Symptoms due to ideas

The delineation of specific ideas at the root of the symptom was best developed by nineteenth century neurologists. Sir John Russell Reynolds (!°> described 'three cases of paralysis dependent upon idea'. Jean-Martin Charcot(!!» said that the idea of paralyses from thoughts had long been known, but only Reynolds had studied them in a methodical and systematic way. Charcot argued that the implantation of the idea of paralysis or loss of use of a body part by means of hypnosis confirmed that hysteria could be produced in accordance with an idea which was provided for the patient.

Reynolds and Charcot recognized that hysteria depended upon an idea, but the way in which the idea works is another matter. For the last hundred years we have relied on Freudian theory to explain this mechanism. Freud came to think that conflict had arisen between two aims, at least one of them usually being based upon an instinctual drive. The conflict was then 'repressed' into the 'unconscious' and the resultant symptom was the only sign of the intrapsychic battle that had ended. In this theory the term 'repression' has been used with a variety of meanings. Erdelyi (!2) gives an impressive list of different ways in which Freud himself employed the term, which was known even before his writings. The nuances given to it have ranged from a degree of conscious avoidance to an absolute unawareness of something being rejected. The latter version of Freudian theory is still dominant in theories of the psychological aspects of psychiatry but has come under strong challenge.

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