322 Abnormal Psychology
neuropathy can be found in genuinely hysterical patients. In
1890 Janet succeeded Charcot as head of the psychological
laboratory.
Janet assumed that mental pathology is determined by the
functional features of the brain and a weakened and poorly
integrated nervous system. In order to determine whether
sexual factors are important in the etiology of hysteria, he
examined 120 hysterical patients. He found a preeminently
erotic disposition in only four and concluded that hysterical
patients are generally too self-centered and emotionally re-
stricted to be preoccupied with sexual interests. Janet empha-
sized the importance of psychogenic or “ideogenic” causes in
the etiology of hysteria and criticize Freud’s insistence on a
universal psychosexual etiology of the neuroses. He traced
hysterical symptoms to a system of “fixed ideas” that con-
centrated in one field of consciousness and controlled the pa-
tient’s mental life. The fixed ideas “may develop completely
during the attacks of hysteria and express themselves then by
acts and words” (Janet, 1892/1977), and are also revealed in
dreams, “natural somnambulisms,” and hypnotic states. The
fixed ideas, over which the patient has no control, arise from
a persisting traumatic memory of a series of emotionally dis-
tressing events that the patient appears to have completely
forgotten, but that can be remembered in a hypnotic state.
Janet claimed that when the patient was able to express the
traumatic memories, the symptoms improved or disappeared.
One of his therapeutic techniques involved asking his pa-
tients, usually under hypnosis, to describe the circumstances
in which a symptom first occurred. Then, to eliminate the
symptom, he gave the patient a direct hypnotic suggestion
that the circumstances the patient recalled had not actually oc-
curred. His success in treating hysterical patients with a com-
bination of hypnosis and psychological analysis led him to
devise a treatment plan for various types of hysterical symp-
toms. He stressed that each patient must be treated as a unique
case, not in terms of a generalized psychological theory.
Sigmund Freud and Psychoanalysis
For most of the first half of the twentieth century, Sigmund
Freud (1856–1939) and his speculations on the origin of
psychopathology had perhaps a more pervasive influence on
both professional and popular opinion in the United States
than any other single theorist.
Freud received his medical degree from the University
of Vienna in 1881, later deciding to specialize in neurology.
In 1885 he studied for six months at Charcot’s clinic at
the Salpêtrière, where he was impressed by Charcot’s theory
that hysterical phenomena are generated by ideas isolated
psychically in some second region of the patient’s mind that
is separate from normal waking consciousness. In 1886, he
began private practice, specializing in nervous diseases
(predominantly hysteria). In this practice he used the con-
ventional treatments for neurosis: massage, hydrotherapy,
electrical stimulation, the rest cure, and hypnosis. Freud
used hypnosis primarily to suggest to the patient that specific
symptoms would disappear. He also used a “pressure tech-
nique” in which he placed his hand on the patient’s forehead
to elicit memories.Breuer, Freud, and the First Version of the Psychoanalytic
Theory of PsychopathologyEarly in the 1890s, Freud and his colleague, Josef Breuer,
began to collaborate in developing a psychoanalytic theory
to explain hysteria. Their collaboration produced the first
version of psychoanalytic theory, On the Psychical Mecha-
nism of Hysterical Phenomena: Preliminary Communication
(Breuer & Freud, 1895/1955), in which they identified an
unconscious memory or complex of memories of a psychical
trauma as the pathogen that causes hysteria. An event (or
series of events) that causes distressing affect, such as fright,
anxiety, shame, or physical pain, can result in a psychical
trauma in a susceptible person, and if memory of the event is
repressed it acts as a determining cause of hysterical symp-
toms. They hypothesized that if the distressing affect thus
generated is discharged by energetic involuntary and/or vol-
untary reaction, the memory of the event fades. However if
no appropriate reaction occurs, either because it is prohibited
by social circumstances or the patient voluntarily suppresses
(defends against) memory of affective ideas intolerable to the
ego, the memory persists, inaccessible to consciousness, and
retains its quota of affect, which is converted into pathologi-
cal somatic symptoms.
Because patients are reluctant to talk about the event that
originally precipitated a hysterical symptom or, much more
often, are genuinely unable to remember it, the event cannot
be discovered by questioning the patient. However, if the
patient is hypnotized, the memory can be recovered. Freud
and Breuer claimed that when the patient described the
event that had provoked a hysterical symptom and expressed
the affect that had accompanied it, the symptom immedi-
ately disappeared. They conceded that new symptoms may
replace those eliminated, but considered their method supe-
rior to attempts to remove the symptoms by means of direct
suggestion.
Much of this theory relied on one particular case. Breuer
treated a young woman identified by the pseudonym Anna O.,