Hysterical psychology is organized around a fear of being dominated or patronized, often rooted in growing up with a powerful other-sex parent and a weak same-sex parent, and it shows up in men as well as women. Be respectful and patient and do not interpret at these patients, because that repeats the domination they fear.
What it is
If the other-sex parent seemed powerful and the same-sex parent seemed weak, identity becomes a problem: how do you grow up to feel like a strong version of who you are?
“If you have an other sex parent who seems to be the powerful parent and the same sex parent seems weak for whatever reason, it's a problem for your identity. How do you grow up to feel like a strong version of who you are”
1:11:55Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode The hysteric is someone pretending to be who they really are. The underlying fear is of being dominated, put down or patronized.
“Philip Bromberg once memorably said that hysteric is someone pretending to be who he really is, meaning I think what the dynamic is, if you have a hysterical psychology, you're afraid of being dominated, being put down, being patronized”
1:19:08Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode It is not only women. Men can do exactly the same thing: hype up the stereotypical aspects of their own gender in the service of power over someone of the other gender.
“he pointed out that the Marlon Brando character was doing exactly the same thing the Vivian Lee character. He was hyping up the stereotypical aspects of his gender in the service of power over somebody of the other gender”
1:15:16Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode Perfectionism here is a defense against fear. Compare obsessive-compulsive people, where it defends against feeling bad, and narcissistic people, where it defends against shame.
“In the hysterical person, it's a defense against fear. In the obsessive compulsive person, it's a defense against the feeling of badness. And in the more narcissistic person, perfectionism would be a defense against shame”
1:39:11Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode
Across the spectrum
Toward the borderline and psychotic end of the spectrum, sexual abuse turns up in the histories of people with hysterical dynamics.
“Down toward the borderline and psychotic end of the spectrum, you find sexual abuse in the histories of people who have hysterical dynamics”
1:15:54Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode At the psychotic end there is so much drama all the time that you cannot get near psychotherapy. You do damage control.
“at the psychotic end of the spectrum, they're creating so much drama all the time, you can't get near psychotherapy. You do damage control all the time”
1:22:22Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode
Treatment
Be very respectful and patient, and do not interpret at the person, because that makes them feel dominated, impinged on or penetrated again.
“What's mostly helpful to people like that is for the therapist to be very respectful, patient, not interpret at the person. because that just makes them feel dominated again or impinged on or penetrated”
1:20:56Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode In medication management it can look like this: you keep offering solutions, and the patient either does not follow through after agreeing, or has outsized, unusual negative reactions to the plans, over and over.
“you keep giving solutions and the patient either doesn't follow through with them after agreeing to them or has outsized or very unusual negative reactions to the treatment plans in a way that is just repeated”
57:26Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025
Pearls
In couples, watch for a pursuer-distancer pattern: when she is upset she moves toward him, when he is upset he moves away. If they truly appreciate the difference, he can learn to come toward her and she can learn to give him space.
“when she's upset, she moves toward him, and when he's upset, he moves away. And you get these pursuer-distancer dynamics in the dyad. But if you really appreciate that difference, He can learn to come toward her if she's upset and she can learn to give him space if he's upset”
1:24:38Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode
It also comes up on
- PsychoanalysisFreud did not work with patients with primary psychotic illness. His formulations of psychosis came mostly from patients with hysteria, a totally different group.
- PsychosisFreud did not work with primary psychotic illness; his ideas came mostly from patients with hysteria. Writers on schizophrenogenic mothers and developmental causes never demonstrated that those were causal.
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.