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Stewart, H. (1977). Problems of Management in the Analysis of a Hallucinating Hysteric. Int. J. Psycho-Anal., 58:67-76.

(1977). International Journal of Psycho-Analysis, 58:67-76

Problems of Management in the Analysis of a Hallucinating Hysteric

Harold Stewart

It is not often that one has the opportunity of analysing a patient who fights with a 'ghost' during the course of treatment and so I thought the case merited clinical discussion. I shall have little to say about the theoretical aspects of hallucinatory phenomena, but there are grounds for a discussion about various parameters that I used during the analysis which I think were necessary to sustain the analysis and bring it to a fairly successful conclusion.

Elizabeth Zetzel in her paper on 'The So-called Good Hysteric' (1968) which mainly concerns women patients, made a useful classification of hysterical patients into four grades according to their psychopathology and prospects of analysability. My patient would, I think, fall somewhere between her third and fourth grades and I shall briefly delineate what these grades represent. To quote:

Third, there are women with an underlying depressive character structure who frequently manifest hysterical symptomatology to a degree which disguises their deeper pathology. Fourth, there are women whose manifest hysterical symptomatology proves to be pseudo-oedipal and pseudo-genital. Such patients seldom meet the most important criteria for analysability.

She describes the fourth group as follows:

However, while their symptoms may present a façade which looks genital, they prove in treatment to be incapable of recognizing a genuine triangular situation. For them, as for Oedipus himself, the parent of the same sex has not remained a real object in any meaningful way.

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