Stephanie Metcalfe : What Freud allowed the Hysteric to teach him*

“Freud, the first to consent not to look away nor to investigate elsewhere, the first not to attempt to hide it in psychiatric theory that more or less harmonised with the rest of medical knowledge; the first to follow its consequences with absolute rigour. So says Michel Foucault in “Madness and Civilisation”.[1] The aim of this paper is to examine and remind ourselves of the way in which the hysteric was essential to Freud’s founding of the technique of psychoanalysis. And to outline Freud’s contention, so succinctly put in ‘A Question of Lay Analysis’ that ‘one cannot run away from oneself’[2].


The Symptom & Symbolism

The reader of ‘Studies on Hysteria’ gets a strong sense that the hysterics that Freud worked with are leading him on a voyage of discovery. He puts himself in a position of learning from them and is led to his greatest achievement – the hysteric can unravel her symptom and the predicament she finds herself in, through speech. He moves from observation of the physical symptoms presented (a process that he witnessed when in Paris with Charcot and his contemporaries) to listening and hearing what she has to say about her suffering. It is important that we remind ourselves how Freud discovered a way of working with the hysteric that facilitated her move in to this position of subjectivity, that allowed her to recognise her desire. He describes the case of Frau Cacilie (one that he cannot fully elaborate on for personal reasons) as his ‘most severe and instructive case’. She presents a catalogue of symptoms that he can trace to their linguistic and verbal origin. She is a woman who had suffered from hysterical attacks for thirty years, and what Freud realises is that she must assign the development of her symptoms their rightful place in her personal history.[3] A bitter insult from her husband is felt as a ‘slap in the face’ and contributes to the development of a facial neuralgia. Understanding the process of symbolisation is key here. As Lacan states:

“…symptoms can be entirely resolved in an analysis of language, because a symptom is itself structured like a language from which speech must be delivered…”[4] 

Freud goes on to provide more examples of the linguistic link with the symptom. An inability to walk forward relates to a fear that Cacilie ‘might not find herself on a right footing’[5]. In fact, she was suffering from a variety of ailments but chooses the physical pain that is symbolically appropriate to her particular fear and develops it n to a psychical pain.[6] Do these examples strike us as perhaps too obvious and simplistic? Freud states that it almost seems like a comic example, but he reminds us that “the hysteric is not taking liberties with words, but is simply reviving once more the sensations to which the verbal expression owes its justification…”[7] A physical feeling of a stab in the heart may be an emotional response to a difficult experience or a painful throat may relate to receiving news that is ‘hard to swallow’. The hysteric teaches us that the signifier hits[8], and the effect of this is converted and manifested in the body. In his enlightening text ‘New Studies on Hysteria’ Melman refers to a Greek phrase from Plato’s text ‘the Laws’ which reads: “soma husteron psuches” which we could translate as ‘the body concedes to the soul’.[9] As Freud exemplifies, the hysteric certainly bears witness to this. We will return to the significance of the Greek language later in the paper.


The Sexual

As well as being alienated in language, Freud also uncovers a conflict that the hysterical patient experiences in relation to assuming a fulfilling sexual position. He asserts that “the hysterical symptoms arise as a compromise between two opposite affective impulses, one trying to bring it to expression and one trying to suppress it”.[10] This struggle regarding the question of how to engage in sexual life is evident in many of his early cases. We come across this very problem in the history of Elisabeth Von R, another significant case from the ‘Studies on Hysteria’. During a period of intense nursing of her father she is persuaded to spend an evening with a young man who is a potential suitor. She finds, on her return, that her sick father’s condition has worsened and resolves to never leave him again. Elisabeth is completely caught up in the family drama and sacrifices her own desire to ensure the health and happiness of those around her. This happens under the guise of altruism and selflessness, but this is not the whole of the story. In fact, the development of the symptom becomes a substitutive satisfaction. Freud states:

“In the case of anyone predisposed to hysteria, the onset of the illness is precipitated when...he finds himself faced by the demands of a real sexual situation. Between the pressure of the instinct and his antagonism to sexuality, illness offers him a way of escape. It does not solve his conflict, but seeks to evade it by transforming his libidinal impulses into symptoms.”[11]

This helps us explain the intense resistance from the patient regarding giving up her symptom. There is a certain ‘jouissance’ that she would have to relinquish in order to deal properly with her suffering. The psychoanalytic perspective shows us that the question of the sexual is inherently tied up with our psychical development and the position the subject assumes. Ceding to the law of the Symbolic also involves the subject’s submission to the primordial law against incest. Lacan informs us in Seminar III that:

“…the Law is there precisely from the beginning, it has always been there, and human sexuality must realise itself through it and by means of it. This fundamental law is simply a law of symbolisation. This is what the Oedipus complex means.”[12]

Does the hysteric in some way battle against this law or, indeed at times, try to make her own law? The family circumstances that the subject finds herself in and the question of what the hysteric rails against are of import here. There may be a feeling that she is used, or pawned off to suit the affairs of others, and treated unfairly, such as we find in Dora. She may be brought to the analyst or therapist as she is ‘causing trouble’ within the family setting, but maybe her problems represent some unwelcome truths within the family. There may be a message conveyed to her that ‘she will find it difficult to get a man of her own’ such as we find in the case of Elisabeth. Surely this message would lead to some difficulty knowing how to situate herself in relation to a sexual relationship with a man. The family complex with all its imaginary identifications and intricate and complicated relationships needs to be examined, not in isolation, but in conjunction with the hysteric’s ‘own part in it’.


Handling the Transference

And so, we are led to Freud’s famous challenge to Dora – in what way was she responsible for the situation she found herself in? Not surprisingly, an unwelcome question for her that would force the young woman to look at things from another perspective. Freud admits himself that he missed the transference in the case of Dora. He was not able to recognise her intense interest in Frau K and how this enigmatic woman represented the mystery of femininity for Dora. He did not pay attention to the homosexual thread in Dora’s discourse. His oversight is caused by the fact that he is overly concerned with Dora finding happiness in settling down with Herr K. He assumed he knew the answer to her question and could guide her to a satisfactory solution to her complaint. We know how the story ends and she decided that she would show him! The case comes to a premature end and Freud is left to ponder what he could have done differently. Maybe we should also take a moment to reflect on the good fortune we have had that Freud left us with such rich material from the case histories and that he had the humility and courage to publish his errors to further the development of the analytic technique.

There is much analytic learning in the case of Dora, not least in relation to the phenomenon of transference. Again, Foucault highlights that “Freud, (is) the first man to accept in all its seriousness the reality of the physician-patient couple”[13] Transference had long been recognised by Freud in the Studies on Hysteria as a false connection or ‘mes-alliance’ (mes-allianz)[14]. The patient transfers feelings she has towards someone in her life, on to the person of the physician/ analyst. This phenomenon, according to Freud, is an ‘inevitable necessity’[15] but it is something that must be carefully handled. It is not enough to recognise that one is implicated as an analyst in the treatment through the transference. It is essential to remember that it will also be used by the patient as a form of resistance. Freud warns us:

“The patient brings out of the armoury of the past, the weapons with which he defends himself against the progress of the treatment – weapons which we must wrest from him one by one”[16] .

In this way, the patient will use it as an impediment to the advancement of the analytic work. However, one of the main aims of psychoanalysis is to facilitate the ordinary neurosis of the patient becoming a ‘transference neurosis’ which can be ‘cured by the therapeutic work’[17]. In this way, transference is an essential element to psychical ‘working through’ and it is salutary for the patient to be facilitated to move from a psychoneurosis to a transference neurosis as the treatment progresses.


The Flight into Illness

With this question of movement, let us return again to Melman’s work on hysteria and his examination of the etymology of the word itself. As we know, if there is movement or migration in hysteria, it is certainly not a physical movement of the woman’s uterus which causes her neurosis, as was once thought. This belief gave rise to the very word ‘hysteria’ from the Greek word ‘he hustera’ which means uterus. But just because it has long been discredited, does not mean that we should not pay attention to these origins. Hippocrates introduced the adjective ‘hysterical’ - ‘hustera’ following on from ‘he hustera’. Melman draws our attention to the homophonies[18] here, and, as psychoanalysis pays such close attention to language, it deserves further examination. ‘Husteros’, a word close to ‘hustera’ has a number of meanings that may not be without relevance to the topic of hysteria – including to arrive late, to find oneself behind, to find oneself inferior or to give in to someone. Surely these meanings resonate when we think of the predicament that the hysteric finds herself in? Perhaps, this is an area that would need further scrutiny on another day, but it is fascinating to follow Melman’s interest in the homophony of the signifier and the effect of language. It is certainly thought provoking.

Rather than the effect of a wandering uterus which is cutting off airways and provoking all sorts of illness, in the ‘Studies on Hysteria’ Freud focuses on the ‘strangulated affect’ which needs to ‘find a way out through speech[19] . In Freudian theory we come across movement via repression – ideas or thought content is pushed out of consciousness, to evade dealing with what the ego finds incompatible. Through working with hysterical patients, Freud discovered the process of repression that is evident in all neurotics – an exclusion of a thought or feeling that is unacceptable to the subject. However, this idea does not go away. It is not so easily escaped from, rather, it reappears in another form elsewhere, in a conversion symptom for example. Lacan states:

“The neurotic symptom acts as a language that enables repression to be expressed. This is precisely what enables us to grasp the fact that repression and the return of the repressed are one and the same thing, the front and back of a single process.” [20]

In the case of Elisabeth, we see that she physically ’cannot stand’, but really, she cannot stand to be alone following the death of her father and the separation of her family… The pain or trauma is converted, excluded from conscious knowledge and unrecognisable to the subject, until she begins to speak… and to re-integrate the repressed signifiers into the signifying chain. Psychoanalysis offers not a physical solution to the somatic problem presented by the patient. It proposes a psychical working through, a way of using the Symbolic to re-work the Imaginary, a new way of looking at things – a process that lends itself to working out the family complexes. Here, with Freud, we have a radical approach to helping the hysteric resolve the riddle that her symptoms present her with. Freud is interested in the patient, in the situation she finds herself in, and in what she has to say about it. The hysterical patient shows him that her reality (not her body, although it is implicated) has become too distressing and unbearable and that she believes that her only option is to take refuge in her illness[21]. Freud, the analyst shows her that there is another way.


From the Imaginary to the Symbolic via the Real

In a tribute to Charcot, Freud praised his ability “to look at the same things again and again until they themselves begin to speak.”[22] What Freud and Lacan taught us is to listen over and over, to listen so that we can hear, to get the patient to speak the same thing again and again until the truth can emerge from the shadows of the unconscious, to re-integrate the repressed signifiers by remembering, repeating and working through. As much as the patient is ushered towards having the words to say it, the analyst is implored to have the ears to hear it. Lacan states: “I will show that there is no speech without a response, even if speech meets only with silence, provided it has an auditor, and this is the heart of its function in analysis”[23].

In this way, the hysteric can move towards subjectivity, with a better handle on his or her alienation, all the while teaching us about the importance of a slow revealing of one’s personal truth. It is not a therapy that focuses on the strengthening and unification of the ego but the realisation of desire, of loss – a lost object that keeps our desire going. It highlights the absolute necessity of speaking about traumatic life events, the necessity of attempting to symbolise the Real with all the challenges and pain that this can entail. Psychoanalysis is born out of working with the alienated, it invites the content of the unconscious in to the patient’s speech, what is strange, what is outside the linear and the logical. It privileges the non-sense that we hold in our mind. It is a radical way of working, turning us upside down and inside out. In his Seminar ‘The Reverse Side of Psychoanalysis’, Lacan states that “Truth does, indeed, seem foreign to us, I mean our own truth”[24] This seemingly foreign truth, begins to make sense and can be taken on by the analysand over time. However, it is not just the patient who will come up against resistance, so too will the analyst. Freud often refers to those physicians and psychoanalysts who have abandoned his technique, as they found particular difficulty with his theories on sexuality. He regularly emphasises that we are all hampered by our own repressions and we may quickly take flight when we first learn the unwelcome truths of analysis, he alludes to“…all those who have found their stay in the underworld too uncomfortable for their taste”. He continues: “The rest of us, I hope, will be permitted without hindrance to carry through to their conclusion our labours in the depths.”[25] It is not only the suffering hysteric who takes flight it seems!


“Approaching the Future as a Friend”?[26]

Psychoanalysis and hysteria go hand in hand, there would be no analysis without the hysterical patient – she has taught us everything. Moustafa Safouan reminds us in his wonderfully entitled paper ‘In Praise of Hysteria’ that “Psychoanalysis begins with hysteria and psychoanalytic knowledge will always be worth only what our knowledge of this structure is worth”[27] How do we preserve this position? How do we ensure that we do not become entrapped or seduced by a position of mastery? How do we speak about the analytic experience without reifying it? How do we suspend both judgement and understanding in our analytic practice when society is placing more and more value on knowledge and, indeed, measurable outcomes? We must not revert to an objectifying of the hysteric by subjecting her to a mere categorisation. This makes our task challenging, for it is easy to slip into dictums in relation to the structure of hysteria. But we must remember to take each particular subject one by one. Lacan contends that we are “practitioners of the symbolic function”.[28] What is the goal of a psychoanalytic practice? To shepherd the patient towards their truth, to guide them back in to their past, through the medium of the Symbolic via the Real. We direct the analysand to analyse, and through questioning, they can transform the Imaginary in order to be able to live with it. In this way one’s alienation is not so extreme, but a tolerable subjectivity can be achieved. Lacan underlines:

Psychoanalytic experience has rediscovered in man the imperative of the Word as the law that has shaped him in its image. It exploits the poetic function of language to give his desire its symbolic mediation….[29] 

With this in mind, I now turn to an Irish poet, Paula Meehan, who eloquently describes her experience of writing, which to my mind represents something of the analytic experience – in other words, a transformation of the Imaginary through the Symbolic via the Real - she states:

“If this poem, like most that I write,

Is a way of going back into a past

I cannot live with and by transforming that past,                                                 

Change the future of it…

That journey takes all my strength

and hope, just as this poem does

which I present to you now.”[30]

* This paper was presented at an International Conference entitled ‘Why was Psychoanalysis Founded by an Emigrant’ which was a collaboration between New Studies on Hysteria Group, Dublin and École Pratique des Hautes Études en Psychopathologies, Paris. The conference took place at Marino Institute of Education, Dublin on 9th December 2017.

[1] Foucault, M. Madness and Civilisation (1967) Reprint: Britain, Routledge Classics, 2005. p.263

[2] Freud, S. A Question of Lay Analysis (1926) Standard Edition XX, London, Hogarth Press. p. 203

[3] Freud, S. Studies on Hysteria (1893) Standard Edition II, London, Hogarth Press. p.177

[4] Lacan, J. ‘The Function & Field of Speech & Language’ in Ecrits (1966) Trans. B. Fink. New York, W.W. Norton & Company, 2006. p.223

[5] Freud, S. op. cit. p.179

[6] Ibid p. 179

[7] Ibid. p.181

[8] Charles Melman’s text ‘New Studies on Hysteria’ is currently being translated by Helen Sheehan and being worked on in seminar meetings by a group of the same name. The translation has not yet been published. The idea that ‘the signifier hits’ was mentioned by Helen Sheehan at one of the ‘New Studies on Hysteria’ seminars.

[9] See Footnote 8.

[10] Freud, S. Hysterical Phantasies and their Relation to Bisexuality (1908) Standard Edition IX, London, Hogarth Press. p. 164

[11] Freud, S. Three Essays on the Theory of Sexuality (1905) Standard Edition VII, London, Hogarth Press, p.165

[12] Lacan, J. Book Three The Psychoses (1981) Trans. R. Grigg, London, Routledge.1993 p. 83

[13] Foucault, M. op.cit, p. 263

[14] Freud, S. Studies on Hysteria (1893) Standard Edition II, London, Hogarth Press. p. 70

[15] Freud, S. Fragment of an Analysis of a Case of Hysteria (1905) Standard Edition VII, London, Hogarth Press.  p. 116

[16] Freud, S. ‘Remembering, Repeating and Working Through’ (1914) Standard Edition XII, London, Hogarth Press. p.151

[17] Ibid, p. 154

[18] Homophony – the linguistic phenomenon whereby words of different origins become identical in pronunciation.

[19] Freud, S. Studies on Hysteria (1893) Standard Edition II, London, Hogarth Press, p. 255

[20] Lacan, J. Book ThreeThe Psychoses’ (1981) Trans. R. Grigg, London, Routledge.1993, p.60

[21] Freud, S. Some General Remarks on Hysterical Attacks (1909) Standard Edition IX, London, Hogarth Press p.231

[22] Freud, S. On the History of the Analytic Movement (1914) Standard Edition XIV, London, Hogarth Press, p. 22

[23] Lacan, J. ‘The Function & Field of Speech & Language’ in Ecrits (1966) Trans. B. Fink. New York, W.W. Norton & Company, 2006. p. 206

[24] Lacan, J. Book XVII, L’Envers, (1969-1970) Trans. Gallagher, C. p.5 of seminar dated 21/1/1970

[25] Freud, S. On the History of the Analytic Movement (1914) Standard Edition XIV, London, Hogarth Press, p. 66

[26] This quote appears in a poem by W.H Auden’s poem ‘In Memory of Sigmund Freud’

[27] Safouan, M. ‘In Praise of Hysteria’ in Returning to Freud, Trans. Schneiderman, S. (1980) New Haven and London, Yale University Press.p.55

[28] Lacan, J. ‘The Function & Field of Speech & Language’ in Ecrits (1966) Trans. B. Fink. New York, W.W. Norton & Company, 2006. p 235

[29] Ibid. 264

[30] Meehan, P. ‘Fist’ in Dharmakaya (2000) England, Carcanet, p. 13