Belle indifférence

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Charcot demonstrates the hysteria patient Blanche Wittman in the Salpêtrière lecture hall. Painting by André Brouillet 1887. In this patient, too, a posture of "belle indifférence" can be recognized, depending on the viewer's position.

Belle indifférence ( French = "beautiful indifference") describes an apparent impartiality and indifference in the face of their disturbances, which can often be observed in hysterics . The term introduced into psychoanalytic literature by Sigmund Freud (1856–1939) goes back to Jean-Martin Charcot (1825–1893). Freud was his student during a study visit at the Salpêtrière in Paris from October 1885 to February 1886.

Paradoxical name?

The designation of carelessness in the face of actually serious physical complaints and often also in relation to one's own conspicuous demonstrative behavior is intended to point out that the symptoms and behavior of the hysteric "secretly" fulfill their own wishes. These own wishes are, however, completely withdrawn from the everyday consciousness of the hysteric himself. Rather, they present themselves to the analyst as wish-fulfillments, as they usually result from the accompanying circumstances or from the survey of the social history. The conscious and appropriate exposure and the social clarification of such connections brings the hysterical symptoms, which are sometimes severely affected by the body, but endured “with a cheerful expression”, to subside. This kind of physical discomfort, from Freud as conversion, i. H. referred to as the “conversion” of psychic energies into body symptoms, was the starting point for a fundamentally new view of physical complaints (→ organ neuroses and psychosomatics ).

Coping with fear

In his work “Die Verdrängung” (1915), Freud describes the success of repression in patients with signs of “belle indifférence” as generally a complete success in terms of neutralizing the affect that triggered them . The original affect that is decisive for repression is, as Freud later recognizes, fear . Neurotic fear development gives way to symptom formation. The appearance of a symptom binds fear.

Self development

Own expectations and the fear of disappointment are to be seen as the starting point and source of human development. Their appearance in childhood is tied to constant caregivers, usually first to the mother (primary object). According to the object relationship theory , the development of a person runs between the poles of turning to this reference person (object-related) and turning away from him (self- or subject-related). Too much consolidation in the direction of either of these two extremes is seen as a threat to the overall desirable development of the self towards independence. Too much object-relatedness can lead to dependency and real fears such as B. of being engulfed by the object. Too much self-centeredness and introspection can lead to regression and an increase in inner fears (implosion as fear of the loneliness of the individual). Constant weighing of both reference poles in the sense of a continuously established homeostasis is desirable. Indifference is usually understood as a narrowing of such an affective ability to vibrate, whether it occurs in the form of indifference, indifference or dullness in numerous other mental disorders.

Special features of the development of hysterical symptoms

Even if one regards the "belle indifférence" as a peculiarity of the development of hysterical symptoms, the reverse question arises whether psychodynamically similar processes also occur in other health disorders, especially since carefree and subjectively lacking feelings of illness often occur in psychological and z. Sometimes physical disorders also occur. Are there reasons that make it easier to neutralize the affects that cause illness in hysteria? Even if one assumes a number of different mechanisms of repression, Freud at least recognized the deprivation of energy for psychic representations as a common characteristic of different forms of neurosis. More recent studies also confirm subjectively lack of concern about existing symptoms in the sense of a "belle indifférence" not only in hysteria i. e. S., but also with organ diseases. It is not only in the disease systematics and nosology that supplementary series can be set up according to the assumed quantum of neutralized fear in the individual psychological and psychosomatic diseases. This approach also appears useful for personality typology .

Problems of hysteria as a model for all psychiatry

The indifference of the hysterics, which is understood as “beautiful indifference”, bears its name because negative affects that trigger displeasure appear completely repressed and eliminated here. However, this does not apply to other neuroses such as anxiety neurosis or obsessional neurosis . Uninhibitedness is almost synonymous with informality. Hysteria is therefore also seen as a “progressive” form of unsuccessful coping with fear or as a “mature” disorder. The amount of fear that is hidden behind hysterical arm paralysis, for example, is viewed as comparatively low. However, the chances of recovery are often limited. Hysterical symptoms not only challenge many therapists to uncontrolled countertransference . These underestimate the patient's subconsciously intended gain from illness and, through their own emotional attitude, favor the chronification of the course of the illness. Relatives are particularly subject to this danger. The indeterminacy, changeability and variegation of hysterical symptoms as well as their positive suggestive influenceability gave rise to manifold therapeutic concepts and theories not only based on older methods of somnambulism , hypnosis , symptom change and protreptic , psychoanalysis also received decisive impulses from the treatment success, which Charcot scored in France in hysterics. Accordingly, Carl Gustav Jung (1875–1961) published several studies in which he investigated possible psychological parallels in the clinical description between hysteria and schizophrenia, taking special account of the "belle indifférence". Ronald D. Laing (1927–1989) followed a similar tendency .

Individual evidence

  1. ^ A b Sigmund Freud : Medical histories. Part D. Miss Elisabeth v. R ... (1895) In: Gesammelte Werke, Volume I, Studies on Hysteria. Early writings on the theory of neuroses, Fischer Taschenbuch, Frankfurt / M 1999, ISBN 3-596-50300-0 ; P. 196 - on district “belle indifférence”.
  2. ↑ a b c d e Sigmund Freud: The repression . (1915) In: Collected Works, Volume X, Works from the years 1913–1917, Fischer Taschenbuch, Frankfurt / M 1999, ISBN 3-596-50300-0 ; Pp. 257 ff. - on the district “belle indifférence”.
  3. ↑ a b c Ronald D. Laing : The divided self . An existential study of mental health and insanity. dtv Munich, 1987, ISBN 3-423-15029-7 ; P. 93 f. - to Stw. "Belle indifférence".
  4. ^ Thure von Uexküll : Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek bei Hamburg 1963, p. 82 ff. U.ö. - to tax authority "Organneurosis".
  5. ^ Sigmund Freud: XXV. Lecture. The fear . (1916–1917) In: Collected Works, Volume XI, Lectures for Introduction to Psychoanalysis, Fischer Taschenbuch, Frankfurt / M 1999, ISBN 3-596-50300-0 ; P. 419 ff. - on taxation “fear”.
  6. ↑ a b c Wolfgang Loch : On the theory, technology and therapy of psychoanalysis . S. Fischer Conditio humana (edited by Thure von Uexküll & Ilse Grubrich-Simitis ) 1972, ISBN 3-10-844801-3 ; P. 19 ff. - on the district “belle indifférence”.
  7. ↑ Stavros Mentzos : Psychodynamic Models in Psychiatry. Vandenhoeck & Ruprecht, Göttingen 2 1992, ISBN 3-525-45727-8 ; P. 30 - on tax. "Object Relationship Theory".
  8. ↑ Stavros Mentzos : Neurotic Conflict Processing. Introduction to the psychoanalytic theory of neuroses, taking into account more recent perspectives. © 1982 Kindler, Fischer-Taschenbuch, Frankfurt 1992, ISBN 3-596-42239-6 ; Pp. 53, 58, 95, 143, 202 - on Stw. " Self-object ", "Transitional object ".
  9. ^ Sven Olaf Hoffmann and G. Hochapfel: Theory of Neuroses, Psychotherapeutic and Psychosomatic Medicine. [1999], Compact textbook, Schattauer, Stuttgart 6 2003, ISBN 3-7945-1960-4 ; P. 230 - on district “belle indifférence”.
  10. ^ Jon Stone: La belle indifférence in conversion symptoms and hysteria . Systematic review, The British Journal of Psychiatry (2006) 188: 204-209. doi : 10.1192 / bjp.188.3.204
  11. ↑ Fritz Riemann : Basic forms of fear . A depth psychological study. (1961) Ernst Reinhardt Verlag, Munich 6 1974/1975 , ISBN 3 497 00749 8 ; z. BS 20. ff. - on “Fear and schizoid personality”.
  12. ↑ a b Walter Bräutigam : reactions, neuroses, psychopathies . A plan of the small psychiatry. dtv Scientific Series, Georg Thieme, Stuttgart 2 1969; (a) p. 84 - on district “belle indifférence”; (b) p. 84 - to district “Protreptik”.
  13. ^ Hermann Samuel glass pane : The labyrinth of medicine . The wrong ways and triumphs of medicine. Rowohlt, Reinbek near Hamburg 1 1961; P. 179 ff. - to the district “Somnambulism”.
  14. ↑ Carl Gustav Jung : About the psychology of dementia praecox. One try. Collected Works. Walter-Verlag, Düsseldorf 1995, paperback, special edition, volume 3, Psychogenesis of mental illnesses, ISBN 3-530-40078-5 ; P. 22 - to district “belle indifférence”, § 35 in the 1st chapter. "Critical presentation of theoretical views on dementia praecox".
  15. ^ Carl Gustav Jung : Dementia praecox and hysteria. A parallel. Collected Works. Walter-Verlag, Düsseldorf 1995, paperback, special edition, volume 3, Psychogenesis of mental illnesses, ISBN 3-530-40078-5 ; P. 78 f. - on tax authority "belle indifférence", § 145 f. in chap. A. "The disturbance of feelings".