Book recommendation: Guises of Desire is the beautifully told story of one of the best known patients with a psychogenic and dissociative disorder

guisesThe time and place: Vienna, Austria in the 1800’s.  The main character of the story is real: Bertha Pappenheim (AKA Anna O). In Guises of Desire, the author, Hilda Reilly, recounts Bertha’s intense years living with these psychogenic symptoms using a wonderful combination of solid research and imagination.  Ms. Reilly descriptions of Bertha’s variety of psychogenic symptoms including a persistent cough, paralysis, sporadic difficulty hearing, blindness, and regressions to childlike speech as well as switches from one language are impeccable.

In it, Bertha, a wealthy young Jewish woman comes down with a mysterious illness that over time produces new and different medically unexplainable symptoms. Her doctor, Dr. Breuer, diagnoses her with “hysteria” which would now be called conversion disorder or functional neurological symptoms disorder (FNSD). Some of her episodes appear clearly dissociative.  Treatment includes hypnosis and then a new form of therapy called the ‘talking cure’ or what we might now call “talk therapy”.

Although Bertha’s story occurred well over 100 years ago, many current patients may see themselves reflected in her symptoms, her emotional struggles, and the incomprehension that occurs in society, family, and the health field when encountering this complex mental health condition.

The ingredients for a conversion disorder are clear.  Bertha is growing up in a highly repressive society in which women have few options other than marriage and child bearing.  She has a marvelous intellect and potential but she knows that in all likelihood this beautiful capacity will be quashed by social expectations.  Add to this mix now that she is forced by her mother to take over the night shift of caring for her very ill father (parts of his illness are repulsive to someone who is not trained to work with blood and gore).  It is not surprising that she becomes traumatized by this experience and soon after develops a variety of medically unexplained symptoms (MSUs).

I have just finished reading Guises of Desire by Hilda Reilly (in a day and a half because I could not put it down). As a clinical psychologist who works with patients diagnosed with psychogenic non-epileptic seizures, a form of conversion disorder, and someone who studied the case of Anna O way back in college and graduate school, this book is an absolute pleasure. It not only brings this case study to life but it also gives Bertha the voice that did not come through in the sterilized case report (Studies on Hysteria).

In closing, I could not help but wonder what might have been of Bertha had she been treated with some of the newer trauma-focused approaches we now have at our disposal as therapists. But that we will never know… (This is not a spoiler because you have to read the book to see what happens to her life-it might surprise you).

Book is available in paperback and Kindle:

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