Matrix of Hysteria (Book Review)

Author:  Yarom, Nitza
Publisher: Routledge
Reviewed By: Mia Biran, Vol. XXVIII, No. 3 (Summer 2008), p. 68

As highlighted by the author of Matrix of Hysteria, the traditional emphasis in psychoanalysis on sexuality has waned recently. With the evolution of newer schools of thought after Freud, such as ego psychology, object relations, self psychology, and intersubjective perspectives, the current attention is redirected to attachment issues (“preoedipal”), introjects, archaic transferences, and relational issues in the psychoanalytic process. Dr. Yarom’s book reminds us of the central importance of sexuality in psychoanalytic understanding by elaborating on the psychopathology of hysteria as a prevalent problem not only in neurotic patients but also in personality disorders and psychosis.

Yarom perceives hysteria as a problem resulting from thwarted development during the phallic stage. For both the boy and the girl, the development of sexual identity is halted due to pathological reactions from both father and mother. The resulting hysteria is exhibited on three axes (the Hysteria Matrix):

  1. Vacillations in gender identity (Am I a man or a woman? Am I weak/strong passive/active?). 

  2. Ways of “not knowing”—usage of repression, dissociation, splitting, denial and foreclosure as the main defense mechanisms. 

  3. Usage of the body and the mechanism of conversion to represent and project the internal conflicts around sexual identity.

All three axes could be perceived as intersubjective processes operating in the transference and countertransference between analyst and analyzand.

In clinical work, the analyst might find the work with the hysterical patient very frustrating and exhausting. These patient often ‘don’t know” what is wrong and how to verbalize their experiences and emotions, they use projective identification processes to have the analyst contain the parts of their identity which they reject at any given time, and they are often afflicted with numerous medical and somatic problems that prevent access to the real conflict, unless fully analyzed. The erotic transference is a central theme in the treatment of many hysterics.

In chapter 3 of the book, Yarom describes clinical work with hysterical patients. The examples are very vivid and the work she does both in therapy and in supervision is impressive. As expected, one of the main difficulties in supervising therapists that treat hysterical patients is their sense of being “stuck” with the patients on one hand, and their difficulty in containing the parts that are projected onto them, on the other. Some therapists feel overwhelmingly seduced by the hysterical patients who project aspects of their sexuality, others collude with the “not knowing” by leaving too many aspects of the material repressed or avoided altogether. Yarom recommends that therapist accept the projected aspects rather than confront, because the containment (with the therapist’s awareness of what is being projected) is what will allow the patient to reintegrated it back into his/her personality.

Chapters 4, 5, and 6 review aspects of hysteria in perversion, psychosis, borderline, and narcissistic conditions. Yarom emphasizes the notion of multi-faceted Oedipal and pre-oedipal conflicts in most patients (in contrast to the recent prevailing emphasis on pre-oedipal pathology).

Chapters 7, 8, and 9 reflect on earlier theoretical understanding of hysteria by different schools (Kleinian, British Independent School, Ego Psychology, Object Relations, Self-Psychology, Intersubjective, Feminist, and French psychoanalysis. The review of the literature is rich and thorough.

The book is refreshing in addressing an old concept of psychoanalysis with a creative and clinically relevant perspective. It can serve as a resource book for analyst when confronting the difficulties in dealing with projections, seductions, “not knowing,” and acting out.

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