Brit. J. Psychiat. (z966), 112, 19—26

The following case study offers an exceptionalopportunity to illustrate the wish-fulfillingnature of auditory hallucinations in a hysteric(Breuer and Freud, @;Freud, i i), the conditions under which these hallucinations areexperienced, and their response to treatment.

MENTAL STATE AND HISTORY

Bonnie F. is a 29-year-old mother of twochildren, a boy 84 and a girl 4. She came totreatment with the following complaints: depression, a fear of dying in her sleep, variousfears of becoming ill, a halting and occasionallystammering speech, and “¿�hearingvoices―. “¿�Ican't get rid of the voices and fears. Please helpme,― she cried. “¿�Thevoices are frightening andhound me all day long.― Contact with her isexcellent; her attention never drifts away. Thequality of her affect is appropriate to the situation discussed and shows at times a tendency tobe dramatic. There is no discernible thinkingdisturbance nor any misuse of words; neologisms are absent. She is intelligent, co-operative and sincerely interested in finding the causeof her symptoms.

Four months after the patient was born, hermother died of a septic flare-up of rheumaticheart disease (subacute bacterial endocarditis ?). Following her mother's death she wasraised by a maternal aunt and her husband,but was never legally adopted; her fatherrefused to give his consent. She dates her fear ofdying back to the age of four years. At this ageshe recalled being told the circumstancessurrounding her mother's illness. She recountedthe following family romance (Freud, 8) whichshe built through fact and fantasy:

“¿�Mymother caught a cold when i6 years old and laterdeveloped heart trouble which I assumed to be rheumatic fever... . Doctors warned her not to get marriedbecause the excitement of intercourse would be too muchfor her., . . And not to have children. . . . She must have

loved my father very much to have married him. . . . Theywere married five years when I was born. My father waslater heard saying that he had only five happy years in hislife. He must have meant the five years he spent with mymother.... My mother was only 24 years old when shedied. She must have been a brave and wonderful personto sacrifice her life in order to have me.―

When the patient was four years old she wastaken to live with her father and his new wife. “¿�Iremember the room I slept in and the toys thatwere there. . . . But I was frightened to staywith my father. I remember wishing he weredead and I wanted to leave.― The patient wasreturned to her adoptive parents after remaining with her father only a few days.

“¿�Ispent my whole life feeling like a freak. Ialways felt different because I didn't have realparents.― While in the fifth grade, when nineyears of age, she was asked for her father's name.“¿�Bothmy fathers' names occurred to me at thesame time and I started to stutter (Breuer andFreud, 2, pp. 92—93).―

At fifteen she once again attempted to livewith her father, but was frightened of him. “¿�Ifelt an unnatural attraction to him. . . as if Iwere his wife, and it frightened me... . And atthe same time I hated him for abandoning me.―She corresponded with her father intermittently until he died of a bleeding ulcer twomonths before her marriage.

At the age of I 7 the patient met her husband,Billy; she became engaged at i8 and marriedhim when i84.

“¿�Icouldn'tdecidetomarry him. I'vealwayswanted tomarry someone tall, dark and rich (this descriptionmatched the one she gave of her father), and my husbandwas poor. . .. My (adoptive) mother forced me to marryhim, and I've always resented it.―It was during the courtship that the fear of dying intensified: “¿�Iwent to see thefireworks with my girlfriend. . . and I saw roman candlesshooting up into the sky. I became extremely anxious anddidn't know why. ... It was then that I may have heardthe voices for the first time. I was too frightened to eventhink.― (At the end of treatment the patient was asked

‘¿�9

Auditory Hallucinations in a Case of Hysteria

By HAROLD LEVINSON

AUDITORY HALLUCINATIONS IN A CASE OF HYSTERIA

what roman candlesreminded her of.Laughingly shereplied, “¿�Itreminds me of a big penis shooting up intothe sky.―) While on her honeymoon she heard the voiceof her husband's aunt say, “¿�Youshould have waited....You could have married someone rich.― While havingintercourse she would sometimes hear a voice saying,“¿�You'llget cancer.―

Her first pregnancy was relatively uneventful.During her second pregnancy she felt wonderful.“¿�Ijust knew the baby would be a girl and thatmother would be back with us again.― Following the birth of her daughter the patient becameincreasingly frightened of dying. “¿�Iwas sofrightened I had to leave the hospital by thefourth day.― The voices became harsh andappeared more frequently. She named herchild Carol Lee after her mother, ConnieLynn, but continued to call her by her mother'sname. The patient was now 25 years of age.

Just before her daughter's first birthday, thepatient became ill with influenza. At this pointher fear of dying intensified. “¿�Thevoices―warned: “¿�Becareful, you'll infect the child.You're holding her too close, Bonnie.― She wasfrightened of hurting the children and of beingleft alone with them. A psychiatrist was consulted. She was hospitalized and given 8 ECT

with no significant improvement. For the lastthree years her symptoms have come and goneat four to five month intervals.

THE RESPONSE OF “¿�DiEVOICES― TO TREATMENT

Before starting treatment the patient complained that “¿�thevoices― were of a harsh,frightening and threatening quality. As forexample: “¿�Bonnie,you're going to die in yoursleep.―

Very soon after the treatment began thevoices and fears dramatically disappeared. Thepatient was delightfully surprised and said,“¿�SometimesI listen and I'm not sure if I hearanything.... I get an uneasy feeling when Iconcentrate and it seems like it said, ‘¿�Ihavenothing snore to say'.... Will it come back?I'm even afraid to talk about it. . . .“

The patient spontaneously contributed to themeaning of the voices from the very firstsession. For example:

(i) “¿�Sometimes the voices remind me of my step

mother who told me I was acting sick and was outafter my father's money.―

(2) “¿�Thevoices make me feel bad, but I also enjoy

them in a way. I seem to look for them like an oldlost friend.―

(@) She compared her looking for the voice to lookingfor her late grandfather to reappear. “¿�Ilookaround, sort of expecting him to come out of theroom again as he did when alive.―

(@)“¿�Thevoicesremindmeofmydaughter'simaginaryplaymate. I guess Carol gets lonely at times andneeds to talk to someone.―

The reasons behind the initial remission weresoon uncovered. The patient would frequentlycall me and sound panic-stricken. As soon as sheheard my voice, she calmed down and evenjoked with me. What I said was insignificantcompared to the soothing quality my voice hadfor her.

One session the patient mentioned how reassured shefelt upon hearing my voice on the phone, and contrastedthis feeling with the emptiness inside her when the voicesleft. “¿�Ilisten for them hoping they'll return,― she said.

“¿�Thevoice is your dead mother's,― I told her.“¿�Ifeel like you're my mother. . . . That's why I call

to see if you're there. . . . You know, the voice was mymother and I miss it. It's comforting to have her there..And when I call you, just hearing your voice makes mefeel good. I knew you were there (meaning alive).― Shelater added, “¿�Iknew it wasn't my father who was responsible for all my troubles.― (She blamed all her difficulties on her father's abandoning her and now realizedfor the first time that her mother was also an importantfactor in her illness.)

The next session she added: “¿�You'reright. I've beenthinking about the voice being my mother's. . . . You'reright. It doesn't come back unless I really get anxiousabout it.... Then 1 hear it say: ‘¿�You'reno good.You'll die.' ... Even what the voices told me, ‘¿�You'regoing to make a mistake. Don't do it this way. That's not agood idea.' They were all things a mother would tell achild.―

The following session she stated: “¿�Iknew by the way thevoices answered it couldn't just be my conscience. Forexample, when my (adoptive) mother comes into myhouse she'll tell me, ‘¿�Getrid of these things in the refrigerator, Bonnie. Don't do it that way.' The voicestoo were constantly telling me what to do just as if a motherwere talking to a child. I guess I wanted a mother so badly Ijust imagined @.... But how did you know ?“As noted,the patient attributed the unpleasant voices to herconscience and the pleasant ones to her mother (Isakower,12). She kept the pleasant voices a secret until the middle

of treatment.

The patient now revealed “¿�hearing―a newvoice. This new voice was mine (Ferenczi, 4).

BY HAROLD LEVINSON 2!

She would often ask me why she got better and Irepeatedly told her it didn't matter. In the abovesession she once again asked why she got betterand this time answered herself: “¿�Thelittlevoice told me, ‘¿�Itreally didn't matter'.― The newvoice was produced by her identification in thetransference situation.

As the patient's condition improved, she feltthreatened by termination. She struggled desperately in order to bring back the symptoms:

“¿�Whywon't the voices come back ?“she cried. “¿�IfIknow what they represent I should be able to bring themback even easier now. . . - I've been thinking why thevoices first left.. . . Do you know why ?“she asked.

“¿�No,―I replied.“¿�Iwonder if it didn't leave so fast because I had you

totalkto.―“¿�Whendid it disappear ?“I asked.“¿�Ithink they left about three months ago, but I wouldn't

admit it. It's funny how miserable I was with them, butyet I wanted to bring them back.... It seems lonelywithout them, as if I lost a playmate. I still feel dividedin two. The child in me wants to remain the same and Iwant to grow up and be happy.... More and more I'mglad the voices are gone and I'm at peace with myself.―

In spontaneously thinking of termination sheagain tried to bring back the voices: “¿�Ifeelempty inside as if something were missing(crying). . . . My mother (the voice) is gone now....The thoughts I have are yours (not mother's) andthe fight to stay sick is still going on. . . . WhenI leave, my mind says, ‘¿�Forgeteverything hesays'.―

Shortly before treatment ended the patientwent on a two-day vacation. She related thefollowing event: “¿�Iwas looking out of the hotelwindow and these thoughts ran through mymind, ‘¿�Whereare you? Where did you go?I wonder where you are, little voice,' and I wasreally trying to find her (mother). I've hadthese thoughts before so I know you're right. Thevoices were my mother. When you first told me Ididn't really believe it. I thought you were justtelling me things to satisfy me as I do to mydaughter just to keep her quiet.―

It was thus established by the patient that“¿�thevoices― unconsciously represented hermother. This desperate need for a mother wasmatched in reality most convincingly by hercalling her daughter Connie Lynn instead ofCarol Lee without being fully aware of it. It wasonly when treatment was nearly complete that

she could stop calling her daughter by hermother's name. At this time she was able tojoke, “¿�I'vecalled her Connie Lynn so much Ibet she doesn't even know her own name―.

TIlE CONDITIONS UNDER WHICH “¿�THEVOICES―

ARE EXPERIENCED

After “¿�thevoices―disappeared a strange andsurprising thing happened. Instead of beinggrateful and happy, she was annoyed and sadand tried her best to bring back her voices in aseemingly conscious and deliberate manner:

A. She became mean and spiteful towards others in adeliberate attempt to sensitize her conscience andforce it to react in a threatening and warning way:“¿�Itseems every time I get better, I can't take itand I act mean on purpose to antagonize myconscience―.

B. She kept suggesting to herself what she should hearand how she should react: “¿�Ikeep telling mysdf,‘¿�Bonnie,you're going to die, you're going to die,'over and over but it doesn't scare me any more andthe voices won't come back. I keep saying, ‘¿�Whatdo you say now, little voice?' but it's quiet. Wheredid it go? It won't answer me any more!― Inanother session she again spoke about her conscience telling her what to do and I asked her ifshe still heard voices. “¿�I'mnot sure. It seems thatI speak to myself and tell myself to do this or that.―

C. She concentrated deeply within herself, listeningvery intently and ignored all other stimulation, a

state resembling auto-hypnosis: “¿�Ilook arounddesperately and listen for the little voice, but itwon't come back any more (definitely implyingthis method worked before).―

In her last session and an ensuing telephone callshe explained that she really heard a voice, laterrecognized it to be a thought, and described the

conditions making this confusion possible.

“¿�Isometimes think, ‘¿�You'regoing to die,' when I actmean, but it doesn't scare me and leave me cold.―

“¿�Didyou ever really hear a voice ?“I asked.

She continued with her answer during a telephoneconversation the next day: “¿�I'vebeen thinking about yourquestion and I never really heard any little voice. . . . Itwas just that I was too preoccupied with myself like a babyand never paid enough attention to the outside.. . . 1 would justconcentrate within me.―

With a sensitized conscience, intense autosuggestion and in a State resembling autohypnosis, a thought was mistaken for a voiceor a voice was imagined.

AUDITORY HALLUCINATIONS IN A CASE OF HYSTERIA22

That the patient wished to hear a voice caneasily be demonstrated in the followingsoliloquy:

“¿�Dayand nightI tellmyself;‘¿�Bonnie,you'regoing todie,' but it (voice) won't come back. Where did they go?I felt like hanging you up by you know what (genitals).When Icouldn'tbringthem back,I blamed you fortakingaway my voices....I feellostand empty inside.What willreplacetheemptiness?Isitpossibletowant tobe sick?I'vealways feltguiltybecausedown deep I'vealways known it.― Incredulously she asked, “¿�Isitpossible?... It's annoying to have to give up my daydreamsandfantasies. . . . I'm so ashamed of my secret....To some extentI knew itallalong,but I wasn'tsure.Ifeel so guilty about the injury I've caused others and yetI enjoy being spiteful.―

In this way the patient discovered her illnesswas an unconscious act, that she wanted to besick, and that she enjoyed “¿�thevoices― andmissed them when they disappeared. Once thepatient became aware of her desire to be illand her need of “¿�thevoices―, she could nolonger duplicate the performance on a consciouslevel even with the greatest possible effort.

We can now complete the picture. A strongunconscious need to be ill and to hear a voicefuelled a number of preconscious man@uvressuch as: sensitizing the conscience to reactloudly and intensely, auto-suggestion and autohypnosis, so that an intense thought wouldpurposefully be mistaken for and experienced asa voice.

THE UNCONSCIOUS NEED TO BE ILL

When the patient's symptoms first disappeared she began to feel increasingly guilty anddidn't know why. At the same time she foughtdesperately to bring back her illness (fears andvoices).

“¿�Thevoicesare definitelygone.. . . It'sstrange,andI have to laugh at what I do. I keep catching myselfsaying, ‘¿�Whatdo you say now, little voice?' and I actuallymiss it. It's funny how the whole thing is in my mind and asmuch as I want to get betterI missit(cryingbitterly),becauseitismy mother....It'samazing how stubbornIam and fighttostaysick....“She describedthefollow.ing: “¿�Iwas resting yesterday when my mind started torace and the thought hit me that my mother was dead(Ferenczi, 5). Isn't it funny and stupid? I've known she wasdead, but I couldn't stop crying.... I knew my holdingon to the fearsand voiceswas connected with mymother's death, but I didn't fully realize it untilyesterday.―

The final link in the case was supplied in thefollowing event:

“¿�Iwas in the fruit store with my daughter Carol whenthe fruitman died of a heart attack right in front ofme.. . . He was nice. . . . Why did it have to happen tohim?... He treated Carol wonderfully and had anamazing amount of patience with her.― Her descriptionof the fruitman was identical to the one she continuallygave of her mother. “¿�Mymind started racing for the nextfew days and I felt bad, worthless and undeserving... . Iwas in a restaurant Sunday when all of a sudden I feltresponsible for my mother's death.... When you first toldme I agreed with you, but it wasn't until Sunday that Ireally felt it. . . . After I realized it I felt much better, asif a terrific weight were lifted from me and I almost ateup the place.... It's funny how I blamed myself for herdeath and didn't even know it.―

By the end of treatment the patient fullyrealized that she felt responsible for her mother'sdeath, felt as if she had killed her, was living onher mother's time, while beneath her fear ofdeath was a wish to die.

“¿�Whenyou told me (she said) last time I was responsible for my parents' deaths it really didn't sink in.I guess I tried to push it out of my mind, but it wasworking on me unconsciously, because yesterday Billy(husband) saw me crying and I told him I was better. Itreally hit me that I'm a murderer. I killed my mother andhad I not been born chances are my father would havestill been alive.― The patient's father died of a bleedingpeptic ulcer which the patient felt was due to the death ofhis first wife whom he loved and the suffering he incurredfrom his second wife and the patient herself. “¿�Itfinally hitme that I've always felt I was living on someone else'stime—my mother's. That beneath my fear of dying wasalways the wish to die.―

The patient had unconsciously felt guilty forher mother's and later her father's death andfelt as a murderer. To relieve her guilt she wishedto die and be sick like her mother. These stepsat retribution were evidently not enough. Thepatient had to deny her mother's death andrestore her to life in fantasy as “¿�voices―and inthis way avoid the guilt for her murder. Asnoted, the patient also searched in a lovingmanner for “¿�thevoices―when they disappeared.She sincerely missed them and felt “¿�lostandempty inside when they left―. It can thus beseen that “¿�thevoices―served another purposetoo. The patient was able to rejoin her belovedmother and be with her to her heart's content.

What part did revenge or spite play in thepatient's need to be ill? To start with we will

BY HAROLD LEVINSON 23

examine the part played by spite in reality. Thepatient was especially fond of spiting andirritating her mother-in-law, adoptive motherand husband. When annoyed, she visualizedstrangling her mother-in-law and castratingher husband. She felt unloved, and any situationwhich stimulated this feeling made her sofurious she “¿�couldkill―.That this jealous furywas directed at representatives of her realparents can easily be seen: “¿�Idon't even likemy mother-in-law (and adoptive mother also)as a person. It's just that she's a mother, and Ibecome furious when she pays more attentionto her daughter. . . . Isn't it stupid? But Ican't help myself.― As the patient herselfrealized, her husband unconsciously represented her father: “¿�Eventhough Billy is steadyand loyal, I feel he'll leave me too as my fatherdid, and I can't stop irritating him.―As notedin the history, the patient recalled wishing herfather would die for leaving her as early as fouryears of age (she left him) and this angerpersisted until the end of treatment. At fouryears of age she learned of her mother's death(abandonment) and the chances are that herwish that her father die masked also the wishthat her mother die. Both parents left her.

During the treatment she often cried whenrecalling (as a déjàvécuphenomenon) howbrave her mother had been and how she died tohave her. “¿�Ifeel so guilty,― she cried, “¿�likeshedied in vain.―When consciously, and as it weredeliberately, trying to bring back her illness shestarted laughing at herself: “¿�Ifmy mother sawme behave this way, she would turn over in hergrave.― These were the first clues as to themotive of spite in her need to be ill.

In the transference, the patient becameincreasingly spiteful once her symptoms disappeared. It manifested itself in the followingways: “¿�Whydo I like to spite you ?“she askedand guessed at an answer, “¿�Idon't want to giveyou credit for helping me.―On many occasionsshe would call up and tell me “¿�thevoices―wereback when they were not, and at home shewould tell her husband and parents she wasworse when in fact she was much better. Attimes she even pretended to be ill at home in aneffort to discredit me. This spiteful act was bothconsciously and unconsciously performed. She

even tried to bring back her illness to get evenwith me. All in all it is by now obvious thatanother motive for illness has been found. Thepatient tried to spite me by getting sick as shetried so spite her mother by wrecking her ownlife—as if to tell her mother, “¿�See,you died invain. I wasn't worth it―.

She also became furious at me when threatened by separation, whether it be vacation ortermination due to improvement, and would tryto bring back her illness in an effort to keep meand also spite me. During these stressful periods,she called frequently almost panic-stricken. “¿�Assoon as I hear your voice,― she said, “¿�Ifeelbetter.― She was excessively frightened lestsomething happen to me, and behind this fearwas the wish I should die for wanting to leaveher. That this was so can be seen in a telephoneconversation after treatment was over: “¿�My(adoptive) mother has to go for an operationand I can't stop crying.... I feel guilty as ifmy aggravating her caused it. I know it's stupidbut I can't help worrying. . . . It's becauseunderneath my niceness and concern its justthe opposite.―

It has now been demonstrated that revengewas another motive in the patient's need to be ill.Revenge played two major roles. First, her illness made her mother's death useless. Andsecond, her illness was an attempt to keep hermother from leaving her. It is as if she would say,“¿�Soyou want to leave me. To hell with you.I'll keep you right here―.She tried to repeat thisin the transference by pretending she was stillill, as she did at home with her adoptive parentsand husband. She expected that everyone closeto her would abandon her as her parents haddone, and as a result attempted to keep them allclose by at her beck and call.

We are now in a position to summarize thedevelopment of the patient's illness. When thepatient first learned her mother was gone, shemissed her and wanted her back. She laterbecame furious and wished her motherwould die for abandoning her. Because ofthis wish, she became guilty. In order tobe with her mother again, relieve her guiltfor wishing mother dead, and revengeherself on mother, the patient's symptomsdeveloped.

AUDITORY HALLUCINATIONS IN A CASE OF HYSTERIA24

FoLLow-up

The patient was seen one year after treatmentended. During this year her condition hadsteadily improved: she remained happy andwell, “¿�thefears and voices―never returned andher stuttering was hardly noticeable. She wasproud to inform me of her ability to move awayfrom her adoptive parents for the first time inher life. Her main purpose in seeing me,however, was to discuss the following realizations:

(i) “¿�Itsuddenly hit me yesterday that the voices were

really my own thoughts.. . . I spoke to the voiceand I answered for it. . . . It was all my ownimagination. I knew this before intellectually, butI refused to accept and admit it. I guess I hated topart with my mother.―

(2) “¿�Itseems that my talking to the voice dates back towhen I was very young (approximately four yearsold) and was first taken to visit my mother's grave.I watched my (adoptive) mother and grandmothertalking to the grave as if my mother were alive andcould hear. . . . This scene frightened me verymuch.―

(@) “¿�Inever realized how much I would daydreameven when people are talking to me. I would eventalk aloud when alone without realizing it.. . . it'sstrange, but with all my daydreaming I never consciously‘¿�houghtabout my mother until you first mentioned her. Iwould usually daydream about my father andmyself.―

It is of importance to note that when thepatient could part with “¿�thevoices― by fullyaccepting them as fantasies, her daydreamingdiminished and she could leave her adoptivemother and father for the first time. In conversing with “¿�thevoices―, she unconsciouslyre-enacted in a fugue-like state the traumaticscene which she experienced at the cemeterywhen very young. This traumatic scene determined the form or choice of “¿�thevoice―as asymptom.

DISCuSSION

The Patient's Oedipal Attitudes Involved HerFantasied Real Parents

During the pubescent upsurge of oedipalfeelings the patient recalled the following: “¿�Ifelt an unnatural attraction to him (father)as if I were his wife, and it frightened me.― Thepatient loved her father dearly and wished to

take mother's (step-mother's in reality) placewith him. At the same time she loved herfantasied mother and wished to be with her.She resolved this conflict by identification. Inthis way she both destroyed and preservedmother. The patient had always imagined hermother raped by her father while asleep anddying as a result of “¿�theexcitement of intercourse―and the ensuing delivery. As a result ofidentifying with her fantasied mother, shefeared (unconsciously wished) father would rapeher at night while she slept and that theexcitement and childbirth would be too muchfor her heart to take. Puberty, marriage, sleep,intercourse and especially the birth of a daughtertriggered off her unconscious oedipal conflicts.To restore the equilibrium she once againrevived mother in fantasy as she had done duringthe oedipal period. As Nunberg (i', pp. 70—71)states:

“¿�Onemight assume that the oedipus complex should notdevelop in children who at a very early age have lost one orboth parents. But experience shows that in such cases thechild creates parents in his fantasy and develops the attitudeof the oedipus complex toward these fantasy figures. Forinstance, if the child has no father, he creates a father infantasy

The Patient's Real Parents Were Irreplaceable

Despite the fact that the patient, as an orphan,was raised under most fortunate and favourableconditions, it is most apparent that her adoptiveparents never replaced her real parents. Shewas fond of them but did not love them. Theirtrue significance to her was in the fact that theywere parents and as such unconsciously represented her own real parents. That this was socan be shown repeatedly in the material. Thepatient was extremely fond of her adoptivefather but called him Stan (as a friend), and asearly as she can recall and certainly since theage of fifteen sought desperately to rejoin her realfather. “¿�Ireally loved him,― she often stated.Her adoptive mother was someone who merelyfell into the category of mother as did hermother-in-law and step-mother. The patientappreciated what her adoptive parents did forher as would a stranger or guest. And as justdemonstrated, her oedipal attitudes involvedher real parents. The patient often said, “¿�Allmy difficulties stem from the fact that I don't

BY HAROLD LEVINSON 25

have real parents,― and her illness as we haveseen verifies this point. It is by now obviousthat her real parents were irreplaceable. Sherestored them to life in her daydreams and inreality named her daughter after her mother andwished to have another son so as to name himafter her father.

Xeurosis versus Psychosis

The earmark of psychosis is, as Freud (@, i o)pointed out, the complete or rather completereplacement of the objective reality by thepatient's own, i.e., psychic reality. This newreality is unshakable and inaccessible to reason.Although it can safely be assumed that thepatient lapsed into psychosis (Freud, ii;Jaspers, ‘¿�3,pp. 383—413)at the time of her postpartum hospitalization, she did not appearpsychotic during the course of treatment. Thepatient unconsciously denied her mother's deathand replaced her with the wish-fulfilling symptom of “¿�hearingvoices― or hearing motherbut this symptom was amenable to insight. Thepatient became clearly aware of the nature andmeaning of her symptom (thus implying that thefunction of reality testing remained basicallyintact), and by this realization she becamecured. The development of this case proceededas in a typical neurosis, and the symptomatologyas well as the dynamics or unconscious motivation clearly defined a hysteria. Even theperiods of intense daydreaming or altered statesof consciousness permitting intense thoughtsand wishes to be perceived as auditory hallucinations are compatible with the diagnosis ofhysteria. In the absence of “¿�fundamentalsymptoms― (Bleuler, i), schizophrenia was ruledout.

Can Memory Traces be Retained in the Unconsciousat Four Months of Age?

Six months of age is taken as the timememory traces first begin to remain in theunconscious. At this age a child smiles inrecognition of mother and cries at the approachof a stranger. Six months also corresponds to theyoungest infant mentioned in Spitz's work onanaclitic depression (i 6—20). During theseearly months of life mother is a psychophysiological nutrient to the infant. She is

instinctively felt and “¿�absorbed―through everyavailable sensory modality (Nunberg, 14;Schiller, i 5). As Jan Frank (6) states:

“¿�Althoughsomewhat rudimentary in men.. smell andtaste are the main instrumentalities in the service of theoral group of partial instinctive strivings. . . . The mother,as the all-important centre of the infant's universe, isoriginally contacted by the baby through taste, smell andtouch.At first,thisempathiccontactisdue toimprinting,as Tinbergen, Lorenz and von Uexkull would term it inethology. After six months of age, trace memories beginto remain in the unconscious.―

It is highly unlikely, however, that this uniquecomplex pattern of stimuli, called mother,should not be physiologically recorded in theinfant's unconscious as trace sensations beforemother is fully recognized. Furthermore, thesetrace Sensations representing mother mustdistinguish her quite sharply for the infant,certainly more so than one would ordinarilyanticipate.

The clinical material gathered in this papersupports the contention that the patient sensedthe possession and loss of her mother at four months ofage and that affective traces of these experiencesremained in the unconscious. The evidence isas follows: The patient's fixation to the traumaof her mother's death is easily demonstrated(Fenichel, 3, p. 404). We have only to glance atthe patient's history in order to see that herentire existence was dominated and taken up bythe never ending search for her lost mother. Shefelt lost, empty and deprived. In “¿�hearingvoices―every four to five months, she attemptedto repair the traumatic experience of losing hermother. Four and five were identical to thepatient unconsciously; both numbers represented the time her mother died—namelyafter five years of marriage when the patientwas four months old. The hallucinatory formof “¿�thevoices― also indicates the depth towhich she selectively and periodically regressed (Freud, 7). It is in line with the patient'shistory that she chose four years as the timeshe learned of her mother's death. Fouryears no doubt screened four months. Sherepeatedly described her mother as if sheexperienced her before (deja vécu).Even themanner in which she searched for “¿�thevoices―was strikingly reminiscent of the way an infantalmost instinctively searches for its mother. In

26 AUDITORY HALLUCINATIONS IN A CASE OF HYSTERIA

conclusion, we can say that the patient'saffective traces at four months of age latergained representation in oedipal fantasies andbecame neurosigenic only when activated bythe oedipus complex and its later ramifications.

SUMMARY

Auditory hallucinations were experiencedby a hysterical patient during periods of intensedaydreaming (or altered states of consciousness), and were disclosed to be the result of anunconscious wishing and yearning to resurrectand rejoin her mother. The fact that the patientcould almost turn “¿�thevoices― on and off,recognize them to be products of her ownimagination, i.e., thoughts and wishes, and wasclearly able to resolve their underlying determinants suggests she was neurotic rather thanpsychotic during the course of treatment.

ACKNOWLEDGMENT

I wish to express my gratitude to Dr. Jan Frank forsupervising the treatment of this case. Upon his suggestion,this paper was written.

REFERENCES

i. BLEULER, EUGEN (19! i). Dementia Praecox oder die

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Hat-old Levinson, M.D., Clinical Instructor in Psychiatry, Downstate Medical Center, .iVewYork

(Received 3 September, 1964)