What is hysteria?

Introduction

The concept of hysteria has a rich history that dates back to early civilizations. Ancient Egyptian papyri provide the first medical records of hysteria. Egyptian physicians believed that the somatic and emotional problems of certain unstable women were caused by a migratory uterus. They prescribed the topical use of sweet- or foul-smelling herbs to entice or repel the uterus back to its original position. This theme of sexual etiology has pervaded theories of hysteria throughout the centuries.

Greco-Roman Views

There is considerable continuity between Egyptian and Greco-Roman views of hysteria. Hippocrates, often considered the founder of medicine, included the condition in the Corpus Hippocraticum (fifth to third centuries b.c.e.; The Genuine Works of Hippocrates, 1849), and solidified its connection with the uterus by assigning the appellation “hysteria,” which is derived from the Greek term for the organ, “hystera.” The Greeks were the first to connect hysteria with sexual activity; they believed that the condition occurred primarily in adult women deprived of sexual relations for extended periods, resulting in the migration of the uterus. Aromatic remedies were also prescribed by the Greeks, but the recommended remedy was to marry and, if possible, become pregnant. Some skeptics of the day denied the motility of the uterus. For example, the Roman physician Galen proposed that hysteria was instead caused by the retention of a substance analogous to sperm in the female, which was triggered by long-term abstinence.

The Dark Ages

As the Middle Ages approached, magical thinking and superstition increased. Some Christian writers, especially Saint Augustine, condemned sex as the work of such unholy spirits as incubi, succubi, and witches. Numerous behavioral afflictions, particularly the peculiar and transient symptoms of hysteria, were viewed as the result of witchcraft. Many hysterics became victims of the witch craze, a long and dark chapter in Western history. The Malleus Maleficarum (c. 1486; Malleus Maleficarum, 1928), a manual whose title means “the witches’ hammer,” was written by two Dominican monks, Heinrich Kraemer and Jakob Sprenger. This book outlined the “telltale” signs of witchcraft, which were widely used and regarded as diagnostic by Middle Age inquisitors. Hysterical patients became both accusers, who came forth with complaints that spells had been cast on them, and confessors, who were willing to implicate themselves by weaving accounts of their participation in strange sexual rituals and witchcraft.

The Renaissance to the Victorian Era

With the arrival of the Renaissance, views on hysteria changed to accommodate natural causes. Medical writers of the day recognized the brain as the source of the affliction. As a result, hysteria soon became a topic of interest for neurologists. In addition, physicians suggested emotional contributions to hysteria, including melancholy (which resembles modern depression). Largely as a result of the writings of physician Thomas Sydenham
, hysteria came to be considered an affliction of the mind. At this time, some proposed a male analogue to hysteria termed “ hypochondriasis”.

Throughout history, the symptoms of hysteria have reflected prevailing sociocultural norms and expectations. In the nineteenth century, ideal women were physically and emotionally delicate, which was reflected in their greater susceptibility to hysteria and in the nature of their symptoms. Over time, infrequent but spectacular hysterical paroxysms gave way to milder chronic symptoms. Fainting spells, euphemistically called “the vapors,” were accepted as a natural reaction of the vulnerable female to emotional distress. Some clinicians of this era considered hysteria a form of “moral insanity” and emphasized hysterical patients’ penchant for prevarication, flamboyant emotional displays, and nearly constant need for attention. Others viewed hysterics with a patronizing compassion, as unfortunate victims of the natural weakness of femininity.

Hypnosis and Psychoanalytic Underpinnings

Conceptions of hysteria were shaped substantially by the work of French neurologist Jean-Martin Charcot. Charcot emphasized the importance of suggestibility in the etiology of hysterical behavior; he found that under hypnosis, some hysterical patients’ symptoms could be made to appear or disappear largely at will. Charcot was also the first to assign significance to a pathogenic early environment in producing hysterical episodes.

The young Austrian neurologist Sigmund Freud
began his career by studying the blockage of sensation by chemicals. This interest extended to hysteria (known for its anesthetic symptoms), which brought him into contact with Viennese internist Josef Breuer
. Breuer’s account of the famous hysterical patient Anna O. and her treatment provided the early foundations of psychoanalytic theory. Breuer found that, under hypnosis, Anna recalled the psychological trauma that had ostensibly led to her hysteria. Moreover, he found that her symptoms improved or disappeared after this apparent memory recovery. Freud studied hypnosis under Charcot and extended Breuer’s concepts and treatments to develop his own theory of hysteria. He reintroduced sexuality into the etiology of hysteria, particularly the notion of long-forgotten memories of early sexual trauma. Freud himself eventually concluded that most or all of these “recovered” memories were fantasies or confabulations, a view shared by many modern memory researchers.

Current Status

The term “hysteria” has long been regarded as vague and needlessly pejorative, and it is no longer a part of the formal diagnostic nomenclature. The broad concept of hysteria was splintered with the appearance of the third edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-III) in 1980 and is currently encompassed by a broad array of conditions, including somatic disorders, dissociative disorders, and histrionic personality disorder. The separation of somatic from dissociative disorders in the current diagnostic system is controversial, because these two broad groupings of disorders often covary substantially with one another. Some researchers have argued that somatic and dissociative disorders should be reunited under a single broad diagnostic umbrella.

Somatic disorders are a group of ailments in which the presence of physical symptoms suggests a medical condition but in which the symptoms are involuntarily psychologically produced. Somatic symptom disorder, conversion disorder, illness anxiety disorder (formerly known as hypochondriasis), and factitious disorder are the major conditions in this group. Dissociative disorders are characterized by disruptions in the integrated functioning of consciousness, memory, identity, or perception. Dissociative amnesia, dissociative fugue, dissociative identity disorder (formerly multiple personality disorder), and depersonalization/derealization disorder belong to this category. The causes of some dissociative disorders, particularly dissociative identity disorder, are controversial, as some writers maintain that these conditions are largely a product of inadvertent therapeutic suggestion and prompting. This controversy has been fueled by the fact that diagnoses of dissociative identity disorder have become much more frequent.

Histrionic personality disorder (HPD), formerly hysterical personality disorder, is the most direct descendent of the concept of hysteria. This disorder involves excessive emotionality and attention-seeking behaviors and is often a correlate of somatic and perhaps dissociative disorders. Due to its roots in diagnoses of hysteria and the fact that it is more commonly diagnosed in women, HPD remains controversial. While the claim that it is used to pathologize normal female behavior is widely regarded to be untrue, there is a somewhat better-respected theory that HPD is not actually distinct from antisocial personality disorder, but is the result of societal factors causing antisocial personality disorder to manifest differently in women. There was some speculation in the psychological community that the two disorders would be merged in the DSM-5, but HPD remains a separate diagnosis.

A paucity of behavior-genetic studies leaves the relative contribution of genetic and environmental factors to somatic and dissociative disorders a mystery. The precise sociocultural expressions of hysteria are also unclear. Many authors have suggested that hysteria has been manifested in a plethora of different conditions over time and across cultures, including dissociative identity disorder, somatoform disorders, purported demonic possession, mass hysteria, and even such religious practices as glossolalia (speaking in tongues). According to these authors, such seemingly disparate conditions are all manifestations of a shared predisposition that has been shaped by sociocultural norms and expectancies.“Hysteria” as a diagnostic label is no longer accepted, but its protean manifestations may be here to stay.

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