteria is tenable for the other three patients.

Comparison of the two groups of patients shows that the schizophrenics differed from the hysterics in their family backgrounds, the nature of their symptoms, and the results of treatment.

The conversion symptoms in the schizophrenics represented both defense against unconscious hostile impulses toward members of the family and punishment for these impulses. Their hallucinations represented hallucinatory wish fulfilments of such impulses. Evidences of orality, and the lack of any clear indications of genitality, suggest that these patients had either regressed to a pregenital level of psychosexual development or had become fixated at such a level. The conversions in the hysterics, on the contrary, derived from unsuccessful repression of Oedipal sexual wishes for the father or a father surrogate. Therefore it seems well that the diagnosis of hysteria, if it is to be prognostically and therapeutically useful, be limited to patients with conversions who have not regressed from the genital level of psychosexual development; the symptoms of such patients represent both defenses against unresolved incestuous Oedipal wishes and punishment for these wishes. Conversions occurring in patients either fixated at or regressed to earlier levels of psychosexual development are not hysterical. Their symptoms are attempts to cope with pregenital needs or with the hostility resulting from frustration of such needs.

However, it may be impractical to define hysteria in terms of a conflict in the unconscious, since evidence for this can be elicited only after much time and effort. Since the use of the term hysteria probably cannot be restricted to a well-defined clinical entity, we might attempt to remedy our semantic confusion by

describing patients in terms of their major symptoms and the nature and degree of ego defect, rather than by applying psychiatric labels of doubtful validity.

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