What is Hysteria?

Introduction

Hysteria is a pejorative term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion.

In the 19th century, hysteria was considered a diagnosable physical illness in females. It is assumed that the basis for diagnosis operated under the belief that women are predisposed to mental and behavioural conditions; a misinterpretation of gender-related differences in stress responses. In the 20th century, it shifted to being considered a mental illness.

Many influential persons such as Sigmund Freud and Jean-Martin Charcot dedicated research to hysteria patients. Currently, most doctors practicing Western medicine do not accept hysteria as a medical diagnosis. The blanket diagnosis of hysteria has been fragmented into myriad medical categories such as epilepsy, histrionic personality disorder, conversion disorders, dissociative disorders, or other medical conditions. Furthermore, lifestyle choices, such as deciding not to wed, are no longer considered symptoms of psychological disorders such as hysteria.

Brief History

The word hysteria originates from the Greek word for uterus, hystera. The oldest record of hysteria dates back to 1900 B.C. when Egyptians recorded behavioural abnormalities in adult women on medical papyrus. The Egyptians attributed the behavioural disturbances to a wandering uterus – thus later dubbing the condition hysteria. To treat hysteria Egyptian doctors prescribed various medications. For example, doctors put strong smelling substances on the patients’ vulvas to encourage the uterus to return to its proper position. Another tactic was to smell or swallow unsavoury herbs to encourage the uterus to flee back to the lower part of the female’s abdomen.

The ancient Greeks accepted the ancient Egyptians’ explanation for hysteria; however, they included in their definition of hysteria the inability to bear children or the failure to marry. Ancient Romans also attributed hysteria to an abnormality in the womb; however, discarded the traditional explanation of a wandering uterus. Instead, the ancient Romans credited hysteria to a disease of the womb or a disruption in reproduction (i.e. a miscarriage, menopause, etc.).[5] Hysteria theories from the ancient Egyptians, ancient Greeks, and ancient Romans were the basis of the Western understanding of hysteria.

Between the fifth and thirteenth centuries, however, the increasing influence of Christianity in the Latin West altered medical and public understanding of hysteria. St. Augustine’s writings suggested that human suffering resulted from sin, and thus, hysteria became perceived as satanic possession. With the shift in perception of hysteria came a shift in treatment options. Instead of admitting patients to a hospital, the church began treating patients through prayers, amulets, and exorcisms. Furthermore, during the Renaissance period many patients of hysteria were prosecuted as witches and underwent interrogations, torture, and execution.

However, during the sixteenth and seventeenth centuries activists and scholars worked to change the perception of hysteria back to a medical condition. Particularly, French physician Charles Lepois insisted that hysteria was a malady of the brain. In addition, in 1697, English physician Thomas Sydenham theorised that hysteria was an emotional condition, instead of a physical condition. Many physicians followed Lepois and Sydenham’s lead and hysteria became disassociated with the soul and the womb. During this time period, science started to focalize hysteria in the central nervous system. As doctors developed a greater understanding of the human nervous system, the neurological model of hysteria was created, which further propelled the conception of hysteria as a mental disorder.

In 1859, Paul Briquet defined hysteria as a chronic syndrome manifesting in many unexplained symptoms throughout the body’s organ systems. What Briquet described became known as Briquet’s syndrome, or Somatization disorders, in 1971. Over a ten year period, Briquet conducted 430 case studies of patients with hysteria. Following Briquet, Jean-Martin Charcot studied women in an asylum in France and used hypnosis as treatment. He also mentored Pierre Janet, another French psychologist, who studied five of hysteria’s symptoms (anaesthesia, amnesia, abulia, motor control diseases, and character change) in depth and proposed that hysteria symptoms occurred due to a lapse in consciousness. Both Charcot and Janet inspired Sigmund Freud’s work. Freud theorised hysteria stemmed from childhood sexual abuse or repression, and was also one of the first to apply hysteria to men.

During the 20th century, as psychiatry advanced in the West, anxiety and depression diagnoses began to replace hysteria diagnoses in Western countries. For example, from 1949 to 1978, annual admissions of hysteria patients in England and Wales decreased by roughly two thirds. With the decrease of hysteria patients in Western cultures came an increase in anxiety and depression patients. Although declining in the West, in Eastern countries such as Sudan, Egypt, and Lebanon hysteria diagnoses remained consistent. Theories for why hysteria diagnoses began to decline vary, but many historians infer that World War II, westernisation, and migration shifted Western mental health expectations. Twentieth century western societies expected depression and anxiety manifest itself more in post World War II generations and displaced individuals; and thus, individuals reported or were diagnosed accordingly. In addition, medical advancements explained ailments that were previously attributed to hysteria such as epilepsy or infertility. In 1980, after a gradual decline in diagnoses and reports, hysteria was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), which had included hysteria as a mental disorder from its second publication in 1968.

Historical Symptoms

Historically, hysteria has had a range of symptoms, including:

  • Shortness of breath.
  • Anxiety.
  • Insomnia.
  • Fainting.
  • Amnesia.
  • Paralysis.
  • Pain.
  • Spasms.
  • Convulsive fits.
  • Vomiting.
  • Deafness.
  • Bizarre movements.
  • Seizures.
  • Hallucinations.
  • Inability to speak
  • infertility.

Historical Treatment

  • Regular marital sex.
  • Pregnancy.
  • Childbirth.
  • Proximal convulsions/orgasms.
  • Rest Cure.

Notable Figures

Jean-Martin Charcot

In the late nineteenth century, French neurologist Jean-Martin Charcot, attempted to tackle what he referred to as, “the great neurosis” or hysteria. Charcot theorised that hysteria was a hereditary, physiological disorder. He believed hysteria impaired areas of the brain which provoked the physical symptoms displayed in each patient. While Charcot believed hysteria was hereditary, he also thought that environmental factors such as stress could trigger hysteria in an individual.

Charcot published over 120 case studies of patients who he diagnosed with hysteria, including Marie “Blanche” Whittman. Whittman was referred to as the “Queen of Hysterics,” and remains the most famous patient of hysteria. To treat his patients, Charcot used hypnosis, which he determined was only successful when used on hysterics. Using patients as props, Charcot executed dramatic public demonstrations of hysterical patients and his cures for hysteria, which many suggest produced the hysterical phenomenon. Furthermore, Charcot noted similarities between demon possession and hysteria, and thus, he concluded “demonomania” was a form of hysteria.

Sigmund Freud

In 1896, Sigmund Freud, who was an Austrian psychiatrist, published “The Aetiology of Hysteria”. The paper explains how Freud believes his female patients’ neurosis, which he labels hysteria, resulted from sexual abuse as children. Freud named the concept of physical symptoms resulting from childhood trauma: hysterical conversion. Freud hypothesized that in order to cure hysteria the patient must relive the experiences through imagination in the most vivid form while under light hypnosis. However, Freud later changed his theory. His new theory claimed that his patients imagined the instances of sexual abuse, which were instead repressed childhood fantasies. By 1905, Freud retracted the theory of hysteria resulting from repressed childhood fantasies. Freud was also one of the first noted psychiatrist to attribute hysteria to men. He diagnosed himself with hysteria – writing he feared his work exacerbated his condition.

Modern Perceptions

For the most part, hysteria does not exist as a medical diagnosis in Western culture and has been replaced by other diagnoses such as conversion or functional disorders. The effects of hysteria as a diagnosable illness in the 18th and 19th centuries has had a lasting effect on the medical treatment of women’s health. The term hysterical, applied to an individual, can mean that they are emotional, irrationally upset, or frenzied. When applied to a situation that does not involve panic, hysteria means that situation is uncontrollably amusing (the connotation being that it invokes hysterical laughter). Hysteria can also impact groups, medically and colloquially referred to as mass hysteria or mass psychogenic illness. Instances of mass hysteria have been recorded throughout history and continue to occur today.

Do High Levels of Physical Activity in Acute Anorexia Nervosa Associate with Worse Clinical Outcomes at Admission?

Research Paper Title

High levels of physical activity in female adolescents with anorexia nervosa: medical and psychopathological correlates.

Background

While overexercise is commonly described in patients who experience anorexia nervosa (AN), it represents a condition still underestimated, especially in the paediatric population.

Methods

The present study aims at assessing the possible associations between levels of physical activity (PA) and clinical features, endocrinological data and psychopathological traits in a sample of 244 female adolescents hospitalised for AN subdivided into two groups according to PA levels (high PA vs. no/low PA). The two groups were compared through multivariate analyses, while multiple regression analysis was conducted to determine whether physical activity predict specific outcomes.

Results

No significant differences were found between the two groups in terms of last Body Mass Index (BMI) before illness, BMI at admission and disease duration, while a difference emerged in delta BMI(rapidity of weight loss), significantly higher in high-PA group (p = 0.021). Significant differences were observed in Free triiodothyronine- (p < 0.001), Free thyroxine (p = 0.046), Follicle-stimulating hormone (p = 0.019), Luteinising hormone (p = 0.002) levels, with values remarkably lower in high-PA group. Concerning psychopathological scales, the high-PA group showed worst Children’s Global Assessment Scale (CGAS) scores (p = 0.035). Regression analyses revealed that higher PA predicts higher delta BMI (p = 0.021), presence of amenorrhea (p = 0.003), lower heart rate (p = 0.012), lower thyroid (Free triiodothyronine p < 0.001, Free thyroxine p = 0.029) and gynaecological hormones’ levels (Follicle-stimulating hormone p = 0.023, Luteinising hormone p = 0.003, 17-Beta estradiol p = 0.041). Concerning psychiatric measures, HPA predicts worst scores at CGAS (p = 0.019), and at scales for evaluation of alexithymia (p = 0.028) and depression (p = 0.004).

Conclusions

Results suggest that high levels of physical activity in acute AN associate with worst clinical conditions at admission, especially in terms of endocrinological and medical features.

Reference

Riva, A., Falbo, M., Passoni, P., Polizzi, S., Cattoni, A. & Nacinovich, R. (2021) High levels of physical activity in female adolescents with anorexia nervosa: medical and psychopathological correlates. Eating and Weight Disorders. doi: 10.1007/s40519-021-01126-3. Online ahead of print.

The Body Cathexis Scale & Body Satisfaction in Women

Research Paper Title

Measuring body satisfaction in women with eating disorders and healthy women: appearance-related and functional components in the Body Cathexis Scale (Dutch version).

Background

Differentiating the concept of body satisfaction, especially the functional component, is important in clinical and research context. The aim of the present study is to contribute to further refinement of the concept by evaluating the psychometric properties of the Dutch version of the Body Cathexis Scale (BCS). Differences in body satisfaction between clinical and non-clinical respondents are also explored.

Methods

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate whether functional body satisfaction can be distinguished as a separate factor, using data from 238 adult female patients from a clinical sample and 1060 women from two non-clinical samples in the Netherlands. Univariate tests were used to identify differences between non-clinical and clinical samples.

Results

EFA identified functionality as one of three factors, which was confirmed by CFA. CFA showed the best fit for a three-factor model, where functionality, non-weight, and weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes.

Conclusions

The three factors of the BCS may be used as subscales, enabling researchers and practitioners to use one scale to measure different aspects of body satisfaction, including body functionality. Use of the BCS may help to achieve a more complete understanding of how people evaluate body satisfaction and contribute to further research on the effectiveness of interventions focussing on body functionality.

Reference

Rekkers, M.E., Scheffers, M., van Busschbach, J.T & van Elburg, A.A. (2021) Measuring body satisfaction in women with eating disorders and healthy women: appearance-related and functional components in the Body Cathexis Scale (Dutch version). Eating and Weight Disorders. doi: 10.1007/s40519-021-01120-9. Online ahead of print.