A Fragmented Doll: Madness in Hysteria

The author describes the process of a once‐weekly psychodynamic psychotherapy with a hysterical patient. In the initial phase, the patient responded well and there was a sense of progress in the therapy. However, the author gradually began to feel stuck. He was under strong pressure to act as a good understanding therapist. At a later stage, the patient complained of severe physical pain and demanded cure. When she was absent from the treatment without notice, her fear of death and madness which had been denied so far was massively projected into the author who was overtaken by the fear of her death. It became clear that in her phantasy, the patient was a princess waiting to be rescued by her White Knight/therapist. However, to understand the transference situation fully, it was necessary for the author to acknowledge and relinquish his narcissistic satisfaction in being an omnipotent rescuer. The author argues that the difficulty in this process reflected her desperate need for an omnipotent illusion to hold herself, in which the author acted a part. He finally states the importance of acknowledging the underlying fragmentation in hysteria which is often hidden behind the façade of ostensible integrity.