The current climate in psychotherapy and counselling is one of increasing popularity demanding faster and more accessible healing. The popular literature reflects these trends. It's rare to find a work that instead of rehashing some earlier views actually brings a new theoretical position to the area: and even rarer to find that such a work is one of scholarship and depth.
Mad Men and Medusas is such a work. Mitchell sets out to build three arguments: firstly that a condition historically labelled hysteria until after its heyday in turn-of-the-19th-century psychoanalysis continues to exist under a variety of different labels and diagnoses. Secondly, that such a condition is best understood as a reaction to the trauma of displacement as a result of the emergence of a sibling contender for the love and attention of parents. Thirdly, that by dismissing the existence of hysteria, Western society runs the grave risk of normalising it and incorporating it into a socially acceptable way of life.
The author is both a psychoanalyst and a feminist. Her ideological positions heavily influence the way she sets out to communicate her ideas. This creates the basis for what is the book's strength - and its weakness. Mitchell begins the main thrust of the book by re-analysing Freud himself - and reviewing the case history of Dora. She does this to incorporate her arguments about hysteria into traditional psychoanalytic orthodoxy.
In so doing she can maintain her loyalty to psychoanalysis - and yet provide a reconstructed dynamic theory of personality that reorganises the role of the Oedipus Complex. As she puts it: "I propose to invert accepted psychoanalytic ordering, which leads from the Oedipus Complex on to the siblings, and suggest instead that it is the initial awareness of the presence of the siblings which produces a catastrophic psychosocial situation of displacement."
Her attempts to incorporate her new ideas are akin to pouring new wine into old wineskins. It doesn't really work. She loses some of the power of her position, and may also lose the interest of those readers who are not convinced by traditional psychoanalytic thinking. The indirect benefit is that she has written a book which is a wealth of information to those interested in traditional psychoanalysis. She traces the journey of hysteria from Freud on to the post-Freudians, Klein, Winnicott, Balint and others. This is well written and informative.
My main criticism of this book is that Mitchell is reclaiming hysteria for psychoanalysis, rather than for the wider world of therapeutic psychology. It was difficult to get a clear picture of what she actually meant by hysteria, a difficulty grounded in her assumptions that we accept its existence (along with much else of the Freudian world view).
Most of modern therapeutic psychology and nearly all psychiatric thinking has dismissed the existence of hysteria as an identifiable condition. It is paradoxical that in her attempts to convince us that the dismissal of hysteria is a mistake, she doesn't really convincingly go about providing evidence for why it should be reinstated.
In the first 100 pages or so there emerged a gradual set of descriptive comments buried in the text that could be put together to get a clinical picture. Later in the book the description of hysteria is far more accessible. It is a condition characterised by compulsive wanting, inability to love and of conversion of repressed ideas into physical symptoms.
These arguments have some merit, particularly the notion that perhaps some of the enormous emphasis on gratification - both sexual and otherwise - is a form of acting out the compulsive wanting that is a core part of hysteria. Other aspects of the book are worth noting. Her arguments around the role of trauma in reactivating hysterical symptoms are interesting and provocative. Her adherence to the role of fantasy in childhood sexuality and the implications for therapists who face the issues of child sexual abuse are quite controversial, reflecting the original Freudian position that much that is reported around sexual abuse is in fact a fantasy, albeit a traumatic one.
On this topic she says: "The traumatic shock experienced by the patient becomes the moral shock of the therapist. This is one of the reasons why it should never be the task of the therapist to investigate what actually happened - that task must fall to others. But the shock itself is crucially important." Her position here is quite at odds with much of feminist thinking.
This is not a book for the fainthearted. Maybe it is the latent hysteric in me that yearned for a bit more flair, a more dramatic turn of phrase. Otherwise, it's a useful contribution for those interested in maintaining a role for traditional psychoanalysis in modern therapeutic psychology.
Michael Hardiman is a counselling psychologist and author. His latest book, Ordinary Heroes: A Future For Men, is published by Gill & Macmillan this month.