My present opinion is that the theory of repression offers the only explanation of many cases of hysteria. This applies particularly to those cases where the symptoms represent a permanent state of embarrassment or fear, such as stammers and tremors, and to the unreasonable fears and impulses, the phobias and obsessions, of the war-strained soldier. As an example I will quote a case of a soldier who had an impulse to attack any single companion, which was cured by bringing into consciousness the repressed memory of a gruesome hand-to-hand fight in which he killed his opponent. The repression was so complete that after its first revival under hypnosis it was 'forgotten' again and again at subsequent interviews in the waking state. This example illustrates Freud's 'tendency to displace affects.' The repressed complex contained within itself the impulse to fight; this 'affect' reached consciousness and an object had to be found for it, the object being the single companion of the patient.
As regards those hysterias in which the secondary function is conspicuous, I incline to the 'Will to Power' theory, and add to it the 'repression of the consciousness of deceit.' To illustrate this, let us trace the growth of a case of hysteria. Imagine a girl who is 'misunderstood', who has her round of daily tasks and feels that she was meant for higher things, that she ought to be loved and obeyed instead of being subject to the will of others. To no one can she tell her thoughts and troubles, sympathy is denied her, and she sees no hope of satisfying her desires or changing her position in the world.
Or imagine another type, the pampered girl who has never had to face a trouble or unpleasant task and has come to regard her own wishes as the supreme law, until at last the time comes when some desire, some wish that she cannot or will not face and conquer, remains ungratified. She feels the need to express her feelings, to obtain that sympathy that she thinks she deserves.
In either case there comes the hysterical manifestation, and here I will quote from Jung[16]:—
'But, the astonished reader asks, what is supposed to be the use of the neurosis? What does it effect? Whoever has had a pronounced case of neurosis in his immediate environment knows all that can be "effected" by a neurosis. In fact there is altogether no better means of tyrannising over a whole household than by a striking neurosis. Heart attacks, choking fits, convulsions of all kinds achieve enormous effects, that can hardly be surpassed. Picture the fountains of pity let loose, the sublime anxiety of the dear kind parents, the hurried running to and fro of the servants, the incessant sounding of the call of the telephone, the hasty arrival of the physicians, the delicacy of the diagnosis, the detailed examinations, the lengthy courses of treatment, the considerable expense: and there in the midst of all the uproar, lies the innocent sufferer to whom the household is even overflowingly grateful, when he has recovered from the "spasms".'
But the end is not always thus. There are victims of hysteria whose symptoms continue for months or years, till cure seems impossible, although, as I have said before in this chapter, there is present in the consciousness a strong desire for recovery. Let us imagine the patient complaining of severe pain in one foot: the sympathising friends tend her with care and affection, the doctor suspects the early stage of some bone disease, and, as is the fate of so many practitioners, he is urged by the friends to say 'what is the matter.' Then the supposed disease receives a name, muscular action pulls the foot into an abnormal position, deformity appears, and if the true nature of the disease is now discovered not only the patient but the friends and family need the most careful treatment.
What has been happening all this time in the mind of the patient? We will assume that she knew at the beginning that her pains were fictitious; what course is now open to her if she wishes to end the deceit when her friends, by their pardonable credulity, have allowed themselves to be deceived and her troubles have been accepted by the doctor as real? Her pride or self-respect prevents open confession, and in her ignorance of the course of the supposed disease she thinks an unexpected recovery will reveal the fraud. Here are the materials for another mental conflict, and her alternatives are:—
1. To solve the conflict by confession or recovery, and I have shown the difficulties of this course.
2. To build a logic-tight compartment; to say, for example, 'They have never given me a chance, and now I am quite right in imposing upon them as long as I can.' But her feelings concerning right and wrong are probably too strong to maintain this attitude indefinitely.
3. To repress the consciousness of deceit and maintain her symptoms as the price of her peace of mind.