Hysterical Paralysis

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HYSTERICAL PARALYSIS

Hysterical paralysis designates various forms of loss of mobility of the upper or lower limbs that are present in certain patients without any indication of a direct neurological cause.

Even before the Studies on Hysteria (1895d), the problems that hysterical paralysis posed for the medical diagnostic model led Freud to introduce the first elements of psychoanalysis in a work called, "Some Points for a Comparative Study of Organic and Hysterical Motor Paralyses" (1893c).

To Freud, hysterical paralyses seemed too precisely delimited in relation to their "excessive intensity" (1893c, p. 164), and they appeared to be related more to the way patients imagined their bodies than to any distribution of lesions in real anatomy. Based as it was on the fact that peripheral points on the body are grouped at the level of the nerves that represent the medullary centers of the cortex, Freud's neurological conception of "representation paralysis" went far beyond what Charcot himself (1880-1893) called a "disease of representation." Freud was in effect seeking "permission to move on to psychological ground" (1893c, p. 170), and he crossed that border on the basis of the difference between organ and function.

This amounted also to placing paralysis on the level representing both fantasy and action. By defining the hysterical paralysis of the arm as "the abolition of the associative accessibility of the conception of the arm" (1893c, p. 170), he raised both the question of trauma and that of the affective value of a function, so anticipating what would later be known as associative links and breaks, isolation and repression.

We see here too that what would later become the "innervation" of the repressed idea—"psychical excitation that takes a wrong path," as Freud wrote in 1894 (1950a, p. 195)—did not restrict the notion of conversion to a single idea of discharge, but installed it within conflictual ambivalence, and this whether it was muscular contraction, paralysis, or anesthesia that was at issue. Thus the symptom achieves the repression of the representation and the return of the related affect to its original innocent status as action. This disconnection between affect and symptom is what Charcot referred to as the "belle indifférence " of hysterics (cf. Freud, 1915d, pp. 155-56).

Thus conversion holds a precise position between hypochondria, which seeks to mentalize the unrepresentable depths of the body's interior, and, at the other extreme, psychosomatic disturbances where improvement or somatic recovery dispense with the symbolic level entirely. Between the two, conversion involves the striated musculature in order to play out a drama at the level closest to the body. The involvement of the vegetative level is not excluded here, so long as it is introduced into a fantasy, the desire of which was expressed in its negative form as a paralysis (Jeanneau, 1985).

Augustin Jeanneau

See also: Charcot, Jean Martin; Conversion; Elisabeth von R., case of; Hysteria; Innervation; Psychic causality; Psychic reality; Psychotic/neurotic; Somatic compliance; Studies on Hysteria ; Symptom-formation.