Editorial illustration connecting historical medical ideas with the psychoanalytic relationship between mind and body.

The term hysteria has its roots in Antiquity. Hippocrates associated its symptoms with the “wandering womb”—an organ believed to move through the body and cause different physical disturbances. Because of this connection with the womb, hysteria was considered a condition found only in women.

The “therapies” used at the time included directing a stream of water toward the female genitals. Whether consciously or not, this practice emphasised the sexualised interpretation of the condition found in some of its earliest medical descriptions.

From the wandering womb to psychoanalysis

This understanding remained dominant until the end of the nineteenth century, when Jean-Martin Charcot, Josef Breuer and Sigmund Freud proposed new ways of explaining hysterical symptoms.

At first, the problem was approached from two directions. Hysteria could be seen as a result of suggestion, autosuggestion or even simulation. Alternatively, it could be treated as a disease that had to be defined through a precise set of symptoms, following the model of neurological disorders.

Breuer and Freud opposed this simplified view. The understanding of hysteria began to develop alongside the psychoanalytic concepts of the unconscious, psychic conflict and psychological defences. Hysterical symptoms played a key role in the emergence of psychoanalysis: through their analysis, Freud formulated some of his central ideas about unconscious processes, conflict and defence.

Freud initially believed that actual sexual assault was the cause of the disorder. He later changed his position, arguing that the decisive material was not necessarily a real assault, but infantile fantasies whose memories had subsequently been repressed.

The two main forms of hysteria

Early psychoanalysts distinguished between two broad types of neurosis: obsessional neurosis and hysterical neurosis. Freud later added anxiety neurosis as a form of hysterical neurosis.

Hysteria thus became a general name for neuroses that could present different clinical pictures while remaining similar in their aetiological principles. Over time, two main forms emerged:

  • Conversion hysteria, expressed through bodily symptoms.
  • Anxiety hysteria, characterised by phobic symptoms.

Conversion hysteria: conflict on the stage of the body

Conversion hysteria appears through bodily symptoms that symbolically reflect a psychic conflict. It can be described as a conflict played out on the stage of the body.

The term conversion refers to an economic transformation: libido becomes detached from an idea and is converted into innervational energy. The part of the body toward which the libido is directed preserves its symbolic character and expresses the repressed idea.

The hysterogenic zone

Charcot and Freud observed that, in conversion hysteria, a particular area of the body could become a source of increased sensitivity. Patients described the area as painful, but closer examination suggested that its stimulation could produce sexual pleasure and could also provoke a hysterical attack. This area was called a hysterogenic zone—a part of the body invested with libido and given an erogenous character.

The reasons for such a displacement of the erogenous zone were sought in the patient’s history. In one case described by Freud, the hysterogenic zone—the right thigh—was connected with an unconscious erotic childhood memory. The patient had used that part of her body to touch her father’s leg. The example illustrates the symbolic connection between the bodily symptom, the event and a repressed wish of an Oedipal character.

Unlike Charcot, who attempted to establish a fixed topography of hysterogenic zones, Freud emphasised the sexual motive behind their selection. He argued that any part of the body could acquire this role.

Symptoms that imitate neurological disorders

Hysterical symptoms often imitate neurological disturbances—paralysis, sensory impairment or seizures—without an anatomical or physiological explanation. For this reason, they are described as pseudoneurological.

They may take several forms:

  • Motor symptoms, such as paresis and paralysis.
  • Sensory symptoms, such as anaesthesia, paraesthesia and hyperaesthesia.
  • Suppression of sensory functions.
  • Psychological states.
  • Pseudo-epileptic manifestations, including possession states, fugue and seizures.

These symptoms do not follow the anatomical logic known to medicine. A paresis extending from the elbow to the fingertips, for example, cannot be explained by the arrangement of the nerves along the arm. Pseudo-epileptic attacks also have a different clinical picture from the seizures observed in epilepsy.

Ambivalence and the return of conflict

The psychological conflicts associated with hysteria are organised around attraction and repulsion. At the centre of the symptom stands an ambivalence toward the same object: it is simultaneously the source of a strong libidinal attraction and the subject of a moral prohibition. This object is usually a parental figure.

The hysterical patient is therefore said to suffer from reminiscences—a form of intense remembering of Oedipal conflicts that would normally have been repressed more deeply into the unconscious.

Anxiety hysteria and the phobic object

In anxiety hysteria, fear is directed toward a relatively stable external object. This distinguishes it from diffuse, free-floating anxiety, in which fear is mobile and repeatedly attaches itself to changing objects.

The central symptom of anxiety hysteria is the phobia. Phobias can also appear in other mental disorders, including schizophrenia and obsessional neurosis, but in anxiety hysteria the phobia occupies the central position.

Freud initially classified phobia under obsessional neurosis or the actual neuroses. After the case of Little Hans, however, he recognised its structural similarity to conversion hysteria. In both cases, an idea becomes separated from its affect.

The essential difference is the destination of the libido released through repression. In conversion hysteria it is directed toward a bodily zone. In anxiety hysteria it remains in the form of fear and later becomes attached to a phobic object, forming a phobia.

Repression, conversion and displacement

Both conversion hysteria and anxiety hysteria use repression as a defence mechanism. The repressed ideas are usually connected with the Oedipal conflict. The conflict may include oral and anal features, while also having a partly genital character.

Conversion hysteria relies on conversion as its characteristic defence, whereas anxiety hysteria is dominated by displacement. In both cases, the libidinal affect is directed toward a symbolic substitute—either somatic or external. The bodily area or external object preserves a symbolic connection with the underlying Oedipal conflict.

Transference and the analytic process

Hysterical patients are distinguished by their capacity for transference, which makes the psychoanalytic technique particularly applicable. By reproducing the Oedipal conflict within the therapeutic relationship, conditions are created for it to become conscious and to be transformed.

The analytic technique relies on transference to illuminate unconscious conflicts. Reproducing the Oedipal dynamic in the relationship with the therapist allows it to be experienced again and gradually worked through with the help of interpretation.

In contemporary diagnostic systems, hysteria is no longer used as a diagnosis. Its clinical manifestations have been reformulated as dissociative or conversion disorders. Psychoanalysis, however, continues to approach hysteria as a structure with a characteristic dynamic and characteristic defences.

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