Hysteria

“ I do not wish to be misunderstood and give the impression that I refuse to accept hysteria as an independent neurotic affection, that I conceive it only as a psychic manifestation of the anxiety neurosis, that I ascribe to it “ideogenous” symptoms only, and that I attribute the somatic symptoms, like hysterogenic points and anesthesias, to the anxiety neurosis. None of these statements are true. I believe that hysteria, purified of all admixtures, can be treated independently in every respect except in therapy. ”

“ Of course everything depends on the exact interpretation to be put on the word hysteria. As far as we are concerned, to consider a symptom of hysterical origin because it seems to be purely functional is sadly to misunderstand the question. The absence of what we call organic signs is a negative feature common to all neuroses, each of which, hysteria included, ought to have definitely fixed limits. ”

“ The appearance of a symptom of hysteria generally proves that the malady has already existed for some time though latent. The name of a provocative agent of hysteria is given to any circumstance which suddenly reveals the malady but the real cause of the disorder is a hereditary disposition. If the real cause is unique, the provocative agents are numberless. ”

“ The Great War has provided plenty of material for the study of hysteria, and French and German writers have dealt extensively with it. The paucity of English writings on the subject may indicate a smaller amount of material, but there has been sufficient considerably to increase our knowledge. The common form of hysteria is a mimicry of bodily disease; pains, paralyses, contractions and joint affections most often occur, though fits and trances are typical and there are few diseases which are not imitated. ”

“ If the patient recovers these impressions naturally become reduced in value, but if he dies and the period of mourning comes during which only that which refers to the deceased seems of value, the impressions waiting for discharge appear in turn, and after a brief pause of exhaustion the hysteria, the germ of which originated during the nursing, bursts forth.
The same subsequent discharge of traumas accumulated during nursing is occasionally encountered where the general impression of the disease does not ensue, and yet the mechanism of hysteria can be noticed. ”

“ Such questions might seem superfluous and impertinent when dealing with old hysterias in whom the mechanism of conversion was habitual, but this girl first acquired hysteria through this trauma, or at least through this slight distress.
From the analysis of similar cases I already knew that where hysteria is to be newly acquired one psychic determinant is indispensable; namely, that some presentation must intentionally be repressed from consciousness and excluded from associative elaboration. ”

“ In typical hysteria the emotional symptoms are the most prominent, and according to many authors the most characteristic. In all the cases of cerebral disease related there were undue emotional manifestations or emotional movements not duly controlled. 2. In typical hysteria many of the objective phenomena are almost always shown on the left side of the body, and we may consequently feel sure that in these cases the right hemisphere is disordered. In nearly all of the above sixteen cases the right hemisphere was the seat of organic disease, and the symptoms were on the left side of the body. ”

“ But it follows from this that it is hardly possible to take hysteria out of connection with the sexual neuroses, that hysteria as a rule presents only one side, one aspect of the complicated neurotic case, and that only, as it were, in the borderline case can it be found and treated as an isolated neurosis. ”

“ Irritation or disease of the uterus or ovaries may result in hysteria, as may the bite of a dog, a tumor of the brain, a polypus in the nose, a phymosis, an irritated clitoris, a gastric ulcer, a stenosis of the larynx, a foreign body in the eye, a toe-nail ulcer, or a movable kidney.
Whatever tends to exhaust the nervous system will also cause hysteria, but only in those who have some inherited predisposition to the disorder. ”

“ I am confident that I have met with many instances in which the nerve power has become so weakened that the patient, without having organic disease, really feels all the symptoms she describes, and is only too anxious to be cured. The cases I shall now narrate are a few of a large number that have come under my care, and I am not without hope that their relation may show that hysteria, instead of being a term of reproach, does truly represent a curable disease. ”

“ Hysteria may appear at any age. It is common with children, especially during the five or six years preceding puberty. Of thirty-three cases under twelve years which came under Dr Still's notice, twenty-three were in children over eight years. Hysteria in women is most frequent between the ages of fifteen and thirty, and most frequently of all between fifteen and twenty. As a rule there is a tendency to cessation after the “change.” It frequently happens, however, that the disease is continued into an advanced period of life. ”

“ Where we encounter an acute hysteria during the most acute production of hysterical symptoms, and the consecutive overwhelming of the ego by the morbid products (hysterical psychosis) , even the cathartic method will change little the expression and course of the disease. One finds himself in the same position to the neurosis as the doctor to an acute infectious disease. ”

“ There is in all this access of power and influence a danger which it is well to recognize and face,--the danger of hysteria. This is in many respects a hysterical age, and neither sex can claim immunity from this dread disease. There are many organizations and movements, masculine as well as feminine, which have their birth and tendency in nothing else than hysteria, and there are others, admirable in inception and purpose, of which the conduct is governed largely by this emotional influence. ”

“ Hysteria, peculiarly a feminine disease, undoubtedly has its origin in sexual functional derangement, and is a striking example of the extent to which the emotional nature may be perverted by the abnormal actions of certain organs. ”

“ Frequently recurring pregnancy and childbirth may, according to Krönig, act as the predisposing cause in the production of neurasthenia. In regard to hysteria also we must admit that the onset of some disease of the organs of generation frequently leads previously latent hysteria to manifest itself openly, and further we have to recognize that diseases of the reproductive system often give the clinical picture of hysteria a quite distinctive coloration; the physiological course of the functions of the generative organs is also competent to produce both of these effects. ”

“ Hardy’s special knowledge of a dangerous and disagreeable form of mental disorder, But it is not the physician’s business to sow disease, and any treatise on hysteria which is thrown into a captivating popular form, and makes hysteria look like an interesting and romantic thing, will spread the malady as surely as a spark will ignite gunpowder. ”

“ Everywhere and at all times we find historical traces of psychic contagion compelling people to perform in crowds or groups the most curious and inexplicable and sometimes the most horrible things. Even in the old myths before the times of the Trojan War, we have the story of hysteria spreading among the daughters of King Proteus, so that the famous old physician, Pelampus, had to administer white hellebore in goat's milk in order to relieve them. It is probable that this rather heroic remedy with its definite effect upon the bowels produced such a revulsion of feeling as to cure the hysteria. ”

“ However, I think that the assumption of a defense hysteria (abwehr hysterie) includes the requisite that at least one such moment has already occurred. For consciousness does not know in advance when such an unbearable idea will present itself. The unbearable idea which with its appendix is later excluded for the formation of a separate psychic group must have been originally in the mind, otherwise no conflict would have resulted leading to its exclusion. ”

“ We accordingly recognize that the characteristic moment of hysteria is not the splitting of consciousness but the ability of conversion, and as an important part of the hitherto unknown disposition of hysteria we can mention the psycho-physical adaptation for the transference of a great sum of excitement into bodily innervation.
The adaptation does not in itself exclude psychic health, and leads to hysteria only in event of a psychic incompatibility or accumulation of excitement. ”

“ Hysteria is a disease the chief characteristics of which are a lack of control over one's emotions and acts, the imitation of the symptoms of various diseases, and an exaggerated self-consciousness. The patient may have extreme pain in the region of the head, ovaries, spine ”

“ It is clearly demonstrated that the physical sexual organs are not the seat of hysteria. It does not, however, follow that even physical sexual desire, when repressed, is not a cause of hysteria. The opinion that it was so formed an essential part of the early doctrine of hysteria, and was embodied in the ancient maxim: "Nubat illa et morbus effugiet." The womb, it seemed to the ancients, was crying out for satisfaction, and when that was received the disease vanished. ”

“ As familiar experiences show, the normal consciousness is not always repressed, it may even perceive the motor phenomena of the attack while the psychic processes of the same escape its cognizance.
The typical course of a grave hysteria, as everybody knows, is as follows: At first an ideation is formed in the hypnoid state which after sufficient development gains control in a period of “acute hysteria” of the bodily innervation and the existence of the patient thus forming persistent symptoms and attacks, and then with the exception of some remnants there is a recovery. ”

“ Even though hysteria as a disease may be described as one and indivisible, there are yet to be found, among the ordinary and fairly healthy population, vague and diffused hysteroid symptoms which are dissipated in a healthy environment, or pass nearly unnoted, only to develop in a small proportion of cases, under the influence of a more pronounced heredity, or a severe physical or psychic lesion, into that definite morbid state which is properly called hysteria. ”

“ The simultaneous occurrence of phobias and hysterical symptoms, so frequently observed in praxis, really belongs to those moments which impede a pure separation of hysteria from other neuroses and urge the formation of the “mixed neuroses.” To be sure the hallucinatory confusion is not frequently compatible with the continuation of hysteria and not as a rule with obsessions; but on the other hand it is not rare that a defense psychosis should episodically break through the course of a hysteria or mixed neurosis. ”

“ Of course, the prominent place occupied by these signs in hysteria is well recognised: the demonologues of old regarded them as an index of the departure of the devils that dwelt in the possessed. In a case of hysteria that came under the notice of Raymond and Janet, [111] a general tremulousness of the whole body was replaced by a chorea of the right arm, which in its turn was succeeded by the perpetual emission of sonorous eructations. In another instance [112] inspiratory hiccoughs and expiratory eructations co-existed. A similar example is cited by Cruchet in his thesis. ”

“ In connection with the phobias and obsessions I have only to deal here with the second form of hysteria which for reasons to be presently explained I will designate as defense hysteria and thus distinguish it from the hypnoid and retention hysterias. ”

“ It is necessary to explain why hysteria in civil life affects women to so far greater an extent than men. The idea that only women are affected has long been given up, but the experience of war has shown how very prone men are to succumb to hysteria when the suitable conditions arise, viz., conditions which make too great a demand on their danger-instincts. We have to discover why hysteria should be so frequent in women, and so rare in men, under the ordinary conditions of civil life. ”

“ In our discussion thus far, the idea of resistance has thrust itself to the foreground. I have shown how, in the therapeutic work, one is led to the conception that hysteria originates through the repression of an unbearable idea from a motive of defense, that the repressed idea remains as a weak (mildly intensive) reminiscence, and that the affect snatched from it is used for a somatic innervation, that is, conversion of the excitement. By virtue of its repression the idea becomes the cause of morbid symptoms, that is pathogenic. ”

“ That the pathological mental symptoms referred to as prevalent in the female, whether we attribute them to hysteria or not, are rarely if ever found in the male sex is an undoubted fact. The rose, it is said, is as sweet by any other name, and whether we term these affections symptoms of hysteria, or describe them as hysteria itself, or deny that they have anything to go with "true hysteria," their existence and frequency in the female sex remains nevertheless a fact. ”

“ It might appear that hysteria need hardly enter into our consideration, and could hardly be mistaken for apoplexy, but most experienced physicians could relate instances where serious organic disease has been made light of under the name of hysteria, and many inexperienced ones could tell of the opposite and safer mistake. An occasional case of deep coma presents itself where, although the age and sex of the patient awaken strong suspicion, we cannot at once be sure that no organic lesion is present ”