Poupart 2014
Poupart 2014
Poupart 2014
12235
Florent Poupart1
Universite Toulouse 2 Jean Jaure s, Laboratoire Clinique Pathologique et
es Antonio Machado, 31058, Toulouse cedex 9,
Interculturelle, 5 alle
France – flo_pou@hotmail.com
The term hysteria has been used in the history of the psychoanalytical move-
ment to describe a large variety of psychic modalities. What is the common
denominator of the hysterias? The author suggests that ambivalence in rela-
tion to penetration in its passive form (vaginal desire), in its pregenital and
genital valences, constitutes the essence of hysteria. It seems that the issue of
hysteria thus configured finds its best resolution in the fantasy of an incorpo-
real penetration, which leads to orgasm, and spares one from the anxiety of
destruction to the internal space as well as from the anxiety of guilt following
the hoped for climax. The author is attempting to discern, by means of two
case studies, how disembodied penetration, depending on whether it is fanta-
sized or delusional, constitutes a solution, neurotic or psychotic respectively,
to the issue of hysteria: the private theatre in neurosis, as well as the inhab-
ited and influenced mind in psychosis (delusion of control), act as psychic
figurations of vagina.
concerning a feminine dimension that is not seen as the negative of the mas-
culine dimension but rather as possessing its own essence. With particular
reference to the contributions of Karl Abraham, Ernest Jones, Melanie
Klein, Josine M€ uller and Karen Horney, and drawing on Freud’s own prop-
ositions (notably Freud, 1905, 1918, 1919) which depart, notably, from the
thesis that the feminine is the negative of the masculine, they have developed
conceptions of the feminine linked to considerations on passivity, the concav-
ity of the subject’s own body, and anxieties related to passive penetration.
For more details on this debate, I would like to refer the reader to my recent
publication on this subject (Poupart and Pirlot, 2014).
I am putting forward the hypothesis here that ambivalence towards vagi-
nal desire, that is to say, penetration in its passive form, constitutes the
essence of hysteria. Drawing on two case studies, I shall try to identify how
incorporeal penetration, depending on whether it is fantasized or of a delu-
sional nature, constitutes a solution, neurotic or psychotic respectively, for
the hysterical conflict thus defined.3
3
I will not be referring here to other contributions of great quality which propose to link hysteria and
the repudiation of femininity: I am thinking in particular of the contributions of Gregorio Kohon (1984)
and Rosine Jozef Perelberg (1999).
nuns during the epidemics of the Middle Ages took the form of violent
blasphemies and unbridled erotic language” (Freud, 1950[1892–93], p. 126).
In his Fragment of an analysis of a case of hysteria, Freud (1905[1901])
insists on the mechanism of “reversal of affect” in hysteria: “I should with-
out question consider a person hysterical in whom an occasion for sexual
excitement elicited feelings that were preponderantly or exclusively unplea-
surable . . . whether or not the person were capable of producing somatic
symptoms” (p. 28). For Freud, then, it is not the somatomorphic character
of the symptoms that constitutes the essence of hysteria, but ambivalence
towards sexual desire that is translated by an experience of “disgust”,
which, as Monique Schneider (2004) reminds us, is “paradigmatic of repres-
sion” (p. 44). But elsewhere Freud evokes the hysterical character of phobic
neurosis which he qualifies, in particular in his Analysis of a phobia in a
five year-old boy (1909), as ‘anxiety hysteria’. Then, in 1911, in his Psycho-
analytic notes on an autobiographical account of a case of paranoia (dementia
paranoides), he qualifies as hysterical the “hallucinatory mechanism”
observed in “dementia praecox” (Freud, 1911, p. 77).
These few examples are sufficient to grasp the difficulty behind the multi-
ple uses of the terms ‘hysteria’ and ‘hysterical’ and to identify their common
denominator in Freud’s writings, where ‘hysteria’ in the singular was from
the outset (that is to say, as early as the years 1894–1895 and the studies
with Joseph Breuer) diffracted into multiple forms: “Freud and J. Breuer
distinguished”, Francßois Richard (in Andre et al., 1999) writes, “at least
seven forms of hysteria: hypnoid hysteria, traumatic hysteria, retention hys-
teria, defence hysteria, conversion hysteria, anxiety (phobia) hysteria, and
finally hysterical psychosis” (p. 62). In addition, and more recently, Joyce
McDougall has elaborated the notion of ‘archaic hysteria’ in connection
with her work on psychosomatic manifestations.
So what is it, then, that constitutes the essence of hysteria? In 1878,
Charles Ernest Lasegue, a French doctor, wrote:
The definition of hysteria has never been given and never will be. The symptoms
are too inconstant, too varied, and too unequal in duration and intensity for one
type, even descriptive, to be able to comprise them all.
(cited in Andre et al., 1999, p. 13)
In a typescript that was never published, entitled L’hyst erie, and dated
1948–1949, the French psychiatrist Henri Ey (a contemporary of Jacques
Lacan who exerted extensive influence on the psychiatric semiology of the
French school in the second half of the 20th century) retraces the history of
the concept: he depicts the variety of the symptomatology and compares
the main explanatory theories, from the most biological to the most psycho-
genic, including the compromise that he had always defended, that is to
say, his “organo-dynamic” conception. Though he proposes right at the end
of the text to infer the “essence” of hysteria from his work, he confines him-
self to emphasizing the “psychoplastic structure of psychic life and the disor-
ders of abnormal somatopsychic expressions that it entails” (Ey, 1948–49, p.
120). In other words, through his timidity, he does not belie Lasegue’s
prophecy.
Paradoxically, it seems that this ancient term, which is an exception in
psychiatric vocabulary inasmuch as it has not disappeared from everyday
health care discourse (only from the official discourse), has never been given
a definition that has enjoyed a consensus. Its etymology takes us back to the
uterus, that is, to the body, to woman, and to the concave aspects of the
female body. In popular language, the hysteric is a woman, and the ‘hysteri-
cal attack’ a form of extreme and unreasonable agitation, a disproportionate
stirring of the body, which is shaken by spasms and temporarily uncontrolla-
ble, associated with a profusion of emotional expression. Now if we go by
the way it is used in health care services, the term hysteria inevitably
refers to the notion of comedy, that is to say, making a spectacle (knowingly
exaggerated, and even simulated) of the affects which invest the body; one
also thinks of the tendency to seek attention, as well as the tendency towards
seduction and the eroticizing of relationships. The theatrical dimension has
also held the attention of the authors of the great international classifications
(APA, 1994; WHO, 2008) who, approximately 30 years ago, replaced the
notion of hysteria with that of ‘histrionic personality disorder’, formed from
histrio, that is to say, the actor, the comedian, in Latin. This disorder con-
denses dramatization, that is to say the exaggeration of emotional expres-
sion, the seeking of attention, seduction, and suggestibility. As for
psychoanalysis, we know that hysteria constitutes the psychopathological
breeding ground from which psychoanalysis emerged: one inevitably thinks
here of the body convulsing and exhibiting infirmities with no somatic basis
(the body is only complicit, compliant4 ), and of affect, projected into the
foreground (in the body and in emotional expression) to the detriment of
representation, which is repressed; and, above all, of the particular place
occupied by the Arlesian sexuality of the hysteric, which is omnipresent in
his or her discourse, but never revealed.
There is one finding, however, that the clinician can cling to: at the heart
of the encounter with a patient, regardless of his or her sex or structure, the
term ‘hysterical’ has a meaning, even though it is not easily accessible to
discursive thinking. This is because it is related to the personal feelings of
the interlocutor in contact with the patient much more than to an objective,
symptomatic description, or even to a specific pathogenic or metapsycho-
logical hypothesis. In other words, it is first and foremost related to the
countertransference experience specifically provoked by the particular orga-
nization of the patient’s libido in the transference.
What can be said of this transference organization? It seems to me that it
is characterized by great ambivalence towards erotic desire. This is translated
by the coexistence of the affirmation of desire along with its repression, of
seduction by, and repulsion for, the other, the reversal of affect that occurs
when the fantasy is in danger of being fulfilled (Freud, 1905[1901], p. 28). In
the introduction to their book devoted to the Probl ematiques de l’hyst erie,
Jacques Andre, Jacqueline Lanouziere and Francßois Richard (1999) remind
4
Concerning “somatic compliance” in hysteria, see particularly Freud, 1905[1901], p. 40.
In one case which I observed, for instance, the patient pressed her dress up against
her body with one hand (as the woman), while she tried to tear it off with the other
(as the man).
(ibid.)
What does a woman want? She wants two contradictory things. Her ego abhors
defeat, but her sexual organ demands it. It wants the fall, the defeat, the ‘masculine
dimension’ of man, that is to say the contrary of the ‘phallic’ dimension an
infantile sexual theory that only exists to avoid the difference between the sexes,
and thus her ‘feminine dimension’. It wants large quantities of libido and erotic
masochism. This is the ‘scandal of the feminine’. Everything that is intolerable for
the ego is precisely what contributes to sexual jouissance: namely, violent intrusion,
the misuse of power, loss of control, the erasure of limits, possession, submission,
in short, ‘defeat’, with all its polysemic meanings.
(Schaeffer et al., 1999, p. 38)
5
This is a manner of speaking. In reality, one may suppose that there is something that the ego fears
more than breaking in, and that is disintegration.
6
The expression ‘psychic modality’ is intentionally imprecise, but I prefer it here to the term ‘psychic
organization’, which has too many connotations from the point of view of structure. What I want to
emphasize, precisely, is that the term ‘hysterical’ is independent of structure. It refers, in my view, to a
mode of investment of oneself and of the other (almost a mode of being) which finds neurotic and psy-
chotic paths of expression.
In hysterical neurosis one can highlight the fact that the hysterical symptom is
directly linked to the subject’s unconscious desire. In hysterical psychosis, on the
contrary, access to desire is no longer possible; in the empty place of desire, one
finds the process of psychosis.
It would seem, then, that the difference between hysterical neurosis and
hysterical psychosis does not lie in the nature of the fantasy, but rather in
the possibility or impossibility of owning the desire as a part of oneself
(even at the price of a repression).
In hysterical psychosis, the desire to be penetrated is no longer accepted:
it is denied. The penetration, instead of being desired, is realized delusional-
ly: the internal space is occupied by the other, representations yield to per-
ceptions, reminiscences to hallucinations, fantasy to delusion. The other is
there in oneself, not with his body but with his thoughts, his mind, his soul,
his ‘nerves’,8 his will, his voice, his influence, etc: xenopathy, the loss of the
subject’s sense of owning his internal manifestations (thoughts, emotions,
sensations, intended actions) which, as a result, acquire an exogenous char-
acter, realizes the fantasy of a incorporeal passive penetration. Henri Ey
insists on the penetrating character of the voice in the phenomenology of
the psychic hallucination:
7
To use the famous expression of Anna O, reported by Breuer (Breuer and Freud, 1895, p. 22).
8
In the words of Daniel Paul Schreber (1903), the most famous case of someone suffering from delusions
of influence.
She complained that the person who was introducing him/herself into her envelope
thanks to the torpor of her mind was doing extravagant things there. The person
who was in the foreground was commanding her muscles, her hands, making her
get undressed.
(1934, p. 139)
One cannot fail to recognize here the conflict that was agitating Freud’s
patient: one of her hands was taking her clothes off, while the other was
resisting this; one hand, as I said above, was expressing a female sexual
desire, and the other a refusal of the feminine. The essential difference
between these two women does not reside, it would seem, in the nature of
the pathogenic conflict (a conflict of ambivalence towards vaginal desire),
but in the solution that is found for it: neurotic, in one case (the conflict is
owned, dealt with, and symbolized in the symptom), and psychotic in the
other (the conflictual desire is ejected and makes its return in the actuality
of hallucinatory experience. Consequently, there is no reason, from my
point of view, not to qualify as hysterical the psychotic solution that Mme
Duf presents.
In 1934, Henri Ey pointed up the parallel between hysteria and delusions
of influence:
The relations between hysteria and delusions of influence seem to me to pose one
of the most fascinating problems in psychiatry. One day, we will come back to the
hysteroid attacks that are encountered in the evolution of these delusions and to
delusional hysteria which is so overlooked today. It is worth noting, however, here,
that the syndromes of external action, with repressed eroticism, suggestion, crepus-
cular states, and the development of a ‘fixed idea’, greatly resemble, on account of
their structure, hysterical delusions.
(1934, p. 162)
Mystico-erotic themes are the rule. The principal delusions that are observed in
hysterics are delusions of demonic possession, either zoanthropic or lycanthropic (the
patient believes he has been transformed into a cat, for example, as in the famous
observation by CHARCOT), ecstatic delusions, prophetic delusions, spiritist delu-
sions, delusions of self-accusation or accusation by others (DUPRE). These delusions
are for the most part delusions of influence, systematized, clear, ordered, lucid, and
with a strong affective charge. . . . As for the hallucinations of hysterics, they can be
divided into two groups: the visual oneiric hallucinatory activity of hypnoid states
and the hallucinatory activity (psychic hallucinations, vivid mental representations,
syndromes of influence) of hysterical delusions.
(1948–49, pp. 26–8)
approaches. During a week’s stay with her companion, she noted with sur-
prise that she had her period the day after they had got together again,
whereas she was expecting it much later; this fortunate anomaly would
oblige her to refuse to have any form of sexual relations during the few
nights she shared with him.
Her attitude towards men condenses three postures:
the posture of a little girl who needs to be protected (and treated?)
when she is infatuated with men (sometimes much older than her) of
whom she dreams day and night, but with whom she exchanges at
the very most an innocent kiss. And when her friend shows signs of
exasperation and threatens to break off their relationship, she sinks
into deep despair;
an aggressive and humiliating attitude, mixed with unconcealed plea-
sure, towards the men who approach her and try to seduce her, and
of course towards her friend himself, whose feelings she does not
spare; sometimes, she is the one who takes the reins of the game of
seduction, skilfully succeeding in manipulating her victims, making
them comply with all her wishes, sometimes even falling into their
arms, but never into their bed;
finally, an attitude of fully accepted, and even openly affirmed feminin-
ity, concerning which Jacqueline Schaeffer (2000) writes that it “coexists
well with the phallic attitude, that of lure, of masquerade, and which is
reassuring for castration anxiety, both that of men and of women”. I
would not have been able to express better the extent to which Geral-
dine’s femininity is a subterfuge (phallic) which, on the contrary, is in
the service of the refusal of the feminine dimension and “reassures” her
against anxiety about being penetrated, which, as Andre Green (1990)
notes, is the “correlate” of castration anxiety (p. 60). One day she
related a dream in which she saw herself, endowed with a penis, “rap-
ing” [sic] a man who was without one.
I understand these three forms of regression, oral, anal–sadistic, and
phallic, respectively, as different modalities of the refusal of the feminine
dimension. It is worth noting, as Freud (1937) did in connection with the
“virile protest”, that it is not a question of a refusal of passivity, since she
fully accepts its oral form, but only of its vaginal form: for Geraldine, it is
only when passivity implies passive penetration that it becomes a source of
anxiety.
It can be seen, then, how this young woman’s hysterical organization
found a path of compromise in incorporeal penetration: the voluptuous
occupation of her ‘private theatre’ by men seems to constitute a stop-gap,
exempt from anxiety and guilt, for physical penetration by them, to which
she only submits in the last resort (and in homeopathic doses), when the
fear of losing her love object temporarily takes precedence over the anxiety
connected with being penetrated by him. At the same time, the oral, anal–
sadistic, and phallic modalities of regression constitute, as we have seen,
diversified modes of defence against vaginal desire.
11
Henri Ey evokes frequent cases of zoanthropy in the delusional syndromes of hysterical psychosis
(1948–49, p. 28).
Ah, now then! The forces of evil, in all its splendour [sic], oh l a . . . it’s all nega-
a l
tive . . . an ultra powerful animal, with a tail; like the dinosaurs, they are sweeping
all before them, with their big heads and horns. I have the impression that it can
see me, because I can see its eyes. It gives me the shivers. I don’t know if it’s Satan.
If it’s not him, it’s one of his advisers.
Apart from the loss of distance with the material (the fragility of
consciousness in interpreting is obvious), one can see here that persecution
anxiety clearly translates a sexual anxiety associated with penetration, the
phallic detail being perceived, in an exaggerated symbolism, as a devastating
weapon;
on the contrary, with Card VII, feminine/maternal, in a hollowed-out
form, the content is idealized: “That’s right! It’s positive! I can see ani-
mals . . . something must have happened with them, but they’re so sweet,
they’re forgiven”
finally, Cards III and VI, which are likely to elicit psychic bisexuality,
give rise to an indefiniteness which is translated not in sexual, but Mani-
chean terms: “There’s something that’s not right in it, because it is both
positive and negative . . . that’s negative, that’s positive. They are per-
haps in purgatory, I don’t know” (Card III); “Those are two boys,
you’re going to think I’m crazy, because there are willies here . . . they’ve
done some stupid things and they are trying to make up for it” (Card
III); “Something negative and positive; as much evil as good . . . it’s the
forces of good, which may eventually turn into the forces of evil, it’s so
positive that it may turn into the negative” (Card VI).
We may suppose that, given the vulnerability of her identity, the conflic-
tual sexual organization resorts to splitting the object in order to manifest
hysterical anxiety: the feminine/masculine opposition is translated into a
conflict between good and bad; her anxiety related to being invaded by the
masculine is manifested, delusionally, in the fear that the “good” internal
space may be subjected to intrusion and destruction by the “forces of evil”.
This assumption is in keeping with the clinical manifestations: delusions of
influence, xenopathy. The hypothesis I am making, then, is, that we are
dealing with a hysterical organization. This is also backed up by the theatri-
cal and spectacular dimension of the disorders, their great lability (in partic-
ular that of delusion), and the erotization of relationships (in particular
with the clinician, albeit projectively). This conflict of ambivalence towards
vaginal desire was deployed in the oral pregenital sphere.
The analysis of the Rorschach protocol thus enabled us to draw attention
to a vulnerability of identity which unquestionably situates Florence’s
psychopathological organization on the side of psychosis, in spite of a false
surface adaptation.
Discussion
The hypothesis of vaginality has led me to pose the “question of the hys-
teric” in different terms: no longer as “to be the phallus or to have it?”,12
but as “to have or not to have a vagina?” The hysteric fears being invaded
by a foreign content in a centripetal, penetrating movement, just as the
obsessional fears seeing his own contents escape him in a centrifugal
momentum: bodily fluids (expulsion of stools, vomiting, ejaculation), psy-
chical material (affective manifestations, libidinal or aggressive discharges,
secrets, free associations in analysis), material and financial possessions.
The obsessional tries to protect himself against such a dispersion of his
internal contents by the centripetal hypercathexis of his inner world: intro-
version, intellectualization, rumination, restraint, modesty, greed, accumula-
tion, collection, “regression from acting to thinking”,13 impulse phobias,
etc. Conversely, exteriorization, putting outside, which forms the backcloth
of the hysteric’s relations to the other (making a spectacle, affective demon-
stration, exhibition of the inner conflict on the somatic stage in conversion
hysteria, projection of the source of anxiety towards an external object in
“anxiety hysteria”, etc.), would appear to be a reaction to the desired/feared
invagination: a defensive centrifugal movement against concave, centripetal,
vaginal appetency. It is thus tempting to draw up a list of a series of pairs
of opposites which seem to be ordered dynamically around the dialectic of
the container and the contained, the outside and the inside: separation/
intrusion; castration/penetration; introversion/extratensivity; convexity/con-
cavity; masculine/feminine. The two main organizational poles of the per-
sonality, rigid and labile, would thus correspond to the configurations set
up to fend against the two prototypical anxieties connected with the two
movements, full of pleasure and anxiety, from the inside towards the out-
side, and from the outside towards the inside. This duality is also related,
obviously, to the question of loss, to the different ways that the masculine
and the feminine try to deal with it: at its masculine pole, loss is regarded
as amputation, as castration, posing the question of the destiny of the lost
object and of the role of the third (anxious jealousy of love); at its feminine
pole, loss is treated as void, as an internal gaping hole. Anxiety, then, might
be seen more as a masculine attribute, and depression as an expression of
the feminine, which runs counter to Elizabeth Lloyd Mayer’s (1985) reflec-
tions on the anxiety of female castration: this author sees anxiety as the
expression of the loss of feminine attributes and depression as the result of
the loss of the phallus.
In short, rather than making the masculine coincide with activity, and the
feminine with passivity, I propose to link the masculine with the centrifugal,
and the feminine with the centripetal, whether or not one considers their
roots to be archaic or their culmination genitalized. The masculine/feminine
pair would be underpinned here by the body (and by anaclisis, the ego),
identified with a container that is liable to empty itself of its contents and
Francßois Richard (Andre et al., 1999, p. 97), with reference to the Lacanian understanding of hysteria.
12
13
Freud, referring to the obsessional neurosis of the ‘Rat Man’ (1909b, p. 244).
Translations of summary
Die Hysterie Ra €tsel. Der Begriff “Hysterie” wurde in der Geschichte der psychoanalytischen Bewegung
zur Beschreibung einer großen Bandbreite psychischer Modalit€aten verwendet. Was ist der gemeinsame
Nenner der Hysterien? Die Autorin vertritt die Ansicht, dass die Ambivalenz gegen€ uber der Penetration
in ihrer passiven Form (vaginales Verlangen) in ihrer pr€agenitalen und genitalen Valenz das Wesen der
Hysterie konstituiert. Offenbar l€asst sich das so konfigurierte R€atsel der Hysterie als Phantasie einer
k€orperlosen Penetration erkl€aren, die zum Orgasmus f€
uhrt und der Angst vor der Zerst€orung des inneren
Raumes sowie der Angst vor den Schuldgef€ uhlen, die sich dem erhofften Orgasmus anschließen, vor-
beugt. Die Autorin versucht, anhand zweier Fallgeschichten zu kl€aren, wie die entk€orperlichte, phantasi-
erte oder wahnhafte Penetration zu einer neurotischen bzw. psychotischen L€ osung des R€atsels der
Hysterie wird: das Privattheater der Neurose bzw. die bev€olkerte und beeinflusste Psyche in der Psychose
(Kontrollwahn) fungieren als psychische Figurationen der Vagina.
L’e nigme de l’hyste rie. Le terme d’hysterie a ete utilise dans l’histoire du mouvement psychanalytique
pour decrire un large eventail de modalites psychiques. Quel est le denominateur commun des hysteries?
L’auteur de cet article suggere que l’essence de l’hysterie est constituee par l’ambivalence liee a la
penetration dans sa forme passive (desir vaginal), dans ses valences pre-genitale et genitale. Il semble que
formulee ainsi, la question de l’hysterie trouve sa meilleure resolution dans le fantasme d’une penetration
incorporelle conduisant a l’orgasme, permettant au sujet de faire l’economie de l’angoisse de destruction
de son espace interne ainsi que de l’angoisse de culpabilite suscitee par l’espoir d’atteindre l’orgasme.
L’auteur tente de deceler a partir de deux cas cliniques comment la penetration incorporelle – selon
qu’elle soit fantasmee ou delirante – constitue une solution, respectivement nevrotique ou psychotique, a
la question de l’hysterie: le the^atre prive dans la nevrose, comme l’esprit habite et sous influence dans la
psychose (delire d’observation) sont des figurations psychiques du vagin.
L’enigma dell’isteria. Nella storia della psicoanalisi il termine isteria e stato usato per descrivere un’am-
pia variet a di modalita psichiche. Qual’ e il comune denominatore delle isterie? L’autore sostiene che
l’ambivalenza nei confronti della penetrazione passiva (desiderio vaginale), tanto nella valenza pregeni-
tale che in quella genitale, costituisce l’essenza dell’isteria. Sembra che tale configurazione del tema
dell’isteria trovi la migliore soluzione in una fantasia di penetrazione incorporea, che conduce all’or-
gasmo e preserva il soggetto dall’angoscia della distruzione dello spazio interno, nonche dall’angoscia di
colpa che esita dal desiderato climax. Attraverso il resoconto di due casi clinici, l’autore cerca di com-
prendere come la penetrazione disincarnata, a seconda che sia fantasmatizzata o delirante, costituisca
una soluzione, rispettivamente nevrotica o psicotica, al problema dell’isteria: il teatro privato nella nev-
rosi, cosı come l’occupazione e il condizionamento della mente nella psicosi (delirio di controllo) fungon-
o da figurazioni psichiche della vagina.
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