The Psychoanalytic Quarterly

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Studies on Hysteria—Katharina

W. W. Meissner

To cite this article: W. W. Meissner (1979) Studies on Hysteria—Katharina, The Psychoanalytic

Quarterly, 48:4, 587-600, DOI: 10.1080/21674086.1979.11926894

To link to this article: https://doi.org/10.1080/21674086.1979.11926894

Published online: 20 Nov 2017.

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STUDIES ON HYSTERIA-KATHARINA
BY W. W. MEISSNER, S.J., M.D.

Freud's account of his meeting with the country maid, Katha­

rina, is re-evaluated from a contemporary psychoanalytic per­
spective. Freud's original explanation of Katharina's hysteria
was based on a set of quantitative-economic assumptions and a
psychic model based on confiict and defense. A modern ana­
lytic perspective would shift the emphasis from the economics
of discharge to the aims and objects of sexual activity. The
understanding of sensual pleasure focuses more specifically on
the related complex of intentions, purposes, meanings, and mo­
tives, as well as on the qualities, characteristics, and patterns of
interaction with important objects.

Of all Freud's case histories, there is none so charming and be­

guiling as the one based on his encounter with the country maid,
Katharina. The case has been little commented on in the psy­
choanalytic literature, presumably because we have no further -
data about it beyond that provided by Freud in the account in
Studies on Hysteria (Breuer and Freud, 1893-1895). The pur­
pose of the present study is to re-examine the details of the case
in an attempt to determine the extent to which Freud's evolv­
ing theoretical views influenced his handling of the case ma­
terial and to venture a recasting of the elements of the case in
terms of a contemporary perspective. This effort will be guided
by my previous attempt to compare Freud's early thinking, par­
ticularly in his Three Essays on the Theory of Sexuality (1905),
with a contemporary psychoanalytic frame of reference (Meiss­
ner, 1976). At attempt will also be made to refocus some of the
elements of the case in terms of the paranoid process (Meissner,
l 978).

THE CASE
Freud met Katharina while mountain climbing during a sum­
mer vacation. He had stopped for a brief respite at a mountain
587
588 W. W. MEISSNER

refuge and was approached by a young woman of eighteen. She

presented Freud with a complaint of a loss of breath of sudden
onset that was accompanied by a feeling of pressure on the eyes,
heaviness and hammering in the head, buzzing sensations, a feel­
ing of giddiness almost to the point of fainting, and a crushing
pressure on the chest that prevented her from catching her
breath. This was accompanied by a squeezing, choking sensa­
tion in the throat, an intense anxiety, and a feeling that she was
about to die. In addition, there was a hallucinatory vision of a
threatening and frightening face that looked at Katharina in a
dreadful way. These symptoms had been bothering her for
about two years.
Freud had no difficulty in diagnosing this as a hysterical con­
dition, and he pressed on to see if he could find the roots of it.
He suggested that the patient must have seen or heard some­
thing embarrassing at the time the symptoms began about two
years previously. Katharina immediately recounted an event
from two years before: she had looked through the window of
her father's1 locked bedroom one day and had seen him having
sexual intercourse with the family cook, Franziska. In relating
the details, Katharina added that she blamed herself for her
parents' divorce, since she was the one who had told her mother
that her father was "carrying on" with the maid. She also in­
sisted that when she looked through the window, she had noth­
ing bad in mind; her little brother, who was with her at the
time, was afraid, but she looked in anyway. When she saw her
father lying on Franziska, she was suddenly overcome by short­
ness of breath and had to lean back against the wall; at the same
time she experienced the hammering and buzzing in her head,
just as in the attacks of hysteria. Apparently Katharina's mother
suspected something and was later able to find out from her
what she had seen. Subsequent arguments between her parents

1 Freud's discretion led him to cloak the identity of the patient's father by

referring to him as her uncle in the account in the Studies. In a footnote added
in 1924, however, Freud revealed that the events recounted in this case had to do
with paternal seduction and incest (Breuer and Freud, 1893-1895, p. 134, n.).
 STUDIES ON HYSTERIA-KATHARINA

were quite disturbing to Katharina. Eventually the mother

moved out of the house with her children and into the inn
where they now lived, leaving Katharina's father with Franziska,
who by this time was pregnant.
These events had taken place when Katharina was about six­
teen, but they carried her back to earlier experiences: for ex­
ample, when she was about fourteen, her father had made sexual
advances toward her. They were on a trip together and had
stopped at an inn. Katharina went to bed early while her father
remained downstairs in the tavern drinking. She had fallen
asleep but was suddenly awakened by "feeling his body" in her
bed. She jumped up, frightened, and scolded him. She would
not return to bed or go to sleep until he had gone to sleep in his
own bed. Freud observed that she seemed not to have clearly
recognized the episode as sexual at the time it happened, but
she admitted to him that it later became clear to her what her
father was trying to do. Freud's conjecture that she had felt her
father's erect penis during this experience seemed to be sup­
ported by her embarrassed expression when he inquired about
it.
An added detail concerns the terrifying hallucination of the
head during her attacks of hysteria. She identified it as her
father's head, but associated it to later experiences when the
disputes between her mother and father had erupted and the
family was in considerable turmoil. Her father blamed Katha­
rina for all the trouble, saying that it was her fault because she
revealed the truth to her mother. If she had kept quiet, there
would have been no question of a divorce. He often threatened
to hurt her, and he would frequently chase her in an angry
rage. The face in her hallucinatory vision was his enraged
countenance.

THE VIEW FROM THE THREE ESSAYS

Freud's encounter with Katharina apparently took place
sometime in the early 189o's, since it appeared in published
form among his cases in the Studies ( 1893-1895). It was only
59° W. W. MEISSNER

a decade later that Freud came to formulate his theory of sex­

uality and its role in the perversions and neuroses. The Three
Essays ( 1905) reflected the early stage of the development of
Freud's theoretical thinking.
We can remind ourselves of some of the fundamental assump­
tions that guided Freud's thinking during this period. The basic
model with which he worked was topographic and economic,
based on the formulations that found their optimal expression
in the early physiologizing attempt of the Project ( 1895) and the
model of the mind presented in The Interpretation of Dreams
( 1 goo).
The first assumption was that of causal determinism derived
from the influence of Helmholtzian physics. Thus, Katharina's
symptoms could be attributed to a form of biological deter­
minism in which libidinal impulses would have come into con­
flict with more socially acceptable restraints. Along this line, it
would seem apparent that the hysterical symptoms that Katha­
rina began to experience on looking through the window re­
flected an obvious identification with the sexually assaulted
Franziska, particularly with regard to the crushing pressure on
the chest, suggesting the weight of the father's body. It is an
interesting side note, however, that there is no mention of hys­
terical identification anywhere in the Studies, even though
Freud soon after was to make this a central aspect of his under­
standing of the origin of hysterical symptoms (Meissner, 1970).
A second important factor that derived from the Project (and
was also embedded in Breuer's theoretical chapter) was the as­
sumption of the quantitative or economic point of view based
on the notion of constancy in all mental operations. The law of
constancy and the correlative discharge of sexual tension gave
rise to a model of instinctual pressures for drive discharge as
matched against countercathectic forces whose operation was re­
flected in feelings of shame, disgust, horror, or morality. These
repressing forces blocked the discharge of libidinal tensions and
brought about a rechanneling and a substitute discharge
through neurotic symptoms. The result of this repression and
 STUDIES ON HYSTERIA-KATHARINA
591

rechanneling was the transformation of libido into anxiety. We

can remind ourselves that Freud's understanding of libido at
this point was largely physiological and even biochemical, a
view that became explicit in the treatment of the actual neu­
roses. Here Freud believed that the excess of sexual stimulation
produced a quantitative accumulation of energy due to inade­
quate discharge which was then followed by a transformation of
this sexual energy into a toxic agent responsible for anxiety. It
was only after a score of years that Freud modified this toxic
view of anxiety, and, in fact, not until 1932, in the New Intro­
ductory Lectures, was he able to surrender the idea. Accord­
ingly, Freud's view of Katharina's symptoms was based on an
essentially economic notion of sexual tension discharge.

KATHARINA REVISITED
From the point of view of contemporary psychoanalytic
theory, the model of impulse and defense which dominated the
thinking in the Studies can no longer be considered adequate.
The sexual theory of discharge in itself is unable to account
satisfactorily for the clinical phenomena; we have come to rea­
lize that the dynamics of sexual experience involve considerably
more than the economics of instinctual discharge. Appropriate
sexual stimulation and sensual gratification cannot be defined
simply in organismic terms: they must be viewed in a context
of meanings and motives involving strong attachments to spe­
cific objects. My earlier discussion of these issues (Meissner,
1976) put them in the following terms:
As a consequence of this broadened conceptualization of the
instinctual theory, there has been a considerable shift towards
an emphasis on the aims and the objects of sexual activity. Thus
the concept of libido has acquired a nonreductive and specifi­
cally motivational aspect. The experiencing of sensual pleasure
is not merely a matter of drive-discharge, but rather has a di­
rectional component which involves intentions, purposes, mean­
ings, and motives. These components of the sensual experience
turn the direction of attention to a diversification and broaden-
592 W. W. MEISSNER

ing of the aims of such experience, as well as to the qualities and

characteristics and patterns of interaction with specific objects.
It is in the interaction with these objects that sensual experience
is not conceived so much in terms of the economic and quantita­
tive terms of energy discharge in response to nonspecific stimu­
lation, but rather it is seen in terms of adaptive functions gen­
erally, as well as the more specific quality and character of the
persisting relationship to significant objects (p. 130).
In the case of Katharina, it is immediately evident that the
situation is considerably more complex than Freud's view would
allow. The girl's curiosity, her insistence on looking, remains
unexplained. We can infer a certain degree of sexual curiosity,
but it also seems reasonable to suggest that Katharina may have
anticipated what she would see when she looked through the
window. Perhaps her curiosity was stimulated by the possibility
that her father was doing with Franziska what he had tried to
do with her, or that he might be doing with Franziska what
Katharina guessed or fantasied he had done with other women,
particularly her mother.
The whole scene is familiar enough to us to suggest a ref­
erence to primal scene experiences (Esman, 1973). It does not
strain the imagination in the least to think that Katharina,
given such a father with his sexual proclivities, might have had
an earlier primal scene experience. Edelheit ( 1974) suggested
that the "primal scene schema" derived from such experiences
gives rise to a set of double identifications that reflect the
libidinal-aggressive aspects of the sexual encounter. This double
identification may operate simultaneously or alternate back and
forth, and it may reflect typical sadomasochistic configurations,
or, more specifically, identification with the victim and the ag­
gressor. The question of the extent to which such primal scene
schema reflect the influence of a child's real experience of see­
ing the parents in sexual activity as against its derivation from
fantasy remains unresolved.
In any case, the dynamics that enter into the understanding
of Katharina's symptoms cannot be divorced from her complex
 STUDIES ON HYSTERIA-KATHARINA 593

involvements with significant objects, particularly her parents.

Not only are questions raised regarding hysterical identifica­
tions in connection with the hysterical symptoms-her identifi­
cation in the first instance with Franziska and perhaps with her
mother in the primal scene experience-but there are also sig­
nificant introjections that derive from other, nonsexual aspects
of the primal scene schema.
We know now that incestuous developments in the family sys­
tem do not come about by chance. In Freud's account, one is left
with the supposition that the father's disordered sexuality is sim­
ply a given and that the main focus of concern is on the stimulus
effect on Katharina. But today we know from the study of family
interactions that the pattern of incest often derives from a dis­
turbed relationship between the parents and that the incest usu­
ally takes place with some form of collusion on the part of the
mother. In these well-known patterns of incestuous family inter­
action there is ample room for the motives of victimization and
aggressive victimizing to be played out. Consequently, the symp­
toms in Katharina's case, as well as the manner in which they
came about, would direct our interest toward the issue of family
dynamics and the patterns of interaction that might lie behind
them. Hence it is not simply a question of the patient's libidinal
involvement with specific objects and the consequences of that;
what is involved is a highly complicated emotional interaction
with significant objects that goes beyond the simple one-to-one
relationship to a more complicated matrix of familial trans­
action.
Such a consideration inevitably directs our attention toward
a more comprehensive view of the patient's psychological devel­
opment, reflecting our more complex grasp of the emergence
and sequencing of developmental patterns. There is no longer
a focus on the predetermined unfolding of inherent biological
potentials emphasized in the earlier theory, but rather an appre­
ciation of the intermeshing of innate maturational factors with
experiential components derived from interaction with signifi­
cant objects. Moreover, the perspective generated by this view is
594 W. W. MEISSNER

not limited to the economically determined repetition of earlier

developmental patterns in later behavior; it extends to the at­
tempt to understand progressive developmental transformations
and the influences of earlier forms of interaction with objects on
later patterns of behavior (Abrams, 1977).
In Katharina's case, then, questions would inevitably arise
about earlier levels of developmental experience that might
have contributed to the hysterical reaction. We would have to
be concerned about the as yet unresolved issues of adolescent
development. These would rest on the course and resolution of
latency concerns, and these in turn would carry us back to an
attempt to reconstruct the dynamics of the oedipal period. Even
this, however, would not satisfy our curiosity about developmen­
tal issues. We know that the organization and patterning of
oedipal dynamics reflect preoedipal involvements with parental
figures; at that early stage, critical components of the emerging
personality are laid down that carry considerable weight in the
organization of psychic structure. These issues go back to the
earliest patterns of mother-child interaction and are concerned
with what Winnicott (1965) has described as the "facilitating
environment."
My own thinking in this matter tends to focus more directly
on the patterns of internalization around which the emerging
personality is organized and which reflect the developmental
vicissitudes (Meissner, 1978). The question here would focus on
the critical patterns of introjection that occur in sequential de­
velopmental organization and provide the rudimentary core ele­
ments around which the patient's sense of self is organized. To
take one element of Katharina's hysterical manifestation, we can
focus on her apparently hysterical identification with Franziska
as the sexual victim. Here the motif of victimization is sexual­
ized, determined no doubt by unresolved and conflictual oedipal
wishes; nevertheless, the more central elements of victimization
and the correlative motif of aggressive victimizing seem to carry
the pathogenic burden.
From this perspective, specifically that of the "paranoid proc-
 STUDIES ON HYSTERIA-KATHARINA 595

ess," a number of interesting possibilities open before us. Let

us indulge in some speculation concerning Katharina's family.
Even if our guesses are incorrect, they at least illustrate a fruit­
ful way of inquiry into such a case. The so-called "identification
with the victim" rests on critical introjections derived probably
from the patient's mother. We might imagine that Katharina
developed a primal scene schema at various stages in her devel­
opment from preoedipal levels through adolescence. In this pri­
mal scene schema she may have viewed her mother as her
father's sexual victim. She also may have viewed her mother as
chronically victimized by her father in a wide variety of situa­
tions dictated not only by the pathology of their relationship as
husband and wife but also by the circumstances and expecta­
tions of the society around them.
This powerful introjection, then, would form a predominant
core around which Katharina's sense of self would have become
organized, providing a powerful motif for her life's direction. At
the same time, however, there is a more hidden element in the
case that has to do with the ways in which her father too was a
victim, particularly a victim of his wife. Here again we would
have to wonder about the patterns of interaction between them
that drove him to seek illicit and dangerous satisfaction from
other sexual objects. In other words, there is enough in the case
to suggest that both of Katharina's parents were caught up in a
process of mutual victimization that would have provided ample
ground for the internalization of a pathogenic sense of victim­
ization in Katharina herself. An important point to note for the
understanding of such introjective configurations is that the
introjection derives not in a simple one-to-one fashion from a
single object of internalization, but can be influenced by multi­
ple objects interacting in intricate patterns to reinforce the
central introjective theme.
We know also that the economy of the introjects demands that
where there is a victim-introject there is also an aggressor­
introject. We can suggest that this element is not lacking in
Katharina's case. Here again the aggressive and victimizing as-
596 W. W. MEISSNER

pects of the introjective organization can derive equally well

from either parent. In Katharina's case, there is evidence to sug­
gest elements of aggressive victimizing and corresponding pas­
sive victimization in both parents. Their reciprocal victimiza­
tion was paralleled by their respective roles as victimizers.
Katharina's internalization, by implication, would have in­
cluded the amalgamation of aggressive and victimized aspects
in both of her parents as well as in their interaction.
We have several hints about the victimizing quality of Katha­
rina's own inner self-organization. To begin with there is a pho­
bic, projective quality to the anxiety symptoms she described­
particularly the fear of dying and the feeling that there was
someone standing behind her about to catch hold of her. The
second important projective element in the case is the frighten­
ing face that she seemed to see during these terrifying attacks.
And finally, there is the sense of guilt she expressed to Freud
about having caused her parents' divorce by telling her mother
about her father and Franziska.
The phobic element suggests the role of externalization in the
development of her symptoms as well as the possibility of an
additional projective element in the unknown figure behind
her. We may reserve the concept of projection to explain the
more specific externalization of introjective derivatives which
might account partially for the hallucinatory figure. Bµt we may
also postulate that Katharina's broader tendency to externalize
inner fantasies about victims and persecutors so as to see herself
as victimized operated to contribute to the hallucinatory figure.
While this kind of externalization does not necessarily specify
the components of the aggressor derivation, it nonetheless
creates an external source of imminent danger to the self and
serves to reinforce the sense of self as victim. This mechanism
is common in all forms of phobic anxiety and is closely related
to aspects of paranoid projection.
For Katharina, the paranoid projection becomes explicit in
the hallucinatory vision of the threatening head. Freud pre­
sented it as a sort of hallucinatory re-creation of the angry face
 STUDIES ON HYSTERIA-KATHARINA 597
of the father, but we can remind ourselves that it served the
ends of maintaining the patient's victim introject. On this ac­
count we would find it necessary to seek further in understand­
ing this particular symptom. The evidence is not available in
Freud's account of the case. But clinical experience suggests
that, often enough, such a paranoid manifestation (the creation
of a persecutory object) is not only related to the dynamics of
the organization of the patient's introjects, but, in fact, also
reflects by projection one of the more latent aspects of the intro­
jective organization itself. If we follow this suggestion in Katha­
rina's case, the threatening projected head derived from her
identification with the hostile aggressive father and reflected an
underlying level of unresolved pathogenic ambivalence toward
the father: she feared and hated him, while at the same time
loving him. Anna Freud ( 1936) has clearly described this mecha­
nism of the formation of the aggressor-introject and its relation­
ship to ambivalence in her discussion of "identification with the
aggressor." Thus, the vision of the terrifying head would repre­
sent not only a reactivation of the representation of the father,
but would also involve projective elements derived from the
patient's aggressor-introject and would thus express more com­
plex developmental and object-related vicissitudes.
Finally, Katharina's guilt over the divorce of her parents sug­
gests that there might have been a latent wish to hurt and even
victimize them, as a way of acting out the repressed levels of
ambivalence toward them. Here we can only hint at the female
child's deep sources of resentment against parents, related not
merely to the dynamics of penis envy, but also to the devalua­
tion and disadvantage often associated with the feminine role in
certain cultural settings. Certainly in the mid-E"uropean Vic­
torian culture of the late nineteenth century these factors were
sign ificant. Thus, the patient's hostile and destructive wishes
may have found expression in this attack upon her parents' rela­
tionship and left her with a resulting sense of guilt and remorse.
In such a reflection we cannot ignore the obvious oedipal impli­
cations, particularly in terms of the revenge motif directed to-
598 W. W. MEISSNER

ward the mother. The wish to bring about a divorce between

the parents and to eliminate mother from the marriage bed are
well-known and traditional oedipal themes. But here the re­
venge also includes the father and can perhaps be seen more
effectively in terms of Katharina's pathological need to place
herself in the position of being her father's victim. This, too, has
its oedipal underpinnings, but the issue of victimization, as I
have already suggested, is a broader and deeper issue than the
question of sexually determined oedipal conflicts.
We may note that the motif of victimization which seems to
pervade this material is related to the more traditional concepts
of masochism and depression; indeed, the dynamics of victimiza­
tion may find varying forms of expression in both masochism
and depression. But it should be clear from this discussion that
the victim motif cannot be simply or reductively accounted for
only in terms of the dynamics of masochism or depression. More
complicated motivational components and relational aspects are
involved than can be explained by instinctual derivatives and
vicissitudes. Complex object relations components, internaliza­
tions, and self-integrative motivations are at work that call for
theoretical integration. Moreover, the discussion here aims at a
reconsideration of the introjective processes relevant to the or­
ganization of an internal sense of self as victim insofar as these
processes pertain to and underlie hysterical processes.
These elements in the case of Katharina, I believe, make it
clear that the somewhat simplistic view of the genesis of hysteri­
cal symptoms on the basis of underlying sexual conflicts and the
somewhat naive model of conflict and defense yield to a more
complex consideration in which the sexual aspect interacts with
a broad range of other psychic determinants. If one asks why the
sexual impulse is a source of pathogenic conflict, Freud has little
to offer by way of explanation other than the restraints and
taboos of social mores and morality. However, in the light of this
discussion we can infer that there are more complicated intra­
psychic determinants that are related to the internal organiza-
 STUDIES ON HYSTERIA-KATHARINA 599

tion of aggressive components in regard to the victim and

aggressor introjections.
I suggest that integrating the concept of sexual wishes and
impulses with the concept of underlying components of victim­
ization and aggressiveness offers a more meaningful explanation
for pathogenic development than does the issue of sexual drive
and conflict as such. Understanding the pathology, then, re­
quires a more comprehensive grasp of the meaning of these
internalizations, their role in the economy of instinctual life­
both sexual and aggressive-and also their relevance to inter­
action with objects. We might add here that narcissism as a
motivating force in the patterning of such internalizations plays
a critical role in all cases, but that the material in the Katharina
case offers little opportunity for speculation in this regard.
Nonetheless, narcissism-as well as the other motivating com­
ponents of the introjective organization-reflects and derives
from intricate patterns of object relations.
It should be clear that the shift in perspective suggested by
this analysis does not imply an abandonment of instinctual
theory in any sense, but rather points toward integration of it
with multiply determined models of psychic functioning. In this
integration instinctual dynamics are seen as embedded in subtle
patterns of interaction with significant objects, which has a pro­
found influence on the organization and functioning of the self.
As I have suggested in a previous discussion of this question
(Meissner, 1976):
The problem of hysteria . . . can no longer be thought of
simply in terms of instinctual striving' and repressive counter­
cathectic forces. Rather, it involves complex issues of develop­
mental vicissitudes, the emergence of ego strengths, the expe­
rience of specific qualities of object relationship, dependence,
aspects of ego-functioning, self-integration, the tolerance and
mastery of affects, and other significant components (p. 132).
These more comprehensive understandings would shape the
course of our therapeutic interests and determine the direction
600 W. W. MEISSNER

of our interpretive efforts in any given analysis. It is no longer

adequate simply to delineate the sexual conflict and repression
in the hysterical patient. The sexual conflicts are embedded in
a complex matrix that involves developmental concerns and re­
flects the progressive patterning of internalizations and the fun­
damental organization of the patient's sense of self. Until these
elements are resolved, we cannot be sure that we have, in fact,
reached the core of the pathology of the hysterical patient. It
seems, then, that in Freud's beguiling account of his encounter
with Katharina, he showed us little more than the tip of the
iceberg.

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