The Approach to the Study of Hysteria

Abstract

THE vicissitudes undergone by hysteria in the succession of the centuries have varied prodigiously, and he would be a bold clinician who to-day would announce their definitive end. Phases of medical doctrine run their course and have their day, but hysteria goes on. Doubtless in the present era of psychological grace we who have been conscious of the immense strides taken by psycho-pathological research are prone to believe, if not, perhaps, to feel entirely sure, that hysteria has at length yielded its secret-a discovery often yielded before, but never, we fain would pride ourselves, with so valid a pathogenesis on which to base the claim. If, for the nonce, however, we approach the question from the standpoint of pure empiricism, confidence may conceivably be somewhat shaken.To this empirical approach objection cannot be raised, No reason exists why study of the objective clinical phenomena of the condition should not be prosecuted, deductions therefrom as to their nature drawn, and generalizations of a nosological dharacter formulated, or, at least, attempted. Nothing, however, has been more typical of this period of psychological study, so far as hysteria is concerned, than the comparative absence of research of an objective and empirical kind. Can it be that acceptance of the former method dispenses with all necessity to conduct the latter ? If this be the case, then psychological theory stands to lose in impressiveness. It is not so very long ago since a distinguished protagonist of new conceptions of hysteria, in a psychiatry club of which I was a member, listened with mild impatience to my exposition of certain neuro-physiological peculiarities in hysterical symptoms, and closed discussion by declaring that since the neurosis had its demonstrable origin in a vita sexualis which did not run smooth its semeiology was of merely secondary interest and minor importance.Possibly the outstanding feature of hysteria as revealed to us by the records of former generations and the knowledge of our own is the changes which its clinical syndromes have suffered. This simple fact of observation must appear deeply significant, as fruitful for theory as it is true in substance. The mediaval ecstatic, simulating in hands and feet the nail-prints of her Redeemer, is long since d6mod6e, as is her eighteenth-century sister, melodramatically counterfeiting the emotional transports of a popular actress. I quote from Kay's Portraits, published in 1837 At the first visit of the great Mrs. Siddons to Edinburgh, many were the fainting and hysterical fits among the fairer portion of the audience. Indeed, they were so common that to be supposed to have escaped might almost have argued a want of proper feeling. One night when the house bad been thrown into confusion by repeated scenes of this kind, and when Mr. Wood (a popular surgeon) was most reluctantly getting from the pit (the favourite resort of all the theatrical critics of that day) to attend some fashionable female, a friend said to him in passing, " This is glorious acting, ...

Hysteria, conversion and functional disorders: a neurological contribution to classification issues

“…This is an ambiguous and confusing term with a long history and a diversity of meanings even among neurologists, 6,7 which led Kinnier Wilson to recommend its abolition as long ago as 1930. 8 A key feature of neurological symptoms in conversion disorder is that they defy our present and quite long understanding of neuroanatomy and neurophysiology. Patients have their own mental conceptions of right and left, of how motor or sensory function is distributed in a limb, of the function of muscle agonists and antagonists, and of the motor components of a seizure, which are quite different to those of a neurologist or a neurologically trained psychiatrist or physician.…”

“…Indeed, vasomotor changes of presumed autonomic origin may be detectable in some paralysed limbs of hysterical origin. 8 Hysteria Epilepsy and hysteria/conversion are universal disorders, perhaps as old as mankind itself. But whereas the variety and phenomena of seizures have not changed since Babylonian times, 9 historians of hysteria have indicated that the clinical phenomena continue to vary with historical periods, ethnicity and culture.…”

“…But whereas the variety and phenomena of seizures have not changed since Babylonian times, 9 historians of hysteria have indicated that the clinical phenomena continue to vary with historical periods, ethnicity and culture. 8,10 Epileptic seizures appear to be physiological reactions, truly a functional disorder of the nervous system, whether or not any pathology is present. Whereas, hysterical/conversion phenomena remain highly suspicious of psychological reactions that can also occur whether or not any underlying neuropathology is present, as for example, in multiple sclerosis or epilepsy.…”