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"Freud and the Literary Imagination"
Lecture Notes: Freud, "Aetiology of Hysteria" (1896)
Preliminary Reflections: Contemporary investigations into the theory and treatment of hysteria:
1) Rachel P. Maines, The Technology of Orgasm (2001): Study of how "vibrator" developed as a treatment for female hysteria. Presupposition: hysteria as illness based on the "blockage" of certain fluids released upon orgasm; treatment as physically instigating orgasm in order to break through this "blockage" and initiate healthy "flow" of fluids. (Fluidal theory! The "humors," black bile, phlegm, blood, etc.)
2) Sarah Ruhl, In the Next Room, or The Vibrator Play: Drama based on Maines's book:
Dr. Givings (note play on name!) treats neurotic patient, Mrs. Daldry, in his clinic, while his wife, "in the next room," overhears the sounds of treatment. In one scene, she begs her husband to conduct his experiments on her; but he refuses. Critique of Victorian society, its secretiveness about sexuality (the bourgeois women must ask the lower-class wet nurse about the meaning of "orgasm"), the "knowledge" attained by men, and their inability to translate this knowledge into adequate social practice. Men in "light"; women in "dark." Note the implication in this play that science and knowledge constitute the privileged domains of men!
3) Hysteria historically linked to sexuality and to physiological cures: it is seen as a real, physical pathology that is somehow tied to sexual malfunction in women. (What Maines and Ruhl try to show is that this "malfunction" in women is connected with a "malfunction" in men.) Freud will retain the link with sexuality, but translate physiological cause into the domain of psychology. Repression as a psychological "blockage" related to issues of sexuality. Freud will reformulate this theory by postulating that what is at issue is not the uninhibited flow of real fluids, but instead the flow of psychic energy. This is what Freud referred to ad the "dynamic" aspect of psychoanalytic theory: there is a kind of "flow" of impulses, psychic information, emotional affects in the economy of the psyche.
I. What is Hysteria?: History and Definition
A. Word "hysteria" = from Greek word hystera, meaning "womb."
1. Originally "hysteria" designated a link between certain nervous disorders and diseases of the female sexual and reproductive organs. It was thought that there was a direct connection between these physical pathologies localized in the female organs and certain nervous symptoms.
2. This explains why hysteria has commonly been conceived as a pathology to which women are exclusively susceptible. If it is based in a physiological source that is gender specific (the uterus), then the illness itself could only occur where this prerequisite physiology is present.
3. Hysteria defined (Webster's): "A psychiatric condition variously characterized by emotional excitability, excessive anxiety, sensory and motor disturbances, or the unconscious simulation of organic disorders." Freud will concentrate on what we today call "psychosomatic" illnesses, that is, seemingly organic symptoms that in fact have a purely psychological origin.
4. Freud's teacher, the famous French neurologist Jean Martin Charcot (1825-1893), spent a great deal of energy studying hysteria and concluded that it derives from a particular hereditary disposition. (To view an 1885 painting of Charcot demonstrating a hysteric patient--a drawing that Freud hung, moreover, in his office--click here.) In other words, certain people are genetically pre-programmed, as it were, to develop hysteria, just as today we know that the predisposition to other diseases (e.g. cancer, alcoholism) can be genetically based.
a. Charcot believed that real events could serve as the trigger that released the hysterical symptoms. Hysteria, in short, can lie "dormant" in one until its symptoms are stimulated by some real-life event. Charcot called such events "provoking agents"; they serve to actualize the hereditary potential for hysteria, to transform it from latent possibility to concrete reality.
5. Note how up until this point in the history of hysteria nature is given precedence over nurture. In the "womb" theory as well as in Charcot's hereditary theory, hysteria is seen as something inescapable, as predetermined because it is somehow programmed into one's very physiological and genetic constitution.
B. Freud's Relation to the History of Hysteria
1. Freud will take issue with the emphasis on nature as the precondition for hysteria and will (try to) shift the focus to questions of nurture. We will see that he is only partially successful at this.
2. From Charcot Freud borrows the notion of the "trigger" or the "provoking agent" that unleashes the hysterical symptoms. The theory here is that the event that stimulates the symptoms is not itself the cause, but merely a reference to a deeper cause. It serves to invoke that cause. It is possible that Charcot's theory of the "provoking agent" of hysteria influenced Freud's later notion of the "day residue" or "trigger" in dreams. The structural mechanism, at any rate, is identical.
a. For Freud, however, what this "trigger" activates is not a hereditary predisposition, as for Charcot, but rather: infantile experience.
3. This has certain consequences for the theory of hysteria:
a. Hysteria no longer must be a pathology exclusively identified with women; it is de-coupled from physiology in the strict sense (it's association with the "womb") and from other forms of somatic or genetic predetermination. This means that, in principle, at least, men are also susceptible to hysteria. (Later in this essay Freud will work toward retracting, or at least limiting, this implication.)
b. Hysteria is a product of upbringing, education, of one's interaction as a child with the world of adults or of other children. In other words, Freud takes a first step toward broaching the possibility that hysteria is a social disease, rather than a physiological one.
c. Nurture is given precedence over nature. (But as was true in Civilization and Its Discontents when he proposes that a piece of nature underpins our social relations, here too Freud will ultimately discover a bit of nature lurking behind this nurture.) "Bad" nurturing seems to be the cause of hysteria.
II. Freud's Theory of Hysteria
1. Freud's procedure here, as elsewhere, is empirical. In this instance his conclusions are drawn from 18 case studies, all of which, he claims, bear out without exception his general thesis. Of these 18 cases, 6 are male, 12 are female. By today's standards, of course, this is an extremely small sample, perhaps too small to be the basis of a universal theory like the one Freud proposes.
2. Freud searches in these 18 cases for a single cause that all of them have in common: this would be their uniform basis and would hence point to the general aetiology of hysteria. What is this shared element? A traumatic experience in childhood that is uniformly of a SEXUAL nature.
3. Freud applies the practice of his friend and colleague Josef Breuer (1842-1925), the evocation of involuntary association, to dig into his patients' memories in order to reveal the traumatic childhood experience that is the cause of the hysterical symptoms.
a. Freud acknowledges the difficulty of penetrating through to the origin, the primal cause of the hysteria. Following the patients' trains of association will often lead to other memories that are related to the cause of the hysteria or recount events that are manifestations of the disease itself, but are themselves not the underlying cause. Freud calls these peripheral but associatively related recollections screen memories: they "screen" the original causal event, but also point toward it by means of association. (On screen memories, see Freud Reader 117-26.) Screen memories have a structure that can be aligned with the "allusion/illusion" reflex the French Marxist Louis Althusser attributes to ideology: they "allude" to deeper causes by pointing to them through structural or other similarity, but they also hide these deeper causes (and hence are "illusions"). Note that these lateral associations that make up the texture of the pathology are similar in structure to the intratextual references and allusions we discovered in certain Freudian literary texts, especially in Hofmannsthal's "Tale of the Cavalry." Freud places much more emphasis on these networks of lateral references in his psychoanalytic practice and theory than is generally recognized. We tend to overstress the "symbolic" nature of the psyche, the allusion to general and universal meanings, whereas Freud always interpreted the data he acquired in the context of other data received from that same patient. The difficulty arises, then, of finding a way to distinguish between genuinely causal remembered events and these related, but ultimately peripheral, screen memories.
b. To distinguish true causes from screen memories Freud proposes 2 conditions that must be at work for an event to give rise to hysteria (see Freud Reader 98-99):
1) Suitability (or appropriateness) of an event to serve as a cause of the symptoms. In other words, the symptom must fit the cause. If a patient suffers from hysterical vomiting, for example, the root cause would likely be something that is associated with disgust. Freud refers to a patient who was forced as a child to stimulate a woman with his foot and whose hysterical symptom was a disorder of the legs, ultimately leading to paralysis. The symptom and the cause must, in short be of the same kind.
2) The traumatic force of an event must be powerful enough for it to act as the cause of a hysteria. Hysterical vomiting cannot be caused, for example, by the experience of eating a rotten piece of fruit during one's childhood; this is simply not traumatic enough. This is the reason why Freud associates hysteria with sexual events: only these, he believes, carry enough traumatic force to stigmatize us to the point of creating a hysterical response.
4. Freud uses the analogy of an archaeological dig to exemplify the temporal, historical nature of these "associative chains," as he calls them. (See Freud Reader 97-98). We can extrapolate from the "ruins" we discover at the surface of our "site" the basic plan of historical structures that no longer exist. And if we dig below the surface, we are liable to find the original foundations, at least in fragmentary form. From this we can reconstruct the original building, the palace, the temple, etc. and draw conclusions about its function. This is how Freud approaches psychological pathologies in his patients: digging for clues that will help him reconstruct the causes of the illness. (To view an example of such a reconstruction on the basis of the Roman Forum, click here.) Note the persistence of this analogy in Freud's thinking: we have discussed it in the context of Civilization and Its Discontents, from 1929, as well, where Freud uses the extended example of the city of Rome, the "eternal city," to describe the persistence of memory traces in the unconscious mind. This analogy thus serves as one of Freud's primary metaphors for the psyche and for psychoanalysic investigation throughout his life.
B. Freud's Basic Conclusions
1. A sexual event experienced during infancy or childhood is the sole origin of hysterical symptoms. Thus, the aetiology of hysteria is situational, not physiological or genetic.
a. Freud goes so far as to generalize childhood sexual abuse as the origin of all neuropathologies; it is, as he says, the "caput Nili" (the source of the Nile) for all the psychopathologies of adulthood.
b. These sexual experiences can include innocent things like stimulation of the genitals during wiping, diapering, hygiene, etc., or can be actual instances of coitus-like acts of seduction during childhood.
2. Freud delineates 3 groups of hysterics based on the source of this sexual stimulation:
a. Assaults by adults: mostly practiced on women by men (fathers, uncles, brothers, etc.) where there is no consent. That is, rape or other forced sexual activities.
b. Love relationships between an adult and a child; these are usually of a longer duration and are the manifestation of deeper emotional and affective bonds. Here genuine feelings of "love" are at work.
c. Relationships between 2 children, usually brother and sister, whereby this situation presumes that one of the children has already been initiated into sexual activities by an adult (presumes "seduction" of one of the children previously).
3. Aside from these qualitative distinctions, Freud also stresses a quantitative factor: the severity of hysterical symptoms is directly proportional to the number of such sexual encounters or acts of sexual abuse that one experiences as a child.
4. The "trigger" that initiates the latent hysterical symptoms for Freud is usually the sexual encounters one has after puberty. These "permissible" sexual acts recall or re-invoke the "inadmissible" acts, the hysteric's moral "shame," associated with childhood sexual abuse and activate the latent hysteria. The hysterical symptoms, in other words, usually don't occur until long after the initial traumatic experience itself.
C. Repression as "Sufficient" Cause:
But Freud also admits that not all individuals who are abused as children become hysterics. How can we explain this?
1. Simple (for Freud): Those who remember and are aware of the abuse they underwent have not repressed it; it is part of their conscious awareness, or, in Freudian terms, is accessible to their ego.
-- Hence a further prerequisite for hysteria is the unconscious (rather than conscious) operation of the memories that cause the trauma. In other words: Hysteria only occurs under the conditions of repression: only when the incidents of sexual abuse are denied and repressed can they recur (as the return of the repressed) in the form of hysterical symptoms.
-- Hysterical symptoms as a distorted form of expression: if one removes the causes of the distortion (repression) and opens up avenues for understanding the causes, the symptoms disappear.
a. This explains why Freud's therapy is based, like Breuer's "talking cure," on bringing the original traumatic memory back into the patient's consciousness: once it is freed from repression, the trauma ceases to cause hysterical symptoms and the patient is "cured."
To view a diagram of how hysterical symptoms and their causes are structured, and the relationship between causes, screen memories, and symptoms, click here.
D. Anatomy and Gender Enter Through the Back Door:
1. But if for Freud all psychoneuroses have the same sexual cause, then how can they be distinguished? This is where Freud sneaks nature and gender in through the back door.
-- His answer: The attitude of the patient toward the experience of abuse determines what form the pathology will take:
a. If the sexual encounter is experienced actively, with a sense of pleasure, then the pathology will manifest itself as an obsessional disorder. This occurs most commonly in men. Why? Because for Freud men are constitutionally the active partners in sexual activities.
b. If experienced passively, with disgust or displeasure, with resistance, the pathology will manifest itself as hysteria. This is more common in women because women are the passive partners in sexual acts (according to Freud).
Freud thus returns the theory of hysteria to its origins (the "womb"); he comes full circle and, after denying hysteria's basis in gender and physiology, reintroduces gender as a criterion. But now this gender distinction is based not in physiology, but rather in "constitutionally" defined mental attitudes. Gender, for Freud, is a state of mind, so to speak, that is related to (but not identical with) physiology.
III. Historical Context
A. The "seduction theory": Until 1897, Freud held onto the position articulated in this essay that hysteria (or any other neuropathology) stems from a real act of seduction during childhood. This gave rise to vehement protests among other clinicians and in the general populace. People did not want to accept the idea that childhood sexual experiences were this common and that sexual abuse was a frequent occurrence.
B. In 1897 Freud abandoned this theory: he now argues that the traumatic sexual event does not have to be real to have a lasting pathological effect: it can be merely imagined, it can be the product of fantasy. In the psychic economy, Freud argues, imagined incidents have the same causational value as real events: the psyche does not distinguish between real and imagined in any evaluative sense. Note the relevance of this theory in debates over rape, seduction, and abuse today. Are these memories "real" or just "fantasies"? On Freud's belief that imagined and real events have the same force in the economy of the psyche, see the handout on hysteria. (to view the handout, click here.) At any rate, this revised theory allowed Freud to account for the frequency of memories of a sexual nature in his patients without the implication that actual sexual abuse was so rampant in the Victorian world. Is this a case of Freud himself falling victim to repression? Of adjusting his theories to fit public demands? In the book The Assault on Truth (1984), Jeffrey Masson took the position that when Freud abandoned the seduction theory, he also abandoned the scientific basis of his own theory. According to Masson, Freud caved in to the resistance of both popular and scientific opinion when he abandoned the "truthful" basis of his theory of hysteria by rejecting the seduction theory.
C. We will see in Freud's analysis of Dora how the idea that the infantile sexual encounter need only be fantasized is turned against the female patient.
IV. Freud's Contributions to the Theory of Hysteria (Summary):
1) Etiology not based in heredity (Charcot);
2) Nurture, not nature, as cause;
3) Pubescent experience not cause, but mere "provoking agent" ("trigger");
4) Hysteria no longer tied to physiology (to hystera, or "womb" (not "gendered"; but gender re-enters picture on psychological level);
5) Hysteria as product of upbringing; it is a social disease;
6) Source of hysterical symptoms as infantile experience;
7) Nature of these experiences is sexual = the so-called "Seduction Theory";
8) Hysteria tied to unconscious memories of this infantile experience (repression);
9) Attitude of patient (active or passive) determines nature of the pathology; passive attitude (victim) = hysteria; active (perpetrator) = obsession.
Last Updated: 3/02/12