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Hysteria, in the colloquial use of the term, means ungovernable emotional excess. Generally, modern medical professionals have abandoned using the term "hysteria" to denote a diagnostic category, replacing it with more precisely defined categories, such as somatization disorder. In 1980, the American Psychiatric Association officially changed the diagnosis of "hysterical neurosis, conversion type" (the most extreme and effective type) to "conversion disorder".
For at least 2,000 years of European history until the late 19th century, the term "hysteria" referred to a medical condition thought to be particular to women and caused by disturbances of the uterus (from the Greek ὑστέρα hystera "uterus"), such as when a newborn child emerges from the birth canal. The origin of the term is commonly attributed to Hippocrates, even though it is not used in the writings that are collectively known as the Hippocratic corpus. The Hippocratic corpus refers to a variety of illness symptoms – such as suffocation and Heracles' disease – which were supposedly caused by the movement of a woman's uterus to various locations within her body as it became light and dry due to a lack of bodily fluids. One passage recommends pregnancy to cure such symptoms, ostensibly because intercourse will "moisten" the womb and facilitate blood circulation within the body. The "wandering womb" theory persisted in European medicine for centuries.
By the mid- to late 19th century, hysteria (sometimes called female hysteria) had come to refer to what is today generally considered to be sexual dysfunction. Typical treatment was massage of the patient's genitalia by the physician and, later, by vibrators or water sprays to cause orgasm. A male counterpart of the diagnosis of hysteria, which then almost exclusively applied to women, was associated with symptoms now mostly considered to be signs of PTSD.
A more modern understanding of hysteria as a psychological disorder was advanced by the work of Jean-Martin Charcot, a French neurologist. In his 1893 obituary of Charcot, Sigmund Freud attributed the rehabilitation of hysteria as a topic for scientific study to the positive attention generated by Charcot’s neuropathological investigations of hysteria during the last ten years of his life. Freud questioned Charcot’s claim that heredity is the unique cause of hysteria, but he lauded his innovative clinical use of hypnosis to demonstrate how hysterical paralysis could result from psychological factors produced by non-organic traumas (psychological factors that Charcot believed could be simulated using hypnosis). According to Freud, this discovery allowed subsequent investigators such as Pierre Janet and Josef Breuer to develop new theories of hysteria that were essentially similar to the medieval conception of split consciousness, but with the non-scientific terminology of demonic possession replaced with modern psychological concepts.[clarification needed]
In the early 1890s Freud published a series of articles on hysteria which popularized Charcot's earlier work, and began the development of his own views on hysteria. By the 1920s Freud's theory on hysteria was influential in the UK and the US. Freudian psychoanalytic theory attributed hysterical symptoms to the unconscious mind's attempt to protect the patient from psychic stress. Unconscious motives include primary gain, in which the symptom directly relieves the stress (as when a patient coughs to release energy pent up from keeping a secret), and secondary gain, in which the symptom provides an independent advantage, such as staying at home away from a hated job. More recent critics have noted the possibility of tertiary gain, as when a patient is induced unconsciously to display a symptom because of the desires of others (for instance when a controlling spouse enjoys the docility of his or her sick partner).
Judith Herman suggests, in Trauma and Recovery: The Aftermath of Violence: From Domestic Abuse to Political Terror, that hysteria was a label given to a form of PTSD arising from routine domestic abuse of women, including physical abuse, rape, and emotional abuse. She describes the work of Charcot and Freud, which had resulted in Freud's finding in "The Aetiology of Hysteria" in 1896 (which he later repudiated):
- "I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience ... ".
Current theories and practices
Current psychiatric terminology distinguishes two types of disorder that were previously labelled "hysteria": somatoform disorder and dissociative disorder. There are many cases of these disorders where nothing else can be diagnosed in the sufferers. The dissociative disorders in DSM-IV-TR include dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified. Somatoform disorders include conversion disorder, somatization disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. In somatoform disorders, the patient exhibits physical symptoms, such as low back pain or limb paralysis, which have no apparent physical cause. Additionally, certain culture-bound syndromes – such as "ataques de nervios" ("attacks of nerves") identified in Hispanic populations, and popularized by Pedro Almodóvar's film Women on the Verge of a Nervous Breakdown – exemplify psychiatric phenomena which encompass both somatoform and dissociative symptoms, and have been linked to psychological trauma. Recent neuroscientific research is now beginning to show that there are characteristic patterns of brain activity associated with these states. All these disorders are thought to be unconscious, not feigned and not intentional malingering.
Jungian psychologist Laurie Layton Schapira has explored the "Cassandra Complex" suffered by those traditionally diagnosed with hysteria. Basing her findings on clinical experience, she delineates three factors which constitute the Cassandra Complex in hysterics: (a) dysfunctional relationships, with social manifestations of rationality, order and reason, leading to (b) emotional or physical suffering, particularly in the form of somatic, often gynaecological complaints, and (c) sufferers being disbelieved or dismissed when attempting to relate the facticity of these experiences to others.
- King, Helen (1993). "Once upon a text: Hysteria from Hippocrates". In Gilman, Sander; King; Porter, Helen; Rousseau, G.S.; Showalter, Elaine. Hysteria beyond Freud. University of California Press. pp. 3–90. ISBN 0-520-08064-5.
- Rachel P. Maines (1999). The Technology of Orgasm: "Hysteria", the Vibrator, and Women's Sexual Satisfaction. Baltimore: The Johns Hopkins University Press. ISBN 0-8018-6646-4.
- See: A Clinical Lesson at the Salpêtrière.
- Freud, Sigmund (1962). The Standard Edition of the Complete Psychological Works of Sigmund Freud: Volume III (1893-1899). London: Hogarth Press. pp. 11–23. ISBN 0-7012-0067-7., first published in Sigmund Freud (1893). "Charcot". Wiener Medizinische Wochenschrift. 37.
- Herman, Judith (1992). Trauma and Recovery: The Aftermath of Violence: From Domestic Abuse to Political Terror. Basic Books. pp. 10 – 16. ISBN 0-465-08765-5.
- Freud, Sigmund (1962). Standard Edition, vol. 3. "The Aetiology of Hysteria": Hogarth Press. p. 203.
- Schechter DS, Marshall RD, Salman E, Goetz D, Davies SO, Liebowitz MR (2000). Ataque de nervios and childhood trauma history: An association? Journal of Traumatic Stress, 13:3, 529–534.
- M Sierra & G E Berrios (1999) Towards a Neuropsychiatry of Conversive Hysteria. Cognitive Neuropsychiatry 4: 267–287.
- Laurie Layton Schapira, The Cassandra Complex: Living With Disbelief: A Modern Perspective on Hysteria (1988)
- Chodoff, P. et al. (1982). Hysteria. New York, NY: John Wiley & Sons.
- Halligan, P.W., Bass, C., & Marshall, J.C. (Eds.) (2001) Contemporary Approach to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford University Press, UK.
- Sander Gilman, Roy Porter, George Rousseau, Elaine Showalter, and Helen King (1993). Hysteria Beyond Freud (Berkeley, Los Angeles, and Oxford: University of California Press).
- Andrew T. Scull, Hysteria. The Biography. Oxford (Oxford University Press) 2009