Archives of Medicine and Health Sciences

MEDICAL HISTORY
Year
: 2020  |  Volume : 8  |  Issue : 2  |  Page : 312--315

Hysteria: A historical perspective


Siddharth A Shetty, S Chandini, Sharol Lionel Fernandes, AT Safeekh 
 Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India

Correspondence Address:
Dr. S Chandini
Department of Psychiatry, Father Muller Medical College, Kankanady, Mangalore - 575 002, Karnataka
India

Abstract

The concept of hysteria has evolved through the ages from the ancient civilizations to the modern era. It has been variously attributed to a wandering uterus by the Greeks, demonic possession, witchcraft, bad humors, and inadequate sexual satisfaction by other cultures, finally culminating as a disorder of the brain and the nervous system. Initially considered as an affliction restricted to the female sex, hysteria has later evolved to include a large variety of psychiatric disorders in both sexes. The term hysteria no longer exists in the modern classificatory system. It has been reconceptualized as functional neurological disorders, dissociative (conversion) disorders, and somatization disorders. The concept continues to evolve with advances in medical sciences.



How to cite this article:
Shetty SA, Chandini S, Fernandes SL, Safeekh A T. Hysteria: A historical perspective.Arch Med Health Sci 2020;8:312-315


How to cite this URL:
Shetty SA, Chandini S, Fernandes SL, Safeekh A T. Hysteria: A historical perspective. Arch Med Health Sci [serial online] 2020 [cited 2021 Feb 25 ];8:312-315
Available from: https://www.amhsjournal.org/text.asp?2020/8/2/312/304717


Full Text



 Introduction



The term hysteria has existed through millennia visualized as various concepts across civilizations. It has remained of interest to the fields of psychiatry, neurology, sociology, philosophy, literature, and the medical practice at large. The psychological, physical, and sociocultural attributes at play have led to various opinions about the nature of the illness and led to various entities being recognized and treated. In this article, we will delve into the history of the concept and its current standing.

The word hysteria owes its origins to the “Corpus Hippocraticum” of the Greeks, the myriad symptoms that encompass hysteria, though, have existed much longer and dates back to the Babylonian–Assyrian era.

 Babylonian, Assyrian, and Egyptian Era



Although there is no definite evidence to show that the ancient Babylonian had a concept of hysteria, there is evidence, however, which points to their knowledge about depression, anxiety, obsessive compulsion disorder, psychosis, epilepsy, stoke, etc.The Assyrians described symptoms suggestive of posttraumatic stress disorder in three patients who were injured in war.[1]

The earliest evidence of a disorder similar to hysteria comes from the Kahun Papyrus (1900 BC) and the Eber Papyrus (1600 BC) of the Egyptians who attributed hysteria to a wandering uterus. Symptoms included pain in various parts of the body and the suggested remedy was the placing of foul smelling and scented substances near the mouth and nostrils or the vagina depending on the movement of uterus downward or upward. These ancient civilizations attributed these afflictions to spiritual or magical elements and they did not seem to have a concept of the brain.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10]

 Greco–Roman Era



The word hysteria is derived from the Greek word Hysterikos, meaning uterus. Hippocrates (5th century BC) was the first to use the term and attributed it to a wandering uterus. The Corpus Hippocraticum (4th BC) contains descriptions of a variety of medical and gynecological disorders. Hippocrates postulated that an inadequate sexual life led to the uterus becoming sick and that caused a putrefaction of humors. A woman's body could be cleansed by widening of the canals. Melampus coined the term “uterine melancholy” arising from a lack of orgasms. Plato in Timaeus said that the uterus remains sad and unfortunate if it does not unite with the male and give birth. Aristotle held similar beliefs, and according to the ancient Greeks, indulging in carnal pleasures was curative.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10]

The Romans tried to debunk the wandering uterus concept of the Greeks, although acknowledging that hysteria was related to the uterus and could give rise to disorders in other systems of the body. Celsus (1st BC) in his book “De re medica celsus” describes symptoms differentiating epilepsy from pseudoseizures. Soranus, considered the founder of scientific obstetrics and gynecology, believed that sexual abstinence and virginity were the cure for hysterical symptoms, as women's disorders arose from the toils of procreation. Galen (2nd AD) understood that the mind and the body influenced each other and emphasized on the effect of emotion on the body. The origins of psychosomatic disorders could be attributed to him.[1],[3],[6]

 The Middle Ages and Renaissance Period



The middle ages witnessed a revival of Hippocratic concepts and the Aristotelian view of the woman being an inferior being, as a consequence of sin. The cause was attributed to the demonic presence and these women were subjected to an exorcism. Witchcraft which was termed illegal leads to a rampant rise in witch-hunting.[1],[3],[4],[6] The rise of the humanistic movement in Italy in the late 14th century (Dante, Petrarch) which spread to most of Europe by the 16th century led to large-scale changes in the prevailing conditions. The 16th century also witnessed a philosophical revolution, Rene Descartes linked the actions attributed to the soul with organs of the body.[1],[3],[6] Edward Jorden wrote a treatise “A brief discourse of a disease called the suffocation of the mother,” in which he tried to refute prevailing beliefs attributing mental illness to spiritual causes. He described hysterical patients presenting with convulsions, globus hystericus, and insensibility and termed it as “perturbations of the mind,” thus shifting the focus from the uterus to the brain.[1],[6],[11] Thomas Willis emphasized on emotions and observed hysteria in men. He believed that hysteria originated in the brain itself.[1],[3] Sydenham further studied emotions, referring to hysteria as “over-ordinate commotions of the mind” with a “faulty disposition of the animal spirits.” His revolutionary work paved the way for dismissal of the “uterine fury” theory. Robert Burton's “Anatomy of Melancholy” firmly established that the mind could influence the body, he described hysteria as a form of melancholy.[1],[3],[6],[12]

 The Age of Modern Medicine



The industrial revolution in the 18th century gave birth to the age of modern medicine. European psychiatry in the late 18th century and throughout the 19th century associated hysteria with the brain rather than the uterus, which paved the way for neurological etiology. The concept of hysteria had moved from the uterus to the brain and finally to the mind. The German physician Franz Anton Mesmer incorporated the theory of magnetism based on the notion that tidal influences exerted a universal magnetic force on humans which he called “animal magnetism” [Figure 1]. His method induced states of anesthesia, paralysis, and hysterical convulsions in the patients. Mesmerism eventually evolved into the modern practice of hypnosis.[1],[3],[4],[10]{Figure 1}

Jean Martin Charcot [Figure 2], the French father of neurology, extensively studied hysteria and practiced the effectiveness of hypnosis on his patients. He believed that hysteria was due to a hereditary degeneration of the nervous system. Charcot's studies revealed that hysteria was more common in men, thus busting the age-old myth of hysteria being primarily a female disease.[1],[3],[6],[8],[13],[14],[15],[16] French neuropsychiatrist Pierre Janet is credited with coining the term dissociation, he was a proponent of hypnosis and advised physicians to use suggestion and dissociation as methods for investigation and therapy. He attributed hysteria to the abnormal splitting of the mental processes in the subconscious which led to compartmentalization of the personality into segments without access to one another.[1],[3],[4],[17] Paul Briquet's work on 430 patients at the Hospital De La Charite in Paris, a detailed systematic clinical investigation and the subsequent paper he published, is considered seminal. He defined it as a “chronic disorder characterized by the presentation of many medically unexplained symptoms in the body's organ systems,” clinical features included multiple, unexplained somatic symptoms, and persistent invalid behavior.[1],[4]{Figure 2}

Sigmund Freud, a student of Charcot in collaboration with Josef Breuer, was presented with the intriguing case of Anna O, she exhibited dual personalities, aphonia, amnesia, paralysis, visual hallucinations, and loss of ability to speak her native language. Her case study paved the way for the birth of psychoanalysis. They extended Charcot's concepts to a general doctrine of hysteria and published a “Preliminary Communication” in 1983 and later “Studies in Hysteria” in 1895. Freud's sequence of steps leading to hysteria is a traumatic event which resulted in ideas incompatible with the ego, the events being repressed or dissociated intentionally from consciousness, and the excitation associated with incompatible ideas was converted into somatic pathways resulting in manifest hysteria. The traumatic event being possible in both sexes led to the assertion of “male hysteria.” Freud is credited with introducing the term “hysterical conversion.” He described memories as “chains of associations with convergences and divergences through nodal points like a complex network.”[4],[5],[9],[18],[19],[20],[21],[22]

The English physician Savill revived Sydenham's description of hysteria and described it as a syndrome “manifested by an immense variety of nervous, neuromuscular, neuro-vascular, sensory and other systems which may be referable to almost any organ or part of the body” and which are “unaccompanied, as a rule, by any obvious physical signs or any gross microscopic anatomical changes.”[4],[23]

The term hysteria came to be used for a variety of disorders which were only related tenuously; neurological conversion symptoms, dissociative fugue and amnesia, anxiety hysteria, etc., were included as hysteria and were viewed pejoratively, and therefore, hysteria underwent a slow demise. The Washington University psychiatry group adopted Savill's description and established a set of criteria for hysteria known as the Perley–Guze checklist. They brought out the “Feighner Criteria” which had a strong influence on the American diagnostic system. The name “Briquet syndrome” replaced hysteria. Stekel coined the term somatization, and later, Lipowski defined it as “the tendency to experience, conceptualize and/or communicate psychological states or contents as bodily sensations, functional changes or somatic metaphors.” Dissociation, conversion, and somatization are understood to have a shared phenomenology. Psychodynamic etiology theory helped to differentiate them historically.[4],[23]

 Modern Classification



The Diagnostic and Statistical Manual I (DSM I-1952) of the American psychiatric association considered “dissociative reaction” and “conversion reaction” under “psychoneurotic disorders” which included anxiety (anxiety hysteria). DSM II (1968) deemed it fit to describe them as two different types of “hysterical neurosis” under the section “neuroses.” it also included a separate diagnosis of “depersonalization neurosis” and “hypochondriacal neurosis.” As the American Diagnostic System started becoming “atheoritical” in nature, the DSM III (1980) adopted the St. Louis criteria for Briquet's syndrome. The diagnosis of somatization disorder required 14 out of 37 possible symptoms, reduced from the 25 of possible 59 symptoms from the original criteria. Somatization disorder was the mainstay of the somatization disorder category. It also included conversion disorder, psychogenic pain disorder, and hypochondriasis; dissociative disorders were grouped separately. The DSM III dissociative disorders included psychogenic amnesia, psychogenic fugue, multiple personalities, and depersonalization disorder. The DSM IV (1994) further reduced the number of symptoms from 37 to 32 with a requirement of 8 symptoms to fulfill criteria for a diagnosis of somatization disorder. Psychogenic fugue was renamed dissociative fugue, psychogenic amnesia was renamed dissociative amnesia, and multiple personality disorder was renamed dissociative identity disorder in par with international classification of psychiatric disorders. The DSM 5 (2013) revamped the entire section and somatization disorders were removed entirely and reconceptualized into “somatic symptom and related disorders.” Diagnosis of pain disorders and undifferentiated somatoform disorder was dropped and hypocondriasis was renamed illness anxiety disorder. Conversion disorder was retained under the new title “functional neurological symptom disorder.”[23],[24],[25],[26],[27],[28]

International Classification of Disease (ICD) 6 included psychoneuroses with somatic symptoms and psychoneurosis without anxiety (hysteria). ICD 7 mentioned psychoneuroses with somatic symptoms affecting other systems. ICD 9 included dissociative, conversion, and factitious disorder under one category and a separate somatoform disorder category was retained. The term hysteria failed to find mention in the ICD 10 version, the term dissociative disorder was preferred to bring together dissociative and conversion symptoms as they share a common etiology. The ICD 10 has kept dissociative disorders and conversion together and provided a separate section for somatoform disorders which mainly included somatization disorders along with undifferentiated somatoform disorder, somatoform autonomic dysfunction, hypocondriacal disorder, body dysmorphic disorder, and persistent pain disorder. The dissociative (conversion) disorder category includes dissociative amnesia, stupor, trance and possession disorders, dissociative disorders of movement and sensation, dissociative motor and convulsion disorders, dissociative anesthesia sensory loss.[4],[23],[26]

Hysteria has been an enigma for millennia. The varied physical symptoms and the fluctuating mental state have piqued the curiosity of psychiatrists and neurologists alike for ages. As humans evolved, so did the nature of hysteria. Although contentious, it remains omnipresent. The history of hysteria is the “history of mankind.”

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Conflicts of interest

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