Was ist aus der Hysterie geworden?

Until the 1960s, hysteria was not only a psychoanalytical but also a psychiatric diagnosis. The descriptive inhomogeneity of the hysterical clinical picture, however, existed and it became extremely disturbing the moment when an attempt was made to operationalise it (in the international manuals of ICD-10 and DSM-IV). As a consequence, the terms "hysteria" as a nosological entity and "hysterical" as an adjective had to be excluded and became obsolete. They were displaced by the "successors" of hysteria, i.e. dissociative and conversion disorders. The "hysterical character" was renamed as "histrionic personality disorder". This was the end of the "crisis" of the concept and the "solution" to the problem was found. The situation in psychoanalysis was much different, as the psychoanalytic definition has never been purely descriptive. Hysteria was first and foremost a neurosis resulting from an oedipal conflict, the symptoms being viewed as an expression of this conflict in body language. The problem here was not the inhomogeneity of the clinical picture but the aetiological aspect: the aetiology, i.e. the conflict, has always been thought to be the same. The oedipal conflict was considered the connecting common denominator. Nevertheless, step by step, it became evident that this was not true. The conflict is not unanimous. There are many other kinds of conflict (narcisstic, oral, external conflicts, etc.), not only the oedipal one. This led to the crisis of the concept in psychoanalysis.The attempted modifications like concepts of "malign and benign hysteria" or "hysteroid" or the expansion of the oedipal conflict to the preoedipal phase did not prove satisfactory. In 1980 the author of this paper proposed a solution to this problem which, in the following years, has been accepted by many other experts in German-speaking countries. This proposal is as follows: there is no nosological entity "hysteria", but there is an eminently important and specific hysterical mode (modus) of the neurotic dealing with the conflict; not only with the oedipal conflict but with many other kinds of conflict including external conflicts (!) as well. This modus consists of an unconscious "mise en scene" resulting in a modified appearance of the self and of the entire situation of the individual. Thus, we can "rescue" the important and specific psychodynamic dimension of hysteria without the "burden" of the old nosological model.