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.
