Advanced Psychopathology

Monday, March 06, 2006


Obsessive-compulsive vs. Hysterical neurotic style: Lucy's Reaction

According to Shapiro's chapters, obsessive-compulsives and hysterics represent profoundly, almost diametrically opposed styles of cognitive and defensive functioning. Cognitively, the obsessive-compulsive patient is a precise, clear thinker and remember; fact-based, rational modes of thinking predominate and attention is narrowly focussed. The obsessive-compulsive person almost never has a moment of wandering attention, in which they just happen to notice an extraneous detail, and never has the experience of a fleeting thought or impression. Their attention is wholly self-directed and restricted so that they may better accomplish tasks and concentrate on serious matters, although Shapiro makes the interesting point that they feel as if they are being directed from the outside -- from a place of “shoulds”-- instead of internally. Their sense of humanness and spontaneity is sacrificed and, according to McWilliams, their predominating defense is isolation (by which I assume she means isolation of affect). McWilliams adds a nice dimnension to the Shapiro chapter by culturally contextualizing the obsessive-compulsive style as a style that may be more prevalent in the West as it is valued for its driven, productive qualities. McWilliams also historically contextualizes this personality style as one that was understood by Freud and others to have originated in the context of harsh or overly rigid toilet training, leading the person to become fixated on issues of withholding, control and external pressure to be clean and accurate.

The hysteric, by stark contrast, lives almost totally in world of impressions, fleeting thoughts and unfocussed attention. The hysteric seems to live in a foggy world where feelings predominate and intellectual focus/curiosity is scarce. Quite unlike obsessive-compulsives, hysterics employ repression both cognitively and defensively. Shapiro points out that where the obssesive-compulsive has a historically accurate, detail and fact-based memory the hysteric affectively-charged memories that lack factual basis. According to Shapiro, this is not necessarily a dynamic, defense-based system but a cognitive one, which is based on how the hysteric originally perceives and experiences the world. Consequently, the hysterical personality, also in contrast to the obsessive-compulsive, lives in a knowledge and detail-impoverished world where emotion and sensation are the primary modes of “knowing.” Shapiro notes that hysterics often have problematic relationships with their own sexuality, an issue which he does not address in terms of the obessional personality. McWilliams also connects hysterical symptoms to repressed sexuality, and adds to Shapiro’s chapter in her discussion of how the hysteric uses regression as a defense against unconscious guilt and fear. McWilliams also suggests that the hysteric uses idealization of a strong, protecting object as a defense against feelings of powerlessness and inadequacy.

To me it seems that the biggest difference between the two styles must be in their internal experience of the world. While obsessive-compulsives seem to experience things as orderly, contained and manageable, the hysteric’s experience seems far more messy and even overwhelming. They are subject to all kinds of external influence and suggestion while the obsessive-compulsive patient is able to defend against almost any kind of cognitive/emotional disorganization.

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