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  • Maria R. de Almeida

Psychosomatic medicine I: Hysteria


When does an illness, apparently organic, needs to be treated by a psychoanalyst? Traditional medicine consideres that soma influences the psique. However, we are not just a biological body, we have psique and soma, which are inseparable entities but different. Traditional medicine believes that our psychical side is consequence of our physical one. For example: Traditional medicine believes that I am depressed because I have been diagnosed with cancer. However, latest researches show depression is a pathology which precedes cancer. Please note that depression is different from being sad. It is a pathology with specific characteristics that needs to be properly diagnosed 1. Being depressed for a long period of time can lead to a depression of the inmune system, which stops guarding as it should, and some of the cells which mutates, could produce tumours, they could develop freely without the “brake” from the inmune system as it is depressed… Depression and inmune system depression go together normally. This example shows that it is not that the soma produces the psychical but the other way round: first the psychic (the depression) and after the somatic injury (the cancer).

When should we go to the psychoanalyst? It is true that “psycho - somatic” is an specific illness whoever, it is also true that apart from the psycho - somatic sickness there are other psychic structures that affect the body.

Which underlying psychic structures affect the body? How? How can they be treated?

HYSTERIA

Nowadays the “romantic fainting” is no longer trendy, however many of the skin sickness have hysteria, as underlying psychic structure: chronic dermatitis, allergies… they have a clear and strong psychic influence. Even the patients are aware their outbreaks are not random, they happen in vital events that deeply affect them: students in an exam, entrepreneurs upon an important project… skin rash isn’t random.

What is hysteria? Like any other neurosis, hysteria is a psychic position in the language, regarding the Oedipus and castration complex 2. In the case of the hysterical individual, he always attributes his desire to someone else. One of the characteristics of the hysterical individual is that his desire is to keep his desire unsatisfied 3. The main mechanism of hysteria is repression 4. The only way we have to learn about repression is when it fails, when whatever was repressed comes back in the form of a symptom. How is this process? When a representation is unbearable for the conscience, the representation is repressed and the affection attached to it, moves to a bearable one with which it can become conscious. In hysteria, one of the most remarkable aspects is that the affection disappears completely: the unbearable representation is repressed and the affection is derived, by conversion in a somatic innervation 5. In the case of an stimulus, psychic or somatic, we need to elaborate it psychic and somatically. What fails in hysteria is the elaboration of the psychic stimulus via psychic 6. The main somatic disorders caused by hysteria are: hysterical paralysis, hysterical blindness and hysterical neuralgia. It is important to remark that these symptoms do not follow the real anatomy, they correspond to an imaginary one (related to the corporal image). According to Freud, hysteria is related to infantil sexuality. There is always a story of desires, a story related to the symptom. The symptom is not random, it is related to the story of the patient (hysterical symptoms affect normally the head, mouth and the musculoskeletal system). And… it does not matter what the patient went through but what he remembers about it. There is a sentence that determines the symptom, it is specifically that one and not any other one. In order to understand all this, let’s see a case of hysteria: Isabel R

- Isabel takes care of his sick father who dies after a long and painful sickness. After that, Isabel presents hysteria being her main symptom pain and difficulty when walking. In the analysis of this case, relevant data appears to explain her symptoms: The main motive for the hysterical symptom is the defence of the individual against his own desire. If we were more tolerant with our desires and we didn’t think we have to make them come truth, many neurosis would be avoided but… we need to realise/ accept we are more intolerant with our desires than it is convenient for our health. Isabel is in love with her sister’s husband. That is the desire she is defending herself against: instead of accepting it (because she doesn’t tolerate it) she represses it. The outcome would have been different if she had renounced to it (what she manages to do in her psychoanalysis). Because she does not accept it and she represses it, the symptom then appears. However, that desire (the love for his brother in law) is still preconscious, the true unconscious desire is the one derived from the Oedipus complex: Isabel love for his father (in fact, her brother in law is an incestuous object which is in the same serie as the father). Isabel case also shows that the area where the hysterical symptom appears is an hysterogenic area 7 . In this case, Isabel’s aching leg was the leg on which his father used to put his leg when Isabel changed his bandage during his long sickness. It was an area of his body repeatedly in contact with her father’s body (as explained before: the symptom is not random but related to the story of the patient). There is a sentence which determines that the symptom is the pain when walking and not any other one: When her father dies, Isabel - as proper hysterical patient, identified herself with him and undertook his father responsibilities in the family. However, she faces difficulties which lead her to the expression: “ not being capable to give one more step towards her purposes”.

Some characteristics from the hysterical symptons:

  • in Hysteria, symptoms are similar to the organic paralysis, however, in hysteria it appears fragmented: for example, a cerebral injury of the left hemisphere would lead to an hemiplegia (paralysis) of the right side of the body. However, hysterical paralysis would affect only to a limb (a leg, an arm…)

  • Organic paralysis normally occur with lost of the feeling of the affected area. However, in hysteria, if we stimulate the affected area, the patient will experience a pleasant/painful feeling, because it is an hysterogenic area as we had explained before.

  • From a medical point of view, in the hysterical symptom, there is not an organic injury, it is just a functional injury and total recovery is possible.

  1. See blog about Melancholia

  2. A position in relation with the four main signifiers grasped in the Oedipus complex: man, woman, father and mother; death and procreation (that does signifiers imply).

  3. Example of how the hysterical individual relates to his desire living it unsatisfied: hysterical woman whose favourite dish is caviar but she doesn’t ask his husband to buy it because it is too expensive: her satisfaction consists of keeping her desire unsatisfied

  4. the psychic apparatus has other mechanism: foreclosure, denial… however, the hysterical individuals abuse of repression: in case of any unbearable situation, he represses it.

  5. In other neurosis, like phobia for example, repression is not so “efficient” because the affection (in the case of the phobia, the anxiety) doesn’t disappear. However, in hysteria is derived by conversion. The hysterical individual does not feel any anxiety: “Belle indifference des hsyteriques”

  6. A hysterical patient in a dispute hears a sentence addressed to her, she feels “ as a slap”. She feels offended but instead of elaborating psychically that offence and create a sentence or accepting the truth in that sentence addressed to her, she represses it. And because she represses it, it comes back in the form of a symptom through the conversion mechanism, in the form of a facial neuralgia. She expresses her offence with a facial pain. She transforms a moral pain into a physical pain.

  7. An erogenous area out of the regular erogenous ones: mouth, anus, genitals…)


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