Topical questions in Psychoanalysis

Hysteria and adolescence

Hendrika C. Halberstadt-Freud

Lecture, Rome march 4 2000, Conference "Isteria e Adolescenza", II Divisione di Neuropsichiatria Infantile, Dipartimento di Scienze Neurologiche e Psichiatriche dell'Età Evolutiva, Università Degli Studi di Roma "La Sapienza", for presenting the book "Perché l'isteria? Attualità di una malattia ontologica" (A cura di F. Scalzone e G. Zontini - Liguori, Napoli, 1999).

Will hysteria in all its diverse forms remain a focus in female development in the present century as it was in the past one? I argue that this might be the case because of the greater narcissistic vulnerability of women. There are two or even three different reasons for her greater susceptibility regarding self-esteem.
First, the woman's body is more of an emotional battle field and an area of concern for her because of its constant and recurring hormonal changes and variations. This makes her bodily narcissism more vulnerable for her than is the case for males, who it is true can also develop hysterical character traits, not unlike women.
Secondly, a girl has first to please her mother, her first object, her first same sex partner, her lifelong example. A little later she also wants the love and attention of her father. She certainly can succeed in both, but she also runs the risk of a double disappointment. Not succeeding in becoming the favourite love object of one or either parent makes a girl more narcissistically vulnerable than a boy. Finally her hetero- and homo-sexual proclivities result in a strong tendency towards bisexuality, in the double sense of wanting to be male and female, and longing for female besides male love.
Finally a girl runs the risk of remaining in a close symbiotic bond with the mother and not becoming her own person damages her self-esteem.
All these factors together added to the fact that a girl is usually less focused on sexuality than a boy and needs more time to learn to enjoy her body can stimulate her to behave in a quasi sexual fashion. This might be called a hysterical character trait, as in fact needing love and attention masquerading for sexuality proper. Her looking for narcissistic support might more easily take the form of wanting to please and oblige, making her more prone to behaving in a theatrical and inauthentic way. Her close attention to her bodily alterations and functions makes her more alert to physical feelings and prone to have imaginary bodily sensations or to develop hypochondriac fears.

Women often prefer body language to verbalisation, hiding her desires and making Freud exclaim: 'What does woman want?' In fact, she often does not know herself. In the nineteenth century women did have few other means of expressing their hidden desires than fainting or physical symptoms. These were called conversions - our present day somatization- and grouped under the heading of hysteria. This diagnosis is contested today because it can have too many manifestations and is also culturally determined. 'Hysteria is a mimetic disorder: it mimics culturally permissible expressions of distaste or distress' (Elaine Showalter, 1997, p. 15).
Over a hundred years ago Josef Breuer and Sigmund Freud published Studien über Hysterie (Breuer & Freud, 1895), which ushered in a new century for psychiatry. Now, however, hysteria as a clinical picture - the model of psychoanalysis and the prototype of neurosis - seems to have all but disappeared and has been banished from diagnostic manuals.

Nonetheless, hysteria, in the sense of physical expression of emotional upheavals is and remains the prototype and the first form of neurosis, just as body language is the first language of the baby. In adolescence moreover, the girl's psychic balance is severely taxed during the period her new impulses and sexual drives compete for her attention. Bodily changes during the physical upheaval of puberty can cause anxiety and shame instead of pride. Her shape and silhouette change when she gets breasts that were not there before and she has to correct her self-image accordingly. She also has to accept her first menarche as a definitive change, whereafter she will always experience monthly variations in her body and psyche. She can no longer pretend she has the choice between being a boy or a girl, (although she can keep the unconscious fantasy she does, a phenomenon I often encountered in pre-as well as postmenopausal women). A girl's body changes to such a degree that she becomes attractive to men, even before she realises what is going on. Boys in her peer group might seem younger, she is not so much interested in them. Whereas adult men, whom she might consider more frightening than attractive, suddenly seem interested in her. It can indeed be frightening if the girl is unprepared to handle this change because her inner experience of herself is so different from her outer appearance. Moreover, even if she masturbates, which is not always the case, she still lacks the experience of being penetrated. (See Wagner's Siegfried, where Brünhilde exclaims: "Wehe! Wehe! Wehe der Schmach, der Schmächlichen Not! Verwundet hat mich, der mich erweckt!Er erbrach mir Brünne und helm: Brünhilde bin ich nicht mehr!" "Aus Nebel und Grau'n windet sich würend ein Angstgewirr: Schrecken schreitet und baümt sich empor!" (Wagner, 1995, pp. 90-91) ).
The girl and later the woman has little control over her intractable body where everything happens: invisible, hidden and inside her. Before long, an ongoing uncontrollable process of ever entering new phases has started. No returning to older states, no looking back is possible without turning into the proverbial salt pillar like the wife of Lot in the Bible.
The transition from innocent young girl to a moody prepuberal one predates the first menstruation, the "sexarche". From there she turns into an 'innocent', albeit sexually mature, virgin. As said, changing sensations in her body from now on recurring every month, make a girl more sensitive to signs of physical well-being, and make her prone to conversion and other hysterical reactions. Maybe she was a tomboy before, who had not chosen yet whether she wanted to have a male or female gender identity (still imagining she possesses both options). Now she has to be female, for better and for worth. The unfolding of a healthy narcissism, self worth and pride in womanhood is usually threatened by too many factors for girls to remain unscathed (Oliner, 1982).

Menstruation increases a girl's bewilderment about her female genitals. Because it is dirty and smelly and the girl lacks control she is thrust back to her old anxieties, where anus and vagina are confused. Her cloaca fantasies, an infantile theory in which one opening serves several purposes, -from impregnation, procreation, to excretory functions -, are revived and she hates her body for it. Girls often have to fight seeing themselves as unattractive, dirty, despicable. They have to ward off feeling ashamed of themselves. Of course, a mother can assist her daughter to take a different view of menstruation. Regular conversations about the body and its sexual functions can be a source of insight and emancipation for the girl. The mother's positive contribution depends on her own freedom to think and talk about bodily functions and sensations without betraying conflict. If her image of the body is laden with taboos and archaic fantasies she will communicate lack of self assurance and aversion rather than satisfaction about being female.
Throughout puberty new concerns loom at the horizon. Through these inner physical changes a girl suddenly turns into her mother's rival, long before she is emotionally ready to have a relationship with a man. She might only have the appearance of a woman. Inwardly she most probably is still a small and timid girl. Although the oedipal struggle with the mother and rivalry for the attention of the father is revived, the girl still feels the need to be protected by her mother. She does not yet know how to react to all the new demands made on her to behave as a sexually mature woman.
The role of the father has to be mentioned here. He is important, not only in helping to separate mother and child and precluding a symbiotic collusion and merging, but also in praising the girls femininity without being seductive towards her. He has to walk the fine line between seductiveness and too much distance.

When he girl has her first sexual experience, her "sexarche", which may be exhilarating, she still loses something as well, because she has changed form virgin into woman. And that is only the beginning not the end. In the Western world a girl does not marry early and she does not want to become pregnant for a while. For a long time she has to be able to take measures to actively regulate her sexlife and protect herself against pregnancy and infections like chlamidia. The virtual possibility of procreation however creates wishes fears and fantasies around fertility and nonfertility as well as ambivalence around the wish to have or not to have children. However, the biological clock ticks on and the time to take fateful life decisions is alas, limited for women. If she wants children, she has to decide whether to move on to a steady relationship with a male partner. Ideally this should mean abandoning the (close) bond with the mother, but as Freud realised in his private life and in his practice this does not always happen. If all goes as planned the woman will experience her first pregnancy, yet another possible source of apprehension and anxiety. Once pregnant, even if planned, a woman often feels trapped because, once more, she realises she has lost her choices, there is no going back. She is never not a mother again. She tends to feel she can not compete with other women any more because she is too fat. In my experience many a young prospective mother has an episode of falling in love with anyone who happens to cross her path, as an escape from her newly woven cage. But even if she does not go to extremes, she is bound to have mixed feelings and regrets because she will never be a free woman without lifelong responsibilities again. No choice without its disadvantages. If she does not have children later mourning about not having a family is just as unavoidable, even if it once was a conscious decision. But, once a family is formed the unstoppable train rushes on to the female middle years, the leaving home of the children, the inescapable phase of menopause, eventually culminating in the spectre of old age. Fear of loss of fertility and physical attraction is a typical complaint of women, all connected to the body and its whims.

During adolescence the girl begins to want to be more on her own. She has new opportunities for authenticity during this second separation-individuation phase. But if she experiences difficulties in this period guilt will predominate. It will not only be like the old oedipal guilt of wanting to replace her mother, but a more primitive version based on the feeling that autonomy is reprehensible even in the absence of specific actions that might suggest it. Autonomy is often felt by women as being synonymous with aggression against the mother. A girl, in contrast to the boy, may easily experience a lack of space to unfold her possibilities and try out more independent ways. Normally a daughter remains in close connection with her mother during adolescence, simultaneously protesting and loosening the ties that bind her. The lack of incest taboos similar to that existing between a boy and his mother seems to me important. Continued physical and emotional closeness, like kissing, hugging and endless talking remain eternally possible. It is my experience that homosexual longing in women has a tendency to continue throughout life. From this I have concluded that no real change of object, so far claimed by psychoanalysis, takes place (Halberstadt-Freud, 1998). In development everything is added, nothing is lost. This uninterrupted emotional bond with the mother has positive as well as possibly negative consequences. A good relationship with mutual love and respect and not too much ambivalence will result in a warm and open personality without paranoiac traits. A parasitic relationship, where the mother needs the daughter for her self-assurance makes the daughter vulnerable. The chance moreover that a morbid trait will be passed on to the next generation is simply greater with daughters than with sons. A woman has to pass through the same stages and phases as her mother did before her. Consequently, she will be helped or hindered by comparing with or imitating and learning from her mother. That is why she remains involved with her mother throughout adolescence and after and benefits from that if all goes well (Kaplan, 1991). Too much mutual rivalry or conflict between mother and daughter can endanger a positive outcome. Unresolved conflicts with a mother can lead the daughter into opposition, seeking to make the distance between them as wide as possible. To resist the backward pull of intense desired and missed symbiosis, she pretends a fake independence. Too little distance on the other hand may result in a symbiotic bond and lack of chances of individuation for the daughter.

Dana, an adolescent girl of fourteen came into therapy because of intense feelings of jealousy towards her stepmother, making her ill and desperate. After her parents divorced she felt deserted by her father and sought refuge in pleasing her depressed mother with whom she lived. In this broken family the task of helping and consoling her mother fell on Dana. The two women developed a symbiotic illusion shared between them. They behaved as if they had to remain each other's favourite, without a third party, excluding others from their 'idyll'. This bond hampered the open negotiating of anger and aggression and resulted in a feeling of being suffocated. Dana reacted by having a secret relationship with a boy which she, out of guilt and solidarity with the mother, could not enjoy. It only served to break away and become more independent from her mother. Dana lived in two worlds, in one she served as an extension and support of her mother. In another part of her mind she was angry and wanted to be her own person. Avoiding open criticism, taking refuge in a false harmony, side-stepping conflict and silencing anger often seem the only ways to deal with these weak and vulnerable but still often domineering mothers. This may lead to the sad realisation later in life when a woman discovers that she never had a puberty phase of protest and is still dependent on her mother's approval. Some women stay afraid of their mother or fear her emotional break down and remain forever unable to say "stop" "enough" or "no" . They behave meekly because they still fear being rejected by her and keep hoping for the love or praise they missed.
Somewhat further on in adolescence, a girl can develop her sense of self and pride in her appearance, doll herself up, go out and see what effect she has on men. This is an experimental phase in which future roles are tried out and in which the female attracts and rejects male attention which might still be feared as much as desired. The girl feels herself to be like Goethe's Sorcerer's Apprentice who did not know how to reign in the flood he unleashed behind his boss's back. The girl, in her confusion, would still like to be able to take refuge in her old homebase, her mother, but the fear of unwanted merging holds her back. Her defence against returning to her mother and imperilling her hard won freedom can turn into an hysterical aversion. But as always, feelings like hate, aversion and primitive aggression are not conducive to the healthy fighting spirit needed to separate. Destructive fantasies return like boomerangs that endanger the self, among them the fantasy that she who attacks her likeness will risk her life. If you strike out at your mother your hand will grow above your grave, the naughty hand that must not give in to the temptation to masturbate. Thus sexuality and aggression are soldered together once again.

A girl's sexuality may be suppressed along with her appetite which can result in anorexia, a reaction close to hysteria, because of the faulty body image, the bisexuality, the need for attention, the theatricality, and the narcissistic vulnerability involved. An illness like anorexia might have to do with these hopeless endeavours to control the uncontrollable changes in her body and remain a sexless boyish girl. The fateful emotionally laden steps and phases involving her body might frighten the girl into frigidity.
Another outcome, masculine tendencies, culminating in homosexuality, marked by hyperactivity, toughness and a need to organise others and take the initiative may hide a deep felt need for dependence. The desire for a man and the wish to have his child, in infantile oedipal terms, the desire for the penis, for the father and the fantasy wish to bear him a child can cause fear and remain something to avoid at all costs if the girl has a violent rather than a loving image about sexual contact. This might lead her to reject femininity altogether.
A girl may have experienced her father as intrusive or aggressive. Certain fathers give rise to such feelings, but it can also happen that fears of an intrusive mother are subsequently projected onto the father, just as hostility towards the mother can easily be displaced onto him. This leads to more repression of feelings about the mother and father creating a double burden of guilt in the girl and, with it, the inhibition of aggression towards both parents. Just as the daughter may fantasise that she must protect her mother from her aggression, the same holds true vis à vis the father. She might harm him or even castrate him so she has to protect him against her aggression. The archaic fear to take hold of the father's penis, to steal it, to eat it, to destroy it, is a big unconscious taboo that can lead to sexual inhibitions, still the hallmark of hysteria. Holding on to repressed hostility gives rise to projection of these tendencies onto the man who comes to be seen as dangerous. This can happen with the father or with men in general.

The risks a girl runs as soon as she is sexually mature are traditionally deemed by parent and child to be much higher than for boys. She can get pregnant. Should she be informed about how to avoid this and given the pill or not? Should she be warned about HIV and given condoms when she goes on holiday? Parents struggle with these questions and worry about daughters coming home late. Besides, the budding flower of a daughter often raises incestuous or erotic feelings in the father which both parties fear. He becomes jealous of her boyfriends and criticises them beyond all measure. The mother can feel threatened in her female dominance by this new rival her daughter. She can even become jealous of her, although most daughters would hesitate to admit to themselves this seemingly improbable state of affairs: a jealous mother is as taboo as a jealous Virgin Mary. Some mothers try to stay young and fight ageing against all odds. They want to be their daughter's friend, go cloth-hunting with her, want to diet together, and they try, in short, to relive her adolescence via her daughter. Others are more competitive and try to flirt with the daughter's boyfriends or steal them away from her.
Usually the girl's first sexual experiences are more frightening than pleasurable. It can take a long time before she learns what she likes and gives expression to her wishes, that have been unknown to her or secret for so long. Even an orgasm can elude her for too long, before she finally discovers the possibilities of her body and how to share that with a partner. Hopefully mothers of the twenty first century will find discussions about the body and its sexual or erotic feelings less difficult, so that daughters will no longer have to get most of the necessary information from their girlfriends only.
It often happens that a girl, hesitating to share her erotic adventures with her mother, secretly goes to bed with a boy without using appropriate contraception. The other extreme is when the girl discusses all her intimacies with her mother as if she were her best friend. The middle ground between distance and symbiosis is hard to find between a daughter and a mother. And an unwanted pregnancy always lurks in the background. Mother and daughter are consciously or unconsciously preoccupied with this eventuality. In the best of circumstances this can be discussed openly. The daughter is usually full of questions for her mother if these can be discussed in a relaxed fashion.

Eroticism has more complexities for women than men. During adolescence the girl is more aware than the boy that sexuality has two aspects, procreation as well as the erotic. For the sexually mature girl the clitoris still serves no other function than pleasure. But the vagina is a hollow organ into which something can be put or disappear, like semen or a penis. Or it can serve as an exit to evacuate, babies, discharge, lubrication or menstruation. These multiple functions can create confusion in the mind of the girl or even the woman. The female must differentiate emotionally between these various functions, while keeping the links in mind as well. Finally a word about a woman and her discontents. Girls and women are too often unhappy about the way they look. When they are blond they want to be dark. When they have curly hair they want to have it straight. When they are short they want to be tall. They invariably want to be thinner. Something is always lacking to make them happy about themselves. When they find themselves positively ugly this might have nothing to do with the way they look. It often is a translation into concrete physical terms of the way they see themselves. Namely as 'bad' or 'reprehensible', meaning jealous, hostile, harbouring ugly thoughts, witch-like wishes, etc. It is also possible that the available space for beauty in the family has been fully taken up by the mother who enjoys the sole privilege of being the attractive prima donna, admired as such by the father. She is the lady, the pinnacle of femininity, the sole possessor of the secrets of charm. Then the girl involuntarily takes the room that is left, she becomes the ugly gosling, the Cinderella of the family. She loses her feeling of self worth, thinking: "My mother is beautiful and attractive which I am not." Lacking self esteem she becomes dependent on the praise and appreciation of others who have to constantly reassure her. This state of affairs makes women narcissistically vulnerable, a fact known and exploited by all Casanovas. However, a mother can help and stimulate (or hinder) her daughter's confidence. Some mothers praise their offspring, others constantly criticise their daughter to enhance their own vulnerable psychic balance.
Female eroticism and excitement is experienced as more diffuse and less readily located than that of men. This might influence her style of thinking and perceiving the world around her. The cognitive characteristics of hysteria, which, it is true, can be found in both sexes, are vagueness of observation and of narration (Shapiro, 1965). Female sexual experience is normally concentrated less in the sex organs and aims towards fusion and the abandonment of control.
. In my opinion the specific characteristics of the female have to be considered as possible factors in the greater frequency of hysteria in women. Foremost among these is Another factor we have seen is the woman's special relationship with her constantly changing bodily state. This aspect of femininity has never had the attention it deserves. Apart from the intersubjectivity between mother and daughter which binds them together for better and for worse, the daughter goes through dramatic metamorphoses of her own.

Hysteria in practice

Hysterical traits have a tendency to meet the expectations of the social environment or the therapist. These have since time immemorial comprised existential complaints that are often difficult to classify nosologically. Today being chronically tired and exhausted, or suffering from mysterious consequences of the Gulf war, or being attacked by extraterrestrial beings belongs to the possibilities of expressing anxiety and discontent.
In practice, hysteria is frequently misleading, tending to make the other powerless by seduction and blockage of any meaningful dialogue. Disavowal of depression and of mourning for lost love is converted into excitement. A therapist has to keep in mind the connection of hysterical character traits and symptoms with depression and feelings of narcissistic deficiency. There is always the danger of being led astray by the erotic elements in the transference and countertransference. If the therapist is male and the patient female, he has to be able to withstand the ever present seduction to choose the sexual or genital level as theme, whereas the anxieties of the patient concern a much more primitive experiential layer of the personality. The need to be loved and admired can be sought with erotic means, seducing the man without the girl or the woman experiencing any sexual desire. She is looking for self-esteem via the love of a partner.


The idea that hysteria no longer occurs is mistaken. Indeed, nothing could be further from the truth. Both anxiety hysteria and conversions are still found, and not only in relatively uneducated subjects. It is true, the more sophisticated, who have acquired a smattering of psychoanalytic knowledge from its widespread popularisation, can make use of more subtle forms that are less transparent. The expression of hysteria varies according to time and place and follows in the wake of the process of civilisation (Showalter, 1997). However, the body is a given of all times. The fateful emotionally laden steps and phases involving her body frighten the girl. It makes her prone to consider her body a battlefield on which all emotional struggles have to be fought. More than the boy, she tends to somatize, that is, to convert psychic conflicts, burdens and pain into physical symptoms for which no physical cause can be found. Headaches, belly pains, tiredness and suicidal thoughts vex her. She suffers all kinds of seemingly inexplicable physical pains, expressing her hidden erotic fantasies and preoccupations. Sometimes these can be fruitfully interpreted as having meaning. At other times the symptoms may lack psychic elaboration, and seem more like the original actual neuroses or point to alexithymia. Thus a woman can remain quite alone, unable to share her vague and unspoken anxieties. But analysts know that, contrary to popular belief, the so-called hysterical complaints should be considered neither harmless nor fake.


1. Breuer J. & Freud, S. (1895) Studien Ueber Hysterie, Deuticke Leipzig/Wien.
2. Oliner, M. (1982) The anal phase,in: Mendell, ed., Early female development. Current psychoanalytic views, pp.25-60, MTP Press, Lancaster.
3. Showalter, E. (1997) HystoriesHysterical epidemics and modern culture, Columbia Univ.Press, N.Y.,Picador, London.
4. Wagner, R. (1995) Siegfried, Reclam, Stuttgart.