Hysteria

Hysteria is a term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion.[1] In the nineteenth century, hysteria was considered a diagnosable physical illness in women. It is assumed that the basis for diagnosis operated under the belief that women are predisposed to mental and behavioral conditions; an interpretation of sex-related differences in stress responses.[2] In the twentieth century, it shifted to being considered a mental illness.[3] Many influential people such as Sigmund Freud and Jean-Martin Charcot dedicated research to hysteria patients.[4]

An 1893 depiction of a woman with hysteria

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Currently, most doctors practicing medicine do not accept hysteria as a medical diagnosis.[5] The blanket diagnosis of hysteria has been fragmented into myriad medical categories such as epilepsy, histrionic personality disorder, conversion disorders, dissociative disorders, or other medical conditions.[5][6] Furthermore, lifestyle choices, such as choosing not to wed, are no longer considered symptoms of psychological disorders such as hysteria.[5]

History

The word hysteria originates from the Greek word for uterus, hystera. The oldest record of hysteria dates back to 1900 B.C. when Egyptians recorded behavioral abnormalities in adult women on medical papyrus. The Egyptians attributed the behavioral disturbances to a wandering uterus – thus later dubbing the condition hysteria. To treat hysteria Egyptian doctors prescribed various medications. For example, doctors put strong smelling substances on the patients' vulvas to encourage the uterus to return to its proper position. Another tactic was to smell or swallow unsavory herbs to encourage the uterus to flee back to the lower part of the female's abdomen.[5]

The ancient Greeks accepted the ancient Egyptians' explanation for hysteria; however, they included in their definition of hysteria the inability to bear children or the failure to marry. Ancient Romans also attributed hysteria to an abnormality in the womb; however, discarded the traditional explanation of a wandering uterus. Instead, the ancient Romans credited hysteria to a disease of the womb or a disruption in reproduction (i.e., a miscarriage, menopause, etc.). Hysteria theories from the ancient Egyptians, ancient Greeks, and ancient Romans were the basis of the Western understanding of hysteria.[5]

Between the fifth and thirteenth centuries, however, the increasing influence of Christianity in the Latin West altered medical and public understanding of hysteria. St. Augustine's writings suggested that human suffering resulted from sin, thus hysteria became perceived as satanic possession. With the shift in perception of hysteria came a shift in treatment options. Instead of admitting patients to a hospital, the church began treating patients through prayers, amulets, and exorcisms. Furthermore, during the Renaissance period many patients of hysteria were prosecuted as witches and underwent interrogations, torture, and execution.[7]

However, during the sixteenth and seventeenth centuries activists and scholars worked to change the perception of hysteria back to a medical condition. Particularly, French physician Charles Lepois insisted that hysteria was a malady of the brain. In addition, in 1697, English physician Thomas Sydenham theorized that hysteria was an emotional condition, instead of a physical condition. Many physicians followed Lepois and Sydenham's lead and hysteria became disassociated with the soul and the womb. During this time period, science started to focalize hysteria in the central nervous system. As doctors developed a greater understanding of the human nervous system, the neurological model of hysteria was created, which further propelled the conception of hysteria as a mental disorder.[4][8]

In 1859 Paul Briquet defined hysteria as a chronic syndrome manifesting in many unexplained symptoms throughout the body's organ systems.[9] What Briquet described became known as Briquet's syndrome, or Somatization disorders, in 1971.[10] Over a ten-year period, Briquet conducted 430 case studies of patients with hysteria.[9] Following Briquet, Jean-Martin Charcot studied women in an asylum in France and used hypnosis as treatment.[4] He also mentored Pierre Janet, another French psychologist, who studied five of hysteria's symptoms (anesthesia, amnesia, abulia, motor control diseases, and character change) in depth and proposed that hysteria symptoms occurred due to a lapse in consciousness.[11] Both Charcot and Janet inspired Freud's work. Freud theorized hysteria stemmed from childhood sexual abuse or repression, and was also one of the first to apply hysteria to men.[12]

During the twentieth century, as psychiatry advanced in the West, anxiety and depression diagnoses began to replace hysteria diagnoses in Western countries. For example, from 1949 to 1978, annual admissions of hysteria patients in England and Wales decreased by roughly two thirds. With the decrease of hysteria patients in Western cultures came an increase in anxiety and depression patients. Theories for why hysteria diagnoses began to decline vary, but many historians infer that World War II, westernization, and migration shifted Western mental health expectations.[4][12] Twentieth-century western societies expected depression and anxiety manifest itself more in post World War II generations and displaced individuals; and thus, individuals reported or were diagnosed accordingly. In addition, medical advancements explained ailments that were previously attributed to hysteria such as epilepsy or infertility. In 1980, after a gradual decline in diagnoses and reports, hysteria was removed from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which had included hysteria as a mental disorder from its second publication in 1968.[4][10]

André Brouillet: A Clinical Lesson at the Salpêtrière

Historical symptoms

Historically, the symptoms of hysteria have a large range.[13][14][11]

  • Shortness of breath
  • Anxiety
  • Insomnia
  • Fainting
  • Amnesia
  • Paralysis
  • Pain
  • Spasms
  • Convulsive fits
  • Vomiting
  • Deafness
  • Bizarre movements
  • Seizures
  • Hallucinations
  • Inability to speak[13][14][11]
  • Infertility[15]

Historical treatment
  • Regular marital sex[16]
  • Pregnancy[16]
  • Childbirth[16]
  • "Paroxysmal convulsions" (orgasms)[16]
  • Rest cure[15]

Notable figures

Charcot

In the late nineteenth century French neurologist Jean-Martin Charcot tackled what he referred to as "the great neurosis" or hysteria.[17] Charcot theorized that hysteria was a hereditary, physiological disorder.[17] He believed hysteria impaired areas of the brain which provoked the physical symptoms displayed in each patient.[17] While Charcot believed hysteria was hereditary, he also thought that environmental factors such as stress could trigger hysteria in an individual.[18]

Charcot published more than 120 case studies of patients who he diagnosed with hysteria, including Marie "Blanche" Whittman.[19] Whittman was referred to as the "Queen of Hysterics," and remains the most famous patient of hysteria.[19] To treat his patients, Charcot used hypnosis, which he determined was successful only when used on hysterics.[19] Using patients as props, Charcot executed dramatic public demonstrations of hysterical patients and his cures for hysteria, which many suggest produced the hysterical phenomenon.[19] Furthermore, Charcot noted similarities between demon possession and hysteria, and thus, he concluded "demonomania" was a form of hysteria.[4]

Freud

In 1896 Sigmund Freud, an Austrian neurologist, published "The Aetiology of Hysteria".[20] The paper explains how Freud believes his female patients' neurosis, which he labels hysteria, resulted from sexual abuse as children.[20] Freud named the concept of physical symptoms resulting from childhood trauma: hysterical conversion.[20] Freud hypothesized that in order to cure hysteria the patient must relive the experiences through imagination in the most vivid form while under light hypnosis.[20] However, Freud later changed his theory.[20] His new theory claimed that his patients imagined the instances of sexual abuse, which were instead repressed childhood fantasies.[20] By 1905, Freud retracted the theory of hysteria resulting from repressed childhood fantasies. Freud was also one of the first noted psychiatrist to attribute hysteria to men.[12] He diagnosed himself with hysteria, writing that he feared his work had exacerbated his condition.[12]

Modern perceptions

For the most part, hysteria does not exist as a medical diagnosis in Western culture and has been replaced by other diagnoses such as conversion or functional disorders.[21] The effects of hysteria as a diagnosable illness in the eighteenth and nineteenth centuries has had a lasting effect on the medical treatment of women's health.[12] The term hysterical, applied to an individual, can mean that they are emotional, irrationally upset, or frenzied.[22] When applied to a situation not involving panic, hysteria means that that situation is uncontrollably amusing – the connotation being that it invokes hysterical laughter.[22]

See also
  • Body-centred countertransference
  • Borderline personality disorder
  • Fainting room
  • Female hysteria
  • Histrionic personality disorder
  • Hysterical contagion
  • Male hysteria
  • Panic attack
  • Scotomization
  • Somatization disorder
  • Wandering womb

References
  1. Basavarajappa, Chethan; Dahale, Ajit Bhalchandra; Desai, Geetha (2020). "Evolution of bodily distress disorders". Current Opinion in Psychiatry. Publish Ahead of Print (5): 447–450. doi:10.1097/YCO.0000000000000630. ISSN 0951-7367. PMID 32701520. S2CID 220731306.
  2. Chaplin TM, Hong K, Bergquist K, Sinha R (July 2008). "Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving". Alcoholism: Clinical and Experimental Research. 32 (7): 1242–1250. doi:10.1111/j.1530-0277.2008.00679.x. PMC 2575018. PMID 18482163.
  3. Beattie M, Lenihan P (2018). Counselling Skills for Working with Gender Diversity and Identity. London: Jessica Kingsley Publishers. p. 83. ISBN 9781785927416.
  4. North CS (November 2015). "The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations". Behavioral Sciences. 5 (4): 496–517. doi:10.3390/bs5040496. PMC 4695775. PMID 26561836.
  5. Micale MS (January 15, 2019). Approaching Hysteria: Disease and Its Interpretations. Princeton University Press. ISBN 978-0-691-60561-6.
  6. Slater E (May 1965). "Diagnosis of "Hysteria"". British Medical Journal. 1 (5447): 1395–1399. doi:10.1136/bmj.1.5447.1395. PMC 2166300. PMID 14286998.
  7. Abse DW (September 24, 2013). Hysteria and Related Mental Disorders: An Approach to Psychological Medicine. Butterworth-Heinemann. ISBN 978-1-4832-2166-3.
  8. Gilman SL, King H, Porter R, Rousseau GS (January 1, 1993). Hysteria Beyond Freud. University of California Press. ISBN 978-0-520-08064-5.
  9. Mai FM, Merskey H (February 1981). "Briquet's concept of hysteria: an historical perspective". Canadian Journal of Psychiatry. 26 (1): 57–63. doi:10.1177/070674378102600112. PMID 7008930. S2CID 45207808.
  10. Winstead BA (1984). "Hysteria". In Widom CS (ed.). Sex Roles and Psychopathology. Springer US. pp. 73–100. doi:10.1007/978-1-4684-4562-6_4. ISBN 978-1-4684-4562-6.
  11. Janet P (1920). The Major Symptoms of Hysteria: Fifteen Lectures Given in the Medical School of Harvard University. Macmillan Company.
  12. Tasca C, Rapetti M, Carta MG, Fadda B (October 19, 2012). "Women and hysteria in the history of mental health". Clinical Practice and Epidemiology in Mental Health. 8: 110–119. doi:10.2174/1745017901208010110. PMC 3480686. PMID 23115576.
  13. Charcot JM (December 19, 2013). Clinical Lectures on Diseases of the Nervous System (Psychology Revivals). Routledge. ISBN 978-1-317-91001-5.
  14. King H (January 4, 2002). Hippocrates' Woman: Reading the Female Body in Ancient Greece. Routledge. ISBN 978-1-134-77221-6.
  15. "Female hysteria: The history of a controversial 'condition'". www.medicalnewstoday.com. October 13, 2020. Retrieved April 6, 2021.
  16. "The History of Hysteria". Office for Science and Society. Retrieved April 6, 2021.
  17. Mota Gomes M, Engelhardt E (December 2014). "A neurological bias in the history of hysteria: from the womb to the nervous system and Charcot". Arquivos de Neuro-Psiquiatria. 72 (12): 972–975. doi:10.1590/0004-282X20140149. PMID 25517645.
  18. Evans M (January 24, 2019). Fits and Starts: A Genealogy of Hysteria in Modern France. Cornell University Press. ISBN 978-1-5017-3431-1.
  19. Hustvedt A (May 23, 2011). Medical Muses: Hysteria in Nineteenth-Century Paris. W. W. Norton & Company. ISBN 978-0-393-08217-3.
  20. Eisen J (January 1, 2001). Suppressed Inventions. Penguin. ISBN 978-0-399-52735-7.
  21. Reynolds EH (October 2012). "Hysteria, conversion and functional disorders: a neurological contribution to classification issues". The British Journal of Psychiatry. 201 (4): 253–254. doi:10.1192/bjp.bp.111.107219. PMID 23028080.
  22. "hysterical adjective – Definition, pictures, pronunciation and usage notes | Oxford Advanced Learner's Dictionary at OxfordLearnersDictionaries.com". www.oxfordlearnersdictionaries.com. Retrieved May 1, 2020.

Further reading
  • Briquet P (1859). Traité clinique et thérapeutique de l'Hystérie. JB Baillière – via Gallica.
  • Chodoff P (May 1982). "Hysteria and women". The American Journal of Psychiatry. 139 (5): 545–551. doi:10.1176/ajp.139.5.545. PMID 7041658.
  • Halligan PW, Bass C, Marshall JC, eds. (2001). Contemporary Approach to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford: Oxford University Press. ISBN 978-0-19-263254-8.
  • Hennefeld M (December 2016). "Death from Laughter, Female Hysteria, and Early Cinema". differences: A Journal of Feminist Cultural Studies. Duke University Press. 27 (3): 45–92. doi:10.1215/10407391-3696631.
  • Rousseau GS, Gilman SL, King H, Porter R, Showalter E, eds. (1993). Hysteria beyond Freud. Berkeley: University of California Press. ISBN 978-0-520-08064-5.
  • Santiago, Christopher (Autumn 2021). Costa, Luiz; Ferme, Marianne; Kaur, Raminder; Kipnis, Andrew B. (eds.). "Twilight states: Comparing case studies of hysteria and spirit possession". HAU: Journal of Ethnographic Theory. University of Chicago Press. 11 (2): 635–659. doi:10.1086/715812. ISSN 2049-1115.
  • Scull A (2009). Hysteria : the biography. Oxford: Oxford University Press. ISBN 978-0-19-956096-7.
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