Hysterical personality and conversion: theoretical aspects.

Abstract

The origin of the concept of conversion reactions and the development of ideas concerning it are discussed. The presence of pre-œdipal components in this reaction, as described by various writers, is noted. Attention is directed to the important paper of Rangell, who has endeavoured to separate the blind linkage of the words ‘conversion’ and ‘hysteria’. His considerations on the psychodynamics of the conversion process are discussed in detail. Conversion is a psychological concept and can only be seen as one step toward a symptom or lesion and depends upon other factors such as previous disease or injury. The possibility of predisposing factors being present at birth which help determine the development of conversion symptoms is emphasized. The attitude taken originally by Alexander that conversion symptoms are confined to the sensory motor system is found to be too restrictive, for there are many accounts of conversion symptoms occurring in structures innervated by the autonomic nervous system. The important recent work of Miller and his associates on the capacity of animals to alter heart rate or intestinal contraction for a reward is considered as effectively demolishing the artificial distinction between the somato-sensory and autonomic nervous system in so far as learning is concerned. Psychological theories of the etiology of conversion reactions are reviewed, beginning with Janet's concept of dissociation and Freud's emphasis on the importance of the Œdipus complex. Other opinions which are dealt with, view conversion as somatized activity below the symbolic level. The conflict in theory between those who see conversion reactions as a manifestation of dissociation and those who see repression as the principle mechanism, for example Fairbairn, is noted. The emphasis placed by Engel on perception of memory traces as a result of experience giving rise to an anlage of body language, is pointed out. Significant traits of the hysterical or histrionic personality are reviewed. Particular attention is paid to the important paper of Lazare, Klerman and Armor, in which the traits are factor analysed, and five of the seven were found to have a high degree of correlation in the patients examined. Two other traits, namely aggression and oral aggression, which had not been anticipated as belonging to this group, were found to have a high degree of correlation, thereby supporting Marmor's concept of the basic importance of oral fixation in the hysterical personality. Physical correlates of the hysterical character may be found in the work of Shagass on the sedation threshold. It is found to be low in this type of individual. The sexuality of the hysterical character was examined in reports from the literature and considerable weight was given to the report of Prosen on two cases considered hysterical characters, in which there was a high degree of orgastic activity reported. In both instances there was a severely unresolved œdipal situation. Recent important contributions to the psychoanalytic study of the hysterical personality from the studies of Easser and Lesser and of Zetzel are considered in detail. Many of the cases of the former authors could be called cryptic, because the diagnosis became manifest only during therapy. A more severe type of case with extreme bizarre emotional lability and poor relationships was characterized as hysteroid. These latter cases were difficult or impossible to treat. Zetzel divided a large series of cases into four groups, depending on their suitability for analysis. Her fourth group called ‘florid hysterics' coincides relatively well with the hysteroids of Easser and Lesser.