HYSTERIA is a morbid state of the nervous system in
which clinical manifestations present a wonderful variety of symptoms closely
simulating organic disease. There is often increased physical irritability; the
condition manifests in neuralgic pains, hyperesthesias, hallucinations, and
convulsive and paralytic phenomena. It may be considered a brain affection - a
mild mental illness. Among the causes of hysteria, heredity plays a significant
role.
There may be direct transmission of the hysterical
temperament from parent to child or other nervous manifestations in the family
and its branches. These manifestations include epilepsy, chorea, neuralgia,
insanity, etc. It occurs more frequently in women, but it is much more common
in men than believed; it occurs in boys and girls at a tender age or about puberty.
Briquet found that one-eighth of his cases were for children under 10. Anything
that lowers the general tone of the nervous system may contribute to it in
predisposed persons.
Haemorrhages, severe illness, poor food, anaemia,
overwork in uncongenial occupations, anxiety, fright, jealousy, and
disappointments, make a profound impression; so does an education that fosters
and stimulates inherited instability. Women's enforced social restrictions
often inflicted upon their young children, with lack of proper exercise for
physical development and artificial and premature education and habits heighten
this predisposition. Accidents are a frequent cause of hysteria, as Charcot
clearly pointed out. _ The disease may occur in young girls who have witnessed
attacks elsewhere.
To understand hysteria symptoms, it must be remembered
that there are two classes of phenomena. These have been termed the
psychological stigmata and the menial accidents. The stigmata are anesthesias
(loss of sensation), amnesias (forgetfulness), abulias (loss if will power),
motor disturbances, and modifications of character. These are the cardinal
symptom groups that characterize the hysteric's mental state. Any or all mental
accidents may also be noted — suggestibility and sub-conscious acting, fixed
ideas, ecstasy, automatism, convulsive movements, sleepwalking, deliriums, etc.
The occurrence of these constitutes substantial
corroborative evidence of hysteria. While not found in all hysterics, they may
be very common symptoms. Hysterical persons often complain of some of the
symptoms found in neurasthenia — neuralgic pains in various parts and
hyperesthetic areas about the abdomen, chest, or back, frequently in the
neighborhood of the ovary, mammary gland, etc. There may be anaesthetic patches
in various parts of the body. In addition, there may be a complete loss of
sensation on one side associated with mucous membrane anaesthesia.
The special senses on that side are involved — sight,
taste, and hearing. There may be irritations of the bladder and urethra; and
pain in the joints, which may be mistaken for joint disease. In some cases, the
senses are exceedingly acute. Persons notice odors imperceptible to others; are
often made sick by odors that do not affect normal individuals; and may like
odors and substances disagreeable to others. Perverted sense is shown in
abnormal tastes, soap, slate, pencils, etc. Hysterical manifestations are
simply emotional exaggerations; they laugh and cry without cause.
In serious attacks, there may be various hysterical
manifestations. Occasionally tactile sensibility is disturbed and the muscular
sense may be abolished. The anaesthesia may affect the mucous membranes of the
mouth, pharynx, and nose, abolishing reflexes. Secretions may be diminished or
stopped. Spasmodic convulsions and paralytic phenomena may occur. The spasmodic
attack may be rhythmic; may simulate organic disease trembling; may be confined
to one member or involve the entire half of the body; may coarse, as in
disseminated sclerosis, or a fine tremor, as in paralysis agitans, or the
tremor may simulate organic brain disease.
It may occur in any muscle or group of muscles; and may
manifest itself as contracture, which may be intermittent or last continuously
for months or years. Contracture may be confined to the strong jaw muscles and
other muscles in their vicinity, resulting in trismus. Spasms of the glottis
may cause severe difficulty breathing or of the pharynx, causing difficulty
swallowing. Globus hystericus is a constant symptom but it is not as frequent
as often thought.
Persistent and severe vomiting often occurs, but
nutritionists rarely suffer materially from these attacks. Retention of urine
is frequent, owing to sphincter spasms, and a catheter may have to be used for
months. Paralysis occurs in these cases; it is variable in distribution and may
come on suddenly after a convulsive attack or without it; it may be flaccid or
associated with contracture; it may come on slowly; it may be confined to one
limb or hemiplegic in type. Hysterics are easily affected by pleasurable or
painful impressions and crave sympathy and attention.
They may show moral perversion; may lie, steal, quarrel
with, and intrigue against their own family; may form and change attachments
and dislikes without obvious reason; may manifest aversions, to frogs, spiders,
mice, cats, etc.; may deceive for deception's sake or to excite wonder. Some
are painfully depressed; they have forebodings or are compelled to do certain
acts. It is here that hysterical insanities and imperative conceptions as well
as neurasthenias are discussed. Hystero-epileptic attacks in their greatest
severity are often preceded by general discomfort or hallucinations of vision
and hearing. Usually sudden, they may be preceded by an "aura,"
globus hystericus, singing in the ear, etc.
Breathing is spasmodic; consciousness is obscured;
convulsions may be similar to mild epilepsy. In some cases, the body is thrown
into all sorts of contortions. Extreme opisthotonos may be present, the body
bent backward, resting on the head and heels. Gestures and noises are made.
Sometimes religious ideas influence attitudes assumed; sometimes demonic
possession. In milder forms, recovery is the rule. In grave cases, and when
there is a strong neuronopathic tendency, the person will probably pass from
one hysterical manifestation to another.
Treatment.
In cases where physical health deteriorates, tonics,
and a nutritious diet should be given. Hydrotherapy improves nutrition and
mental state. Many drugs have been recommended, but they are all uncertain
about their action, giving a result and failing at another. Convulsive attacks
may be stopped by applying a cold douche to the spine. Isolation from the
family circle is of the utmost importance in treating these cases. Every effort
should be made to discover the psychic shock that triggered the attack. Only
the patient may know this and will not often reveal it. There is no disease
whose treatment is harder to describe. Suggestion therapy gives the fastest
results, but the great difficulty is that successful results are rarely
permanent.
