[SOLVED] The Significance of Anna O and Hysteria in Psychoanalysis

This assignment delves into the significance of Anna O and hysteria in the development of psychoanalysis. It discusses how Anna O, a patient of Josef Breuer, played a crucial role in the formation of psychoanalytic theory. The assignment also explores how Freud's initial seduction theory was later abandoned, and how his subsequent work on hysteria led to the development of key concepts such as the unconscious mind and defense mechanisms. The text provides an overview of historical events, theoretical frameworks, and scientific developments that shaped the field of psychoanalysis.

Running Head: HYSTERIA AND PSYCHOANALYTIC THEORY 1
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HYSTERIA AND PSYCHOANALYTIC THEORY 2
Hysteria and Psychoanalytic Theory
Introduction
The human mind functions in intricate mechanisms that influence behavior and
interaction with the surrounding environment. Human behavior is complex and cannot be
extensively explored on the basis of a single theory. These statements are supported when
hysteria is put into consideration. It is a condition with a long history but there was no clarity and
conclusive model about its pathophysiology and bio-mechanisms. The field of Psychology
studies the mental processes and their effect on human behavior (Crawford & Krebs, 2013)). It
tends to deeply understand human needs, habit formation, reaction and stimulating factors
towards making specific decisions.
Psychological disorders are a common entity in the contemporary world. These disorders
antedates all the way from time of Plato sweeping through a number of philosophers who made
effort to experiment, study and describe them. Barlow (2014), describes a psychological disorder
as a pattern of feelings, thought and actions that deviate from what is regarded normal. They are
usually distressful and usually lead to a dysfunction. In this paper, I shall describe the
understanding of hysteria during times of Freud and Charcot, its contribution to the development
of psychoanalytic theories and perspective. In this regard, despite hysteria not being a current
psychiatric diagnosis as explained by Feinstein (2011), it will be used as a model and a platform
of reference due to its main role in major findings and discoveries in psychology and mental
health with regard to the concept of psychoanalysis.

HYSTERIA AND PSYCHOANALYTIC THEORY 3
Description of Hysteria
The timeline of history of hysteria in terms of description is traced from the work of
Hippocrates and Trotula De Ruggiero in 500 and 1100BC respectively. They described it as an
atypical disorder that caused dissociation for reasons which were not obvious. It is a name with a
Greek origin meaning the uterus. Therefore, it was thought to arise from the abdomen/pelvis and
affected normal mental function especially in women. It has a very long timeline that covers the
efforts of Sigmund Freud in his follow up experiments. Literature by Rose (2013), shows that
hysteria referred to a serious psychoneurotic disorder that presented with anxiety, emotional
outburst, excessive fear and irritable behavior, changes in personality, anesthesia, cognitive
impairment, motor control deficits, insomnia and irrational sexual desire.
Hysteria is described as not such a common disorder in the population but it is likely to
occur in those with a positive history of bereavement, conflicts, personality disorders and past
traumatic event or abuse (Bernheimer, 1985). There is a theory suggesting that persistent
repression of aggressive and sexual behaviors could lead to hysteria. The comorbid
psychological states related to hysteria are depression, anxiety and sexual disorders. Later,
Breuer & Freud (2009), concurred that the occurrence mechanism should be described as a
psychological reaction to unbearable situations to which the body’s resilience mechanism cannot
handle.
Currently, a constellation of manifesting symptoms of hysteria are considered in the large
umbrella of psychological disorders called dissociative and somatoform disorders. This was after
critiques that it lacked valid reasons to qualify as a DSM diagnosis. Most of the DSM critics
arrive to the conclusion that hysteria lasted for quite a long time as a psychiatric diagnosis in the
ancient times due to traditional support. Therefore, this means that there is no psychological

HYSTERIA AND PSYCHOANALYTIC THEORY 4
diagnosis of hysteria and its associations such as female hysteria, conversion hysteria, mass,
anxiety hysteria and male hysteria in the current mental diagnostic practice. The DSM- IV states
that the symptoms which were formerly relevant for the diagnostic criteria of hysteria are
conclusively covered under dissociative and somatoform disorders.
Dissociative disorders refer to a group of psychopathologies characterized by a disruption
in the unitary state of self or disturbances in the experience of self, resulting in a lack of
connection in a person‘s thoughts, memories and feelings, actions or sense of identity. The term
dissociation infers a mechanism that allows the mind to separate or compartmentalize certain
memories or thoughts from normal consciousness. These split-off mental contents are not erased.
They may resurface spontaneously or be triggered by objects or events in the person's
environment. The DSM-4 classification of dissociative disorders include: - dissociative fugue,
dissociative amnesia, derealisation, dissociative identity disorder and depersonalization disorder.
On the other hand, somatoform disorders comprises a group of mental disorders characterized by
a firm belief of suffering, abnormal body sensations, excessive worry and dislike of body parts.
This disease cluster consists of body dysmorphic disorder, conversion disorder, somatization
disorder, hypochondriasis, factitious disorder and somatoform pain disorder. Symptoms of these
disorders were given the diagnosis of hysteria by early theorists in order to apply a standardized
mode of therapy to the affected patients.
The psychoanalytic theory was developed by Sigmund Freud (1856-1939). This theory
has a special emphasis on importance of childhood activities and experiences in shaping
personality. He successfully described the structural/tripartite model which consists of the id, ego
and superego. The mind changes its state depending on the pleasure principle. This is the
constant drive to reduce tension and stress through expression of instinctual urges. The id is the

HYSTERIA AND PSYCHOANALYTIC THEORY 5
home of instinctual drives. It is present at birth and always operates on the pleasure principle.
The superego rationalizes internal morals, values and the right or wrong. It serves as a moral
conscience to suppress the instinctual drives of id through shame and guilt. Development of the
superego is presumed to be with socialization, identification with same-sex parent and resolution
of the oedipal complex. Through socialization, one assimilates societal rules for behavior from
role models. The ego component is the one which mediates between the id, superego and the
external reality. It is partly conscious and uses primary process thinking. Furthermore, he
described the topographical theory of the mind that consists of 3 components namely the
unconscious, subconscious and conscious. The unconscious part of the mind contains repressed
thoughts and feelings and shows itself in dreams and parapraxes/Freudian slips (Lapsley & Stey,
2011). It is driven by primary process thinking characterized by illogical thoughts, fantasy,
immediate gratification and lack of cause effectiveness. It does not take reality into account.
On the other hand, the subconscious mind was described as accessible but not readily
available. It always runs in the background. The conscious part is the mature type. It is fully
available and readily accessible. He noted that the conscious mind does not have access to the
unconscious. According to Ehrenzweig (2013), it utilizes secondary process thinking which is
based on reality, logical analysis and mature ideas that are well-oriented to time. Freudian
developments and contribution were related to psychic determinism/ dynamic model,
topographical model of the mind, psychosexual development and ego defense mechanisms. After
an approximate stay of 1 year with Charcot, Sigmund Freud’s interest in psychology developed
specifically in hysteria (Arsalidou et al, 2013). He was initially a general medical practitioner
and a neuropathologist. He evolved from being a neurologist to a psychiatrist. In the 1900s,

HYSTERIA AND PSYCHOANALYTIC THEORY 6
Freud and Charcot were mostly involved in the treatment of signs and symptoms of what is
currently related to conversion disorder. In those days, this disorder was named hysteria.
Breuer & Freud (1893), state that the symptoms that they considered were not related to
any medical condition, drug or substance abuse or any close relation to cultural or religious
practices and endorsements like trance. The development of full interest in psychopathology
made him to study hysterical related issues such as male hysteria, effect of the subconscious
mind, trauma as a factor in psychopathology and sexual aspect of psychology. Freud’s
psychoanalytic theory begun to take course by experimenting on a patient, Ann O. This was a
patient with classical symptoms of hysteria. Her symptoms included right-sided paralysis, cough,
hearing disorder, intermittent contractures, constant visual and language deficits.
The main symptoms related to psychological instability were prolonged hallucinations
and lapse in level of consciousness. When compared to the presentation of conversion disorders
in the DSM-4, these symptoms tally (Yarom, 2005). On further inquiry into Anna O’s
presentation, there was no history of an underlying medical condition or inappropriate substance
and drug use. Freud concluded that his patient was suffering from hysteria. The roadmap to
psychoanalysis unraveled through investigations and follow up on a number of patients including
Fraulein Anna O (1880-1882), Frau Emmy Von N, Fraulein Elisabeth Von R and Frau Cacilie M
among others. Therefore, this was ideal to Freud’s work on psychoanalysis. He together with
Breuer treated Anna O for symptoms of hysteria with Breuer’s talk therapy and help of views
from Charcot.
Most of these work that he made theories from were borrowed and based on the primary
findings of Professor Charcot, Breuer and other pioneers including Paul Richer and Janet Pierre.
With a solid basis from his predecessors, he (Freud) and a colleague called Breuer came up with

HYSTERIA AND PSYCHOANALYTIC THEORY 7
a hysteria theory based on known concepts developed by Janet and Moriz Benedikt. In fact,
Freud was moving from known to unknown using early precedents set by his senior pioneers.
Janet’s concept on fixed subconscious idea played a major role in developing the theory on
hysteria. The other theory that made his work a success was using Moriz Benedikt ideas, “The
pathological secret”.
Later, Freud and Breuer’s association was interrupted. On the basis of sexual hysteria, he
singlehandedly managed to develop the concept of converting psychological problems to
quantifiable somatic manifestations. This was through a belief that his sample patients had
actually undergone the process of sexual abuse, He named this as “the seduction theory”. Later,
accused his clients of deception hence he consequently developed another theory to explain this
behavior. This was named “the fantasy theory”. Borch-Jacobsen, (1996a), exploits this issue and
notes that this theory explained the reason behind development of sexual abuse symptoms in his
sample population despite being their no actual physical or emotional abuse.
In all of Freud’s subsequent case analyses, he construed illnesses as hysteria and
employed the same method of approach by investigating any traumatic incident that could have
triggered the patient’s present presentation. In the earlier cases when with Breuer, Freud adopted
Breuer’s hypnotic method as a mechanism to stimulate expression of repressed ideas and
feelings. This worked for some time. Anna O’s case helped Freud to make a conclusion that
patients who have symptoms that translated to motor manifestation had repressed feelings and
ideas that are locked in the unconscious part of the mind. In repression, the patient kept any idea
or feeling out of conscious awareness. Freud postulated that keeping a patient in a hypnotic state
may help the therapist access the unconscious part of the mind, get the deranged part of the mind
and apply the appropriate therapy to correct these manifestations. Later, Freud changed to the

HYSTERIA AND PSYCHOANALYTIC THEORY 8
“pressure technique” to induce a state of concentration to his patients in order to access the
repressed ideas in the unconscious mind. Ellenberger (1970), describes this as a method where
he pressed on the client’s forehead and instructed them to concentrate on their thoughts then
report faithfully what was running in their head with reference to the current presentation. This
was believed to evoke vivid pictures, unconscious memories and ideas. Freud believed that in
this technique until it became nonfunctional due to negative attitude from patient. He then
switched to “dream analysis” technique which provided patient with insight into the working of
the primary process. This technique led to the discovery of oedipal complex and infant sexuality.
These are concepts of psychoanalytic theory. Freud describes Oedipus complex as a child’s
unconscious desire to have sexual relations with parent of the opposite sex while developing a
feeling of hatred and anger against same sex. Resolution of this phase marks the end of superego
development. Fixation is associated with abnormal sexual behaviors. These therapeutic
techniques were used to treat and manage all patients who presented with symptoms suggestive
of hysteria. This was successful and hence psychoanalysis was being brought to full maturity
with subsequent patient care.
Development of psychoanalysis was further upgraded by exploration of different
processes of the mind such as displacement, transference and intrapsychic conflicts and the
unconscious mind. From such efforts of managing a patient named Frau Emmy Von N, Freud
managed to reinforce the basis of psychoanalytic theory through inclusion of these positive
techniques to the psychoanalysis. The treatment mechanism in the case of Emmy Von N was
through carthatic method. Freud exploited Breuer’s technique of hypnosis to gain entry to the
unconscious mind when he realized that she could be put in a state of somnambulism with ease.
The carthatic method was successful in this case because Emmy Von N could get trauma out the

HYSTERIA AND PSYCHOANALYTIC THEORY 9
mind by talking and releasing pent-up tensions and feelings. Brown (2009), notes that the theory
of the unconscious mind was the main point of almost total emphasis in the Freudian
Psychoanalytic Theory. The associated practices about the unconscious mind played a function
of supportive pillars in the approval of his main theory.
Ego defense mechanisms are also exploited in Freud’s patients. These are unconscious
parts of the mind that help to keep unconscious thoughts to remain unconscious. They comprise
an input from the id, ego and superego. In this regard, they are used to find a leverage of meeting
id’s demands while trying to remain socially acceptable. Defense mechanisms are classified as
mature, immature, narcissistic and neurotic. Examples of mature defenses are altruism,
anticipation, humor, suppression and sublimation. Immature defense mechanisms include; acting
out, somatization, dissociation, denial, reaction formation, rationalization and projection among
others. Ego defense mechanisms are a normal thought and feeling in daily life. However,
constant persistence of some defense mechanisms is associated with mental conditions.
When the case of Frau Emmy Von N is viewed from another context, Freud’s findings
point to employment of both mature and immature ego defense mechanisms by his subject.
Freud notes that Emmy Von O was married to an extremely successful and gifted husband. He
later died of stroke and left him with 2 children with nervous problem to bring up. From this
event, she developed hallucinations, language and motor difficulties. From this case, there is
evidence of repressed thoughts, suppression of traumatic ideas, denial, displacement, dissociation
and transference as ego-defense mechanisms. She had repressed thoughts of her husband which
were tucked deeply in the unconscious mind. The body mechanism of containing these thoughts
was overwhelmed hence leading to somatic manifestations. Transference refers to the action of
deliberately (consciously) pushing anxiety-provoking or personally unacceptable material out of

HYSTERIA AND PSYCHOANALYTIC THEORY 10
conscious awareness. It is probable that she employed transference as a mode of defense by
carrying forward the life experiences they had together with the deceased husband. When
therapy was initiated by Freud, her symptoms improve. She could experience less episodes of
insomnia and auditory hallucinations. Freud helped her rationalize the traumatic events
associated with her life.
As earlier mentioned, Freud proposed that the mind was solely a collection of
components that were trying to balance between internal instinctual demands and the fulfilment
of external expectations. Freud explains that childhood behavior can rule our future character and
personality. He explained this basing on the stages of psychosexual development in children. He
even tried to probe into childhood experiences of his patients through hypnosis in order to apply
the necessary therapy. These Freud's stages are based on clinical observations of his patients. The
psychosexual developmental stages are: oral, anal, phallic, latency and genital. These stages
occur at different phases and ages between birth and young adulthood. Each stage has a
designated pleasure zone, primary activity and the conflict to solve. Failure of successfully
traversing a particular stage is associated with fixation and some psychiatric disorders. The
psychoanalytic theory supports the theory that the oral phase is the stage of ego development.
Conflicts related to suppress ego development can lead to fixation at oral stage (Fromm, 2014).
Freud associated this with symptoms that occur in hysteria such as difficulties with trust,
attachment, commitment, eating disorders, smoking and drinking problems. Freud made a point
that the ego and the superego have a role to subdue the unnecessary demands of the id in drive
towards sexual gratification.
The psychoanalytic theory also wants us to view issues related to the conflicts at the
phallic phase. Using research done by McLeod (2014), the pleasure zone is the genitalia and the

HYSTERIA AND PSYCHOANALYTIC THEORY 11
primary activity is genital fondling. Failure to successfully navigate this phase leads to oedipal
Conflict. The conflicts at this stage have been theorized into the psychoanalytical model to
explain the Electra complex and oedipal complex as modes of fixation related to failure to
navigate this stage (Crain, 2015). However, it has been discussed in many theories and models
that the ego, id and superego play a major role in resolving any conflict arising from sexual
gratification at this stage. In this stage boys have a feeling that they should marry their mother
and kill their father. Nevertheless, the ego and superego comes into control by instilling fear of
retaliation from father; the so-called castration anxiety. They ultimately resolved thru
identification with father. On the other hand, girls have penis envy; they have a strong feeling of
wanting to marry their father. The superego resolves this by making them identify with their
mother to try to win their father’s love.
It has been studied that once the oedipal conflict is resolved, then it is a sign that the
superego is mature (Zimberoff & Hartman, 2000). In relation to hysteria, the behavior or
children in this stage of development may mimic those with classic symptoms of hysteria
because of rejected sexuality as described by Freud. Also, it is necessary to note that Freud
clearly brings out the idea that genitalia especially in penis envy should be treated as a secondary
phenomenon. Freud believed that sex and its experiences formed a platform for repressed
thoughts and left a physical trace which was deeply locked away. Basing on this belief he
analyzed the concepts of repression, displacement and transference as mechanisms of neuro-
psychoses defense (Cramer, 2012). An idea was formulated to paint hysteria to be arising from
the same common etiology of adaptive psychological defense techniques. He saw this as a
confluence of related interdependent factors relating to sexual abuse and unwanted physical
experience. Other theorists included heredity as a risk factor to Freud’s patients’ presentations of

HYSTERIA AND PSYCHOANALYTIC THEORY 12
hysteria but as for him, he only considered physical and sexual abuse as the sole cause of such.
Basing on this, Freud developed the sexual stages of development of a child. He introduced the
idea that the development of hysteria and neurosis are dependent on the stage of sexual
development during the abuse.
The intellectual achievements of Freud have received many critics all through the years.
The seduction theory is one area where there are a number of detractors. This theory is viewed
by many psychologist as a form of making the patient re-experience unwanted traumatic thought
about a previous event. Many theorists also criticized him on the basis of increased doubt on
validity of his findings whether they were unconscious fantasies or actual infantile abuses. His
work on Anna O was criticized by a number of scholars that probably she had a brain lesion that
was resulted in her physical manifestations. Bernheimer (1985), emphasizes that he probably
committed medical errors by concentrating on hysteria as a primary diagnosis and his main focus
was to prove that this was the case. Some even use the famous phrase “the eyes see what the
brain knows”.
However, Wright (2013), explains that these critics should put into consideration that
despite Freud sticking to one form of diagnosis after investigation, we see him change from one
form thought and investigations across the number of patients he treated starting with Anna O to
Dora and so forth. He could allow the patient to practice control over her own encounters,
explain the feelings, sexual thoughts, repression and dream analysis. It is not suggested that we
treat these criticism as merely petty but it is better to appreciate Freud’s contribution to
psychoanalysis.

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Conclusion
Despite his excellence in coining the psychoanalytic theory, it is unfortunate that Freud’s
experiments were not based on a strict verifiable scientific process. His theories were more
anchored to his belief evolution process with regard to psychological evolution. This was the
same case with his contemporaries. Freud emphasized so much on the aspect of therapy to
support his emerging ideas that arose from evolution of his belief in psychological setting.
From this kind of mannerism, it remained an unresolved challenge to get a clear picture
and vision of Freud’s final theory of hysteria despite hysteria being his ultimate origin of the
psychoanalytic theory. Freud saw people as passive. Gleaves & Hernandez (1999), say that
Freud believed that behaviors is almost completely determined by interaction of external reality
and internal drives. That all behaviors are driven by antecedent events and experiences. From the
study of his patients with symptoms of hysteria, he has a strong conviction that there are no
accidents in human life and that nothing happens by chance. This may not be the case in the
contemporary life even if human being was to be ideal. However, it brings to conclusion that
Anna O and hysteria played a major role in development of psycho analysis. It is also necessary
to make a clear stand that the term hysteria is archaic and its related symptoms have been divided
into the correct DSM-4 criteria of diagnosis.

HYSTERIA AND PSYCHOANALYTIC THEORY 14
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