Hysteria

I

Introduction

Hysteria, type of mental illness, in which emotionally laden mental conflicts appear as physical symptoms, called conversion reactions, or as severe mental dissociation. In modern psychological classification, hysteria is known as somatization disorder or conversion disorder, depending on the specific symptoms displayed. 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 1977 involved 57 members of a high school marching band who experienced headache, nausea, dizziness, and fainting after a football game. 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. The term collective stress reaction is now preferred for these situations.

II

Conversion Reactions

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. Common symptoms of conversion reactions include muscular paralysis, blindness, deafness, and tremors.

III

Dissociative Reactions

Patients with 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 dissociative fugue, in which a person forgets his or her identity and unexpectedly wanders away from home.

IV

Study and Treatment

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”) to disease phenomena characterized by highly emotional behavior. During the Middle Ages hysteria was attributed to demonic possession and to witchcraft, which led to persecution.

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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 Austrian psychoanalyst 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.

Current treatment of hysteria consists of some form of psychotherapy and, in some cases, prolonged forms of analytic psychotherapy, or of psychoanalysis. For cases of acute hysteria associated with anxiety, tranquilizing medication may also be necessary (see Tranquilizer). see Mental Illness: Somatoform Disorders.

In the late 1900s and early 2000s, neuroimaging techniques such as positron emission tomography (PET) enabled researchers to identify parts of the brain that appear to be involved in conversion disorder. When activated inappropriately—by emotional stress, for example—these neurons may disrupt brain circuitry and hamper motor or sensory functioning, thus producing the physical symptoms associated with hysteria. Such research suggests that hysteria is a neurological disorder.

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