After reading this article you will learn about:- 1. Concept of Hysterical Neuroses 2. Types of Hysterical Neuroses 3. Freud and Psychoanalytic View 4. Treatment.
Concept of Hysterical Neuroses:
By converting or compartmentalizing the fear into a physical symptom in hysterical neuroses the patient tries to reduce anxiety. In anxiety neuroses and phobias anxiety is easily observed while in hysterical neuroses anxiety is converted to various physical symptoms.
History of hysteria reveals that Hippocrates and the ancient Greeks believed that hysteria is a disorder restricted to woman only. The source of this disorder they thought to be the uterus and the term hysteria is thus derived from the Greek word meaning uterus.
These people viewed that the uterus wandered through the various parts of the woman’s body in search of a child. But Freud by showing that it occurred in males as well as females has changed the above conception of hysteria. Freud viewed that hysterical symptoms were an expression of repressed deviated sexual energy i.e. the sexual conflict in hysteria was converted to physical illness.
For instance, a sexual conflict over masturbation might be solved by developing a paralyzed hand. According to McCall (1963) the basis of hysterical personality includes “a child like immaturity, self centeredness, poor insight, a notably weak psychic, integration and an extraordinarily high degree of suggestibility”.
The reaction of the hysteric patients are basically spontaneous unpremeditated attempts to adjust to life difficulties through flight into incapacity having definite motives behind. Hysteria is different from malingering (pretended illness) in that in hysteria, patients do so without the motive being known while in case of the later, the motive is illness.
In the words of Coleman (1981) “Hysteria is a neurotic defence in which symptoms of some physical illness appear without any underlying organic pathology.” There is also minimum loss of contact with everyday life.
In chronic or prolonged hysteria the patient tries to achieve a more or less permanent way of life by developing functional incapacity. By doing this his symptoms allow him to adapt to that part of the environment which he desires to face.
Types of Hysterical Neuroses:
Hysterical neuroses can be divided into two general types:
1. Dissociative type
2. Conversion type
Indicating the differences between the above two types McCall says dissociative have a propensity to become overtly anxious under stress, a tendency usually not shown by conversion hysterics.
1. Dissociative Type:
There is blocking off from awareness of significant portions of one’s present experience in hysterical dissociative disorders. In other words, dissociative hysterical reactions can be said to be as departure from normal states of consciousness. It excludes certain specific activities from awareness and hence is similar to the defence of denial.
In short, the blocking off process otherwise known as compartmentalization makes it possible for the dissociative hysteric patient to be unaware of certain activities which he actually carries in reality. In other words, when a person is under the influence of an isolated portion of awareness, he is said to be in a state of dissociation.
Though there are various experiences of physical damage by the patient of the dissociative type, such as partial paralysis, anaesthesia and disturbances of audition and vision, there is actually no physical damage. Dissociative reactions include about 5 per cent of all neurotic disorders as stated by Coleman.
Dissociative reactions include 3 sub types such as:
(1) Amnesia,
(2) Somnambulism,
(3) Multiple personality.
1. Amnesia and Fugue:
Being the most common of the dissociative reactions, this refers to the total or partial loss of memory for a period of time during which the patient cannot recall any event of his life, his family associations, past and present occupations, not even his name and birth place etc.
He cannot recognize his relatives and friends either. It is as if a part of his life has been dropped out though the person concerned is not at all aware of the gap in his recollection.
Janet (1925) has described different types of amnesia:
Localized amnesia:
In localized amnesia the patient suddenly becomes aware of his loss of memory for a period of time. Systematized amnesia is more rarely found. In this type the person forgets selected types of events or incidents. The third category is called continuous amnesia. Here the individual forgets each successive event as it occurs. For instance, he even forgets his own question which he puts to the doctor or some-one else.
In this connection Janet reports a very interesting case of a patient who tried to read a book but ended in reading only the first page over and over again. To add to this, after an entire days reading he could not even remember the name of the book.
In amnesia, the person however is able to talk, read, reason and write. His social habits are also intact. There is no intellectual or mental retardation and he can utilize his talent and ability effectively. The period of amnesia range from a few hours to a few years.
Aetiology:
Through this amnesia, the patient tries to hide some incident about which he has felt guilty and which would be otherwise painful to remember. Instead of avoiding the situation itself, by getting sick, the patient avoids the unpleasant situation by suppressing and repressing the stressful events. When the dissociative reactions involves repression, it takes place in the unconscious level.
Studies indicate that in the hypnotic trance or under a sedative drug his identity can be revealed. Kanzer reported such a case, where a married woman asked the police man to take her home as she could not say who she was.
But application of hypnosis and sedative drugs revealed her marital unhappiness and love for another man. She in her unconscious wanted to forget the home in which she was living as it was very unpleasant to her.
Fugue:
Like amnesia in fugue states there is partial or total loss of memory and loss of identity. In addition to this, the patient almost leaves his previous area of residence and reappears at a distant place with a new name, new identity and new occupation and ultimately a new life.
Thus in fugue the area of residence and geographical location is changed. Again, after a period, he may all on a sudden revive his past memory. Like amnesia it may last for several hours to several years.
Aetiology:
Amnesia, occurs practically under psychological stress. As the name itself implies, fugue state is a defence by actual flight. Generally precipitated by some stressful emotional experience. It is a flight from personal difficulty.
According to Duke and Nowicki (1979) “Individuals who develop a fugue reaction usually have histories of being dependent, anxious and inadequate. They seem to have difficulty keeping themselves together under normal stresses of everyday living. When additional stress is introduced they seem to fragment in to the resulting flight from the scene.”
2. Somnambulism:
Though popularly believed as sleep walking, it is not sleep walking in fact. Rather it is a sleep like state during which the individual may experience a stressful event. It takes place at a particular time during the night either in the waking state or in the sleep state.
The same route is followed and the same kind of behaviour is shown every-time. Though most commonly found in adolescence, the disease may occur during childhood and adult life.
According to Duke and Nowicki (1979) Somnambulistic people may or may not have conscious awareness of the event in their waking state. Once the somnambulistic state is over, the patient does not remember of its occurrence.
In sleep like state, while the main personality remains asleep, dissociated fragment or a secondary personality takes controls of the ego and engages in various activities. However, after the somnambulistic state is over, he completely forgets this secondary personality. The secondary personality is neither asleep, nor awake.
The victim goes to sleep in a normal manner, but sometimes during night gets up, goes to another room or outside and then again comes back and sleeps normally. In the morning he remembers nothing that has taken place.
According to Coleman, usually such sleep walking episodes last from 15 minutes to half an hour.
Somnambulism is found in 5 per cent of the people. It is more common in young people and frequently occurs in college going young people. Jenness and Jorgensen (1941) have reported that 5 per cent of a group of 1808 college freshmen admitted walking in their sleep. Observations show that males are greater victims of Somnambulism than females.
As popularly believed, sleep walking and Somnambulism are not same. There are differences among the two. Somnambulism may occur during sleep or walking state. Somnambulism is usually associated with dreams and is believed to be purposive while sleep walking is more random and directionless.
Aetiology:
According to Kessen and Mandler (1961) anxiety may be reduced by a flight from trauma Anthony views that sleep walking occurs in individuals prone to the motor discharge of tensions rather than to nightmare of fantasy. The personality traits like immaturity, suggestibility and heightened need for approval and security obvious in the conversion hysteric patients are also found in sleep walkers.
Coleman views that various problems during adolescence like dependence, independence, struggles, sexual conflicts and allied problems seem to be related to sleep walking. In adulthood it seems to be precipitated by the stress and anxiety caused by adult responsibilities and making decisions for self.
In the opinion of Sadler (1945) the precipitating cause in the sample he analysed was same type of traumatic experience that had just occurred or was about to occur in the near future. Desires repressed and suppressed due to social restrictions and inhibitions may lead to sleep walking or somnambulism in which the patient tries to satisfy these suppressed or repressed desires.
3. Multiple Personality:
While amnesia, fugue and somnambulistic states affect the person’s thinking or personality partially, multiple personality affects the person’s personality or self in totto. Duke and Nowicki (1979) define multiple personality as a neurotic disorder in which an individual alternates between two or more personalities.
According to Shanmugam (1981) “The examples of Sally, the saint, the woman and the devil (given by Morton Prince) who had three different personalities (which alternatively occupied the field of consciousness) and of Dr. Jekyll and Mr. Hide can explain the concept of multiple personality (which alternatively occupied the field of consciousness) and of Dr. Jekyll and Mr. Hide can explain the concept of multiple personality.”
Dual personality in short, is a dissociative reaction of frustration and stress in which the person shows two or more types of personality pattern.
The two personalities can be called primary and secondary personality. The new or the secondary personality that develops is inhibited and morally constructive than the original primary personality.
There is sudden change from one personality to another and the personalities are dramatically different from each other having their own distinct set of traits, emotional qualities, values and specific behaviour characteristics. For example, one may have extroverted traits while the other may have introverted traits.
In-spite of their own unique qualities, the secondary personality is conscious of the primary personality, but the primary or the original personality is not aware of the secondary personality. Prince (1906), Schreiber (1973) Sizemore (1977) have given various descriptions of multiple personalities. However, dual personalities are rarely observed in reality though they are very much ‘in’ in novels, televisions and motion pictures.
According to Goddard multiple personality may develop as an escape from the monotony, strains, drudgery and responsibilities of life.
Alexander (1930) went to the extent of saying that the potential for developing multiple personalities was in all of us and in-fact, there is no definite aetiology of multiple personality.
Treatment of dissociative reactions:
The treatment of dissociative reactions is same as for conversion reaction. However, certain cases of amnesia are cured by hypnosis, free association and narcosis methods and methodical questioning. In a few cases, the recovery is spontaneous. In order to cure the dissociative reactions permanently, however more extensive psychotherapy is required to unveil the underlying personality problems.
2. Conversion Reaction:
In the opinion of Coleman (1981), “Conversion reaction is a neurotic defence in which symptoms of some physical illness appear without any underlying organic pathology”. It is a very common and most frequent type of pathological syndrome.
Specially during “world war I and II” conversion reactions were more frequently found. The salient differences between conversion hysteria and associative neuroses are the following.
In conversion hysteria without any appropriate physical basis, a physical incapacity or physical disease appears. This physical incapacity with a psychological basis is connected to the psychological conflicts of the individual. It is in-fact symbolic in character.
The term conversion hysteria is self explanatory in the sense that the hysterics universally convert their psychological conflicts and anxiety to physical illness and become free from overt anxiety and tension after conversion in comparison to dissociative hysterics.
No doubt, they receive a lot of attention and sympathy from near and dear ones because of this symbolic illness, which is otherwise known as secondary gain. But they are least aware that this physical illness of theirs is physically baseless and has only a psychological origin.
Coleman holds that conversion reactions are mainly found among adolescents, young adults and are much more frequent among women than among men. They constitute about five per cent of all neurotic reactions.
Duke and Nowicki (1979) hold that most likely because in the increase in educational standard of people for the last 75 years, there has been a steady decline in the frequency of conversion hysterics.
They support this view by saying that in less educated and less bright people this disease is more frequently found. Thus, there seems to be negative correlation between education and conversion hysteria, according to Duke and Nowicki (1979).
Coleman further adds, “In general, these patients are slightly lower than other neurotic types in intelligence, educational level and socio economic status.” They are highly suggestible and dramatic. Recent investigations indicate the demanding behaviour of these patients and their difficulties in fulfilling adult responsibilities.
According to Ziegler (1960) hysterics typically show a special need for attention. They tend to be excitable and shallow in emotional responsiveness, are often seductive, but frigid sexually and are dependency demanding and manipulative in their interpersonal relationships.
Freud and Psychoanalytic View on Hysterical Neuroses:
According to Freud, “Hysterical symptoms are memory traces of sexual traumata, the hysteric suffers from reminiscences.” Hysterical symptoms are the result of conflict between the super ego and wishes not acceptable to the super ego. Hence the mechanism of conversion is used to escape from reality and protect the person from anxiety.
In conversion hysteria, the repressed wishes are converted into a symptom in such a way that unconscious conflict is avoided or reduced.
This is called the primary gain of the neuroses. The anxiety is controlled and the ego is left relatively intact. Those organs which have some significance in the life history of the patient are involved in showing the conversion reactions. Besides, these organs may be somatically weak through constitutional factors and previous disease. This is called the principle of somatic compliance.
The conversion hysteric patient also gains sympathy from the family members, in-laws and friends and he does not have to face the real life situation and solve varied problems of life. Thus, this helps in the escape from reality.
The conflict in hysteria usually goes back to the Oedipus situation where there was a conscious attachment at the phallic stage to the parent of the opposite sex. As a consequence of the fear developed because of the Oedipus attachment, there is repression and denial of sexual behaviour.
During the adolescence when there is strong urge for sex, this sexuality is denied and the libidinal energy is converted into the symptoms of physical disease. Hysteria is thus a regression to the phallic level of sexuality.
Freud holds that the struggle of the hysteric is always over a conflict between hetero sexual urges and the fear of consequences of all these. The conversion symptoms represent the displacement of repressed genital striving upward.
Freud had gone to the extent of saying that the hysterical episodes always represent a disguised sexual act in which certain psychoanalytic mechanisms are involved. Freudian explanation cannot be accepted as having universal validity. For example, in soldiers suffering from hysteria during war, there is nothing to see anything sexual.
Purposive Theory:
The purposive theory propounds that there is usually the following chain of events. First a conscious desire to escape from some unpleasant situation, then a wish to be sick to avoid the situation. In the third stage, there is stress on the appearance of some specific physical ailments. All these symptoms help him to face the traumatic situation.
In addition to this, it also brings him secondary gains in the form of attention and extra sympathy and love and affection of the people around him. As the original wish is repressed, the patient does not see any relationship between his stress situation and symptoms.
The symptoms thus are symbolically related to the neurotic conflict. Sometimes also the hysterical illness represents an attempt to regain or to achieve some desired goal.
Treatment of Hysterical Neuroses:
A complete physical examination and a carefully chronological detailed history are essential. Suggestion is not always wise to use. Nevertheless, in selected cases, suggestion is sometimes permissible, say in a feeble minded case where the intellectual cooperation of the patient is required.
Drugs, hypnosis and extensive psychotherapy can be used to deal with the underlying problems of the hysteric patients.
Amnesias can be cured by methodological questioning, free association and narcoanalysis.
When ordinary conversion fails to elicit the complete psychological setting of a symptom, free association and hypnosis may be used. This is always justifiable when the other methods have failed to bring back the memories that must be present in the association of symptoms. It is perhaps the only method to get back the lost memory.
All these techniques are used with an aim to counter act with resistance and bring back to consciousness the mental events more or less responsible for the development of the symptoms.
In most of the cases by gaining the confidence of the patient through rapport and by exercising firmness and tact it is put into his mind that the lost function can be recovered and that he can move the rigid or affected parts of his body. Such cases have a better chance of cure.
Patients having an overall attitude of superiority are most difficult to cure. It is the job of the counsellor to teach them a new attitude towards life.
Drugs and electrotherapy may bring only a symptomatic cure. But the general illness is not cured through these procedures. On the contrary, physical methods of treatment might increase the liability to breakdown greatly and greater than before.