A Reading of Contemporary Hysteria from Lacan’s teachings

The classic conversion symptoms of hysteria have become rare in contemporary clinical practice, so much so that the category of ‘hysteria’, as well as the category of neurosis itself, have practically disappeared from modern psychiatric nosography.  This is most evident in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (American Psychiatric Association, 2013). Lacan proposed a different outlook on hysteria. He read it as a posing of the question of the essence of femininity. The hysteric seeks to answer this question through an unconscious identification with a man: for Lacan “the hysteric impersonates a man” (Lacan1966a, p.626; Soler,2003, p.66).

Today, in the absence of any real morals of sexual repression, one might think that hysteria has disappeared, insofar as the symptoms of this neurosis were based on repression as an internal prohibition. But the repression Freud speaks of depended on the morals of his day and indeed, the decline of the father and of moral prohibitions has modified hysteria, which today presents itself in a very different way (Freud, 1972; Miller; Laurent, 1996-97).  In fact, hysteria has simply changed in appearance, and Lacan’s understanding can help us recognize its contemporary forms.

Lacan and the Symptom of Conversion

Let us consider the symptoms of Freud’s most famous hysteric, Dora.  Lacan believed, like Freud, that Dora’s catarrh and cough were symptoms produced by an unconscious fantasy of fellatio between Dora’s father and his lover, Frau K.  While Freud considered the possibility of Dora being homosexual, Lacan dismisses this hypothesis and reads the catarrh and cough as a means of questioning her femininity, using the symptom to pose this question. Lacan maintained the Freudian interpretation of the conversion symptom as the translation of a repressed fantasy, but he added that the symptom also poses the question of the essence of the woman and searches for an answer to this question through the identification with a man, in this case, with Dora’s father. For Lacan, the point was not knowing what satisfies the father or Herr K, but knowing what satisfied Frau K.  Whether one focuses on the satisfaction of the man or the satisfaction of the woman, the more fundamental issue is finding knowledge that belongs to women or at least knowledge about women.

In hysteria, there is a sexual deadlock which we may state as follows: the hysteric cannot abandon the belief that there is an essence of femininity.  She imagines, therefore, that another woman may represent the real or true woman. In the case of Dora, it is Frau K who represented this “other woman” of the hysteric. At the heart of the hysteric question there is an “I don’t know” (“I don’t know what a woman is”) and the answer to this interrogative is sought in another woman. Therefore, the lack of knowledge is real and women are understood as existing individually, one by one, not in relation to something that could identify them in their entirety.  This ‘I don’t know’ is often masked by the hysteric’s identification with the man, another aspect of hysteria mentioned in Freud and emphasized by Lacan.

While for the early Lacan, this uncertainty weighed most heavily upon the hysteric herself, and she is the one who doubts her own femininity, for the late Lacan, the hysteric makes the man bear the weight of this uncertainty.  The hysteric throws a challenge, “Let’s see if you are a man!” (Lacan, 2001a, p. 438); it is as if she said: “show me if you are capable of making me exist as a woman”. The hysterical question is made dependent on the man.  By testing all the men she meets, the hysteric proves they are insufficient to make a real woman of her.

Identification, Acting, and “Intrigue” in Hysteria

Lacan offers clear interpretations of hysteric behavior: in its initial formulation he talks about the “hysterical intrigue”, a circulation of desire that has to hold together several subjects connected to each other through different relationships. He notes, for example, how Dora facilitated the encounters between her father and Frau K by looking after K’s children.  Hysterical acting out is a pantomime.  It stages a scene of desire and at the same time avoids conscious understanding.

In his course, Jacques-Alain-Miller (1982) underlined how behavior can be a manifestation of the symptom. This consideration is prompted by Lacan’s mention of how symptoms can become manifest through certain types of behavior and how the answers found by the subject on his being and on his sex are “dependent on the condition of manifesting themselves through a behavior of the subject which becomes its pantomime” (Lacan 1966b, p.451). This theme is developed in the Seminar L’Angoisse (Lacan, 2004, p.145-146) in which Lacan treats behavior in hysteria, generalizing the use of the term acting out defined as a symptom exhibited in a museum. Acting out is a pantomine played out using the proceedings of comedy to circle around the question of desire. In reality, when she acts out she shows something that cannot be grasped, and this is one of the most frequent symptoms in hysteria. The hysterical staging attempts to show us something and yet it orbits around what cannot be seized.

Another example from clinical practice.  A woman has an affair with an unfaithful man.  She seeks revenge by becoming herself unfaithful, by – as she clearly states – identifying with him, acting like him by transforming seduction into a game. She reveals in her analysis that she does not reach orgasm in these sexual encounters and that she finds it repulsive to kiss the men on the mouth.  This is fundamental, as it shows how her female body is not completely at stake in these encounters, and how, instead, they deepen the feeling/conviction that her female pleasure remain excluded from such experiences.  She leaves this man and meets another, the ‘ideal’ man: good-looking, with a successful career, loving and caring.  The woman falls into depression.  She finds herself incapable of desiring or loving this ideal man.  Her thoughts return to her unfaithful companion, who fuels the fantasy of Don Juan.  As Lacan points out, Don Juan is a hysterical fantasy, the fantasy that a series of conquests might result in the knowledge of femininity.  The repetition of seduction cannot sustain the fantasy of a knowledge that would authorize a sexual relationship, and depression erupts the very moment she wishes to actually fulfill a feminine position with a man. She finds herself unable to do so and has to confront the truth that her ability to seduce does not bring her any closer to fulfilling her position as a woman.

This example is particularly significant at a time of gender equality: fun and seduction for all! She explicitly states that by imitating her partner she was able to embark on the path towards the pleasures of seduction. This shows how ‘natural’ it can seem in contemporary society for women to identify with the man. Instead, it has become more difficult to see how repetitive seduction, which seems to put desire into play, can actually become a defense against desire itself.

As Lacan points out in Seminar XVI, the more the hysteric thinks that the real woman knows what desire is, the more she remains unsatisfied (Lacan, 2006, p. 387).  In Seminar XVII, the hysteric challenges the man she identifies as her master and exposes his impotence to produce knowledge about her as an object of enjoyment (Lacan, 1991, p. 179).  In fact, one of the new definitions of castration could be precisely this lack of knowledge of jouissance.

Another reading of hysteria offered by Lacan is as a questioning of desire, a questioning that exposes the lack and dissatisfaction that are at its core.  The hysteric absents herself (in French la dérobade, the evasion); she seduces, provokes and then slips away. As Lacan notes, “desire can be maintained only through the dissatisfaction provoked by subtracting oneself as its object” (Lacan 1966c, p.824).  For Colette Soler, this is the main symptom of hysteria.  Hysterical jouissance is a “jouissance of being deprived” (Lacan, 1991, p. 112); insofar as the identification is with the desire, not the object, desire concerns “lack taken as an object, and hence not a cause of lack” (Lacan, 2001c, p.557).  As Jacques Alain Miller points out, “the cause-object, in contrast to the intent-object, is by its very structure hidden and unrecognized.” (Miller, 2007,  p. 216).

Depression in Hysteria

A great love can keep this question of femininity dormant.  A patient had become attached to a man at a very early age. This love compensated for what she had suffered during what was a very painful childhood. Yet, elements of her femininity had remained problematic: for example, she always kept her beach robe on until the very last moment before going into the sea; she could only make love to her husband after turning the lights off.  Something was unresolved in her relationship with her body.  One day, she found messages on her husband’s phone and discovered he had a lover.  A new phase of her life began as she fell into a crisis of hystericization.  An enigma stood before her; her husband’s unfaithfulness forced her to interrogate herself.  She looked for the solution to her queries in her husband’s lover, fantasized about meeting her so that her lack may be revealed to her.  Though not depressed, she became restless and incessantly asked her husband about his lover.  I would like to underline a structural knot of hysteria: it is this desire to know that induces her to question him so relentlessly. Her husband, who had no intention of questioning their marriage, barraged by his wife’s questions, became himself uncertain and decided to take a break from the relationship.

A third period began, one of depression: the patient felt abandoned, and her depression became immediately very severe.  Her great love had fallen apart and her childhood ailments had repeated themselves.  As a child, the patient was abandoned twice: first her parents had abandoned her by leaving her with her grandmother, and then her grandmother, who had replaced the mother, in turn abandoned her by leaving her with her parents again.  Back with them, her father began beating her as her mother held her still.  When confronted with desire, the girl must always ask herself: am I an object of desire or an object to be discarded?

For this woman it was important to feel loved and her relationship with her partner was based on the certainty that he loved her. This love counterbalanced the fact that her parents did not love her. This patient had concealed to herself, and to her partner, her problematic relationship with desire and pleasure. She used stratagems to avoid exhibiting her womanly body to the eyes of men, though she was particularly attractive and ultimately had nothing to hide. She had sexual intercourse for love, but without any sexual enjoyment. Her confrontation with her husband’s lover forces her to consider that as a woman she has to confront not only love, but desire too. Discovering that her husband has a lover forces her to acknowledge her very problematic relationship with desire and at the same time destroys the  certainty she held of being loved. The cause of her depression, however, is not her uncertainty regarding desire, but the destruction of her certainty on love, the feeling of abandonment. The loss of love reopens the deep wound of not being loved by her parents.

Hysteria is the search for a knowledge that could provide a valid definition of femininity or sexual difference. According to Lacan, the hysteric responds to a defect of her own knowledge with a symptom, or with identifications.  She constructs a scene to portray situations of desire, to awaken desire, and so to keep open an interrogation regarding the lack, the weight of which she bears as a hardship.  We can therefore consider hysteria not only a symptom, but also a strategy to fuel the belief that there may be a knowledge of womanhood.  This belief in a definitive knowledge of womanhood precludes, however, the necessary creation that would allow the subject to assume a feminine position.  The hysterical strategy therefore fails to satisfy the desire and places the subject in an impossible position that, in this case, leads to serious depression.

I wish to further stress three aspects of hysterical depression.  The first is that one consequence of the hysterical strategy is the impossibility of desire.  Both the clinical examples mentioned demonstrate this. In the first, the woman meets an ideal man and realizes she cannot desire him or experience sexual satisfaction.  In the second, although depression is long deferred by a great love, her hysterical strategy and its inherent failure to succeed emerges when she cannot locate her lover’s desire and hence hystericizes him, so that he, too, is unable to trace his own desire.  The second aspect regards mourning as the loss of love.  Love has a very particular meaning for Lacan: it fills a void left by knowledge; it acts as a substitution or a remedy.  Love allows the hysteric to find her own version of femininity, but this can be lost if the affective bond is broken.  The third aspect is the hysterical identification with the reject, with an object that has no value.  This factor, which is so evident in depression, is such that it offers the subject an alternative: if the hysteric falls from her contingent position as the object of desire, she inevitably adopts that of the valueless, discarded object.

Hysterical Position and Feminine Position

Lacan initially understood hysteria as an interrogation on femininity, but he came to see a substantial disjunction between the hysterical and the feminine position (Lacan, 2006).  In the end, he defines the woman as a symptom of a man insofar as she answers to the fantasy of the man and tethers her jouissance to the jouissance of the man.  The hysteric, on the contrary, refuses to renounce her faith in a knowledge of the absolute jouissance of the woman as such, independent of the man.     “It is because she assumes jouissance as something absolute, that the hysteric is rejected. In fact, she can respond [to enjoyment] only from the perspective of a desire unsatisfied in respect to herself” (Lacan 2006, p.212).  Feminine jouissance is split between a phallic jouissance linked to man’s fantasy and an Other jouissance of which the woman can say nothing.  Lacan (2001c, p.466) described this intricacy, “… the jouissance a man enjoys when he goes with a woman, divides the latter, making her the partner of her own solitude.”  In a first moment, the hysterical subject is taken in and captured by the circulation of desire, and in a second, she seeks out knowledge of desire and, subsequently of jouissance.  Knowledge of desire and jouissance does in fact exist, but this knowledge is articulated in an unconscious fantasy that guides the behavior of the subject, as Jacques-Alain Miller (1982) pointed out, even if the subject is not aware of it and appears to be in control of his actions.

Contemporary Pathologies

In a time in which doctors act as intermediaries between patients and the sophisticated instruments used to identify pathologies, the instruments themselves provide the data attesting the illness Knowledge is thus displaced from the doctor to his instruments.  This makes it increasingly difficult for the hysteric to find an addressee for her questions on the body or a type of knowledge that can provide the answers she seeks. The consequence is that she often finds herself alone with a suffering that seems to make no sense, because no longer diagnosed as hysteria. She is simply told that it does not fall within a clinical picture that medical knowledge may yet define. New, rather inconsistent, categories are invented, such as Fibromyalgia or Chronic Fatigue Syndrome. Medical diagnoses proliferate but provide no integration into the symbolic, something that would address the subject towards questioning the possible unconscious causes of the symptoms. Indeed, as Lacan points out, “In order for the symptom to emerge from the state of an as yet unformulated enigma, the step is not that it should be formulated, it is that something should suggest to him that there is a cause for it.” (Lacan, 2004, p.325). These new diagnoses like Fibromyalgia or Chronic Fatigue Syndrome stand in the way of the possibility that subjects will question themselves on the cause of the enigma.

As well as her relation with her own body, the hysterical subject also faces the problem of her relation with the man.  In an age where “everyone sleeps with everyone” (Brousse, 2011), the logic of consumerism governs the paths of jouissance. In an age that allows enjoyment and where desire is beyond the Oedipus, love is what can go beyond purely consumeristic relationships. The conditions for this, however, are to “let love deceive you” and “to accept to believe in mourning” (Brousse , 2011). The difference then is that the status of the object is no longer that of an object of consumption, but it becomes the object that replaces the lost object. Love is what can go beyond a purely consumable relationship, as long as it allows itself to be “deceived by mourning” (Brousse, 2011), accepting the possibility of irreplaceable loss and, thereby, maintaining open the dimension of a void that cannot be filled by consumerist extra-enjoyment, by plus-de-jouir (surplus-jouissance).

Translated from the Italian by Laura Tarsia (with assistance from Anne Dunand and Francesca Passacantando)