Freud originally accepted the belief of his mentor, Charcot, that trauma and hereditary predisposition caused hysteria (McGrath, 161). He downplayed the role of sexuality in hysteria; in fact, he wrote in his encyclopedia article on hysteria that “[sexuality’s] importance is as a rule over-estimated” (McGrath, 166). However, as he spent more time examining the traumas causing hysteria, Freud found that the experiences were almost always sexual in nature. This realization, along with his growing commitment to looking at psychological over physiological symptoms, led Freud to determine that hysteria was primarily a sexual disorder.
Freud believed that all neuroses associated with hysteria were based in sexual dysfunction. He recognized that his definition of hysteria seemed purely psychological; he insisted that although his treatment was psychological, he recognized that the dysfunctions were caused by an organic factor (Freud, 104). This organic factor was based in sexuality, especially in women. His emphasis on sexuality made hysteria a gendered disorder again; he believed that sexual life had a higher psychical significance and effect in women than in men and would therefore affect them more (McGrath, 166).
Repression played an important role in Freud’s theory of hysteria. According to Freud, hysterical symptoms expressed unconscious sexual desires:
In the hysteric, Freud argues, the memory of a passive sexual seduction in early childhood is repressed and remains like a foreign body in the unconscious until reanimated at puberty, when it may either be converted immediately into a symptom or once again repressed as unacceptable to a now sexually aware consciousness (Bernheimer, 13).
Particularly in women, Freud believed that hysteria was a “breakthrough of the repressed oedipal constellation,” where girls instinctively sought out sexual relationships with their fathers (Bernheimer, 159). When girls could not make these fantasies a reality, hysterical symptoms emerged. Freud believed that instead of using words to express repressed sexual scenarios, hysterics used physical symptoms, and therefore only revealing the repressed memories could cure hysteria.
Freud argued that sexuality was “the motive power for every single symptom, and for every single manifestation of a symptom” (Freud, 105). Hysterical symptoms were a substitute for the traumatic experience but also helped the patient achieve sexual gratification (Freud, 116). Therefore, while hysterical symptoms occurred because of repressed memories, they also occurred because of unconscious sexual phantasies. They were “a compromise between a libidinal and a repressive force” (Freud, 117). The physical symptoms were therefore the direct expression of sexual disturbances and the mental symptoms were the conflict between repression and arousal.