• DOI:10.1038/sj.sc.3101327
• Corpus ID: 215237272

Hysteria

@article{Illis2002Hysteria,
  title={Hysteria},
  author={L. S. Illis},
  journal={Spinal Cord},
  year={2002},
  volume={40},
  pages={311-312}
}

• L. Illis
• Published 2002
• Psychology, Medicine
• Spinal Cord

Hysteria has a long and complicated record. A narrative which is unlikely to have a basis in a pathological entity unchanging throughout its history. The earliest record is probably an Egyptian medical papyrus dating from around 1990 BC recording peculiar abnormalities produced by movement of the uterus, moving upwards from the pelvis, applying pressure on the diaphragm and giving rise to bizarre physical and mental symptoms. Plato (c. 429 ± 347 BC) continued the descriptive language to evoke what men found particularly irritating or incomprehensible about women `The animal within them is desirous of procreating children, and when remaining unfruitful . . .gets discontented and angry, and wandering in every direction through the body . . .drives them to extremity, causing all varieties of disease . . .'. Hippocrates (c. 460 ± 377 BC) described how the female reproductive parts, moving, convulsing or prolapsing caused dizziness, motor paralysis and sensory disturbance. Galen (AD 129 ± 216?) regarded the cause as being due to the retention of excessive menstrual blood. The onset and expansion of Christian civilisation produced a change towards the supernatural and hysteria was regarded as a sign of possession by the devil. Advances in the understanding of the human nervous system produced a shift from gynaecological and demonological theories. Thomas Willis (1621 ± 1675) thought that an excess of animal spirits was released from the brain and carried by the nerves to eventually enter the blood stream and circulate throughout the body. Robert Whytt (1714 ± 1766), who ®rst described the phenomena of spinal shock, thought that the disorder was caused by a disturbance or weakness of the nerve ®bres. Charcot (1825 ± 1893) felt that hysteria was a dysfunction of the central nervous system. Briquet, a nineteenth century French neurologist, has, somewhat dubiously, been credited with the ®rst description of the syndrome of hysteria, and always insisted that it was a neurological disorder. Briquet's Syndrome is now known as somatisation disorder, although the symptoms that Briquet actually described show a greater resemblance to conversion disorder. The term historical conversion was introduced by John Ferriar: `In hysterical conversion the body possesses a power of representing the most hazardous disorders . . . of counterfeiting the greatest derangement . . .has in this class of diseases, reconciled contradictions, and realised improbabilities with a mysterious versatility. . . .' Freud also used the term conversion hysteria: `In hysteria, the incompatible idea is rendered innocuous by its sum of excitation being transformed in to something somatic. For this I would like to propose the name of conversion'. Freud invoked, at ®rst, sexual trauma, and then sexual fantasy as the key pathogenic factor with the emphasis, therefore, on psychological mechanisms, ie the repression of remote traumatic memories invariably sexual in content. Over the last century or so there has been a decline in the recorded incidence of hysteria, partly perhaps due to a sexual liberalisation but also to the fact that many previously described symptoms and syndromes are now reassigned to organic disorders and the psychoses and psychoneuroses. In the past hysteria has not only produced brilliant clinical observation and neuropathological and psychological research, it has also been the vehicle for sensationalism and misogyny. The obvious problem when confronted with a patient with unexplained neurological or other complaints is making an accurate diagnosis and, in this particular case, to rule out other physical and psychiatric disorders which require treatment. There are modern diagnostic criteria but there remains confusion. The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994, 4th Edition) does not show full agreement with the ICD-10 classi®cation (World Health Organisation, The ICD-10 Classi®cation of Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines, 1992). In the DSM-IV, conversion disorder is classi®ed with the somatoform disorders, whereas dissociative symptoms such as hysterical fugue states are classi®ed under dissociative disorders. The ICD-10 classi®cation groups them altogether under neurotic, stress-related, and somatoform disorders. The term hysteria has been dropped from both classi®cations although it is still widely used in practice. DSM-IV criteria for somatisation disorder (Briquet's Syndrome) includes: