Search

Hysteria has generated the most heated debates among physicians, from antiquity to the present day. It has been long confused with neuroses and neurological pathologies such as Parkinson's disease and epilepsy, principally associated with women and sexual disorders. The clinical manifestations must first be seen in their historical context, as interpretation varies according to the time period. Recently, the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association marked a break in the consensus that previously seemed to apply to the concept of hysteria and approach to the clinical manifestations. The clinical manifestations of hysteria are numerous and multifaceted, comprising 3 main classifications: paroxysms, attacks, and acute manifestations; long-lasting functional syndromes, and visceral events. Each main classification can be subdivided into several subgroups. The first main group of paroxysms, attacks, and acute manifestations includes major hysterical attacks, such as prodrome, trance and epileptic states, minor hysterical attacks such as syncope and tetany, twilight states, paroxysmal amnesia, and cataleptic attacks. The second group includes focal hysterical symptoms, paralyses, contractures and spasms, anesthesia, and sensory disorders. Visceral manifestations can be subdivided into spasms, pain, and general and trophic disorders. The diversity of the symptoms of hysteria and its changing clinical presentation calls into question the same hysterical attacks and the same symptoms, which have had only a few differences for over 2,000 years. A new definition of hysteria should be proposed, in that it is a phenomenon that is not pathological, but physiological and expressional.

Babinski, 'Chef de Clinique' of Charcot from 1885 to 1887, fully supported the ideas of his teacher on hysteria and thought that a dynamic brain cortical lesion is the cause of the disease. After Charcot's death in 1893, Babinski gradually revised his position. In a first step, he described many neurological signs in order to clearly distinguish hysterical manifestations from the organic disorders of the central nervous system. The most famous one bears his name, the Babinski sign, an inversion of the plantar cutaneous reflex, testifying to a lesion of the pyramidal tract. In a second step, he defined what remained of hysteria and proposed in 1901 to abandon the term 'hysteria' in favor of the neologism 'pithiatism', defined as a pathologic state resulting in disorders which can be very accurately reproduced by suggestion, and can disappear by persuasion. Babinski therefore retained the exclusive etiological role of suggestion and refuted, unlike Dejerine, the role of emotion. He also sought to separate pithiatism from simulation, but ambiguously he made pithiatics 'semi-malingerers'. During the Great War, with Froment, he described physiopathic disorders and separated them from pithiatic disorders and simulation. After being accepted by many French neurologists, pithiatism, the word as well as the concept, gently died out. There remained little more than a few philosophical uses (especially by Jean-Paul Sartre and Maurice Merleau-Ponty) or metaphorical ones. What remains of the work of Babinski in the field of hysteria is not so much the creation of pithiatism as the masterly description of neurological signs to formally exclude an organic lesion of the nervous system or simulation before looking like hysteria disorders.

Medical humanities is the interdisciplinary field of humanities (literature, philosophy, ethics, history, and religion), social science (anthropology, cultural studies, psychology, and sociology), and the arts (literature, theater, film, and visual arts), and their application to medical education and practice. In this chapter, the concept of 'hysteria' is put into a medical humanities perspective. We review the concept of hysteria concisely. Two novels and one autobiographical story are used as material in order to study how 'hysteria' is represented in literary work. Madame Bovary (Gustave Flaubert), Hedda Gabler (Henrik Ibsen), and A Story in an Almost Classical Mode (Harold Brodkey) were searched for elements that are characteristic of hysteria. Excessive emotion, dramatics, attention-seeking behavior, physical symptoms of unknown and unidentifiable organic causes, self-centered behavior, and flirtatious behavior are the six elements used to operationalize hysteria. It was found that these elements were present in both a quantitative and qualitative manner in the literary works examined. Acknowledging some limitations and suggesting some research areas and clinical implications, we conclude that literary works are useful in analyzing concepts in medicine. Also, more generally, using literary works seems to have a positive impact on readers, healthcare providers, and researchers in the healthcare domain. Studying novels and related literary work contributes to the body of knowledge of medical humanities.

At the end of the 19th century, neurasthenia and hysteria were considered distinct diseases. Specifically, neurasthenia was regarded as a disease of the body, whereas hysteria was regarded as a disease of the psyche. However, immediately before World War I, due to their common characteristics, both hysteria and neurasthenia were thought to be 'functional diseases'. Moreover, it was suggested that heredity and the presence in both of the predisposing condition called 'nervous weakness' were other shared factors. Nervous weakness was considered essential for the definition of neurasthenia, but it was also considered a precondition for the development of hysteria. Because of this, it is still difficult to demarcate a line between neurasthenia and hysteria; therefore, the two diseases should be considered as sharing a common borderland with each other.