Perhaps we can start with the case history of one of Joseph Breuer's patients, Anna O, which is classical case in the field and has been used widely in the field as a part of professional training to illustrate some conceptual ideas and constructs of psychoanalysis.
Anna O was a highly intelligent young woman. In the course of a two-year illness starting in 1880, she had developed numerous physical and mental disturbances and they are outlined as follows:
- paralysis of the right arm and leg
- blurred vision
- nausea
- inability to drink any liquid
- inability to speak and comprehend her own mother tongue
- altered state of consciousness
- personality change
- forgetting of events that took place during that period of illness
Anna O received a diagnosis of hysteria at that time which referred to an illness in which there were physical symptoms but no physiological basis for the problem. Though we seldom have this diagnosis nowadays, hysteria and conversion disorder, which has been included in DSMs, are comparable in nature.
According to DSM IV-TR (2000), individuals with this disorder have one or more symptoms or deficits affecting voluntary motor or sensory functions, such as impairment of eyesight, paralysis of limbs and inability to swallow as mentioned in the case of Anna O, that are judged to be temporally associated with psychological factors such as stress or psychological conflict originating in traumatic experiences rather than physiological deficits or any other medical condition.
To me, it is like the expression of psychological pain through physical symptoms due to its inability to release or discharge its distress (psychic energy) through appropriate means due to some reasons like repression of unacceptable and excessively painful materials. Since there is an innate tendency for us to strike an equilibrium, the excess energy finds its own ways out and other physical symptoms or other disturbances are then formed.
The case of Anna O suggested that her symptoms were in association with the illness and the death of her father what posed a dramatic psychological impact on her. Her emotions were blocked and repressed from the conscious mind at that time as they were too painful and hence the energy inside found its own way to seek discharge so as to reduce the tension arised. However, during the talk therapy designed and conducted by Freud, through recollecting the relevant events, memories and emotions she had restrained, in other words, through bringing the repressed materials from the unconscious to the conscious, she were freed from the disabling symptoms.
It sounds magical and unbelievable, yet it could be explained in terms of psychoanalysis.
It was asserted that at the time of the original traumatic event, the patient had to hold back (repress) a strong emotion due to the reasons we talked about previously. This may also be due to the circumstances that surrounded the event. Nonetheless, the fact was that the patient was unable to express the emotion in a normal way through thought or word. The emotion, which was a strong form of psychic energy resulted from intra-psychic conflicts, prevented from discharging normally, had found another outlet and was expressing itself through a neurotic symptom. Once the emotion was recollected and allowed to release properly, the symptom disappeared.
Hysteria, in this sense, it closely connected with repression, conflict and psychic energy flow. Perhaps this could also cast some light on our understanding of the formation and development of mental illnesses.
References
American
Psychiatric Association, & American Psychiatric Association. (2000). Diagnostic
and statistical manual of mental disorders : DSM-IV-TR (4th , text revision
ed.). Washington, DC: American Psychiatric Association.
Engler,
B. (2009). Personality theories :An introduction (8th ed.). Belmont, CA:Wadsworth/Cengage
Learning.
Freud, S. (1910). Five lectures on psychoanalysis. SE (vol.11).
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