Search

It is widely recognized that the diagnosis of hysteria is infrequently applied to male patients and very commonly to female ones. A paper by Robins et al. 1 suggests that hysteria in men is extremely rare, if indeed it occurs at all, and there is general agreement that an initial diagnosis of hysteria in males is somewhat of a clinical anomaly. 2 It should be noted that grave hysterical symptoms (e.g., conversion reactions, dissociative phenomena) have been observed in male patients, but these individuals tend not to manifest the type of cognitive and personality organization that is characteristic of the hysterical individual. 3 It is especially in regard to the hysterical personality, character, or "style" that the male patient is a rarity, and it is in this sense that the word hysteria will be used in the present paper. In explaining the preponderance of female hysterics, psychoanalytic theorists have focused on differences in preoedipal and oedipal developmental tasks that the two sexes must master. 4 It is my opinion, however, that theories of libidinal development offer only a partial explanation of the sex difference in hysteria and that social and cultural factors play a major role. Although the importance of such extrapsychic factors has not been fully appreciated, neither have these factors been entirely ignored. Marmor, 5 for example, has noted that the traits characteristic of the hysterical personality are feminine ones and are thus more acceptable in women than in men. Chodoff and Lyons 3 have commented that the hysterical personality "is a picture of women in the words of men and … what the description sounds like amounts to a caricature of femininity!" But beyond noting that the concept of hysteria involves a description of traditionally feminine qualities, the theoretical and diagnostic significance of this observation has not been explored. The plan of the present paper is first to review the diagnostic indications and behavioral characteristics of this patient group in order to outline with some specificity the criteria that will lead to a diagnosis of hysterical personality. Next it will be demonstrated how a girl's immediate social environment puts enormous pressure on her to develop a style of cognition and personality that will lend itself to this diagnosis on the clinical test battery or diagnostic interview. In this regard, it will be noted how the ego-constricting effects of a feminine socialization process may too readily be confused with the effects of massive repression. Finally, certain conceptual tangles that have resulted from the overlap between the hysterical character and the feminine character will be outlined.

There has been considerable controversy concerning adaptive versus pathogenic effects of sex-role stereotypes on individual development. The author evaluates both the positive and negative consequences of sex-role stereotypes without regard for any particular sociocultural definition of masculinity or feminity. She hypothesizes that the degree to which sex-role stereotypes are adaptive and facilitative (as opposed to restrictive and pathogenic) is inversely related to the degree to which an individual has consolidated a comfortable and stable gender is identity. Implications for parenting and treatment are elaborated.

For many women, passive-dependent behavior serves a protective function in the maintenance of primary relationships. The therapist's ability to identify and appreciate the systemic meaning behind the patient's dependent posture is an important factor in facilitating autonomy and self-direction.

A systemic approach to resistance allows the individual therapist to appreciate the adaptive, protective, systems-maintaining aspects of "help-rejecting" behaviors which might otherwise elicit negatively toned interventions that serve to heighten or rigidify a resistant impasse. This article illustrates how a systemic perspective assists the psychodynamically oriented psychotherapist in adopting a neutral and respectful attitude toward a patient's resistant posture, and also explores implications for the theoretical understanding and technical management of resistance.