Does hysteria exist today? Current trends in working with psychopathology in Gestalt therapy undeservedly ignore the hysterical modality of relationships, since hysteria is considered an obsolete phenomenon inherent to women of the past times of Freud. Rosaria Lisi, author of the book that came out in the spring of 2019 in the Italian Institute of Gestalt Therapy Kairos (founded in 1979), entitled “Hysteria and Gestalt Therapy. When everything is in relation”, when was referring to the work of the director of the institute, Giovanni Salonia, fully described how hysteria is inherent in our modern society, equally to men, and women, justifying its origins and relevance, as well as “putting it through» Gestalt therapeutic theory backed by practice. Since the book is still only in Italian, and its ideas have captured me so much that I found it necessary to bring them to light, in this article I tried to convey the essence of it in the most concentrated way, after all, psychotherapy (psychoanalysis), as a method of “treating with the word” was created of out of hysteria.

Initially, hysteria (from ancient Greek «uterus») was considered a mental disorder of women. In her book, the author shows how, over time, this disorder was revised, and its symptoms opened from other sides, so now it is considered inherent also to men, and the origin of its name from the word “uterus” indicates not the female side, but the maternal side that gives life to children (sons and daughters) who enter the world not only in vertical relationships with their parents, but also in the horizontal world of brothers and sisters, which makes it possible to enter the polis and build it. The modern understanding of hysteria comes not only from relations with the father and mother, but also with brothers and sisters (siblings).

According to Salonia, the hysterical person remains hanging between the expulsive mother, the non-approaching father (because he is always not at home or rigid) and the brother or sister who too early takes away affective space. It derives from this that for the hysterical modality, fixation of attention and energy occurs on the environment, and the self is more in it than in itself, which speaks of problems with boundaries and with separation, in the process of which much of fear and anxiety are hidden. And then “ anything is relevant” (“anything is relevant” PHG, 1951) indicates that nothing is assimilated.

“According to Salonia, in a hysterical modality the confluence is represented both as a need for a healthy merger, and as an anxiety of differentiation (acceptance of a difference), i.e. the style of relationships is marked by the search for “similarity” and anxiety of difference. “(Rosaria Lisi)

A hysteric is a person with confluent predispositions. He learned to imitate the behavior that is appropriate for his environment, without restoring the spontaneity and creativity of the body in accordance with its needs. His behavior is theatrical, dramatic, charming and manipulative and with targeted appeals, but is characterized by shallow and piecemeal contact, since energy cannot be directed inward, instead it is intensified outside and tries to capture more things, feel more, see more, have more.

The Id function impairments in hysteria are characterized by the fact that sensing cannot be assimilated, so the work of the Gestalt therapist must occur at the level of the Personality function in order to assimilate experience, maintain its clarity and separation with the function of Personality of the therapist without anxiety, worry and fear.

The Ego function also receives a call to find a solution between what a hysteric feels (the ID function) and who he becomes (the Personality function) to find a creative solution, and not to imitate actions and play using the usual Ego function that in a hysteric consists of imitation of the environment.

Salonia offers to work with the ID function, relying on the following client’s assignment of his own body: “these are my hands, these are my shoulders, these are my eyes”, “I feel anger, but I am not anger myself”.

If for a narcissist the need for admiration serves to feel the guarantee not to be humiliated, disqualified and disappointed, then for a hysteric not to be in the spotlight means not to exist and causes the fear of losing the ground under your feet. For him inherent is fear of non-existence and inadequate sexual seduction with provocative behavior. A hysterical person tries to focus on YOU in order to create WE without I. It is as if he does not live through his emotions, but lives with the emotions of the environment and other people. His emotions change quickly, so in therapy it is important to work not with the emotions themselves, but with the senses and meanings that he associates with the experiences. The hysterical person uses appearance to attract attention, and the visible body as a function of being visible (does not have a body, but is one). His speech is abundant and impressionable, theatrical and with an exaggerated emotional expression, but with a lack of details, as it does not come from a narrative history assimilated through his own experience, and the biographical function of Personality is not a verbal copy of the ID function (as Goodman called it). Hysterical personality easily falls under the influence of others and circumstances, and also often considers the relationship more close and intimate than it really is, which indicates to blurred boundaries and a tendency to merge. Salonia advises the therapist to say more often “I AND YOU” instead of “WE”, focusing on the “AND”, which testifies to both compatibility and separation at the same time.

Uncontrolled spontaneity and too shallow and imaginary desire of a hysterical person lead to organizing the experience of the imaginary desired and provoke imitative behavior, imitative play, and the body turns into a scene where an overdose of spontaneity emotions and desires makes ideas and inventions capricious or sexifies them because of strong excitement, which does not activate the function of orientation and does not give energy for manipulations (actions) with the environment. A hysteric imitates and plays to feel that he is living, since the need to be visible by others is urgent in order to confirm his existence, and his self is immersed in suppressive darkness.

There is a difference between playing as the creative function of the Ego from living full contact, in which we are both similar and different in our distinctions, and imitating the game as a hidden hysterical desire to be in that contact. It is also worth distinguishing the ability to imitate, which is based on mirror neurons and includes the concept of introjection for learning (a process that assimilates new beliefs and feelings in Personality) with imitation, which does not correspond to the real needs of a person with hysterical modality, but is reproduced impulsively from bodily tension in order to exist in the eyes of others, and by doing so it represses the feeling of the whole body, which leaves only one of its parts speaking, and itself belongs to the environment.

The experiences that the other person lives through (including the therapist) in relation to the hysterical person are noted to be the impossibility to interpret the behavior for their complete satisfaction, which in fact indicates a weak awareness of the hysterical person’s own needs and true desires. This can be traced back to the example of Freud’s work with Anna O. and Dora, whom he gave the opportunity to speak out, which launched the healing process, but due to his commitment to the Oedipus complex, he missed the chance to realize his father’s transference as the need of patients to feel warmth towards a man who cares about her interpreting these impulses of contact intentionality as sexual attraction.

Paradoxically, from these cases of work, psychoanalysis arose. At the same time, the book contains the arguments of various authors that Freud’s hysteria lies in the fact that he, having directed all his attention to vertical relationships, lost sight of horizontal relationships, since he himself did not cope with the sibling complex (relations with brothers/sisters) . Therefore, the modern vision of hysteria takes into account both vertical and horizontal relationships, arguing that it is from the latter that the ambivalence of feelings flows, causing an identity violation, which instead of looking for the answer to the question “Where am I?”, looks for the answer to the question “Who am I?” by imitating behavior in relationships with others, rather than trying to confirm their existence.

The ambivalence of feelings originates in the horizontal relationship of brothers/sisters, as the emotional intensity ranges from love to jealousy, from cooperation to competitiveness and the struggle for space, from admiration to envy. Feelings of envy, for example, taking into account violations of horizontal relations, indicates only that a person does not feel his place next to siblings, and is a sign that he is not aware of his internal processes, and the only possibility for him to realize his needs is to reproduce the feeling of envy from the environment, i.e. find another person, with jealous to whom he can identify his desires or needs. In this case, the body is in the space of the environment, and not felt by a person, which indicates to a non-integrated person without the ability to sense his own needs and desires from within himself. Therefore, envy says that a person is looking for an answer in the environment to the question “Who am I?” Instead of “Where is my place?”. The hysterical person needs the other to confirm his existence and the sensation of life, while the other person turns from a subject into an object, and is not perceived phenomenologically as “being” and another life next to me. Hysterics treat the other not as YOU, but as a means of existence, which gives him the opportunity to be no different. To overcome the sibling complexes (sibling-horizontal) means to assimilate the following in Personality: I am unique, but not the only one.

The danger for humanistic fields of psychotherapy in working with clients with a hysterical modality of relationships is that they are often confused with a neurotic entity, therefore, taking into account all the above characteristics, the therapist must be especially attentive.

In conclusion, I emphasize that what in DSM-5 is called Hysterical Personality Disorder in Gestalt therapy is called the Hysterical modality of relationships. Thus, Gestalt therapy transforms the original vision of the psychoanalytic model, from which psychotherapy was born as a method of “treating with a word”, and provides its enriched, more complete and promising vision of the process of “treatment.”

The article is based on the Rosary Lisi book «Hysteria and Gestalt Therapy. When everything is in relation» — Rosaria Lisi Isteria e Gestalt Therapy. Quando tutto è partinente. Gestalt Therapy Kairos. Collana diretta di Giovanni Salonia. 2019, Il Pozzo di Giacobbe.