Hysteria

I

Introduction

Hysteria, type of mental disorder, in which emotionally laden mental conflicts appear as physical symptoms (called conversion reactions), or as severe mental dissociation. Psychiatric diagnosis of hysteria depends on recognition of a mental conflict and of the unconscious connections between conflict and symptoms. The term mass hysteria is applied to situations in which a large group of people exhibit the same kinds of physical symptoms with no organic cause. For example, one incident of mass hysteria reported in the United States in 1977 involved 57 members of a school marching band who experienced headache, nausea, dizziness, and fainting after a sports event. After a fruitless search for organic causes, researchers concluded that a heat reaction among a few band members had spread by emotional suggestion to other members of the band. However, it must be stressed that this conclusion may have come about because the band members were female (see Study and Treatment below). The term collective stress reaction is now preferred for these situations, which may occur when people are crowded together.

II

Conversion Hysteria

Under the stress of mental conflict, anyone may react temporarily with physical symptoms. In conversion reactions, mental conflicts are unconsciously converted to symptoms that appear to be physical, but no organic cause is found. Among common symptoms of conversion hysteria are muscular paralysis, blindness, deafness, and tremors.

III

Dissociative Reactions

Patients with hysterical conversion reactions may have periods of intense emotion and defective power of self-observation. In such a mental condition, patients may interact with others in a bizarre way. Extreme symptoms of dissociation are shown in fugue (flight) or somnambulism (sleepwalking). In fugue, a person suddenly leaves home, may assume a new identity, and has no recollection of their past. In somnambulism, which is a restricted but focused state of consciousness, and is most common in adolescence, the patient may be trying to come to terms with a former painful situation, but without adequate reference to the current realities of the situation.

IV

Study and Treatment

Among the most controversial of mental disorders, hysteria was assumed to be suffered only by women. The ancient Greeks accounted for the instability and mobility of physical symptoms and of attacks of emotional disturbance in women, when these were otherwise unaccountable, by a theory that the womb somehow became transplanted to different positions. This “wandering of the uterus” theory gave the name hysteria (Greek, hystera, “uterus”) its name and it was used to describe disease phenomena characterized by highly emotional behaviour. During the Middle Ages hysteria was attributed to demonic possession and to witchcraft, which led to the appalling mass persecution of women.

As the sciences of anatomy and physiology developed in the 19th century, a tendency to interpret all mental phenomena in terms of diseased structure of the brain became apparent in medical circles. At the end of the 19th century, however, the French neurologist Jean Martin Charcot demonstrated that morbid ideas could produce physical manifestations. Subsequently his pupil, the French psychologist Pierre Janet, formulated a description of hysteria as a psychological disorder. Later Sigmund Freud began to develop the theory that hysterical symptoms are the result of conflict between the social and ethical standards of an individual and an unsuccessfully repressed wish. However, the link between hysteria and gender persisted; men were rarely diagnosed. The disorder has been possibly one of the most misdiagnosed in psychiatry and is thought by many not to be a single disorder at all.

Nevertheless, people (usually women) diagnosed as having hysteria would be treated with some form of psychotherapy and, in some cases, prolonged forms of analytic psychotherapy, or of psychoanalysis. For cases of acute hysteria associated with anxiety, tranquillizers may be prescribed.