Hysteria

Hysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by events in one's past^{[citation needed]} that involved some sort of severe conflict. The fear can be centered on a body part, or most commonly, on an imagined problem with that body part. Disease is a common complaint; see also body dysmorphic disorder and hypochondriasis. Generally, modern medical professionals have given up the use of "hysteria" as a diagnostic category, replacing it with more precisely defined categories such as somatization disorder. In 1980, the American Psychiatric Association officially changed the diagnosis of "hysterical neurosis, conversion type" to "conversion disorder".

History

For at least two thousand years of European history until the late nineteenth century hysteria referred to a medical condition thought to be particular to women and caused by disturbances of the uterus (from the Greek ὑστέρα "hystera" = uterus), such as when a newborn child emerges from the female birth canal. The origin of the term hysteria is commonly attributed to Hippocrates, even though the term isn't used in the writings that are collectively known as the Hippocratic corpus.^[1] The Hippocratic corpus refers to a variety of illness symptoms, such as suffocation and Heracles' disease, that were supposedly caused by the movement of a woman's uterus to various locations within her body as it became light and dry due to a lack of bodily fluids.^[1] One passage recommends pregnancy to cure such symptoms, ostensibly because intercourse will "moisten" the womb and facilitate blood circulation within the body.^[1] The "wandering womb" theory persisted in European medicine for centuries.

By the mid to late 19th century, hysteria (or sometimes female hysteria) came to refer to what is today generally considered to be sexual dysfunction.^[2] Typical treatment was massage of the patient's genitalia by the physician and, later, by vibrators or water sprays to cause orgasm.^[2]

Professor Jean-Martin Charcot of Paris Salpêtrière demonstrates hypnosis on a "hysterical" patient.

A more modern understanding of hysteria as a psychological disorder was advanced by the work of Jean-Martin Charcot, a French neurologist. In his 1893 obituary of Charcot, Sigmund Freud attributed the rehabilitation of hysteria as a topic for scientific study to the positive attention generated by Charcot’s neuropathological investigations of hysteria during the last ten years of his life.^[3] Freud questioned Charcot’s claim that heredity is the unique cause of hysteria, but he lauded his innovative clinical use of hypnosis to demonstrate how hysterical paralysis could result from psychological factors produced by non-organic traumas (psychological factors that Charcot believed could be simulated through hypnosis).^[3] To Freud, this discovery allowed subsequent investigators such as Pierre Janet and Josef Breuer to develop new theories of hysteria that were essentially similar to the medieval conception of a split consciousness, but with the nonscientific terminology of demonic possession replaced with modern psychological concepts.^[3]

In the early 1890s Freud published a series of articles on hysteria which popularized Charcot's earlier work and began the development of his own views of hysteria. By the 1920s Freud's theory was influential in Britain and the USA. The Freudian psychoanalytic school of psychology uses its own, somewhat controversial, ways to treat hysteria. Freudian psychoanalytic theory attributed hysterical symptoms to the unconscious mind's attempt to protect the patient from psychic stress. Unconscious motives include primary gain, in which the symptom directly relieves the stress (as when a patient coughs to release energy pent up from keeping a secret), and secondary gain, in which the symptom provides an independent advantage, such as staying home from a hated job. More recent critics have noted the possibility of tertiary gain, when a patient is induced unconsciously to display a symptom because of the desires of others (as when a controlling spouse enjoys the docility of his or her sick partner).

Many now consider hysteria to be a legacy diagnosis (i.e., a catch-all junk diagnosis),^[4] particularly due to its long list of possible manifestations: one Victorian physician cataloged 75 pages of possible symptoms of hysteria and called the list incomplete.^[5]

Current theories and practices

Current psychiatric terminology distinguishes two types of disorder that were previously labelled 'hysteria': somatoform and dissociative. The dissociative disorders in DSM-IV-TR include dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified. Somatoform disorders include conversion disorder, somatization disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. In somatoform disorders, the patient exhibits physical symptoms such as low back pain or limb paralysis, without apparent physical cause. Additionally, certain culture-bound syndromes such as "ataques de nervios" ("attacks of nerves") identified in Hispanic populations, and popularized by the Almodóvar film Women on the Verge of a Nervous Breakdown, exemplify psychiatric phenomena that encompass both somatoform and dissociative symptoms and that have been linked to psychological trauma.^[6] Recent neuroscientific research, however, is starting to show that there are characteristic patterns of brain activity associated with these states.^[7] All these disorders are thought to be unconscious, not feigned or intentional malingering.

Jungian psychologist Laurie Layton Schapira explored what she labels a "Cassandra Complex" suffered by those traditionally diagnosed with hysteria, denoting a tendency for those with hysteria to be disbelieved or dismissed when relating the facts of their experiences to others.^[8] Based on clinical experience, she delineates three factors which constitute the Cassandra complex in hysterics: (a) dysfunctional relationships with social manifestations of rationality, order, and reason, leading to; (b) emotional or physical suffering, particularly in the form of somatic, often gynaecological complaints, and (c) being disbelieved or dismissed when attempting to relate the facticity of these experiences to others.^[8]

Mass hysteria

The term also occurs in the phrase "mass hysteria" to describe mass public near-panic reactions. It is commonly applied to the waves of popular medical problems that "everyone gets" in response to news articles. Hysteria was often associated with events like the Salem witch trials, or slave revolt conspiracies, where it is better understood through the related sociological term of moral panic.

See also

• Histrionic Personality Disorder
• Hysterical contagion
• Body-centred countertransference
• Somatization disorder
• Horror and terror

References

Further reading

• Chodoff, P. et al. (1982). Hysteria. New York, NY: John Wiley & Sons.
• Halligan, P.W., Bass, C., & Marshall, J.C. (Eds.) (2001) Contemporary Approach to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford University Press, UK.
• Sander Gilman, Roy Porter, George Rousseau, Elaine Showalter, and Helen King (1993). Hysteria Beyond Freud (Berkeley, Los Angeles, and Oxford: University of California Press).

External links

• Is Hysteria Real? Brain Images Say Yes at the New York Times.
• The H-Word, Guardian Unlimited, 2002-09-02

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