Excerpted from Psychotherapy with Sex-Abuse Victims
True False and Hysterical
©1996 Creative Therapeutics, Inc. All Rights Reserved

Chapter SEVEN


Imagine, if you can, Freud’s patients, Anna O., Elizabeth von R., Katharina, and Dora, marching down the street, arm in arm. They are wearing tee shirts or sweatshirts on which is emblazoned "I am a sex-abuse victim" or "I am a sex-abuse survivor." They are waving banners with such slogans as "Believe the children" and "Children never lie." They are proceeding to testify before a public legislative hearing, the purpose of which is to modify statutes of limitations so that adults who belatedly recall that they were sexually abused as children can sue their perpetrators. After providing their testimonies, they will spend the evening in their sex-abuse victims’ survivors group. In the next few days, they will have one or two individual sessions with a therapist whose primary purpose is to help them retrieve in ever more specific detail the repressed memories of their childhood sexual encounters with adults. A few days later, they will participate in a marathon weekend for sex-abuse survivors and those who suspect they might have been abused as children and hope to bring into conscious awareness their repressed memories of such abuses. In the "healing" process they are encouraged to express pent-up repressed anger against their perpetrators, anger that has long been simmering in the unconscious mind. This is best accomplished by group orgies of beating mats with rubber hoses and chanting barrages of vile profanities directed against the perpetrators.

If you can envision this scene, then you will have a good idea about the differences between Anna O. and her compatriots and women a century later who profess they were sexually abused as children. They do, however, share one important element in common, namely, that their sex-abuse accusations against their perpetrators may either be true or false.

We are living in dangerous times. Sex-abuse hysteria is omnipresent. Open any newspaper or magazine and the likelihood of seeing an article on sex abuse is extremely high. Hardly a day goes by when there are not at least some television or radio programs devoted to the subject of sex abuse. There is no question that many accusations of child sex abuse are true, and this is especially so in settings such as homes and boarding schools (where the potential abuser has the opportunity for ongoing contact with the children). However, there is no question, as well, that many of the accusations are false, especially in child-custody disputes (where the vengeance element and the opportunity for exclusion of a hated spouse is operative) and day-care centers and nursery schools (where the potential abuser has little opportunity for ongoing contact alone with the child).

The sexual abuse of children, like the abuse of women, is an ancient tradition and has been seen in every society in history. In fact, there is good reason to believe that there is less sexual exploitation of children in Western society (especially because of the proscriptions of the Judeo-Christian ethic) than has existed anywhere in the history of humanity. In recent years, we have become increasingly aware of how widespread sexual abuse of children is in Western society and have come to appreciate that there has been enormous denial of the phenomenon. At the same time, however, we have witnessed an exaggerated reaction to the phenomenon, so much so that the term hysteria is often warranted. The hysteria is seen at every level, from the time of the initial suggestion or suspicion to the final sentence meted out to an accused (whether truly guilty of the crime or not). A whole parade of individuals can predictably overreact—an overreaction that beclouds objectivity and lessens significantly the likelihood that a proper assessment will be conducted. I include here parents, police, detectives, prosecutors, psychologists, psychiatrists, social workers, "validators," "child advocates," teachers, school administrators, boards of education, lawyers, judges, juries, and legislators. In this atmosphere constitutional safeguards of due process are ignored, people are jailed on the basis of the babbling of three-year-olds, traditional courtroom procedures designed to protect the defense are no longer followed, and excessively punitive sentences are the rule. I believe that the average murderer in the United States today will be out of jail much sooner than the average person convicted of sex abuse. When it comes to sex abuse, there seems to be an exception to the Eighth-Amendment constitutional safeguard against "cruel and unusual punishment."

Divorced fathers (and even those who are not divorced) have become afraid to bathe and shower their children, or even help them when they go to the bathroom. No sane teacher will spend time alone in a room with a girl. Scoutmasters on overnight hikes are sure to travel two at a time. Many nursery schools have ongoing videotapes, and no one takes a child alone to the bathroom. For at least a quarter of a century now, doctors have been ever-vigilant regarding their patients suing them for malpractice. Now, there is a new danger: accusations of sexual molestation, sexual abuse, and sexual harassment.


To the best of my knowledge, hysteria was first described by Hippocrates in the fourth century B.C. He observed the condition almost exclusively in women who exhibited crying fits, agitated movements of their bodies, and exhibitionistic displays. He considered the disorder to be the result of the wandering of the uterus, which had somehow gotten loose from its fixations in the pelvic cavity. The word hysteria is derived from the Greek word hystera, which means uterus. Hysteria, unlike most other psychiatric disorders, has the capacity to spread, resulting in group hysteria and even mass hysteria. Accordingly, a study at any particular level adds to our knowledge of the others. As will be elaborated upon below, my studies of group hysteria have enhanced my knowledge of the individual as well as the mass types.

Group and Mass Hysteria

Group hysteria is an ancient tradition. Human beings are sheeplike, and the desire to "go along with the crowd" is deep-seated and, I suspect, possibly genetically determined. Obviously, it is safer to be one of the "herd" than to be a maverick. If only for the sake of protection from predators, groups are safer than isolated individuals. Those who are different inevitably suffer scorn and rejection. The word gregarious is derived from the Latin word grex, which means flock of sheep. In addition, human beings are amazingly suggestible and can, under proper circumstances, be brought to the point of believing anything, no matter how absurd. And I am not only speaking of children in this regard, but adults as well. Group hysteria is built upon these foundations of gregariousness and suggestibility. Other factors, depending upon the particular needs of those involved in the hysteria, become incorporated. Society must provide acceptable releases for the pent-up hostilities that inevitably result from the predictable frustrations of life. When the group has found a scapegoat for such hostilities, then this element may contribute to the hysteria. Most often the oversimplification element is operative. Life is complex, and most phenomena are multidetermined. Accordingly, simple solutions are much more attractive than complicated ones. When the mob’s goal is to remove a particular person or group—and thereby solve all of its problems—the movement becomes particularly attractive. Joining such a movement enhances self-esteem in that one surrounds oneself with others who share—often to a fanatic degree—one’s convictions. Feelings of power may also be gratified in that the mob has much more power than any single individual. Although each outbreak has its own special factors, the aforementioned are most often operative.

Some of the more well-known examples: Early in the thirteenth century, processions of flagellants (people who whipped themselves and others) traveled throughout Europe convinced that their lashings were punishments decreed by God and served, therefore, to assuage the guilt they felt about their sins. Within 20 years these groups spread over Bohemia, Moravia, Poland, and Italy. As late as the seventeenth century they were still to be found in Russia under the name "the self burners" (Zilboorg and Henry, 1941).

During the Middle Ages we witnessed throughout central Europe waves of dancing hysteria, referred to as St. Vitus’s dance. Men and women, usually peasants, would form circles and dance frenetically, as if possessed, until they fell to the ground while foaming at the mouth. The Children’s Crusade (Lyons and Petrucelli, 1978) is now generally considered to be another example of mass hysteria. In the second decade of the thirteenth century, an estimated 30,000 children from all parts of France streamed into Marseilles with the plan of conquering the Holy Land from the Muslims. They fell victim to disreputable merchants who shipped them to slave markets in North Africa. During the same period an estimated 20,000 German children crossed the Alps into various parts of Italy with the hope of reaching the Holy Land via Italian ports on the Mediterranean. Many of these children, like the French group, ultimately ended up as slaves in the Middle East (Encyclopaedia Britannica, 1982).

Menninger (1957) describes an epidemic of hysteria that took place in Lancashire, England, in 1787. It all began when a working girl, as a prank, placed a mouse into the bosom of another girl, who was quite fearful of mice. The victim of this prank immediately developed convulsions that lasted 24 hours. This episode served as the nidus of an outbreak of group hysteria that ultimately involved 300 fellow employees. The main symptoms were anxiety, feelings of being strangled, and convulsions. The convulsions lasted from 15 minutes to 24 hours and involved tearing of hair, dashing of the head, and falling against walls and floors. Interestingly, all of the afflicted were cured with an alcoholic beverage and the suggestion that they join in a dance.

Kanner (1935) describes an outbreak that took place in 1892 in Bieberach, Germany, in which 13 girls had attacks that began with headaches and then consisted of dancing movements, hallucinations, delirium, and finally profound sleep. In 1892 in the village of Gross-Tinz in Silesia, a ten-year-old girl exhibited tremors of the hand, which spread over her whole body. Next, several other girls were similarly afflicted. Within a few weeks 20 girls had similar attacks. All this stopped with the summer vacation but, on return to school in the autumn, the wave of hysteria continued, with the girls exhibiting convulsions, astasia-abasia (the psychological inability to stand and/or walk), delirium, arc de cercle (psycho- logically caused bending of the body anteriorally or posteriorally), profuse perspiration, and barking like dogs. Interestingly, only girls were afflicted during this epidemic. Kanner describes other epidemics of hysteria, mainly in Europe.

It is of interest that in the late nineteenth century, in both the United States and England, we witnessed a period of excessive preoccupation with and Draconian condemnation of childhood masturbation, which had many of the hallmarks of hysteria. Unfortunately, physicians (who should have known better) were actively involved in this campaign of denunciation and attempts to obliterate entirely this loathsome practice. Doctors considered it to be the cause of a wide variety of illnesses, e.g., blindness, insanity, and muscle spasms. Various kinds of restraints were devised to prevent children from engaging in this dangerous practice. Some girls were even subjected to clitorectomies, so dangerous was the practice considered to be. Parents were given a long list of symptoms that were considered to be concomitants or the result of masturbation. Some of the alerting signs were: temper tantrums, bedwetting, sleep disturbances, appetite changes, mood fluctuations, and withdrawal. Obviously, in the hundred years since those sad times, we seem to have gone back full circle. The same list of symptoms that were indicators of masturbation are now considered to be indicators of sex abuse. Legrand et al. (1989) have written a fascinating article describing the similarities between the masturbation hysteria of the late nineteenth century and the sex-abuse hysteria of the late twentieth century, with a comparison of the lists of "indicators."

The Salem witch trials are viewed by many as our country’s most famous episode of mass hysteria. Many do not appreciate that the trials lasted less than five months (June 2, 1692-October 29, 1692). During this period 27 people were convicted of witchcraft. Nineteen were hanged (the last hangings took place on September 22, 1692), one man (who refused trial by jury) was executed by being pressed to death with heavy stones (he took two days to die), and four died in prison. On October 26, 1692, the Massachusetts legislature, at the prodding of Reverend Increase Mather (president of Harvard University and United States ambassador to England), dictated to the Salem magistrates that they use much more stringent criteria before judging an individual guilty of witchcraft. On October 29, 1692, Massachusetts Governor Phips dismissed the court. This basically brought an end to the trials. For many years thereafter courts and churches declared days of penance and prayer in apology for the injustices perpetrated upon the accused. In January 1696 12 of the jurors signed a statement of contrition, claiming that they had operated under the influence of the devil. In subsequent years survivors of the accused were granted redress and compensation for their losses. The Salem witch trials are well viewed as the first wave of hysteria that we witnessed in this country.

The Salem witch trial hysteria was not unique to the United States. Actually, belief in witches was pervasive in Europe throughout the Middle Ages, and there have been many episodes of persecution of witches throughout Europe since that time. The Salem witch trial episode can be considered a derivative of the European phenomenon, with additional contributing factors particular to the Massachussetts Colony in the late seventeenth century. The second great wave of hysteria that we witnessed in the United States were the McCarthy hearings in the early 1950s. In the course of this wave of hysteria, threats of Communist infiltration and takeover of our government were exaggerated enormously, and Draconian punishments were administered to those who had any sympathies for the movement. Even those who had involved themselves in the Communist party only superficially and transiently earlier in life did not escape. Blacklists were drawn up, people were fired from their jobs, and a whole network of investigators and informers served to promulgate the belief in Communism’s formidable dangers to the U.S. government. Many of those unfortunate enough to have been subjected to the abominations of McCarthy’s committee became social outcasts, and some were even incarcerated. Although thousands certainly suffered during the hysteria of that era, I believe that their numbers are small compared to those whose lives have been destroyed by the sex-abuse hysteria that has been prevalent in the United States since the early 1980s. Accordingly, I believe we are now experiencing the United States’ third great wave of hysteria. I believe that more have suffered in its course than all those who suffered in Salem and the McCarthy era combined.

I am certain that the number of people who have died as a result of the current hysteria far exceeds the number who were executed in Salem. These people have not literally been executed, but they have been given psychological death sentences. These people have not been literally hanged or stoned to death, but many have been dealt with the equivalent treatment psychologically. I am convinced that there are hundreds (and possibly thousands) of people who are in jail in the United States today who have been convicted of sex crimes that they never committed. (I am not denying that there are many more incarcerated who actually did indeed commit such crimes.) There are hundreds, I am sure, who have committed suicide because of a false sex-abuse accusation. There are others who have died of heart attacks, strokes, and other diseases caused by the stresses and humiliations of a false sex-abuse accusation. Careers and marriages have been destroyed, reputations ruined, and people are suffering lifelong stigma because of such an accusation.

The event that, to the best of my knowledge, laid the foundation for our current hysteria—which I refer to as sex-abuse hysteria—was the The Child Abuse Prevention and Treatment Act (The Mondale Act), which was passed by the United States Congress in 1973. Congress was certainly well intentioned in its desire to protect abused children. However, the results have been disastrous. The law mandated child-abuse reporting laws in all 50 states, laws in which civil and criminal immunity to lawsuits would be provided for anyone reporting the abuse of a child. Furthermore, individuals aware of such crimes—who did not report such abuse—were subject to criminal prosecution. This has resulted in a philosophy of "when in doubt, report." Federal funding was provided for district attorneys to set up special units for the prosecution of child sex abuse, but no funding was provided for defendants. The result has been the development of a nationwide army of zealous prosecutors and a sense of impotence for those (the defendants) who are not wealthy enough to finance their own defense (Clancy and Firpo, 1991). Federal monies were also provided for setting up clinics devoted to the evaluation and treatment of abused children. No funding was made available for children who were found not to be abused or who were found to be used as vehicles for a false sex-abuse accusation.

A cornerstone of our constitutional system is the principle that a man is innocent until proven guilty. This is often stated as the dictum, "Rather 10 (or 100 or 1,000) guilty men go free, than one innocent man be falsely convicted of a crime he did not commit." In the service of this principle, civil courts generally require a preponderance of evidence before concluding that the defendant is guilty of the alleged crime. In criminal cases, the requirements are even more stringent in that the jury must conclude beyond reasonable doubt that the defendant did indeed commit the crime. These traditional constitutional safeguards are being ignored. Rather, judges now subscribe to the philosophy, "I’d rather be on the safe side" and find defendants guilty with minimal evidence, even "evidence" provided by a three-year-old child who has been relentlessly programmed by her vengeful divorced mother to allege that she was sexually abused by her father. One judge said to me, "If there is a scintilla of evidence that this man sexually abused this child, I will send him to jail for as many years as the law will allow." Although juries in criminal cases have been instructed to subscribe to the beyond-reasonable-doubt principle, the instructions of many judges and the ambient hysteria have encouraged them to ignore this factor in their deliberations. Elsewhere (Gardner, 1991a) I have described in detail the ways in which the current sex-abuse hysteria has been promulgated.

Individual Hysteria

It would be difficult and simplistic to try to apply Hipprocrates’ theory that hysteria arises primary in the uterus to the aforementioned episodes of mass hysteria. Whatever sexual elements may or may not be operative in producing each individual’s hysterical reaction, there is no question that a multiplicity of other factors must be operative. The uterine theory, however, has persisted in medicine—down even to the twentieth century. Charles Lepois (1563-1633) claimed that the cause of hysteria is not to be sought in the uterus but in the brain (Zilboorg and Henry, 1941). However, this notion was not given general credibility. Although Freud considered repressed sexual factors to be operative in producing hysteria, he did not consider the uterus to be its source, but rather the brain. Interestingly, his colleagues had little conviction for this bizarre idea, especially because they did not believe that the disorder could be found in men. This is particularly surprising because, by that time, the brain was generally considered the seat of mental disease.

In the 1880s, Jean-Martin Charcot described what he considered to be a new neurological disease: "hystero-epilepsy." He considered this to be a disorder that was a combination of hysteria and epilepsy. The symptoms included screaming, crying, convulsions, contortions, fainting, and fluctuating consciousness. His demonstrations of these patients to the professional community at the Salpêtrière Hospital was well-known and Freud was one of the enthusiastic attendees. Joseph Babinsky, a skeptical student, claimed that Charcot had invented "hystero-epilepsy" rather than discovered it. He held that these patients’ symptoms were the result of the suggestions of Charcot and the attendant staff who were treating them. A hospital decision required hysterics and epileptics to be placed in the same facility and, because the hysterics were very suggestible, they took on the symptoms of the epileptic patients with whom they lived. Babinsky was successful in convincing Charcot that this might have occurred. When patients with hystero-epilepsy were transferred to a separate facility, and when staff members stopped attending directly to the hysterical symptoms but rather addressed themselves to the underlying problems that these patients had in life, the symptoms were either reduced significantly or disappeared entirely (McHugh, 1993).

This link between hysteria and suggestibility is an important one and has been well recognized since. Psychoanalysts are well aware of the seminal studies on hysteria of Freud and Breuer (1895), published in the late nineteenth and early twentieth centuries. Their patients (the most well-known of which are the aforementioned Anna O., Dora, etc.) exhibited a wide variety of symptoms such as convulsive ticks, spastic speech inhibitions, paralysis, crying fits, psychosomatic complaints, neuromuscular complaints, agitation, depression, and even hallucinations. Freud believed that these patients were suffering with sexual inhibitions that were the results of overstringent superegos inhibiting freer expression of their basic libidinal impulses. Many of them described sexual stimulation, overtures, and encounters with their fathers, neighbors, or nearest of kin. Freud subsequently went through a period of disillusionment when he began to doubt the validity of some of the sexual experiences his patients described to him. He resolved this conflict by deciding that his patients’ fabrications and/or delusions were also "data" and that their need to create such fantasies was a derivative of their wish to actually have sexual experiences with these individuals.

Subsequently, there has been much debate in psychoanalytic circles over this issue. I myself do not have very much conviction for the inquiry. It is not that I am oblivious to the importance of history. Rather, my disinterest relates to my appreciation that the data that we have available to us is extremely sparse, even though Freud is famous for the meticulousness with which he collected the data he has provided us. The data, however, is 100 years old and there are areas of inquiry that we would investigate today that were not focused on by Freud and Breuer. Another reason for my lack of commitment to this discussion is that, approximately twice a week, I get letters from people in jail who are claiming that they have been falsely accused of sexual abuse and are pleading for my help. Although some of these individuals may indeed have perpetrated these acts, there are others, I am certain, who are innocent and who are victims of the hysteria of our times. Accordingly, I have devoted my efforts to developing criteria for differentiating between true and false accusations in the hope that I may help these people now and protect other innocent individuals in the future from being similarly incarcerated (Gardner, 1995a).



Here I present the results of my own "studies on hysteria," both its manifestations and psychodynamics. The concept of hysteria that I present here is based primarily on the in-depth evaluation of hundreds children and adults involved in sex-abuse accusations over the last 15 years. Most of the "children" were indeed children at the time of my evaluation. Some, however, were adults who claimed that they were sexually abused as children. The evaluated adults included parents and stepparents of the allegedly abused children who were accusers, accused themselves, or provided me with information that helped me ascertain whether the alleged child victim had indeed been sexually abused. Some of the adults were accused grandparents, teachers, clergy, and scoutmasters. These evaluations were conducted primarily over the last 15 years, the period during which we have witnessed our present sex-abuse hysteria. The primary purpose of these evaluations was to ascertain whether the child had been sexually abused. In each of these cases, I made every attempt to interview the accuser, the alleged child victim, and the alleged perpetrator. The conclusions were generally based on the utilization of criteria that I developed for differentiating between true and false accusations. The updated and latest version of these differentiating criteria are described in my book, Protocols for the Sex-Abuse Evaluation (Gardner, 1995a).

Interestingly, DSM-III-R considered hysteria to be the less desirable term. In fact, it does not recognize a primary diagnosis of hysteria. When somatic elements are operative, the preferred term is Conversion Disorder or one may use Hysterical Neurosis, Conversion Type. The group of Dissociative Disorders may also be referred to as Hysterical Neurosis, Dissociative Type. When emotionality and attention-seeking elements are operative, the diagnosis Histrionic Personality Disorder is used, without any parenthetic possibility of using the term hysteria to apply to this symptom complex.

DSM-IV maintains the Conversion, Dissociative, and Histrionic Disorders but has dropped entirely the hysteria equivalent terms. I consider it unfortunate that DSM-IV has dropped all reference to hysteria. I have no problem with removing its association with the Conversion Disorder because this, by today’s standards, is an anachronism. Few believe today that people with psychogenic paralysis are channeling sexual libido into other parts of their body. Nor do I have problems removing the term hysteria from the Dissociative Disorders, which, today, are being overdiagnosed and are serving to give medical credibility to false accusations of sexual abuse in that the person who has no memory of such abuses is considered to have repressed, dissociated, and depersonalized the experiences (Gardner, 1992a, 1992d). Histrionic Personality Disorder provides criteria that are closest to classical hysteria and might justify an alternative hysteria diagnostic label. However, neither DSM-III-R nor DSM-IV includes the capacity-to-spread factor. I consider this an unfortunate omission.

Manifestations and Psychodynamics

I will use as my starting point the overt manifestations that originally caused Hippocrates to suggest that the agitation he was observing in these screaming women was the result of the roaming around in their bodies of the uterus, which had somehow loosened from its attachments in the pelvis. This is the same behavior that I have observed on numerous occasions in parents (more often mothers than fathers) when they accused someone of having sexually abused their children. In fact, they themselves will often say, "I was hysterical when I first found out about it" or "My wife was in a state of frenzy that lasted at least three days after they told us about it." One mother told me: "When I found out that the bus driver molested that Boy Scout, I called every mother in both the morning and afternoon kindergartens. In my business I need five telephones on my desk. I can make two and sometimes three calls at a time. I have both speaker phones and handsets. I must have made about 70 calls in three hours." (This woman, interestingly, had been a professional actress in her teens and twenties and the "business" she referred to here was a theatrical agency.) Hysteria, as I view it, consists of the following components:

Emotional Outbursts It is this characteristic of hysteria that is most familiar to the general public. And this is the characteristic described by Hippocrates approximately 2,400 years ago. It is also the manifestation focused on in most dictionaries. For example, The Random House Dictionary (1987) defines hysteria as "an uncontrollable outburst of emotion or fear, often characterized by irrationality, laughter, weeping, etc." Most individuals get upset at times. Hysterical individuals, however, are more likely to get upset—to the point of exhibiting emotional outbursts—and are likely to manifest such outbursts much more frequently than the average individual.

Overreaction The individual reacts in an exaggerated fashion to events and situations that others would either not respond to at all or respond to with only minimal emotional reaction. In hysteria individuals react with excessive tension, anxiety, and agitation.

Dramatization Hysterical individuals, in association with their overreaction, may become quite dramatic, sometimes akin to a theatrical performance. It is this aspect of hysteria that is referred to as histrionic in DSM-IV in the diagnosis, Histrionic Personality Disorder.

Attention-Getting Behavior Whereas people with other psychiatric symptoms often suffer silently and alone (although they may draw others into their psychopathology), hysterical people typically attract significant attention and attempt to surround themselves with others who will provide them with sympathy and support. This element in hysteria can easily be gratified in the twentieth century. Whereas in Freud’s time sex abuse, especially by a father, relative, or neighbor, was considered a source of shame, just the opposite appears to be the case in the United States in the last 15 years. By merely picking up the telephone and calling a child protection service, one can call into play an apparatus that will include investigation by "validators," social workers, psychologists, psychiatrists, police, detectives, lawyers, and judges. Another call will bring in the mass media: newspaper and magazine interviews and television appearances. A third call to a lawyer will start things rolling down the track of a lawsuit, with further interviews by lawyers and insurance company people. Another call to a mental health facility will predictably result in "validation" and then "therapy," both individual and group therapy for the abused children, parent group therapy for the parents, and special classes for child "survivors" and their parents. Support groups, political action committees, fund-raising campaigns, weekend marathon experiences, consciousness-raising groups, and victim-survivor groups are ubiquitous. This factor was operative for the accusing children in Salem in that their accusations were made in public situations before magistrates and just about everybody in the community who could get down to the proceedings (Mappan, 1980; Richardson, 1983). But their attention was minuscule compared to what is available today 300 years later.

In short, making a sex-abuse accusation public involves one in a cause célèbre. Bringing sex abuse to the attention of the world as a step toward wiping out this abomination engages one in a noble pursuit that is bound to engender the admiration of all.

Assumes Danger When It Does Not Exist In hysteria the individual sees danger in situations in which others do not see danger. In mild cases the hysteria may be reduced and even eliminated by calm discussion and confrontation with reality. In moderate and severe forms of hysteria, confrontation with reality does not dispel the anticipation of harm. Hysteria can progress to a state of delusion, which is not altered by logic and confrontation with reality. Because hysteria can progress to delusion, they are on a continuum. Group pressure, especially, has the effect of moving hysteria down this continuum into the delusional realm.

For example, in sex-abuse hysteria in the context of child-custody disputes, the parents of an accused father, who previously may have been considered to have had a very loving and close relationship with their grandchildren, may come to be viewed as facilitators and even participants in their son’s sexual abuse and the children’s contacts with them may be cut off entirely by the mother. And the original "proof" of the father’s sexual abuse may have been a stain in the crotch area of the child’s panties.

The danger element in hysteria has often been intensified by the so-called sexual abuse "validators" who present parents with a long list of the signs and symptoms that are allegedly diagnostic of child sex abuse. These may include just about every behavioral manifestation, normal and abnormal, healthy and pathological, known to the child psychiatrist, e.g., bedwetting, nightmares, mood swings, sibling rivalry, and low self-esteem. Validators may refer to these symptoms as "the sexual-abuse syndrome." When looking at such lists, I often think that the subtitle of DSM-IV should be: "The Sexual Abuse Syndrome."

Impairment in Judgment States of high emotion compromise judgment. The tensions, anxieties, and overreactions present in hysteria reduce the individual’s capacity to think logically and assess situations in a calm and deliberate manner. The impairments in judgment can result in the individual believing the most unlikely, preposterous, and bizarre scenarios and can even contribute to the development of delusional thinking.

Release of Anger Hysteria allows for release of anger in a manner the individual considers to be socially acceptable. The entity that is seen as noxious or dangerous becomes the focus of anger and even rage. The hysteric is essentially saying: "Look how much grief and agitation you have caused me." It is for this reason that scapegoats are often seen in hysteria, especially in group and mass hysteria. Scapegoats not only provide a convenient target for the release of anger but are also used as a simple explanation for all the griefs that have befallen the hysterical person. During the time of the Salem Witch trials, witches were the focus of the anger. The cruelty of children was also well demonstrated then. As the accused witches were hanged, the children literally danced and clapped with joy—with absolutely no sense of guilt or remorse. In the McCarthy hearings, after World War II, Communists were the selected targets of anger. With the breakdown of the Communist empire in the late 1980s, a new scapegoat had to be found for paranoids. One of them is sex abusers. Others (at the time that I write this in the mid-1990s) are space aliens, satanic ritual abusers, and a network of government conspirators planning to invade the homes of individuals and take their guns and other protective equipment. Again, we see how hysteria is on a continuum with paranoia. In hysteria the distorted idea is capable of modification. When the paranoid level is reached, the idea becomes a fixed delusion and cannot be changed by logic.

The Sexual Element Interestingly, I believe that the sexual repression element is still operative in hysteria, although it is handled differently from the way Freud’s patients dealt with their sexual thoughts and feelings. Freud’s patients lived in a world in which overt expressions of sexuality were not considered acceptable. It may very well be that the amount of premarital and extramarital sex that Victorians engaged in was no more or less than that which people today engage in. However, there is no question that the "official" standards of these two societies are very different, and this must have an effect on the psychological processes of patients living in these two very different eras. Little Hans (Freud, 1909) was warned that if he played with his penis, his parents would take him to the doctor, who would cut it off. (No surprise, then, that Little Hans developed castration anxiety [Gardner, 1972]). A few years ago a mother brought her 14-year-old girl to me for consultation. The youngster was the only one in her group who had not yet started to masturbate and the mother wondered whether there was something wrong with her child. Touching one’s own genitals has become a standard part of the repertoire of some rock singers. Every known profanity is now standard fare on television, especially in the context of R-rated movies. These same films, which can be readily viewed by the child by the press of a button of the channel control while Mom is in the kitchen, enable children to view many aspects of heterosexual intercourse.

In spite of these vast differences in the two societies’ attitudes toward overt sexual expression, there are still many people in the United States today who are sexually repressed. My experience has been that this is especially likely among people who are extremely religious, e.g., religious fundamentalists. Whereas Freud’s patients were dealing with their sexual feelings via repression and somatization, today’s hysterics are dealing with their sexuality by repression and projection (externalization). Repression is still operative but projection has replaced somatization. This is one of the reasons why many of the nursery school sex-abuse hysteria cases occur in settings in which there is an affiliated church, often in the strict fundamentalist category. It is as if these parents are saying: "It is not I who harbor within me all these primitive sexual impulses; it is they." Somatization is primarily a personal matter, although the person with somatic symptoms may get a little sympathy from close friends and relatives. Projection, in contrast, is a public matter associated with vociferous condemnation and the need to "take action." Rejecting, punishing, incarcerating, and even destroying those "perverts" serves to lessen the guilt the individual feels over his (her) own unacceptable sexual impulses. And removing them also protects the projecting party from the temptations that might be aroused by contacts with the so-called pervert. This, of course, is the core mechanism in prejudice.

Whereas the sources of sexual suppression and repression in Victorian Vienna were familial and societal, one can only wonder about the sources of sexual repression today, repression that results in the need for projection. I suspect that one source relates to a backlash against the sexual freedom so common in the 1960s and 1970s in association with the so-called sexual revolution. Another factor that I suspect is operative is the AIDS epidemic. I believe that it is no small coincidence that sex-abuse hysteria and the AIDS epidemic both began in the early 1980s. And these elements are part of a broader picture of sexual suppression and repression associated with the rise of religious fundamentalism that we have witnessed in the United States during the last decade. My experiences with families in which sex-abuse hysteria is present have provided me with the opportunity to address myself to the question of hysteria in the male. As mentioned, even Freud’s colleagues were dubious about his theory because it allowed for the possibility that sexually repressed men might develop similar symptoms. Few if any such males were to be found. This is not surprising because even in the Victorian era young boys and men were still given greater sanction than girls and women to express overtly their sexual feelings. Most of the hysterical men I have seen have been involved in nursery school cases wherein they have been swept up in the hysteria as a manifestation of its capacity to spread. In addition, their hysteria is fueled by the ambient brouhaha seen at meetings and demonstrations in which other nursery school parents are similarly hysterical. Accordingly, they have often involved themselves in a folie-à-deux relationship with their wives who, typically, are the primary agitators in these cases. This element in these men’s hysteria, then, has been induced. Some of them are clearly hyperreligious types who project out onto others their own unacceptable sexual impulses. They exhibit the mechanisms of repression, projection, and external condemnation.

Another sexual element in these men’s hysteria relates to the unconscious rivalries they have with their potential rivals for their daughters. Freud focused significantly on the boy’s sexual attraction to his mother and less on the girl’s sexual attraction to her father. He did not give proper attention, I believe, to the complementary attractions of the parents to the children. Of course, Freud’s descriptions of patients’ fathers who had involved themselves in incestuous relationships with their daughters indicate an appreciation of this phenomenon—but it played a limited role in his broader theories. And even less is said about mothers’ sexual attractions to their sons. These parental designs on children are part of the polymorphous perversity of us all and are playing a role in the need of accusing parents to project their pedophilic impulses onto others. The fathers here are basically saying: "It is not I who wants to have sex with my daughter. It is he, that vile pervert." It is this jealous rage that is operative in the traditional warning of such fathers: "I’ll kill anyone who even lays a hand on my daughter." And some of these fathers really mean it. Many would actually be willing to accept capital punishment if they had the opportunity to murder the man who sexually abused their daughters. In some of these cases, the "abuse" was no more than "possible" touching of the child’s genitals, outside the clothing, without any further sexual involvement. Also, such preoccupations allow for a socially acceptable vehicle for the expression of pent-up anger.

I believe that there are genetic differences, as well, in the somewhat different ways in which men and women today manifest hysteria. Women tend to be more emotional. I suspect there is some genetic loading for this difference, but environmental factors are certainly operative. Accordingly, the histrionic and agitation elements in hysteria are likely to be more apparent in women. In contrast, fathers are more likely to be overtly belligerent and combative. (Here, too, I believe genetic loading plays a role, although environmental factors are certainly operative.) Accordingly, they are more comfortable with the anger-release aspect of hysteria.

Capacity for Spread Whereas other psychiatric symptoms tend to exist in relative isolation and not to spread to other individuals, hysteria is much more analogous to a contagious disease. It is for this reason that group hysteria is often seen and sometimes even mass hysteria. Although sexual abuse may certainly take place in the day-care center setting, there is no question that many of the day-care center accusations seen in the United States in recent years have no basis in reality and arise in an atmosphere of group hysteria. Furthermore, there is compelling evidence that we have been witnessing during the last decade an epidemic of mass hysteria in the United States as well as certain Western countries. Because the hysteria involves child sexual abuse, I believe the term sex-abuse hysteria is a proper term to describe this phenomenon.

Intensification of Symptoms in the Context of Lawsuits In the context of lawsuits the symptoms of hysteria are likely to become intensified. This is especially the case when the individual has something to gain by such elaboration. Accordingly, in civil lawsuits, when financial remuneration is being sought, the individual—consciously or uncons- ciously—is likely to expand the symptoms. In criminal lawsuits, wherein the goal is to punish and even incarcerate an alleged perpetrator who is the focus of the hysteria, such elaborations are also predictable.

Lawsuits not only bring about an intensification and elaboration of the symptoms of hysteria, but they also prolong enormously the time over which the pathology becomes imbedded in the psychic structure. Lawsuits require repeated interrogations by lawyers and other mental health professionals. They involve depositions and court appearances (either in the judge’s chambers or in open court). The hysterical parents may keep the child in ongoing therapy. Generally, the "therapist" is an individual who does not question for one second the validity of the accusation, who is blind to the fact that she (he) may be witnessing a false accusation and thereby entrenches in the child the notion that he (she) has been subjected to an abominable crime, which may produce lifelong psychiatric disturbance. Placing the child in such "treatment" fattens the purse that will hopefully be acquired at the end of the lawsuit. Such embellishment also has the effect of impressing upon the court the gravity of the psychiatric damage, damage that "requires years of therapy." In fact, one cannot know exactly how long it will take, so traumatized has this child been.

Concluding Comments on My Concept of Hysteria

I recognize that the hysteria I describe here derives from experiences with hysterical people in the context of sex-abuse accusations. I recognize, as well, that my data has been collected in special settings, especially child-custody disputes, nursery school and day-care center group accusations, and belated accusations by adult women. I believe, however, that these experiences have enhanced my understanding of hysteria (especially group hysteria) and such insights should prove useful in other situations in which hysteria is seen, situations in which the sexual element may not be operative.

Excerpted from Psychotherapy with Sex-Abuse Victims
True False and Hysterical
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