Is hysteria real?

charcot_feint.jpg

The New York Times has an article on the scientific investigation of ‘hysteria’, the condition now typically called conversion disorder, where physical symptoms such as paralysis, seizures or even blindness seem to be caused by mental disorder rather than any detectable physical problems.

The diagnosis is controversial for many reasons, not least because it is largely Freudian in origin.

Actually, Freud was not the first to investigate the disorder. The French neurologist Jean-Martin Charcot made it popular with his dramatic case demonstrations using hypnotism and especially theatrical patients.

That’s Charcot in the picture above, with a patient in a ‘hysterical fit’. This painting hung above Freud’s consulting couch, and can still be seen there in his London home, now the Freud Museum.

Freud’s contribution was to provide a popular theory of why this occurs.

He argued that physical disorder could result from inner psychological turmoil as a result of unresolved conflict. He described a case of ‘hysterical paralysis’ in one of his most famous case studies, that of ‘Anna O‘.

Notably, there was little hard evidence for his theories, and critics have argued that his explanation is just used a fig leaf to hide the fact that doctors don’t know what is actually wrong with such a patient.

However, similar cases turn up regularly in neuropsychiatry clinics, and in recent years a growing body of research has tackled the issue.

‘Psychogenic non-epileptic seizures’, where people seem to have epileptic seizures but without any detectable brain disturbance, have probably received the most research attention to date (see two previous articles on Mind Hacks).

More recently, brain scanning studies have attempted to make sense of what’s going on – with some success.

In a 1997 paper published in the journal Cognition, Dr. Halligan, of Cardiff, and John C. Marshall and their colleagues analyzed the brain function of a woman who was paralyzed on the left side of her body. First they spent large amounts of money on tests to ensure that she had no identifiable organic lesion.

When the woman tried to move her “paralyzed leg,” her primary motor cortex was not activated as it should have been; instead her right orbitofrontal and right anterior cingulate cortex, parts of the brain that have been associated with action and emotion, were activated. They reasoned that these emotional areas of the brain were responsible for suppressing movement in her paralyzed leg.

Other studies have looked at paralysis induced by hypnosis as a comparison, and interestingly found that similar brain areas are involved in some cases.

Conversion disorder is still poorly understood, but it seems as if these patients are not ‘faking it’ and may have problems that are not caused by permanent damage, but are outside their conscious control.

The New York Times article looks at some of the most recent research in this area, and charts the growing acceptance of a diagnosis which has been dismissed by some people as nonsense.

Link to NYT article ‘Is hysteria real? Brain Images Say Yes’.
Link to BMJ editorial ‘New approaches to conversion hysteria’.

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