Hysteria is considered a mental disorder characterized by excessive fear or emotions; patients often imagine that a part of their body is ill and feel unable to control it.
The term originates from the Greek word hysterikos, which referred to a condition thought to affect only women and believed to be caused by the uterus.
A Brief History of the Condition
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Hysterikos – Greek term (Image: aefraser) |
During the time of Hippocrates, it was referred to as Hysteria, believed to be caused by uneven blood flow from the uterus to the brain. In the mid-19th century, the condition was frequently discussed under the term female hysteria, which many today associate with sexual dissatisfaction. Consequently, the “treatment” at times involved the use of vibrators or water sprays to induce pleasure.
Modern Western medicine no longer uses the term female hysteria, but during the Victorian era, it was a common diagnosis that encompassed a range of symptoms such as fatigue, anxiety, bloating, insomnia, water retention, cramps, shortness of breath, irritability, poor appetite, loss of libido, and a tendency to cause disruptions.
Once diagnosed with female hysteria, patients would receive pelvic massages, where practitioners would stimulate the female genitalia to induce what was termed “hysterical paroxysm,” now known as orgasm.
By 1859, it was estimated that one in four women suffered from hysteria, with over 75 pages describing symptoms, meaning almost any ailment could be diagnosed as hysteria. This was advantageous for doctors as patients were not in life-threatening situations yet required regular treatment.
The only issue was that doctors were not keen on lengthy massage therapies for patients to reach orgasm, which led to the invention of electric machines and vibrators that emerged in the 1870s. By 1918, convenient home-use devices were available.
In the early 20th century, with the rise of psychoanalysis proposed by Sigmund Freud, hysteria began to be treated through different methods. By the early 20th century, the number of diagnosed hysteria cases had significantly decreased for various reasons, with many doctors attributing this to increased understanding of conversion disorder. Several cases of hysteria were reclassified by Freud as anxiety disorders. Today, many manifestations of hysteria are recognized as dissociative disorders, conversion disorders, and anxiety disorders.
It is also important to note that advancements in understanding hysteria were significantly influenced by the research of the French neurologist Jean-Martin Charcot.
Pathophysiology
In 400 BC, Hippocrates identified hysteria as “a disease of the uterus, treatable through movement and massage.” Plato proposed the hypothesis that the condition arose from the uterus wandering throughout a woman’s body, potentially suffocating the patient if it moved to the chest, thus the name of the condition derives from the Greek term for uterus.
A renowned physician in the second century, Galen, wrote that hysteria was a condition resulting from sexual deprivation, commonly seen in unmarried women, nuns, widows, and sometimes married women. Treatments in the medieval and Renaissance periods included facilitating sexual relations for married women or arranging marriages for those unmarried, or employing midwives to massage the pelvic area…
In the 19th century, a widely debated topic was whether sex was primarily for reproduction or for pleasure. Despite being a sacred image of the time, Queen Victoria of England had many children. As fertility decreased, the reproductive purpose of sexual activity became less paramount; prevailing views on female sexuality at the time mistakenly assumed that women had no sexual urges, leading to the belief that women engaged in sex solely for reproduction. This viewpoint potentially increased the number of women dissatisfied with their sexual lives and consequently raised the demand for hysteria treatment.
Clinical Presentation and Treatment Approaches
Conversion disorder, historically rooted in hysteria, has been described and treated by Sigmund Freud through psychoanalytic methods. Conversion disorder manifests in various ways and may be triggered by an acute psychological stressor that the individual cannot process. A general decline in psychological function can lead to the brain becoming unconsciously paralyzed or weakening bodily functions to the extent that the patient no longer perceives the impact of this stress. As a result, psychosocial stress can be “converted” into physical symptoms. The patient is often unaware of this process—a characteristic known as complete indifference.
Symptoms often resemble neurological disorders and may include one or more of the following: paralysis of a limb or whole body; reduced hearing or vision; loss of sensation; reduced or loss of speech ability; psychogenic seizures; psychological causes of increased muscle tone.
Diagnosis can often be challenging, requiring a thorough history and observation to rule out the possibility of the patient feigning symptoms or having undetected biological causes. A careful physical and neurological examination is necessary to identify whether there is a sufficient organic cause for the paralysis. If not due to an organic cause, the patient may need to undergo cognitive-behavioral therapy to break down psychological barriers and behavioral cycles that trigger stressors.
Dr. ĐÀO XUÂN DŨNG
