Hysteria

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An 1893 depiction of a woman with hysteria Drawings of a woman in catalepsy by Albert Londe.jpg
An 1893 depiction of a woman with hysteria

Hysteria is a term used to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. [1] In the nineteenth century, female 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]

Contents

Currently, most physicians 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 BCE when Egyptians recorded behavioral abnormalities in adult women on the Kahun Papyrus. [7] The Egyptians attributed the behavioral disturbances to a wandering uterus –thus the condition later being dubbed 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 unwillingness to marry. [8] Plato and Aristotle believed that hysteria, which Plato also called female madness, was directly related to these women’s lack of sexual activity and described the uterus as those who suffered from it as having a sad, bad, or melancholic uterus. [7] In the 5th century BCE Hippocrates first used the term hysteria. [7] 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. At this time, writings such as Constantine the African’s Viaticum and Pantegni, described women with hysteria as the cause of amor heroycus, a form of sexual desire so strong that it caused madness, rather than someone with a problem who should be cured. [7]

Trota de Ruggiero is considered the first female doctor in Christian Europe as well as the first gynecologist, though she could not become a magister. She recognized that women were often ashamed to go to a doctor with gynecological issues, and studied women’s diseases and attempted to avoid common misconceptions and prejudice of the era. She prescribed remedies such as mint for women suffering from hysteria. [7] Hildegard of Bingen was another female doctor, whose work was part of an attempt to combine science and faith. She agreed with the theories of Hippocrates and suggested hysteria may be connected to the idea of original sin; She believed that men and women were both responsible for original sin, and could both suffer from hysteria. [7] Furthermore, during the Renaissance period many patients of hysteria were prosecuted as witches and underwent interrogations, torture, exorcisms, and execution. [9] During this time the common point of view was that women were inferior beings, connected to Aristotle’s ideas of male superiority. Saint Thomas Aquinas supported this idea and in his writing, Summa Theologica stated “'some old women' are evil-minded; they gaze on children in a poisonous and evil way, and demons, with whom the witches enter into agreements, interacting through their eyes”. [10] This type of fear of witches and sorcery is part of the rules of celibacy and chastity imposed on the clergy. [7] Philippe Pinel believed that there was little difference between madness and healthy people, and believed that people should be treated if they were unwell. He considered hysteria a female disorder. [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 Le Pois 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] [11] Joseph Raulin published a work in 1748, associating hysteria with the air quality in cities, he suggested that men and women could both have hysteria, women would be more likely to have it due to laziness. [7] [12]

In 1859 Paul Briquet defined hysteria as a chronic syndrome manifesting in many unexplained symptoms throughout the body's organ systems. [13] What Briquet described became known as Briquet's syndrome, or Somatization disorders, in 1971. [14] Over a ten-year period, Briquet conducted 430 case studies of patients with hysteria. [13] Following Briquet, Jean-Martin Charcot studied women in an asylum in France and used hypnosis as treatment. [4] Charcot detailed the intricacies of hysteria, understanding it as being caused by patriarchy. [8] [12] He also mentored Pierre Janet, another French psychologist, who studied five of hysteria's symptoms (anaesthesia, amnesia, abulia, motor control diseases, and character change) in depth and proposed that hysteria symptoms occurred due to a lapse in consciousness. [15] Both Charcot and Janet inspired Freud's work.Freud theorized hysteria stemmed from childhood sexual abuse or repression. Briquet, Freud and Charcot noted male hysteria; both genders could exhibit the syndrome. Hysterics may be able to manipulate their caretakers thus complicating treatment. [7] [8]

L.E. Emerson was a Freudian who worked at the Boston Psychopathic Hospital and saw hysteric patients.  Literary Scholar Elizabeth Lunbeck, stated that most of hysteric patients at this hospital, were typically single from either being young or purposefully avoiding men for past sexual abuse. Emerson published case studies on his patients and was more interested in the stories they told, relating their stories to sex and their inner sexual conflicts. Emerson stated that their hysteria, which ranged from self-harm to immense guilt for what happened, was due to the patients' traumas or a lack of sexual knowledge, to which he stated that they were sexually repressed. [16]

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. [8] 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, along with the use of the diagnosis of shell-shock, westernization, and migration shifted Western mental health expectations. [4] [7] [12] [17] 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. World Wars caused military doctors to become focused on hysteria as during this time there seemed to be a rise in cases, especially under instances of high stress, in 1919 Arthur Frederick Hurst wrote that “many cases of gross hysterical symptoms occurred in soldiers who had no family or personal history of neuroses, and who were perfectly fit”. In 1970 Colin P. McEvedy and Alanson W. Beard [18] suggested that Royal Free Disease (Royal Free Hospital outbreak, now also known as myalgic encephalomyelitis/chronic fatigue syndrome a neurological disease), which mainly affected young women, was an epidemic of hysteria. [19] They also said that hysteria had a historically negative connotation, however that should not prevent doctors from assessing symptoms of the patient. [7] [12] [17] 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] [14]

The term is still used in the twenty-first century, though not as a diagnosis. When used, it is often a general term for any dramatic displays of outrage or emotion. [8]

Andre Brouillet: A Clinical Lesson at the Salpetriere Pr Charcot DSC09405.jpg
André Brouillet: A Clinical Lesson at the Salpêtrière

Historical symptoms

Historically, the symptoms of hysteria have a large range. [20] [21] [15]

Historical treatment

Notable theorists

Charcot

In the late nineteenth century, French neurologist Jean-Martin Charcot tackled what he referred to as "the great neurosis" or hysteria. [25] Charcot theorized that hysteria was a hereditary, physiological disorder. [25] He believed hysteria impaired areas of the brain which provoked the physical symptoms displayed in each patient. [25] While Charcot believed hysteria was hereditary, he also thought that environmental factors such as stress could trigger hysteria in an individual. [26]

Charcot published more than 120 case studies of patients who he diagnosed with hysteria, including Marie Wittman. [27] Whittman was referred to as the "Queen of Hysterics", and remains the most famous patient of hysteria. [27] To treat his patients, Charcot used hypnosis, which he determined was successful only when used on hysterics. [27] Using patients as props, Charcot executed dramatic public demonstrations of hysterical patients and his cures for hysteria, which many suggest produced the hysterical phenomenon. [27] 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". [28] The paper explains how Freud believes his female patients' neurosis, which he labels hysteria, resulted from sexual abuse as children. [28] Freud named the concept of physical symptoms resulting from childhood trauma: hysterical conversion. [28] 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. [28] However, Freud later changed his theory. [28] His new theory claimed that his patients imagined the instances of sexual abuse, which were instead repressed childhood fantasies. [28] By 1905, Freud retracted the theory of hysteria resulting from repressed childhood fantasies. Freud was also one of the first noted psychiatrists to attribute hysteria to men. [7] He diagnosed himself with hysteria, writing that he feared his work had exacerbated his condition. [7]

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. [29] 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. [7] The term hysterical, applied to an individual, can mean that they are emotional, irrationally upset, or frenzied. [30] When applied to a situation not involving panic, hysteria means that that situation is uncontrollably amusing –the connotation being that it invokes hysterical laughter. [30]

See also

Related Research Articles

Psychoanalysis is a set of theories and therapeutic techniques that deal in part with the unconscious mind, and which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Sigmund Freud, whose work stemmed partly from the clinical work of Josef Breuer and others. Freud developed and refined the theory and practice of psychoanalysis until his death in 1939. In an encyclopedic article, he identified the cornerstones of psychoanalysis as "the assumption that there are unconscious mental processes, the recognition of the theory of repression and resistance, the appreciation of the importance of sexuality and of the Oedipus complex." Freud's colleagues Alfred Adler and Carl Gustav Jung developed offshoots of psychoanalysis which they called individual psychology (Adler) and analytical psychology (Jung), although Freud himself wrote a number of criticisms of them and emphatically denied that they were forms of psychoanalysis. Psychoanalysis was later developed in different directions by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

Dissociative identity disorder (DID), previously known as multiple personality disorder, is one of multiple dissociative disorders in the DSM-5, DSM-5-TR, ICD-10, ICD-11, and Merck Manual. It has a history of extreme controversy.

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.

<span class="mw-page-title-main">Conversion disorder</span> Diagnostic category used in some psychiatric classification systems

Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established organic cause, which cause significant distress, and can be traced back to a psychological trigger. It is thought that these symptoms arise in response to stressful situations affecting a patient's mental health or an ongoing mental health condition such as depression. Conversion disorder was retained in DSM-5, but given the subtitle functional neurological symptom disorder. The new criteria cover the same range of symptoms, but remove the requirements for a psychological stressor to be present and for feigning to be disproved. The ICD-10 classifies conversion disorder as a dissociative disorder, and the ICD-11 as a dissociative disorder with unspecified neurological symptoms. However, the DSM-IV classifies conversion disorder as a somatoform disorder.

<span class="mw-page-title-main">Jean-Martin Charcot</span> French neurologist (1825–1893)

Jean-Martin Charcot was a French neurologist and professor of anatomical pathology. He worked on groundbreaking work about hypnosis and hysteria, in particular with his hysteria patient Louise Augustine Gleizes. Charcot is known as "the founder of modern neurology", and his name has been associated with at least 15 medical eponyms, including various conditions sometimes referred to as Charcot diseases.

Neurasthenia is a term that was first used as early as 1829 for a mechanical weakness of the nerves. It became a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologist George Miller Beard reintroduced the concept in 1869.

False pregnancy is the appearance of clinical or subclinical signs and symptoms associated with pregnancy although the individual is not physically carrying a fetus. The mistaken impression that one is pregnant includes signs and symptoms such as tender breasts with secretions, abdominal growth, delayed menstrual periods, and subjective feelings of a moving fetus. Examination, ultrasound, and pregnancy tests can be used to rule out false pregnancy.

Psychogenic non-epileptic seizures (PNES), which have been more recently classified as functional seizures, are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND), also known as conversion disorders. These are typically treated by psychologists or psychiatrists. PNES has previously been called pseudoseizures, psychogenic seizures, and hysterical seizures, but these terms have fallen out of favor.

<span class="mw-page-title-main">Female hysteria</span> Outdated diagnosis for patients with multiple symptoms of a neurological condition

Female hysteria was once a common medical diagnosis for women. It was described as exhibiting a wide array of symptoms, including anxiety, shortness of breath, fainting, nervousness, sexual desire, insomnia, fluid retention, heaviness in the abdomen, irritability, loss of appetite for food or sex, even sexually forward behavior, and a "tendency to cause trouble for others". It is no longer recognized by medical authorities as a medical disorder. Its diagnosis and treatment were routine for hundreds of years in Western Europe.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

<span class="mw-page-title-main">Gender bias in medical diagnosis</span> Concept in medical & psychological diagnoses

Gender-biased diagnosing is the idea that medical and psychological diagnosis are influenced by the patient's gender. Several studies have found evidence of differential diagnosis for patients with similar ailments but of different sexes. Female patients face discrimination through the denial of treatment or miss-classification of diagnosis as a result of not being taken seriously due to stereotypes and gender bias. According to traditional medical studies, most of these medical studies were done on men thus overlooking many issues that were related to women's health. This topic alone sparked controversy and questions about the medical standard of our time. Popular media has illuminated the issue of gender bias in recent years. Research that was done on diseases that affected women more were less funded than those diseases that affected men and women equally.

The Aetiology of Hysteria is a paper by Sigmund Freud about the child sexual abuse of children before the age of puberty, and its possible causation of mental illness in adults. Presented in April or May 1896, it is where Freud first outlined his seduction theory.

Wandering womb was the belief that a displaced uterus was the cause of many medical pathologies in women. The belief is first attested in the medical texts of ancient Greece, but it persisted in European academic medicine and popular thought for centuries. The wandering womb as a concept was popularized by doctor Edward Jorden, who published The Suffocation of the Mother in 1603. Suffocation of the Mother was the first text on the subjects of the wandering womb and hysteria that was written in English.

In the nineteenth and early twentieth century, hysteria was a common psychiatric diagnosis made primarily in women. The existence and nature of a purported male hysteria was a debated topic around the turn of the century. It was originally believed that men could not suffer from hysteria because of their lack of uterus. This belief was discarded in the 17th century when discourse identified the brain or mind, and not reproductive organs, as the root cause of hysteria. During World War I, hysterical men were diagnosed with shell shock or war neurosis, which later went on to shape modern theories on PTSD. The notion of male hysteria was initially connected to the post-traumatic disorder known as railway spine; later, it became associated with war neurosis.

Functional neurologic disorder or functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms, and blackouts. As a functional disorder, there is by definition no known disease process affecting the structure of the body, yet the person experiences symptoms relating to their body function. Symptoms of functional neurological disorders are clinically recognisable, but are not categorically associated with a definable organic disease.

Paul Briquet or Pierre Briquet was a French physician and psychologist who advanced the reasoned treatment of disturbed people said to be hysterics.

<span class="mw-page-title-main">Louise Augustine Gleizes</span> 19th-century French woman

Louise Augustine Gleizes, known as Augustine or A, was a French woman who was publicly exhibited as a "hysteria" patient by neurologist Jean-Martin Charcot while she was held at the Salpêtrière Hospital in Paris.

References

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  21. 1 2 King H (January 4, 2002). Hippocrates' Woman: Reading the Female Body in Ancient Greece. Routledge. ISBN   978-1-134-77221-6.
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  30. 1 2 "hysterical adjective – Definition, pictures, pronunciation and usage notes | Oxford Advanced Learner's Dictionary at OxfordLearnersDictionaries.com". www.oxfordlearnersdictionaries.com. Retrieved May 1, 2020.

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