Hysteria, that is:
Hysteria is a 4,000-year-old diagnosis that has been applied to no mean parade of witches, saints and, of course, Anna O.
But over the last 50 years, the word has been spoken less and less. The disappearance of hysteria has been heralded at least since the 1960’s. What had been a Victorian catch-all splintered into many different diagnoses. Hysteria seemed to be a vanished 19th-century extravagance useful for literary analysis but surely out of place in the serious reaches of contemporary science.
The word itself seems murky, more than a little misogynistic and all too indebted to the theorizing of the now-unfashionable Freud. More than one doctor has called it “the diagnosis that dare not speak its name.”
Nor has brain science paid the diagnosis much attention. For much of the 20th century, the search for a neurological basis for hysteria was ignored. The growth of the ability to capture images of the brain in action has begun to change that situation.
Functional neuroimaging technologies like single photon emission computerized tomography, or SPECT, and positron emission tomography, or PET, now enable scientists to monitor changes in brain activity. And although the brain mechanisms behind hysterical illness are still not fully understood, new studies have started to bring the mind back into the body, by identifying the physical evidence of one of the most elusive, controversial and enduring illnesses.
Despite its period of invisibility, hysteria never vanished — or at least that is what many doctors say.
“Hysteria,” back in the day, was the term applied to just about any complaint a woman had if she wasn’t bleeding. The term itself is derived from the Greek word for uterus, and it was thought to be the result of an idle womb. Hippocrates’ usual prescription for hysteria was marriage.
Yes, *that* Hippocrates. First, do no harm, indeed.
In current medical circles, the term isn’t used any more, but the symptoms haven’t gone away — real illness with no determinable physical cause.
But it did change its name. In 1980, with the publication of the third edition of its Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association officially changed the diagnosis of “hysterical neurosis, conversion type” to “conversion disorder.”
“Hysteria, to me, has always been a pejorative term, because of its association with women,” said Dr. William E. Narrow, the associate director of the research division of the American Psychiatric Association. “I think the fact we got rid of that word is a good thing.”
I’m not really sure how to read Dr. Narrow’s comment here — does he mean that it’s pejorative because it was a term used to dismiss women’s concerns, or does the mere association with women render the term too pejorative to apply to men? Here’s another one, who sees the term as a throwback of a different sort:
“It’s one of those woolly areas, and it has this pejorative association,” said Peter W. Halligan, a professor of neuropsychology at Cardiff University in Wales and the director of Cardiff’s new brain imaging center. “Some people say, ‘That’s a Freudian throwback, let’s go into real science.’ ”
I wonder how much the complaints about this not being “real science” have to do with the association of hysteria with women?
Freud, that misogynistic bastard, certainly had a lot to do with the popularization of hysteria as a diagnosis — though restrictive whalebone corsets and even-more-restrictive social roles for women in the upper classes probably had a lot to do with it, particularly the swooning and seizing:
Freud’s innovation was to explain why hysterics swooned and seized. He coined the term “conversion” to describe the mechanism by which unresolved, unconscious conflict might be transformed into symbolic physical symptoms. His fundamental insight — that the body might be playing out the dramas of the mind — has yet to be supplanted.
“Scores of European doctors for generations had thought hysteria was something wrong with the physical body: an unhappy uterus, nerves that were too thin, black bile from the liver,” said Mark S. Micale, an associate professor at the University of Illinois at Urbana-Champaign and the author of “Approaching Hysteria” (Princeton University Press, 1994). “Something somatic rooted in the body is giving rise to fits, spells of crying, strange aches and pains. Freud reverses that direction of causality. He says what the cases on his couch in Vienna are about is something in the psyche or the mind being expressed physically in the body.”
One of the treatments prescribed for female hysterics around the time of Freud was orgasm (aka “hysterical paroxysm“). The vibrator, in fact, was developed to save doctors the trouble of doing all the work manually.
Scientists are starting to look at hysteria with diagnostic tests that can monitor brain activity in patients with, for instance, hysterical paralysis. But the medical community doesn’t like uncertainty, and hysteria — now called “conversion disorder” — has never merited very much study. Or, for that matter, compassion.
Such imaging studies may one day be useful as diagnostic tools. Conversion disorder has long been a troubling diagnosis because it hinges on negative proof: if nothing else is wrong with you, maybe you’ve got it.
This has led to some obvious problems. For one thing, it means hysteria has been a dumping ground for the unexplained. A number of diseases, including epilepsy and syphilis, once classified as hysterical, have with time and advancing technology acquired biomedical explanations.
Such specious history makes patients skeptical of the diagnosis, even though the rates of misdiagnosis have gone down. (One widely cited 1965 study reported that over half of the patients who received a diagnosis of conversion disorder would later be found to have a neurological disease; more recent studies put the rate of misdiagnosis between 4 percent and 10 percent.)
“It helps to have some information from functional imaging to support the diagnosis,” Dr. Vuilleumier said. “That helps make the treatment and the diagnosis in the same language. The patient is coming to you with bodily language. The patient is not saying, ‘I’m afraid.’ It’s ‘I’m paralyzed.’ If you can go to the patient with bodily language, it helps.”
Such physical evidence might help hack away at prejudice among medical practitioners too. “Hysterical patients take a bad rap in the medical profession,” said Deborah N. Black, an assistant professor of neurology at the University of Vermont.
“We don’t like them,” Dr. Black said. “Somewhere deep down inside, we really think they’re faking it. When we see a patient with improbable neurological signs, the impulse is to say: ‘Come on, get off it. Sure you can move that leg.’ The other reason we don’t like them is they don’t get better, and when we can’t do well by them we don’t like them.”