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GENERAL REMARKS ON HYSTERICAL
ATTACKS¹⁾

(1909)

A. WHEN one psycho-analyses a patient subject
to hysterical attacks one soon gains the
conviction that these attacks are nothing
but phantasies projected and translated into motor
activity and represented in pantomime. It is true
that these phantasies are unconscious but otherwise
they are of the same nature as those that may be
observed directly in day-dreams or revealed by an in-
terpretation of nocturnal dreams. A dream frequently
takes the place of an attack and still more frequently
helps to explain one, since the same phantasy finds
different forms of expression both in dreams and in
attacks. One might expect by observing an attack to
be able to discover the phantasy it represents, but
this is rarely possible. As a rule the pantomimic
representation of the phantasy undergoes distortions,
due to the influence of the censorship, analogous to
the hallucinatory ones of dreams, so that to begin with
both these manifestations are rendered unintelligible
either to the patient’s conscious mind or to the
observer’s comprehension. An hysterical attack, there-
fore, must be subjected to the same analytic procedure
as we use in dream-interpretation. Not only are the
forces producing the distortion and the purpose of this
distortion the same as those we are familiar with from
the interpretation of dreams, but the technique of
the distortion is the same also.

¹⁾First published in the Zeitschrift für Psychotherapie und medizinische
Psychologie, Bd. I., 1909; reprinted in Sammlung, Zweite Folge.
[Translated by Douglas Bryan.]

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1. The attack becomes unintelligible through its
representing several phantasies simultaneously by
means of the same material, that is, through condensa-
tion. Features common to two (or more) phantasies
form the nucleus of the representation, as in dreams.
The phantasies thus made to coincide are often of quite
different kinds, for instance, a recent wish and the
re-activation of an infantile impression; the same
innervations are then made to serve both purposes,
often most cleverly. Hysterical patients who make
use of condensation to a considerable extent may find
a single type of attack sufficient; others express a
multiplicity of pathogenic phantasies by several types
of attack.

2. The attack becomes obscured by the patient’s
undertaking the parts played by both the persons
appearing in the phantasy, that is, through multiple
identification. For instance, I have mentioned a case ¹
in which a patient tore off her dress with one hand (as
the man) while she pressed it to her body with the other
(as the woman).

3. A particularly effective form of distortion is
antagonistic inversion of the innervation, which is
analogous to the very usual changing of an element
into its opposite by dream-work. For instance, in an
hysterical attack an embrace may be represented by
the arms being drawn back convulsively until the
hands meet above the spinal column. Possibly the
well-known arc de cercle of major hysterical attacks is
nothing but an energetic disavowal of this kind, by
antagonistic innervation of the position suitable for
sexual intercourse.

4. Scarcely less confusing and misleading is the
reversal of the sequence of events in the phantasy, which
again has its complete counterpart in some dreams
which begin with the end of an action and finish with its
beginning. For instance, an hysterical patient may

¹‘Hysterical Phantasies and their Relation to Bisexuality’, No. V.
of this volume, p. 51.

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have a phantasy of seduction, the content of which is
that she is reading in a park, her dress being slightly
raised so that one foot is visible; a gentleman
approaches and speaks to her; they then go to some
other place where a love-scene takes place. This
phantasy may be acted in the attack in such a way as
to begin with a convulsive stage corresponding to the
act of intercourse; she may then get up, go to another
room, sit down to read and reply to the imaginary
remark made in accosting her.
The two last-mentioned forms of distortion give
some indication of the intensity of the resistance with
which the repressed material has to deal, even when it
breaks through in an hysterical attack.

B. The outbreak of hysterical attacks follows laws
that are readily understood. Since the repressed
complex consists of libidinal cathexis and ideational
content (phantasy), the attack may be aroused (1)
associatively, if the content of the complex (sufficiently
charged) is stirred by a conscious occurrence; (2)
organically, if from some internal somatic reasons or
external influences on the mind the libidinal cathexis
exceeds a certain amount; (3) in the service of the
primary tendency (paranosic gain) as an expression of
‘flight into illness’ if reality becomes painful or
frightening, therefore as a consolation; (4) in the service
of the secondary tendencies (epinosic gain) with which
the state of illness becomes connected as soon as the
patient can gain a useful purpose by the production of
an attack. In the last case the attack is aimed at
particular people; it may be put off until they are
within reach, and gives an impression of conscious
simulation.

C. Investigation of the childhood history of hys-
terical patients shows that the hysterical attack is a
substitute for an auto-erotic gratification previously
practised and since given up. In a great number of
cases this gratification (masturbation by manipulation
or pressure of the thighs, movement of the tongue, etc.)

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recurs during the attack itself during the deflection of
consciousness. The outbreak of attacks due to an
increase of libido and in the service of the primary
tendency, as a consolation, then exactly repeats the
conditions under which the patient at one time con-
sciously employed this auto-gratification. The anam-
nesis of the patient then gives the following phases:
(a) auto-erotic gratification without ideational content,
(b) the same in connection with a phantasy which
culminates in the act of gratification, (c) renunciation
of the act with retention of the phantasy, (d) repression
of this phantasy, which then breaks through in the
hysterical attack either unchanged or else modified and
adapted to new experiences, and (e) which may even
restore the action producing gratification which belongs
to the phantasy and has apparently been given up.
This is a typical cycle of infantile sexual activity:
repression, failure of the repression, and return of
the repressed.

The involuntary passing of urine can certainly not
be considered irreconcilable with the diagnosis of
hysterical attacks; it merely repeats the infantile
form of a violent pollution. Moreover, biting the tongue
may be met with in undoubted cases of hysteria; it is
no more inconsistent with hysteria than with love-
making. It occurs in attacks more readily when the
physician’s questions have drawn the patient’s attention
to the difficulties of a differential diagnosis. Self-
injury may occur in hysterical attacks (more frequently
in the case of men) and then repeats an accident that
happened during childhood (for instance, during a
fight).

The loss of consciousness, the ‘absence’ of the
hysterical attack, is derived from the fleeting but
unmistakable loss of consciousness which can be
observed at the climax of every intensive (also auto-
erotic) sexual gratification. Where hysterical ‘absences’
arise from pollutions in young female persons this
development can be most clearly followed. The so-

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called hypnoidal states, ‘absences’ during day-
dreaming so frequent in hysterical cases, reveal the same origin.
The mechanism of these ‘absences’ is comparatively
simple. In the first place all the attention is con-
centrated on the course of the process of gratification
and this whole cathexis of attention is suddenly removed
at the moment when gratification occurs, so that a
momentary void in consciousness takes place. This
gap in consciousness, which may be called a physio-
logical one, is then extended in the service of repression
until it takes up everything which the repressing
faculty rejects.

D. It is that reflex mechanism of the coitus-action
which we see becoming manifest during unrestrained
surrender to a sexual activity and which is available
to everybody, including women, that points the way
to the motor discharge of the repressed libido in
attacks. Even the ancients called coitus a ‘minor
epilepsy’. We may alter this statement: the hysteri-
cal fit is an equivalent of coitus. The analogy with
the epileptic attack helps us little, since its genesis is
even less intelligible to us than that of hysterical
attacks.

In general, the hysterical attack, like every form
of hysteria, in women recalls to action a form of sexual
activity which existed during childhood, and had
at that time a pronounced masculine character. One
may often observe that it is just those girls who in the
years before puberty showed a boyish character and
inclinations who tend to become hysterical at puberty.
In a whole series of cases the hysterical neurosis is
nothing but an excessive over-accentuation of the
typical wave of repression through which the masculine
type of sexuality is removed and the woman emerges.¹

¹Cf. Freud, Drei Abhandlungen zur Sexualtheorie.