PSYCHIATRY AND HISTORY
Fall 2021 Issue |
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History of ‘Hysteria’ and Implications for Current Practice
By Cassandra Dao, MS4, Stephanie Peglow, DO, MPH
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| Dr. Peglow |
The term hysteria is derived from the Greek husteros, meaning “uterus,” based on the belief in a set of disorders unique to women. Historically, this encompassed symptoms that we now associate with conversion disorder and histrionic personality disorder. Freud believed they were defense systems against sexual impulses.1 Hysteria has been recognized in history as a female disorder, dating back to at least 2000 BC, where it was recorded in written records from ancient Egypt, which described it as convulsions from spirit possession.2 Records from 1900BC and 1600BC attributed the disease to the position of the uterus.3
Hippocrates also believed the condition was caused by movement of the uterus and was the first to use the term hysteria around 500BC. He distinguished it from epilepsy, which he attributed to the brain rather than the uterus. He believed hysteria was due to poisonous stagnation from an inadequate amount of sex and procreation, which would widen a woman and cleanse her.3
Dissociative symptoms were also mixed into the descriptions of hysteria, often attributed to demonic practices or possession throughout the course of history. The first clearly described case of dissociative personalities was in 1646. Additional reports continued over the next two centuries. Treatment modalities were dominated by exorcisms. Dissociation was not recognized as its own concept until the 19th century, when the French psychiatrist Pierre Janet created the term, borrowing the concept from an earlier concept by Moreau de Tours who described hysterical seizures. Freud is credited with having first introduced the concept of hysterical conversion and emphasized psychological origins.2 He also suggested a “male hysteria” when he wrote in 1897: “After a period of good humor, I now have a crisis of unhappiness. The chief patient I am worried about today is myself. My little hysteria, which was much enhanced by work, took a step forward.”3
In 1909, the English physician Savill described hysteria as a variety of nervous symptoms that were not accompanied by physical signs. In the late 1900s, this was affirmed in America by the Washington University psychiatry group in St. Louis and referred to as “Briquet’s syndrome” to replace the older term “hysteria” which had pejorative connotations. Briquet’s syndrome was described as a chronic disorder that began following puberty and occurred almost exclusively in women. Patients with this disorder had numerous complaints without physiologic basis, saw many physicians, underwent extensive testing, and often had poor social function. By the middle of the 20th century, the syndrome of hysteria was established as multiple recurrent unexplained physical symptoms presenting in many different organ systems. The Diagnostic and Statistical Manual of Mental Disorders (DSM) listed “dissociative reaction” with “conversion reaction.” The DSM-II had a category for “hysterical neurosis” and listed dissociation and conversion as two different types. DSM-III separated dissociative and conversion disorders, listing the latter under a somatoform category.2
The full history of hysteria is lengthy, and the term is now technically outdated. It is still used as a lay term and retains its pejorative connotations. Unfortunately, this trend of pathologizing women continues. For example, the DSM V criteria for Depression with Peripartum Onset are only defined for women, when this disorder occurs in men as well.4 It is important to understand the historical development of psychiatric conditions to better and more objectively inform future guidelines and classifications.
References:
- American Psychological Association. (2021). APA Dictionary of Psychology. https://dictionary.apa.org/hysteria
- North C. S. (2015). The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations. Behavioral sciences (Basel, Switzerland), 5(4), 496–517. https://doi.org/10.3390/bs5040496
- Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women and hysteria in the history of mental health. Clinical practice and epidemiology in mental health : CP & EMH, 8, 110–119. https://doi-org.evms.idm.oclc.org/10.2174/1745017901208010110
- Scarff J. (2019). Postpartum Depression in Men. Innovations in Clinical Neuroscience. May 1;16(5-6):11-14.
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