ABSTRACT
Our attention is drawn by Susan Loden to some of the complex theoretical issues touched on in Chapter 5a, particularly in regard to the relation of the symptom to hysteria. The patient presents with an alarming array of regressive symptoms and varying psychiatric diagnoses along with medical advice to avoid psychoanalysis. Clinically, Jonathan engages this patient, despite ‘major mental fragmentation’, looking for potential psychological-mindedness alongside his physical symptoms. These he understands as related to past trauma. Theoretically, Jonathan links the patient’s symptom to Breuer and Freud’s (1883–95) early conception of hysteria and traumatic memory. The author opens up a discussion about the differential diagnosis: is the tic a symbolic phenomenon – the bodily conversion of a repressed memory with psychological meaning? Or is it the direct representation of a trauma forcing itself into consciousness, as Ferenczi (1921) speculated? Freud later acknowledged that his pre-psychoanalytic treatment (hypnosis) of his tic patient Emmy failed, and wondered if after all the symptom is organic, to be classed with Tourette’s syndrome. Abraham (1921) placed tic somewhere between psychosis (paranoia) and hysteria and saw it as ‘mimicking the object’. Later authors are discussed, including Fenichel, Mahler (1946) and Taylor (1993). These authors developed different psychoanalytic models for the genesis of the symptom along with different approaches to treatment. Susan leaves the patient to his treatment with the diagnosis still to be determined, stating that conversion can occur along the whole spectrum of psychopathology.
