Beyond hysteria

I’ve just discovered that the eScholarship Editions site that has 500 academic books freely available online, several psychology and psychiatry books among them, including the excellent book ‘Hysteria Beyond Freud’ which takes a historical look at this fascinating and curious condition.

‘Hysteria’ has meant many things in medical history and originally the Ancient Greeks used it to describe what they thought was a ‘wandering womb’. Its modern meaning implies the presence of what seem like neurological symptoms, such as paralysis, seizures or blindness, but without any detectable neurological damage.

Borrowing an idea from Pierre Janet, Freud popularised the idea that these symptoms were physical manifestations of psychological distress or trauma as a way of diverting the psychological pain from the conscious mind – essentially ‘converting’ the emotional energy to something else.

Although the idea of hysteria ‘psychological defence’ or ‘emotional conversion’ has not been well supported by the evidence, it certainly seems the case that striking physical impairments can be unconsciously triggered.

Which is amazing if you think about it.

You could go blind, despite all your visual systems seeming to work perfectly, and you’d have no conscious control over it.

Recent evidence suggests this is possibly due to attentional systems in the brain impairing perceptual functions that occur early in the stream of consciousness, but it’s not clear why this happens.

The modern diagnostic manuals label hysteria as ‘conversion disorder’ or ‘dissociative disorder’ but they’re not necessarily good names because there’s still debate about whether the disorder actually involves ‘dissociation’ or ‘conversion’.

Many clinicians and researchers still use the term hysteria, or describe the symptoms as ‘functional’ or ‘psychogenic’, or perhaps even the more mysterious ‘medically unexplained’.

The picture on the left is called ‘The hypnotized patient and the tuning fork’ and was taken in the Salp√™tri√®re Hospital in Paris in 1889, where much early work on hysteria was conducted by neurologist Jean-Martin Charcot and his colleagues.

It’s featured in a chapter of ‘Hysteria Beyond Freud’ about artistic and photographic depictions of the ‘hysteric’ which contains many such striking images.

Owing to the fact that hysteria is at once a ‘psychological’ and ‘bodily’ condition, images were an early way of studying the condition and popularising it among doctors.

Interestingly, although hysterical symptoms are not consciously produced, they can respond to suggestion. If you’re puzzled by how suggestions can have unconscious effects on the body, think placebo.

‘Hysteria Beyond Freud’ is a fascinating book that tracks the condition through history and there are several other freely available psychology and psychiatry books also available.

Link to chapter ‘The Image of the Hysteric’.

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