Int J Psychoanal (2014) doi: 10.1111/1745-8315.

12235

The hysterical organization

Florent Poupart1
Universite
Toulouse 2 Jean Jaure  s, Laboratoire Clinique Pathologique et

es Antonio Machado, 31058, Toulouse cedex 9,
Interculturelle, 5 alle
France – flo_pou@hotmail.com

(Accepted for publication 14 May 2014)

The term hysteria has been used in the history of the psychoanalytical move-
ment to describe a large variety of psychic modalities. What is the common
denominator of the hysterias? The author suggests that ambivalence in rela-
tion to penetration in its passive form (vaginal desire), in its pregenital and
genital valences, constitutes the essence of hysteria. It seems that the issue of
hysteria thus configured finds its best resolution in the fantasy of an incorpo-
real penetration, which leads to orgasm, and spares one from the anxiety of
destruction to the internal space as well as from the anxiety of guilt following
the hoped for climax. The author is attempting to discern, by means of two
case studies, how disembodied penetration, depending on whether it is fanta-
sized or delusional, constitutes a solution, neurotic or psychotic respectively,
to the issue of hysteria: the private theatre in neurosis, as well as the inhab-
ited and influenced mind in psychosis (delusion of control), act as psychic
figurations of vagina.

Keywords: hysteria, feminine, penetration, ambivalence, delusion of control, hyster-

ical psychosis, case study

I should without question consider a person hysterical in whom an occasion for

sexual excitement elicited feelings that were preponderantly or exclusively unplea-
surable; and I should do so whether or not the person were capable of producing
somatic symptoms.
(Freud, 1905, p. 28)

“When we attempt to reduce them further,” Sigmund Freud wrote in

1920, “we find masculinity vanishing into activity and femininity into pas-
sivity, and that does not tell us enough” (1920, p. 171). The masculine/femi-
nine pair is seen to be the ultimate degree of elaboration of another pair,
considered to be more elementary: activity/passivity. What is there to say
about Freud’s remark “that does not tell us enough”? Where does the gap
between passivity and the feminine lie? The feminine is to be understood
here, I suggest, not in terms of gender identity, but as an expression of what
Freud calls “the feminine nature”2 (1924, p. 161) that is to say, the femi-
nine identificatory position, one of the terms of the masculine/feminine pair
that characterizes psychic bisexuality in both men and women.
1
Translated by Andrew Weller.
2
Translator’s note: in French“l’^
etre de la femme” (literally, a woman’s being).

Copyright © 2014 Institute of Psychoanalysis

2 F. Poupart

Elsewhere (Poupart and Pirlot, 2014), I have suggested that vaginality

should be defined as the primal erotic appetency for taking the other pas-
sively into oneself. The passive aim of a woman’s desire, that is, of aban-
doning her own body to invasion by the body of the object in genital sexual
relations, is simply its most accomplished form. It is preformed, in the
infant of both sexes, by early experiences in which the internal space is
occupied by diverse foreign bodies: breast, milk, faeces, sensoriality, uncon-
scious in the adult, drive tension. I think that this concavity, this experience
of one’s own body and the subjective space as receptacles for the object, is
transmuted into a vaginal dynamism (or vaginality) under the influence
of primary masochism (owing to the erotization of the breach or violent
intrusion), and of the paroxistic anxieties of loss associated with Hil-
flosigkeit, the primal state of distress (taking into oneself the person whose
loss one wants to avoid) before being elaborated as feminine.
The essence of the feminine, in both men and women, may be said to lie,
then, in a vaginal sexual component, in other words, a concavity that has
acquired the characteristics of the drive. This ‘primary femininity’ (Kulish,
2000) is based on the orifices and internal spaces, which are not unique to
the female body. What we are concerned with, then, is not a specifically fem-
inine psychosexual stage which would be the counterpart of a phallic stage
that is supposedly only found in boys (Glover and Mendell, 1982); and its
development does not imply the existence of early vaginal sensations (Roiphe
and Galenson, 1981), for it can perfectly well be based on internal spaces
that are not genital. I think of vaginality more as a drive component that is
constituted transversally, starting from archaic oral and anal experiences and
culminating in the genital ‘feminine’ dimension ‘feminine nature’ in
both sexes (from this point of view the phallic position may be considered as
a defence against the vaginal insofar as the accent is placed there on a mem-
ber, the penis, whether present or absent, rather than on an orifice: by neu-
tralizing the orifices, the phallic is in the service of the refusal or repudiation
of the vaginal and protects against penetration anxieties). However, it is evi-
dent that the properties of the female body, and particularly the existence of
a vaginal cavity (and of a uterine cavity), by placing the accent on the con-
cavity, are suited for projecting vaginality, then femininity (and maternity),
into the foreground of the psychosexual scene in women.
My reflections are situated, to a large extent, within the context of a
debate that particularly concerns the French psychoanalytic community. The
school of Jacques Lacan defends the phallocentric position of femininity
understood as a reaction to the castration complex: the little girl envies the
boy’s penis and displaces the phallic value of the missing penis onto that of
the sexual partner, and also onto the baby that she is capable of bearing. She
is first a little man; she later becomes a woman, and a mother, to compensate
for her castration (see, in particular, Freud, 1931, 1933[1932]). As Nancy Ku-
lish puts it: “Early views of female development, which were modeled upon
development in the male, conceived of femininity essentially as a secondary
reaction to an original masculinity” (2000, p. 1355). More recently, others, in
particular, French authors (for instance, Jacques Andr
e, Catherine Chabert,
Jacqueline Schaeffer, Monique Schneider) have put forward hypotheses
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 The hysterical organization 3

concerning a feminine dimension that is not seen as the negative of the mas-
culine dimension but rather as possessing its own essence. With particular
reference to the contributions of Karl Abraham, Ernest Jones, Melanie
Klein, Josine M€ uller and Karen Horney, and drawing on Freud’s own prop-
ositions (notably Freud, 1905, 1918, 1919) which depart, notably, from the
thesis that the feminine is the negative of the masculine, they have developed
conceptions of the feminine linked to considerations on passivity, the concav-
ity of the subject’s own body, and anxieties related to passive penetration.
For more details on this debate, I would like to refer the reader to my recent
publication on this subject (Poupart and Pirlot, 2014).
I am putting forward the hypothesis here that ambivalence towards vagi-
nal desire, that is to say, penetration in its passive form, constitutes the
essence of hysteria. Drawing on two case studies, I shall try to identify how
incorporeal penetration, depending on whether it is fantasized or of a delu-
sional nature, constitutes a solution, neurotic or psychotic respectively, for
the hysterical conflict thus defined.3

Hysteria and vaginality

Hysterical ambivalence
In his Draft H, dated 24 January 1895, to Wilhelm Fliess, Sigmund Freud
distinguishes hysterical neurosis and hysterical psychosis. He draws up a
“summary” which compares hysterical neurosis, obsessional neurosis, hallu-
cinatory confusion, paranoia and hysterical psychosis in relation to the
vicissitudes of the instinctual drive representatives (affect and representa-
tion), on the one hand, and to the characteristics of eventual delusional
ideas on the other. In paranoia, the “content of the incompatible idea” is
“projected into the external world”, which constitutes an effective defence,
but the delusional idea is “hostile to the ego” (persecution mania): “The
official who has been passed over for promotion requires that there be a
conspiracy against him and that he be spied on in his room. Otherwise he
would have to admit his shipwreck” (Freud, 1950[1892–99], p. 210). Hysteri-
cal psychosis, in contrast, marks the failure of defence: “It is precisely the
ideas warded off that gain mastery” and “dominate consciousness”; the
delusional idea is hostile to the ego, but also to the defences. Freud thus
qualifies as “hysterical” a delusional idea constituted around the element
initially rejected, which henceforth “dominates consciousness”. It was just
such an operation that had led him to write, two years earlier, that the
“general exhaustion” to which the hysteric is predisposed favours the fact
that “ “the antithetic idea . . . gains the upper hand”: the “inhibited and
rejected ideas prevail “over those of the “normal ego”. These “inhibited
projects” can equally well take the path of “somatic innervation” as that of
delusion: “It is owing to no chance coincidence that the hysterical deliria of

3
I will not be referring here to other contributions of great quality which propose to link hysteria and
the repudiation of femininity: I am thinking in particular of the contributions of Gregorio Kohon (1984)
and Rosine Jozef Perelberg (1999).

Copyright © 2014 Institute of Psychoanalysis Int J Psychoanal (2014)

4 F. Poupart

nuns during the epidemics of the Middle Ages took the form of violent
blasphemies and unbridled erotic language” (Freud, 1950[1892–93], p. 126).
In his Fragment of an analysis of a case of hysteria, Freud (1905[1901])
insists on the mechanism of “reversal of affect” in hysteria: “I should with-
out question consider a person hysterical in whom an occasion for sexual
excitement elicited feelings that were preponderantly or exclusively unplea-
surable . . . whether or not the person were capable of producing somatic
symptoms” (p. 28). For Freud, then, it is not the somatomorphic character
of the symptoms that constitutes the essence of hysteria, but ambivalence
towards sexual desire that is translated by an experience of “disgust”,
which, as Monique Schneider (2004) reminds us, is “paradigmatic of repres-
sion” (p. 44). But elsewhere Freud evokes the hysterical character of phobic
neurosis which he qualifies, in particular in his Analysis of a phobia in a
five year-old boy (1909), as ‘anxiety hysteria’. Then, in 1911, in his Psycho-
analytic notes on an autobiographical account of a case of paranoia (dementia
paranoides), he qualifies as hysterical the “hallucinatory mechanism”
observed in “dementia praecox” (Freud, 1911, p. 77).
These few examples are sufficient to grasp the difficulty behind the multi-
ple uses of the terms ‘hysteria’ and ‘hysterical’ and to identify their common
denominator in Freud’s writings, where ‘hysteria’ in the singular was from
the outset (that is to say, as early as the years 1894–1895 and the studies
with Joseph Breuer) diffracted into multiple forms: “Freud and J. Breuer
distinguished”, Francßois Richard (in Andr
e et al., 1999) writes, “at least
seven forms of hysteria: hypnoid hysteria, traumatic hysteria, retention hys-
teria, defence hysteria, conversion hysteria, anxiety (phobia) hysteria, and
finally hysterical psychosis” (p. 62). In addition, and more recently, Joyce
McDougall has elaborated the notion of ‘archaic hysteria’ in connection
with her work on psychosomatic manifestations.
So what is it, then, that constitutes the essence of hysteria? In 1878,
Charles Ernest Lasegue, a French doctor, wrote:

The definition of hysteria has never been given and never will be. The symptoms
are too inconstant, too varied, and too unequal in duration and intensity for one
type, even descriptive, to be able to comprise them all.
(cited in Andr
e et al., 1999, p. 13)

In a typescript that was never published, entitled L’hyst
erie, and dated
1948–1949, the French psychiatrist Henri Ey (a contemporary of Jacques
Lacan who exerted extensive influence on the psychiatric semiology of the
French school in the second half of the 20th century) retraces the history of
the concept: he depicts the variety of the symptomatology and compares
the main explanatory theories, from the most biological to the most psycho-
genic, including the compromise that he had always defended, that is to
say, his “organo-dynamic” conception. Though he proposes right at the end
of the text to infer the “essence” of hysteria from his work, he confines him-
self to emphasizing the “psychoplastic structure of psychic life and the disor-
ders of abnormal somatopsychic expressions that it entails” (Ey, 1948–49, p.

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 The hysterical organization 5

120). In other words, through his timidity, he does not belie Lasegue’s
prophecy.
Paradoxically, it seems that this ancient term, which is an exception in
psychiatric vocabulary inasmuch as it has not disappeared from everyday
health care discourse (only from the official discourse), has never been given
a definition that has enjoyed a consensus. Its etymology takes us back to the
uterus, that is, to the body, to woman, and to the concave aspects of the
female body. In popular language, the hysteric is a woman, and the ‘hysteri-
cal attack’ a form of extreme and unreasonable agitation, a disproportionate
stirring of the body, which is shaken by spasms and temporarily uncontrolla-
ble, associated with a profusion of emotional expression. Now if we go by
the way it is used in health care services, the term hysteria inevitably
refers to the notion of comedy, that is to say, making a spectacle (knowingly
exaggerated, and even simulated) of the affects which invest the body; one
also thinks of the tendency to seek attention, as well as the tendency towards
seduction and the eroticizing of relationships. The theatrical dimension has
also held the attention of the authors of the great international classifications
(APA, 1994; WHO, 2008) who, approximately 30 years ago, replaced the
notion of hysteria with that of ‘histrionic personality disorder’, formed from
histrio, that is to say, the actor, the comedian, in Latin. This disorder con-
denses dramatization, that is to say the exaggeration of emotional expres-
sion, the seeking of attention, seduction, and suggestibility. As for
psychoanalysis, we know that hysteria constitutes the psychopathological
breeding ground from which psychoanalysis emerged: one inevitably thinks
here of the body convulsing and exhibiting infirmities with no somatic basis
(the body is only complicit, compliant4 ), and of affect, projected into the
foreground (in the body and in emotional expression) to the detriment of
representation, which is repressed; and, above all, of the particular place
occupied by the Arlesian sexuality of the hysteric, which is omnipresent in
his or her discourse, but never revealed.
There is one finding, however, that the clinician can cling to: at the heart
of the encounter with a patient, regardless of his or her sex or structure, the
term ‘hysterical’ has a meaning, even though it is not easily accessible to
discursive thinking. This is because it is related to the personal feelings of
the interlocutor in contact with the patient much more than to an objective,
symptomatic description, or even to a specific pathogenic or metapsycho-
logical hypothesis. In other words, it is first and foremost related to the
countertransference experience specifically provoked by the particular orga-
nization of the patient’s libido in the transference.
What can be said of this transference organization? It seems to me that it
is characterized by great ambivalence towards erotic desire. This is translated
by the coexistence of the affirmation of desire along with its repression, of
seduction by, and repulsion for, the other, the reversal of affect that occurs
when the fantasy is in danger of being fulfilled (Freud, 1905[1901], p. 28). In
the introduction to their book devoted to the Probl
ematiques de l’hyst
erie,
Jacques Andr
e, Jacqueline Lanouziere and Francßois Richard (1999) remind
4
Concerning “somatic compliance” in hysteria, see particularly Freud, 1905[1901], p. 40.

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6 F. Poupart

us that Freud localized “the appearance of hysteria at the point of encounter

between an exaggerated sexual demand and an equally exaggerated rejection
of sexuality” (p. 3). The hysteric fears the same thing as he or she desires;
but which hysterical desire is he or she afraid of?
In Hysterical phantasies and their relation to bisexuality, Freud (1908)
writes: “Hysterical symptoms are the expression on the one hand of a mas-
culine unconscious sexual phantasy, and on the other hand of a feminine
one” (p. 165). This may be found, he adds further on, in “certain hysterical
attacks in which the patient simultaneously plays both parts in the underly-
ing sexual phantasy” (p. 166). Freud thus associates hysterical ambivalence
with psychic bisexuality, which finds satisfaction in a disguised manner in
symptoms. He illustrates his remarks with a brief reference to his clinical
experience:

In one case which I observed, for instance, the patient pressed her dress up against
her body with one hand (as the woman), while she tried to tear it off with the other
(as the man).
(ibid.)

His interpretation, dispatched in a few words between parentheses, is

worthy of our attention. Freud associates the feminine role with the hand
that spurns the advances, and the masculine role with the hand that
expresses a sexual desire. In other words, the ‘feminine unconscious sexual
phantasy’ that Freud is trying to illustrate here is not a desire but a foil for
desire, a refusal of the sexual. And yet one could equally well offer the
opposite interpretation of this clinical observation, namely, that a woman’s
desire to offer herself to a man is present in the hand that does the undress-
ing; the prudish hand, on the contrary, betrays the masculine affirmation
which rebels against such an abandonment to the other and, more precisely,
to penetration by the object, the aim of such undressing. The conflict that
this hysterical attack reveals in an exaggerated manner could thus be one
that opposes feminine desire and the refusal of the feminine. Hysterical
symptoms, whatever form they take, could thus be defined as those that
achieve a compromise between these two forces in conflict.
In an article published a year later (Some general remarks on hysterical
attacks), Freud (1909a) refers to the “antagonistic inversion of the innerva-
tions”: “It is possible that the well-known arc de cercle which occurs during
attacks in major hysteria is nothing else than an energetic repudiation like
this, through antagonistic innervation of a posture of the body that is suit-
able for sexual intercourse” (p. 230). The ambivalence towards the sexual is
emphasized once again: the opposition of a sexual wish and a refusal of the
wish is “portrayed in pantomime”. But here, unlike in the text of 1908, only
“masculine sexuality” is unconscious: it has been repressed “[to allow] the
woman to emerge”, and makes its return in the hysterical attack (p. 234).
Does this mean that hysteria results from a conflict between masculinity
and femininity? Freud always opposed the ‘doctrine of masculine protest’,
dear to Alfred Adler, the shadow of which hangs over the whole of the case
of the ‘Wolf Man’:

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 The hysterical organization 7
To insist that bisexuality is the motive force leading to repression is to take too
narrow a view; whereas if we assert the same of a conflict between the ego and the
sexual tendencies (that is, the libido) we shall have covered all possible cases.
(1918[1914]), p. 110)

Does postulating a conflict between feminine aspirations and the ‘repudia-

tion of the feminine’ amount to validating the theory of virile protest? Not at
all, as soon as one considers that if there is a ‘male protest’ (Adler), it is only
by virtue of what Jacqueline Schaeffer calls the “scandal of the feminine”:

What does a woman want? She wants two contradictory things. Her ego abhors
defeat, but her sexual organ demands it. It wants the fall, the defeat, the ‘masculine
dimension’ of man, that is to say the contrary of the ‘phallic’ dimension an
infantile sexual theory that only exists to avoid the difference between the sexes,
and thus her ‘feminine dimension’. It wants large quantities of libido and erotic
masochism. This is the ‘scandal of the feminine’. Everything that is intolerable for
the ego is precisely what contributes to sexual jouissance: namely, violent intrusion,
the misuse of power, loss of control, the erasure of limits, possession, submission,
in short, ‘defeat’, with all its polysemic meanings.
(Schaeffer et al., 1999, p. 38)

The ‘repudiation of the feminine’ is thus not the expression of a virile

protest, but much more an expression of a narcissism that sees itself chal-
lenged by a vaginality which aspires to that which the ego fears more than
anything else:5 namely, violent intrusion, invasion by the other. In other
words, I am in agreement with Freud when he asserts that the conflict is sit-
uated “between the ego and sexual tendencies”.
If one takes into account my considerations on vaginal dynamism we can
go a step further and consider that the essence of hysteria consists in an
ambivalence towards desire, no longer only feminine desire but, more
broadly, vaginal desire which, I have postulated, is a pregenital precursor of
hysteria: what characterizes the hysteric’s transference cathexis is the coexis-
tence, in equal parts, on the psychic stage, of vaginal desire and of its foil,
the refusal of the vaginal. Thus the genital character of the hysterical organi-
zation is no longer presaged, for attempts have been made to show that an
ambivalence towards passive penetration pre-exists the opposition between
an accomplished feminine dimension and a refusal of the feminine. Once it
has its source in pregenitality, penetration anxiety is liable to play a primor-
dial role in a psychotic configuration. We can therefore postulate with
assurance the existence of a psychotic resolution of the hysterical conflict:
that penetration, as a drive aim arising from the normal outcome of sexual-
ity bears traits of genitality, should no longer impede us to consider it as
being at the heart of the issues at stake in a psychotic organization.
In Psychanalyse et p
ediatrie [Psychoanalysis and Paediatrics], Francßoise
Dolto (1939) refers to a girl’s “utero-ovarian vaginal castration anxiety”,

5
This is a manner of speaking. In reality, one may suppose that there is something that the ego fears
more than breaking in, and that is disintegration.

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8 F. Poupart

which she describes as “a fear of evisceration as a punishment for female

genital desire” (p. 283) Andr
e Green (1990), for his part, remarks that “it
would not be exaggerated” to see in penetration anxiety “a fear of damage
to the internal space that is meant to receive babies” (p. 111). In both cases,
we see that the uterus is inscribed in the representation of an undifferenti-
ated vagino-uterine organ which condenses the reproductive and female sex-
ual organs in a single cavity (just as the cloaca condenses fantasmatically
the anus and the vagina). If we stick to this hypothesis, a strong link can be
established between hysteria and vaginality: in hysteria, the ‘uterus’, which,
according to ancient medical theory, wanders throughout the patient’s body
and causes her all sorts of troubles, is not the maternal cavity but the fan-
tasmatic representation of an undifferentiated utero-vaginal cavity organ,
the very one that is supposed in the act of coition to accommodate the body
of the penetrating object; in other words, the ‘uterus’ of hysteria is not dif-
ferentiated from the vagina. Consequently, hysteria, according to its etymol-
ogy, to its ancient, almost mythological definition, is the illness of flight
from passive penetration.
Furthermore, it is worth noting that for both these authors passive pene-
tration has a twofold role: it is at once the object of desire and the tool of
punishment in retaliation for this same desire. On this view, ambivalence
towards vaginal desire, the nucleus of the hysterical organization, is seen,
then, up to a certain point, as being intrinsic to the universal psychosexual
condition. This postulate is not belied by the observation made by Henri Ey
when he speaks of the “‘hysterical’ aspects of the human soul”: “‘the hyster-
ical reaction’ is part of human behaviour and we come across it in certain
normal manifestations of humanity, in children, in women, and also in the
human behaviour of the crowd or during certain collective religious mani-
festations” (Ey, 1948–49, p. 112). Jacques Andr
e et al. (1999, p. 42) for their
part, put forward the hypothesis of an “infantile primary hysteria”, “which
is no other than the Oedipal situation in which the child is torn between a
phallic movement of identification with the father and a slippage towards
identification with the passivity and castration of the mother as he imagines
them in his sexual theories and his fantasy of the primal scene”, a hypothe-
sis that is in line with the idea that there is a certain proportion of hysteri-
cal ambivalence in each one of us.
I want now to examine the means for resolving ambivalence when it
becomes excessive and, thereby, pathological.

‘Incorporeal penetration’: A compromise in the face of ambivalence

I have proposed to define the term hysterical as characterizing a psychic
modality6 marked by a radical ambivalence towards concave, vaginal erotic
desire: the satisfaction of this desire, which aims at taking the other

6
The expression ‘psychic modality’ is intentionally imprecise, but I prefer it here to the term ‘psychic
organization’, which has too many connotations from the point of view of structure. What I want to
emphasize, precisely, is that the term ‘hysterical’ is independent of structure. It refers, in my view, to a
mode of investment of oneself and of the other (almost a mode of being) which finds neurotic and psy-
chotic paths of expression.

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 The hysterical organization 9

passively into oneself, comes up against penetration anxieties which have

their roots in pregenitality before being elaborated at the genital stage as a
refusal of the feminine.
I am suggesting that the hysterical conflict thus delineated must find a
privileged path of resolution in the fantasy of an incorporeal penetration: the
latter condenses the realization of a vaginal desire (which has the passive
aim of being penetrated) and its proscription, since its aim is a virtual,
immaterial, non-physical penetration by parts of the other which are not
bits of his physical body. The young woman who dreams day and night
about the man she loves, but who is not ready for anything in the world to
take a step towards realizing her desire for him, has found in incorporeal
penetration a solution to her hysterical conflict: she is inhabited by her
memory of the man, his image, his voice, perhaps his smell, in short, by
reminiscences, rather than by his penis. In short, the “private theatre”7 of
the hysteric serves as an intrapsychic vagina. The young woman thus satis-
fies her desire to be penetrated and protects herself against its dangers
(anxiety and guilt). This is a neurotic solution to the hysterical conflict, for
the desire remains; one still has “access” to it, to cite Gisela Pankow (1977,
p. 143):

In hysterical neurosis one can highlight the fact that the hysterical symptom is
directly linked to the subject’s unconscious desire. In hysterical psychosis, on the
contrary, access to desire is no longer possible; in the empty place of desire, one
finds the process of psychosis.

It would seem, then, that the difference between hysterical neurosis and
hysterical psychosis does not lie in the nature of the fantasy, but rather in
the possibility or impossibility of owning the desire as a part of oneself
(even at the price of a repression).
In hysterical psychosis, the desire to be penetrated is no longer accepted:
it is denied. The penetration, instead of being desired, is realized delusional-
ly: the internal space is occupied by the other, representations yield to per-
ceptions, reminiscences to hallucinations, fantasy to delusion. The other is
there in oneself, not with his body but with his thoughts, his mind, his soul,
his ‘nerves’,8 his will, his voice, his influence, etc: xenopathy, the loss of the
subject’s sense of owning his internal manifestations (thoughts, emotions,
sensations, intended actions) which, as a result, acquire an exogenous char-
acter, realizes the fantasy of a incorporeal passive penetration. Henri Ey
insists on the penetrating character of the voice in the phenomenology of
the psychic hallucination:

Experiences of hallucinatory dissociation include or imply the experience of intru-

sion, of strangeness, when it is not the horror of the martyr, of the torture whereby
these ‘experiences’ become ‘experiments’ of which the hallucinating subject feels he
is the object . . . (persecution, influence, telepathy, suggestion, bewitchment, etc.). It

7
To use the famous expression of Anna O, reported by Breuer (Breuer and Freud, 1895, p. 22).
8
In the words of Daniel Paul Schreber (1903), the most famous case of someone suffering from delusions
of influence.

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10 F. Poupart
is a frequent occurrence, moreover, in clinical practice . . . that the experience of this
penetration, of this cohabitation is erotic: the voice that enters and leaves the body
and the brain is, as it were, the symbolic vehicle of all the forms of rape . . . the
object of his thought enters the experiential field of the Subject like a foreign body.
The voice is a rape.
(1973, pp. 421–2)

In the delusion of influence, in spite of the abolition of the desire to be

penetrated, which leaves an ‘empty place’, the specific form of this penetra-
tion retains the traces of the initial ambivalence, since it is not physical. If
this fantasy is not specifically psychotic, it is nonetheless psychosis, as is
often the case, which exhibits it the most transparently.
In 1934, Henri Ey reports, among a large number of clinical vignettes,
the case of “Mme Duf”, who was suffering from a “hallucinatory delusion
accompanied by psycho-motor phenomena”:

She complained that the person who was introducing him/herself into her envelope
thanks to the torpor of her mind was doing extravagant things there. The person
who was in the foreground was commanding her muscles, her hands, making her
get undressed.
(1934, p. 139)

One cannot fail to recognize here the conflict that was agitating Freud’s
patient: one of her hands was taking her clothes off, while the other was
resisting this; one hand, as I said above, was expressing a female sexual
desire, and the other a refusal of the feminine. The essential difference
between these two women does not reside, it would seem, in the nature of
the pathogenic conflict (a conflict of ambivalence towards vaginal desire),
but in the solution that is found for it: neurotic, in one case (the conflict is
owned, dealt with, and symbolized in the symptom), and psychotic in the
other (the conflictual desire is ejected and makes its return in the actuality
of hallucinatory experience. Consequently, there is no reason, from my
point of view, not to qualify as hysterical the psychotic solution that Mme
Duf presents.
In 1934, Henri Ey pointed up the parallel between hysteria and delusions
of influence:

The relations between hysteria and delusions of influence seem to me to pose one
of the most fascinating problems in psychiatry. One day, we will come back to the
hysteroid attacks that are encountered in the evolution of these delusions and to
delusional hysteria which is so overlooked today. It is worth noting, however, here,
that the syndromes of external action, with repressed eroticism, suggestion, crepus-
cular states, and the development of a ‘fixed idea’, greatly resemble, on account of
their structure, hysterical delusions.
(1934, p. 162)

Fifteen years later, he refers to the “mental disorders of hysteria” and

emphasizes that “the question of the hysterical psychoses is classical”. He is

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 The hysterical organization 11

“certain”, he writes, that “in the symptomatology” of hysteria, “there exist

psychotic states and syndromes”; “hysterics can be subject to delusions, delu-
sional and hallucinatory states, etc.” and, in particular, chronic delusions”:

Mystico-erotic themes are the rule. The principal delusions that are observed in
hysterics are delusions of demonic possession, either zoanthropic or lycanthropic (the
patient believes he has been transformed into a cat, for example, as in the famous
observation by CHARCOT), ecstatic delusions, prophetic delusions, spiritist delu-
sions, delusions of self-accusation or accusation by others (DUPRE).
These delusions
are for the most part delusions of influence, systematized, clear, ordered, lucid, and
with a strong affective charge. . . . As for the hallucinations of hysterics, they can be
divided into two groups: the visual oneiric hallucinatory activity of hypnoid states
and the hallucinatory activity (psychic hallucinations, vivid mental representations,
syndromes of influence) of hysterical delusions.
(1948–49, pp. 26–8)

Henry Ey thus defines hysterical psychosis as a non-schizophrenic chronic

psychosis, organized around a delusion of influence.
Twenty years or so later, in his voluminous Trait
e des hallucinations (Ey,
1973, p. 317), he returns to the hallucinatory phenomena in hysteria, “which
fall so easily . . . within the category of dramatic experiences of influence
and possession”, and evokes the “delusion of possession” in hysteria. But
this time, it is no longer a question of “hysterical psychosis”: only “superfi-
cial clinicians consider that these kinds of manifestations belong to the ‘Psy-
choses’”. The hallucination of hysteria should be “catalogued in the group
of delusional Hallucinations, insofar as Hysteria contains a lot of Delusion”;
consequently, this type of hallucination “falls within the scope of the
famous ‘borderline states’ where the neurotic and psychotic structure cannot
be distinguished radically” (p. 879). Henri Ey, for once, is not very convinc-
ing, insofar as he resorts in this way to the category of borderline states
understood as neither . . . nor.
On the contrary, I think that the hysterical conflict can find either a neu-
rotic or psychotic path of resolution, as I am going to try to illustrate with
reference to two case studies.

Neurotic and psychotic resolutions of hysterical ambivalence

I am now going to present two case studies arising from my institutional
clinical practice in a sectorized public psychiatric service: in France, each
geographical sector has a full-time hospital unit, and ambulatory structures
(centres of consultation, day hospitals). We see patients face-to-face, for a
once-weekly session of 45 minutes.

Geraldine: Incorporeal penetration in hysterical neurosis

Geraldine is about 20 years old. She comes across as young woman who is
at once very feminine, discreetly seductive, and sometimes childish. Her
intelligence and her appetite for introspection allow her to examine her
mode of functioning with lucidity.

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12 F. Poupart

She presented herself at the centre for consultations for anxiety-related

complaints: she had been suffering for several weeks from panic attacks
associated with a sense of depersonalization and derealization (she has the
impression of being “absent to herself”,9 she feels as if she is separated from
reality by a veil). She also mentioned repeated “urinary infections” which
she has suffered from since childhood, although no organic cause has been
identified, leading her general practitioner to suggest they might by psycho-
logical in origin.
After studying at university, she worked in the cultural domain. She
lives alone with her mother, whom she describes as a strong and rigid
woman, little disposed to showing affection and motherly care, much to
Geraldine’s dismay, who is constantly waiting for expressions of tender-
ness from her. At the end of her adolescence, Geraldine suddenly lost
her father, who was much older than her mother. She described a man
without authority, with whom she had done a lot of “silly things” [sic]
without her mother’s knowledge; in short, she remembers him more as a
friendly grandfather than as a father.
The patient is essentially preoccupied with her love life. She is in a rela-
tionship with a young man of her own age who lives a long way away from
her. This distance is the source of major depressive anxiety for her, reacti-
vating, by her own admission, the pain of the loss of her father. But inde-
pendently of this love affair, she constantly has platonic love affairs,
relationships of mutual seduction with other men who, above all, play a
large part in her constant day dreams (from which, she says, she derives
more pleasure than from real life). Through them, she imagines herself as a
business woman, having extraordinary love affairs with unknown people
she meets by chance.
She is much less audacious at the level of real, acted sexuality. She even
admits deriving benefit from her urinary infections (even though they are
particularly unpleasant) in that they allow her to abstain from all sexual
relations for about a week.10 Moreover, these symptoms would disappear
during the early stages of the therapy. This manifest conversion symptom
appeared to be doubly determined: if it protected her against sexual pene-
tration, it also seemed to constitute a disguised equivalent of clitoridian
masturbation which the patient recalled having practised passionately in
childhood (the distressing nature/discomfort caused by the symptom bearing
the mark of compromise). We can see how the regressive hypercathexis of
the phallic (clitoris) is in the service of the avoidance of the feminine
(vagina) in this hysterical configuration.
Penetration is a source of major anxiety for her: “How I would dearly
like never to have to make love again!” She described how her whole body
tenses up when the distressing, but inevitable moment of intercourse
9
Freud, proposing to trace each of the elements of the symptomatology of the hysterical attack to the
“auto-erotic satisfaction that the subject previously practised”, writes that the “absence” characteristic of
a hysterical attack “is derived from the fleeting but unmistakeable lapse of consciousness which is obser-
vable at the climax of every intense sexual satisfaction” (1909a, p. 233).
10
These infections usually occur during the week preceding her periods. Geraldine noted that sum of
both the disturbances spares her from conjugal duty during almost half of her menstrual cycle.

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 The hysterical organization 13

approaches. During a week’s stay with her companion, she noted with sur-
prise that she had her period the day after they had got together again,
whereas she was expecting it much later; this fortunate anomaly would
oblige her to refuse to have any form of sexual relations during the few
nights she shared with him.
Her attitude towards men condenses three postures:
the posture of a little girl who needs to be protected (and treated?)
when she is infatuated with men (sometimes much older than her) of
whom she dreams day and night, but with whom she exchanges at
the very most an innocent kiss. And when her friend shows signs of
exasperation and threatens to break off their relationship, she sinks
into deep despair;
an aggressive and humiliating attitude, mixed with unconcealed plea-
sure, towards the men who approach her and try to seduce her, and
of course towards her friend himself, whose feelings she does not
spare; sometimes, she is the one who takes the reins of the game of
seduction, skilfully succeeding in manipulating her victims, making
them comply with all her wishes, sometimes even falling into their
arms, but never into their bed;
finally, an attitude of fully accepted, and even openly affirmed feminin-
ity, concerning which Jacqueline Schaeffer (2000) writes that it “coexists
well with the phallic attitude, that of lure, of masquerade, and which is
reassuring for castration anxiety, both that of men and of women”. I
would not have been able to express better the extent to which Geral-
dine’s femininity is a subterfuge (phallic) which, on the contrary, is in
the service of the refusal of the feminine dimension and “reassures” her
against anxiety about being penetrated, which, as Andr
e Green (1990)
notes, is the “correlate” of castration anxiety (p. 60). One day she
related a dream in which she saw herself, endowed with a penis, “rap-
ing” [sic] a man who was without one.
I understand these three forms of regression, oral, anal–sadistic, and
phallic, respectively, as different modalities of the refusal of the feminine
dimension. It is worth noting, as Freud (1937) did in connection with the
“virile protest”, that it is not a question of a refusal of passivity, since she
fully accepts its oral form, but only of its vaginal form: for Geraldine, it is
only when passivity implies passive penetration that it becomes a source of
anxiety.
It can be seen, then, how this young woman’s hysterical organization
found a path of compromise in incorporeal penetration: the voluptuous
occupation of her ‘private theatre’ by men seems to constitute a stop-gap,
exempt from anxiety and guilt, for physical penetration by them, to which
she only submits in the last resort (and in homeopathic doses), when the
fear of losing her love object temporarily takes precedence over the anxiety
connected with being penetrated by him. At the same time, the oral, anal–
sadistic, and phallic modalities of regression constitute, as we have seen,
diversified modes of defence against vaginal desire.

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14 F. Poupart

If hysterical neurosis strives to resolve ambivalence towards the vaginal–

genital dimension, that is to say, the feminine sphere, we will see that
hysterical psychosis is confronted with ambivalence towards the vaginal–
pregenital dimension.

Florence: A hysterical organization in the psychotic field

I received Florence, aged 30, for a consultation one week after she had been
admitted to hospital. She works as a saleswoman and lives with a man and
their son, who is 2 years old. She presented manifestations of a psychotic
turn: she spoke deliriously about animals which took possession of her and
her behaviour; she made animal sounds, taking herself for a lion, a cat,
etc.11 There were no signs of dissociation. The patient had already been
hospitalized in a similar context, seven years earlier.
Florence was easy to get on with: she was friendly, quick on the uptake,
and her appearance was tidy, charming, and appropriate. She has a good
intellectual level and expresses herself with ease. She comes from an upper
middle-class family, which one can tell from her particularly distinguished
elocution and postures.
Initially, her discourse was conventional and artificial, normative, and
very critical of her morbid preoccupations: “I was out of my mind, it was
my brain, my imagination that was playing tricks on me; but now I know
that all that is false”, she said. And yet the rest of the interview revealed
the persistence of an intact delusional conviction, in a discourse combining
recognition of the disorders, a rational capacity to stand back from the
delusional process, and a capacity for introspection that was largely pre-
served (“I know that it’s my illness; how can I stop this madness? Should I
take more medication?”, and so on) and delusional preoccupations (“I’m
the chosen one; the devil entered my bedroom and tried to strangle me; I
see signs everywhere, the forces of evil are reminding me that they are there;
they are trying to enter me, etc.”), without either of these currents appar-
ently coming into contact with each other or influencing each other (in con-
formity with the mechanism of ego-splitting, which Freud considers is
always at work in psychosis [1940[1938], pp. 201–02]).
The delusion is rich and associated with an exalted mood. The mecha-
nism is mainly imaginative, hallucinatory and, to a lesser extent, interpreta-
tive. A mental automatism is present: thoughts are both imposed on her
and stolen from her, which is translated, in particular, by pseudo-barriers
(she loses the thread of what she is saying, but notices it). During a session,
for example, in the middle of a sentence she would remain silent for a few
seconds, in a listening attitude, and then say, as if for her own sake: “Thank
you, I needed that. . .”. I questioned her about what had happened: “They
are testing me up there, by taking away my thoughts,” she replied. The
patient introduces messianic delusional themes: she is the “chosen one”, the
one who has been chosen by “providence” to forge links between the dead

11
Henri Ey evokes frequent cases of zoanthropy in the delusional syndromes of hysterical psychosis
(1948–49, p. 28).

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 The hysterical organization 15

and the living. The delusion is constructed around a syndrome of influence:

“souls” enter her, take possession of her, and influence her behaviour. This
is particularly true of her mother, who died of cancer when the patient was
an adolescent: she lives on in her, shares her body, and thereby maintains a
relationship with her. Florence also evokes ideas of reference, with an inter-
pretative mechanism: she constantly sees “signs” (for example, the television
sends her messages, the lights come on in the corridor when she is passing,
the papers, the television, the songs on the radio speak about her, etc.), to
which she attributes a meaning (which, moreover, overwhelms her: she
would like to stop attributing a meaning to everything like this). She also
has romantic preoccupations: she is expecting to meet up again with her
“first love” (who has the same first name as the patient’s elder brother, who
died two years before her birth).
The striking element of the encounter is the mismatch between the heavi-
ness of the symptomatology and the quality of contact. If I go by the imme-
diate feelings I have when in contact with the patient, there is no trace of a
countertransference characteristic of an encounter with psychosis. To put it
quite simply, Florence neither looks nor behaves like a psychotic; she seems
more like a hysteric (in the most trivial sense of the term) who is playing at
being the mad woman between the walls of the asylum. Her delirium has
something false about it, one does not believe it, and one feels more like
laughing (or getting annoyed) when, on all fours in the middle of the can-
teen, Florence miaows or roars like the feline which she claims to be.
In the third session, Florence feels the psychologist’s gaze has changed: is
he “possessed by the forces of evil”? Her preoccupations are now mainly to
do with a confrontation between good and evil, dialectalized around rela-
tions between inside/outside, emblematic of an oral object relation.
In our fourth session, Florence constantly repeats that she is imagining
crazy things, that she is mad, that it is her illness, that she needs to “calm
down”, that things are going too far. She wonders if the people around her,
particularly the carers (and the psychologist in particular) are themselves, or
if they are actors. She feels as if the she is living in the film The Truman
Show (1998), as if she has been placed in the middle of an artificial world
where each person is playing a role designed to deceive her, to keep her in a
state of illusion. My gaze disturbs her: she feels she is being scrutinized.
She has several personages in her: Emilie Jolie, Nala (the young lioness
of the comic book The Lion King), but also a “sex maniac” who pushes her
towards men, but whom she refuses to speak about; she would simply like
that to stop. Does the dual relationship with a man stir up sexual desires in
her that cannot be owned and assimilated, which are ejected and experi-
enced like a foreign entity that takes possession of her (and which, at the
same time realize, without a body, without anxiety, without guilt, the
desired/feared penetration?). Ga€etan Gatian de Cl
erambault (1927, p. 55)
noted that, in chronic hallucinatory psychosis, the “second personality” is
often “hypersexual”, and even “constantly and intensely so in women”. The
different personages that inhabit my patient thus highlight the splitting of
sexuality in her: the “sexual maniac” on the one hand, and the little girl
innocently in love on the other.
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16 F. Poupart

I suggested to Florence that she take a Rorschach test. We resort to this

test, with psychotic patients, in particular, as therapeutic mediation, inas-
much as it is sensitive to deficiencies in the ‘body image’ (with reference to
the conceptions and clinical methodology of Gisela Pankow, who, from the
1950s on, conceptualized a method of a ‘dynamic structuring’ in psychotic
patients. Pankow mainly uses modelling clay, but also drawings and projec-
tive tests (see, in particular, Pankow, 1987). The Rorschach test also helps
us to acquire some understanding of the patient’s psychic functioning for
diagnostic purposes. Our reference here is the Paris School, which has
devised a methodology for interpreting responses to the Rorschach test
psychoanalytically. When the patient takes the test, he or she is invited to
propose representations in response to non-figurative material. In confor-
mity with the dialectic of the manifest and latent content inherent to the
Freudian model for interpreting psychic facts, Didier Anzieu and Catherine
Chabert have identified ‘latent solicitations’ specific to each test card (fol-
lowing the work of Nina Rausch de Traudenberg (1920–2013) in line with
the formal and chromatic characteristics of the material, but also with the
place occupied by each card in the sequence of the test procedure. This lat-
ter criterion leads Didier Anzieu to say that the “discontinuities” introduced
by the succession of cards “compensates in part” for the problem of the
“timelessness” of the procedure with regard to the temporality of an ana-
lytic treatment (Anzieu, in Chabert, 1983, p. xiii). For more details on this
methodology, I would refer the reader to the studies of these two authors
(see, in particular, Anzieu and Chabert, 1961; Chabert, 1983).
In response to the Rorschach test, Florence’s discourse is logorrheic and
often hermetic. She often seems to start with representations of good for-
mal quality but then engages, through diffluence, in a discourse centred
on delusional preoccupations: the forces of good against the forces of evil,
her role as a “chosen one” to save animal species, etc. Her primary identi-
fications are undeniably extremely fragile: the content of her responses is
often unreal (the devil, souls, etc.), the visceral anatomical responses reveal
major bodily anxiety (“Once illness has taken hold of the human body,
the organs are not so beautiful”). Occasionally, there is even confusion
between inside and outside (“I can see a human body, the organs. The
thoracic cage, here are the lungs in pink; those are the tits, the breasts,
aren’t they?). This was probably her most pathological response during the
protocol, betraying, fortunately only transitorily, the massive disorganiza-
tion to which the patient’s identity can be subjected. She was responding
to a pastel card which, precisely because of this, put the patient’s narcissis-
tic foundations to the test of regression. At any rate, such vulnerability is
a mark of the psychotic character of the psychic organization. The dissoci-
ation, however, is not clear and continuous enough to suggest a schizo-
phrenic disorder.
An analysis of the sexual identifications proves to be a source of great
richness here. We noted, in fact, that the opposition masculine/feminine
seems to be translated in a disguised form by the opposition between the
bad and the good, the forces of evil and the forces of good:

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 The hysterical organization 17

Card IV, labelled masculine/paternal, with its strongly phallic latent

solicitation, gave the patient a shock associated with a major experience
of persecution:

Ah, now then! The forces of evil, in all its splendour [sic], oh l a . . . it’s all nega-
a l
tive . . . an ultra powerful animal, with a tail; like the dinosaurs, they are sweeping
all before them, with their big heads and horns. I have the impression that it can
see me, because I can see its eyes. It gives me the shivers. I don’t know if it’s Satan.
If it’s not him, it’s one of his advisers.

Apart from the loss of distance with the material (the fragility of
consciousness in interpreting is obvious), one can see here that persecution
anxiety clearly translates a sexual anxiety associated with penetration, the
phallic detail being perceived, in an exaggerated symbolism, as a devastating
weapon;
on the contrary, with Card VII, feminine/maternal, in a hollowed-out
form, the content is idealized: “That’s right! It’s positive! I can see ani-
mals . . . something must have happened with them, but they’re so sweet,
they’re forgiven”
finally, Cards III and VI, which are likely to elicit psychic bisexuality,
give rise to an indefiniteness which is translated not in sexual, but Mani-
chean terms: “There’s something that’s not right in it, because it is both
positive and negative . . . that’s negative, that’s positive. They are per-
haps in purgatory, I don’t know” (Card III); “Those are two boys,
you’re going to think I’m crazy, because there are willies here . . . they’ve
done some stupid things and they are trying to make up for it” (Card
III); “Something negative and positive; as much evil as good . . . it’s the
forces of good, which may eventually turn into the forces of evil, it’s so
positive that it may turn into the negative” (Card VI).
We may suppose that, given the vulnerability of her identity, the conflic-
tual sexual organization resorts to splitting the object in order to manifest
hysterical anxiety: the feminine/masculine opposition is translated into a
conflict between good and bad; her anxiety related to being invaded by the
masculine is manifested, delusionally, in the fear that the “good” internal
space may be subjected to intrusion and destruction by the “forces of evil”.
This assumption is in keeping with the clinical manifestations: delusions of
influence, xenopathy. The hypothesis I am making, then, is, that we are
dealing with a hysterical organization. This is also backed up by the theatri-
cal and spectacular dimension of the disorders, their great lability (in partic-
ular that of delusion), and the erotization of relationships (in particular
with the clinician, albeit projectively). This conflict of ambivalence towards
vaginal desire was deployed in the oral pregenital sphere.
The analysis of the Rorschach protocol thus enabled us to draw attention
to a vulnerability of identity which unquestionably situates Florence’s
psychopathological organization on the side of psychosis, in spite of a false
surface adaptation.

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18 F. Poupart

Discussion
The hypothesis of vaginality has led me to pose the “question of the hys-
teric” in different terms: no longer as “to be the phallus or to have it?”,12
but as “to have or not to have a vagina?” The hysteric fears being invaded
by a foreign content in a centripetal, penetrating movement, just as the
obsessional fears seeing his own contents escape him in a centrifugal
momentum: bodily fluids (expulsion of stools, vomiting, ejaculation), psy-
chical material (affective manifestations, libidinal or aggressive discharges,
secrets, free associations in analysis), material and financial possessions.
The obsessional tries to protect himself against such a dispersion of his
internal contents by the centripetal hypercathexis of his inner world: intro-
version, intellectualization, rumination, restraint, modesty, greed, accumula-
tion, collection, “regression from acting to thinking”,13 impulse phobias,
etc. Conversely, exteriorization, putting outside, which forms the backcloth
of the hysteric’s relations to the other (making a spectacle, affective demon-
stration, exhibition of the inner conflict on the somatic stage in conversion
hysteria, projection of the source of anxiety towards an external object in
“anxiety hysteria”, etc.), would appear to be a reaction to the desired/feared
invagination: a defensive centrifugal movement against concave, centripetal,
vaginal appetency. It is thus tempting to draw up a list of a series of pairs
of opposites which seem to be ordered dynamically around the dialectic of
the container and the contained, the outside and the inside: separation/
intrusion; castration/penetration; introversion/extratensivity; convexity/con-
cavity; masculine/feminine. The two main organizational poles of the per-
sonality, rigid and labile, would thus correspond to the configurations set
up to fend against the two prototypical anxieties connected with the two
movements, full of pleasure and anxiety, from the inside towards the out-
side, and from the outside towards the inside. This duality is also related,
obviously, to the question of loss, to the different ways that the masculine
and the feminine try to deal with it: at its masculine pole, loss is regarded
as amputation, as castration, posing the question of the destiny of the lost
object and of the role of the third (anxious jealousy of love); at its feminine
pole, loss is treated as void, as an internal gaping hole. Anxiety, then, might
be seen more as a masculine attribute, and depression as an expression of
the feminine, which runs counter to Elizabeth Lloyd Mayer’s (1985) reflec-
tions on the anxiety of female castration: this author sees anxiety as the
expression of the loss of feminine attributes and depression as the result of
the loss of the phallus.
In short, rather than making the masculine coincide with activity, and the
feminine with passivity, I propose to link the masculine with the centrifugal,
and the feminine with the centripetal, whether or not one considers their
roots to be archaic or their culmination genitalized. The masculine/feminine
pair would be underpinned here by the body (and by anaclisis, the ego),
identified with a container that is liable to empty itself of its contents and

Francßois Richard (Andr
e et al., 1999, p. 97), with reference to the Lacanian understanding of hysteria.
12

13
Freud, referring to the obsessional neurosis of the ‘Rat Man’ (1909b, p. 244).

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 The hysterical organization 19

to be filled by a foreign content. From this point of view, the hysterical

organization corresponds to an ambivalence towards this latter, truly femi-
nine, movement, and to the specific treatment of this ambivalence. It is
worth noting that the relations of the pair masculine/feminine to the pair
activity/passivity are not thereby evaded, but enriched, complexified, and
nuanced.
“To have or not to have a vagina?” This would be the neurotic way of
formulating the ambivalence towards passive penetration. In hysterical psy-
chosis, Oedipus, as always in psychosis, makes way for Hamlet, the dialectic
of having for that of being, thereby reformulating the question as: “To be
or not to be the vagina?” Owing to functional dissociation (Pankow), the
body as a whole is equated with its feminine genital containing function, in
its positive and negative forms (being able to take the other into oneself or
not). This ambivalence towards passive penetration is resolved through a
compromise which consists in getting rid of the threatening aspect of pene-
tration, namely, the body of the other. I have thus postulated the pivotal
role in hysteria of the fantasy of a incorporeal penetration which at once
excites, makes the subject come, and protects him or her against anxiety
related to the destruction of the internal space as well as the guilt-ridden
anxiety following the hoped for experience of sexual satisfaction.
If hysteria corresponds to a structure, the latter transcends, from my
point of view, the split between neurosis and psychosis: the two major sys-
tems of psychic functioning, both related to two distinct types of dissocia-
tion [Verdr€ angung/Verwerfung], give rise to a differential treatment of the
hysterical conflict, without its losing its essence. The considerations concern-
ing hysterical psychosis, understood in a sense which fully acknowledges the
significance of the two signifiers that are juxtaposed, inevitably creates a
bridge between the two models of reference of psychic functioning, neurotic
and psychotic, by taking into account the pregenital roots of what is at the
heart of the issues at stake in the hysterical organization, namely, the femi-
nine. For from sweeping aside what distinguishes these two structures, it
provides an opportunity for reaffirming their differentiation in a living way,
for it rests on a dynamic, that is to say, process-oriented apprehension of
psychic phenomena.

Translations of summary

Die Hysterie Ra €tsel. Der Begriff “Hysterie” wurde in der Geschichte der psychoanalytischen Bewegung
zur Beschreibung einer großen Bandbreite psychischer Modalit€aten verwendet. Was ist der gemeinsame
Nenner der Hysterien? Die Autorin vertritt die Ansicht, dass die Ambivalenz gegen€ uber der Penetration
in ihrer passiven Form (vaginales Verlangen) in ihrer pr€agenitalen und genitalen Valenz das Wesen der
Hysterie konstituiert. Offenbar l€asst sich das so konfigurierte R€atsel der Hysterie als Phantasie einer
k€orperlosen Penetration erkl€aren, die zum Orgasmus f€
uhrt und der Angst vor der Zerst€orung des inneren
Raumes sowie der Angst vor den Schuldgef€ uhlen, die sich dem erhofften Orgasmus anschließen, vor-
beugt. Die Autorin versucht, anhand zweier Fallgeschichten zu kl€aren, wie die entk€orperlichte, phantasi-
erte oder wahnhafte Penetration zu einer neurotischen bzw. psychotischen L€ osung des R€atsels der
Hysterie wird: das Privattheater der Neurose bzw. die bev€olkerte und beeinflusste Psyche in der Psychose
(Kontrollwahn) fungieren als psychische Figurationen der Vagina.

Copyright © 2014 Institute of Psychoanalysis Int J Psychoanal (2014)

20 F. Poupart
El dilema de la histeria. El t
ermino histeria se ha utilizado en la historia del movimiento psicoanal
ıtico
para describir una gran variedad de modalidades ps
ıquicas. ¿Cu
al es el denominador com
un de las histe-
rias? La autora sugiere que la ambivalencia en relaci
on con la penetraci
on en su forma pasiva (deseo
vaginal), en sus valencias pregenital y genital, constituye la esencia de la histeria. Aparentemente, el
problema de la histeria configurado de este modo encuentra su mejor resoluci
on en la fantas
ıa de una
penetraci
on incorp
orea. Esta lleva al orgasmo y evita tanto la angustia de la destrucci

on del espacio in-
terno, como la de la culpa que surge a partir del esperado cl
ımax. A trav
es de dos estudios de caso, la
autora intenta discernir de qu
e manera la penetraci
on incorp
orea, dependiendo de si es una fantas
ıa o
un delirio, constituye una soluci
on neur
otica o psic

otica, respectivamente, al problema de la histeria: el
teatro privado, en el caso de la neurosis, y la mente habitada e influida, en el de la psicosis (delirio de
control), act

uan como figuraciones ps
ıquicas de la vagina.

L’e
nigme de l’hyste
rie. Le terme d’hyst
erie a
et
e utilis
e dans l’histoire du mouvement psychanalytique
pour d
ecrire un large
eventail de modalit
es psychiques. Quel est le d
enominateur commun des hyst
eries?
L’auteur de cet article suggere que l’essence de l’hyst
erie est constitu
ee par l’ambivalence li
ee a la
p
en
etration dans sa forme passive (d
esir vaginal), dans ses valences pr
e-g
enitale et g
enitale. Il semble que
formul
ee ainsi, la question de l’hyst
erie trouve sa meilleure r
esolution dans le fantasme d’une p
en
etration
incorporelle conduisant a l’orgasme, permettant au sujet de faire l’
economie de l’angoisse de destruction
de son espace interne ainsi que de l’angoisse de culpabilit
e suscit
ee par l’espoir d’atteindre l’orgasme.
L’auteur tente de d
eceler a partir de deux cas cliniques comment la p
en
etration incorporelle – selon
qu’elle soit fantasm
ee ou d
elirante – constitue une solution, respectivement n
evrotique ou psychotique, a
la question de l’hyst
erie: le th
e^atre priv
e dans la n
evrose, comme l’esprit habit
e et sous influence dans la
psychose (d
elire d’observation) sont des figurations psychiques du vagin.

L’enigma dell’isteria. Nella storia della psicoanalisi il termine isteria e stato usato per descrivere un’am-
pia variet a di modalita psichiche. Qual’ e il comune denominatore delle isterie? L’autore sostiene che
l’ambivalenza nei confronti della penetrazione passiva (desiderio vaginale), tanto nella valenza pregeni-
tale che in quella genitale, costituisce l’essenza dell’isteria. Sembra che tale configurazione del tema
dell’isteria trovi la migliore soluzione in una fantasia di penetrazione incorporea, che conduce all’or-
gasmo e preserva il soggetto dall’angoscia della distruzione dello spazio interno, nonch
e dall’angoscia di
colpa che esita dal desiderato climax. Attraverso il resoconto di due casi clinici, l’autore cerca di com-
prendere come la penetrazione disincarnata, a seconda che sia fantasmatizzata o delirante, costituisca
una soluzione, rispettivamente nevrotica o psicotica, al problema dell’isteria: il teatro privato nella nev-
rosi, cosı come l’occupazione e il condizionamento della mente nella psicosi (delirio di controllo) fungon-
o da figurazioni psichiche della vagina.

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