hysteria

hysteria, in psychology, a disorder commonly known today as conversion disorder, in which a psychological conflict is converted into a bodily disturbance. It is distinguished from hypochondria by the fact that its sufferers do not generally confuse their condition with real, physical disease. Conversion disorder is usually found in patients with immature, histrionic personalities who are under great stress. Women are affected twice as frequently as men. Symptoms, which are largely symbolic and which relieve the patient's anxiety, include limb paralysis, blindness, or convulsive seizures. The specific physical disorder usually does not correspond to the anatomy; e.g., an entire limb may be paralyzed rather than a specific group of muscles. The person may also appear to be unconcerned about the illness, a condition French psychiatrist Pierre Janet called la belle indifference (1929). At the end of the 19th cent., great advances were made in the understanding and cure of hysteria by the recognition of its psychogenic nature and by the use of hypnotism to influence the hysteric patient, who is known to have a high degree of suggestibility. The Austrian physician Josef Breuer, the French psychologists J. M. Charcot and Pierre Janet, and Austrian psychiatrist Sigmund Freud were pioneers in the investigation of hysteria through hypnosis. Freud concluded that hysterical symptoms were symbolic representations of a repressed unconscious event, accompanied by strong emotions that could not be adequately expressed or discharged at the time. Instead, the strong effect associated with the event was diverted into the wrong somatic channels (conversion), and the physical symptom resulted. Psychoanalysis has had reasonable success in helping patients suffering from conversion disorder.

formerly hysteria

In psychology, a neurosis marked by extreme emotional excitability and disturbances of psychic, sensory, vasomotor, and visceral functions. The earlier concept of hysteria was used frequently in the first half of the 20th century to explain a wide variety of symptoms and behaviours observed particularly in women. (The term hysteria derives from the Greek word for womb, reflecting the Greeks' belief that the condition resulted from disturbances of the uterus.) Disorders with symptoms similar to those of conversion disorder include factitious disorder, dissociative identity disorder, and personality disorder (histrionic type).

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Hysteria, in its colloquial use, describes a state of mind, one of unmanageable fear or emotional excesses. The fear is often caused by multiple events in one's past 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. And see also Body dysmorphic disorder and Hypochondriasis. People who are "hysterical" often lose self-control due to the overwhelming fear.

Psychiatrists and other physicians have in theory given up the use of "hysteria", replacing it with more euphemistic terms that are essentially synonyms. These include "psychosomatic", "functional", "nonorganic", "psychogenic", and "medically unexplained". In 1980 the American Psychiatric Association officially changed the diagnosis of "hysterical neurosis, conversion type" to "conversion disorder". Hysteria also has significant overlap with the diagnostic term "somatization disorder" and with somatoform disorders in general.

History

The term originates with the Greek medical term, hysterikos. This referred to a medical condition, thought to be particular to women, caused by disturbances of the uterus, hystera in Greek. The term hysteria was coined by Hippocrates, who thought that suffocation and madness arose in women whose uteri had become too light and dry from lack of sexual intercourse and, as a result, wandered upward, compressing the heart, lungs, and diaphragm.

The same general definition, or under the name female hysteria, came into widespread use in the middle and late 19th century to describe what is today generally considered to be sexual dissatisfaction. Typical treatment was massage of the patient's genitalia by the physician and later vibrators or water sprays to cause orgasm. By the early 1900s, the practice and usage of the term had fallen from use until it was again popularized when the writings of Sigmund Freud became known and influential in Britain and the USA in the 1920s. The Freudian psychoanalytic school of psychology uses its own, somewhat controversial, ways to treat hysteria.

The knowledge of hysterical processes was advanced by the work of Jean-Martin Charcot, a French neurologist. However, many now consider hysteria to be a legacy diagnosis (i.e., a catch-all junk diagnosis), 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..

Current psychiatric terminology distinguishes two types of hysteria: somatoform and dissociative. Dissociative hysteria includes amnestic fugue states. Somatoform disorders include conversion disorder, somatization disorder, chronic 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. Recent neuroscientific research, however, is starting to show that there are characteristic patterns of brain activity associated with these states. All these disorders are thought to be unconscious, not feigned or intentional malingering.

Freudian psychoanalytic theory attributed hysterical symptoms to the subconscious mind's attempt to protect the patient from psychic stress. Subconscious 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 subconsciously to display a symptom because of the desires of others (as when a controlling husband enjoys the docility of his sick wife). There need be no gain at all, however, in a hysterical symptom. A child playing hockey may fall and for several hours believe he is unable to move, because he has recently heard of a famous hockey player who fell and broke his neck.

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 facticity of their experiences to others. 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.

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.

A similar usage refers to any sort of "public wave" phenomenon, and has been used to describe the periodic widespread reappearance and public interest in UFO reports, crop circles, and similar examples. Also, when information, real or fake, becomes misinterpreted but believed, e.g. penis panic.

Hysteria is often associated with movements like the Salem Witch Trials, McCarthyism, the First Red Scare, the Second Red Scare and Terrorism where it is better understood through the related sociological term of moral panic.

See also

• Histrionic Personality Disorder
• Female hysteria

References

• The H-Word, Guardian Unlimited, http://www.guardian.co.uk/weekend/story/0,3605,782338,00.html
• 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 Before Freud (Berkeley, Los Angeles, and Oxford: University of California Press).

External links

• Is Hysteria Real? Brain Images Say Yes at the New York Times.