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The Hysterical Personality

The Diagnostic and Statistic Manual of the APA (First Edition) makes no mention of a “hysterical personality” category, although unofficially it is used by many psychiatrists. Since it is frequently used as a diagnostic label in this study, a brief description of the criteria used and an explanation of the diagnostic terms related to the derivation of the “hysterical” category, are in order. The label “personality pattern disturbance” is applied to individuals whose life style demonstrates limited adaptive flexibility and certain relatively unchanging modes of expression and action (Brody1967). Included officially in the statistical manual are inadequate, schizoid, cyclothymias, and paranoid personalities.

Authors (Brody 1967) add to this list of personality pattern disturbances the hysterical or histrionic personality, with these comments:

Histrionic personality. The substitution in 1952 of the terms “conversion reaction” and “dissociative reaction” for “hysteria” in the Diagnostic and  Statistical Manual precluded further formal recognition of a clinically accepted though poorly described syndrome, the hysterical personality. The literature of preceding years was confused by usage—”hysteria” as described by Charcot and Freud, “hysterical personality” as a psychiatric medical label covering the wide range of problems from malingering to physiological visceral disorders, “hysterical” as used in a defamatory sense by the laity. A semantic solution may be achieved by using the term “histrionic personality” to designate those individuals described as hysterical personalities.

“Personality Trait Disturbances” is defined as the category for those individuals whose behavior is organized around a single, well-crystallized response tendency (Brody 1967). These traits seem less pervasive in their influence in total family structure than the “pattern disturbance.” However, boundary lines between the two categories are often artificial. Trait disturbances include the emotionally unstable, the passive-aggressive, the compulsive, and as a catch-all for those who defy classification, a last category given in the official manual is ”Personality trait disturbances, other.”

Elmer Gardner (1965), in his study of over-representation of “Hysterical Personality” and “Passive-Aggressive Personality,” opined that to some extent, these two terms were probably used as “waste-basket diagnoses,” having been used in 65% of the cases in which a diagnosis of personality trait disturbance was given.

This writer found particularly impressive in these Filipino patients the predominance of personality attributes associated with the “hysterical” character. The so-called “hysterical” character is described in textbooks in connection with conversion reaction patients who demonstrate, par excellence, the substrata of hysterical character defenses. However, this defense also exists in other clinical reactions, notably anxiety states and reactive depressions, as well as by themselves as abnormally exaggerated defenses, constituting a true character neurosis. In this study, the latter were classified under personality disorders, pattern or trait disturbance.

There are some differences, however, between the clinical picture of the hysterical personality as described in psychiatry textbooks (a stereotype encountered in Western culture) and that of the Filipino patient in this study who was given the same label.
 
First, let us look at some of the descriptions in psychiatric textbooks of the hysterical personality.

This character trait is strongly expressed in bodily behavior. Movements are soft and sexually seductive, with a special kind of agility. it has little tendency toward sublimation or reaction formation. There is little actual sexual satisfaction and little anchoring of sexuality in the character. Sexual tensions are discharged automatically or in the form of anxiety (Nagler 1967).

This personality type is frequently marked by coquetry, appeal, charm, readiness to quick friendships, elasticity, a false kind of apprehensively-tinged seductiveness, labile emotions, impulsiveness, suggestibility, dependency, flights of imagination and a limited drive toward sustained intellectual achievement (Laughlin 1967).

Under stress they may exhibit impaired reality testing, intensive fantasy production, and convictions about the motives of others bordering on delusion. In moments of repose, they are characteristically vague and imprecise about emotionally significant matters. They cannot express their inner feelings with accuracy and often utilize bodily action for communicative purposes (Nemiah
1967).

The above statements endeavor to bring into bold relief the picture they attempt to describe. When applied to all hysterical personalities, they may appear to create an exaggeration. Actually, a portion of these outward manifestations often suffice to warrant the diagnosis. Analysis of underlying conflicts and defenses substantiate it.

Since this type of individual rends to mimic existing norms, he may be seen as caricaturing prevailing tendencies in the culture. Therefore, such a personality will vary from one culture to another. The above textbook descriptions may represent more accurately the Western (American) version of the hysterical personality. In cultures where the people are generally more blunt, forward or direct in conveying what is on their mind, the traits of being exhibitionist, outgoing and dramatic will very likely stand out in the hysteric.

In this study of Filipino patients, the picture of the hysterical personality is not quite the same. For the Filipino woman, the hysterical personality is one who is also dramatic, exhibitionist and seductive, but in a different way. Her histrionics’ tend to be self-conscious; she sighs, cries, or fell faint. When emotive, she can be eloquent and effective in getting attention. Her exhibitionism comes out in many negative forms, such as shyness or inhibited. This too becomes exaggerated but nonetheless effective in calling attention to a person. Her seductiveness is never obvious or brash; it is childishly coy or demure, at times naive in its directness. The “apprehensive coloring”, cannot be missed; it is as if she is constantly in fear of being raped. This is conveyed not only in furtive glances, but also in body movements and in much tendency to laugh or giggle.
     
The Filipino culture, for all the increasing signs and protests to the contrary, still has a large hangover from its ego ideal for women of many bygone years. This is the so-called “Maria Clara” image of a woman who is shy, demure, modest, self-effacing, and loyal to the end. The openly provocative, sexually aggressive female who is frequently associated with the American female image is still comparatively rare in the Filipino culture , and even more so in this psychiatric study . There were two women in this study who, by present Filipino standards, would unhesitatingly be labeled by the culture as “immoral,” “nymphos” or some such terms, because of their unusually active sexual lives and their frank and often aggressive enjoyment of sex. However, their outward appearance and their manner of entering heterosexual relationships concealed much of this activity. It is interesting to note that Filipino movies often depict the sexually aggressive female in a rather caricatured and exaggerated form as a stereotyped villains.

With regard to men, the “hysterical personality” label has been applied with greater caution and hesitation. Hysteria has classically been regarded as a woman’s disease. Men who are diagnosed as hysterical are those who are thought to be seriously disturbed or of “borderline” potential. Lately, more authors have come to recognize the male counterpart of the female “hysterical” reaction. It seems that wherever the culture emphasizes masculinity and hesitates to doubt or question existing practices of enforcing the “masculine” image, there will be less inclination to detect and label hysterical reactions in men.

In this study, there is only one male patient diagnosed as a hysterical character. However, one can see that there is a significant incidence of hysterical traits in men suffering from anxiety, phobic and conversion reactions. These reactions often exist on a substratum of traits associated with the hysterical character. One will also note other traits and tendencies, notably summarization and poor impulse control found frequently in the male patients. This would strongly suggest a greater incidence of hysterical character than the statistic of one case so diagnosed would imply.

In the Filipino culture, the ego-ideal for men is that of one who is cool, cautious, inoffensive, pleasant, relaxed to the point of being rather easy-going, incapable of anger except when his Amor propio (narcissism) is provoked. His masculinity is definitely and emphatically regarded as intrinsic to this narcissism. Of this masculinity, he is quite conscious and proud, and will emphasize it in many subtle and not-so-subtle ways. Outside of this ego-ideal, the Filipino male may appear to some, and in particular to foreigners, as nor being masculine enough. He tends to be fastidious about his appearance, particularly his hair and clothes, to have soft and graceful movements. With strangers and in some unfamiliar situations, he may say very little and act even less,
which is the antithesis of the American male’s tendency to quickly state his identity and give his opinion. The Filipino will be quiet will strive to be inoffensive in situations where an American would feel obliged to be more vociferous.

The Filipino male psychiatric patient suffering from hysterical conflicts will therefore present an exaggeration of these cultural traits. He will tend to be extremely shy, inhibited, very conscious of, and doubtful about, his male adequacies. His body movements will show effeminate tendencies, much more than what is observable in the general population. The other extreme seems to occur just as often. This type is ostensibly sexually aggressive, tending to be show-offish about masculine traits and sexual exploits. In this study, the inhibited type tended to occur more among adolescent patients, although they were not as shy or inhibited as they were self-conscious. In the adult group, there were more of the aggressive types, with many Don Juan overtones. Thus, after the conversion reaction had disappeared or the depression had been alleviated or the anxiety reaction had subsided, the hysterical features emerged.

Throughout this discussion of the hysterical personality, it is hoped that the reader clearly dissociate the term “hysteric” from the layman’s notion which equates it with being theatrical or unrestrained in one’s reactions. It is used in this discussion in the psychiatric-psychoanalytic sense, based on a set of dynamics which have to do with certain patterns of dealing with sexual and aggressive drives, primarily derived from the phallic phase of psycho-sexual development. However, one will note that the description of “hysterical outbursts” in women patients in a later section of this work combines both meanings cogently.

 

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