Hysteria and the Evolution of Psychiatry

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The history of psychiatry dates back to neolithic times and the practice of drilling holes into the skull (trepanation) to release evil spirits.

However it is with hysteria that psychiatry can date its origins to 1900BC in Egypt. Portrayed exclusively among women, symptoms varied but they always involved the body-mind interface. Characteristic features included shortness of breath, seizures, ‘heaviness in the abdomen’, muscular spasms and fainting. Egyptian physicians came up with the wandering uterus theory (hysteron is Ancient Greek for uterus) and thought that symptoms arose by virtue of the wayward organ migrating from its home in the pelvis up to the chest and it needed to be dragged back. To do so meant encouraging the patient to drink noxious fluids or by applying perfumes to the genitals to entice the itinerant organ back to where it belonged.

The Greeks picked up on the traveling uterus idea and both Plato and Hippocrates felt that women should be kept  pregnant (and barefoot presumably) such that the uterus would stay put. The Romans didn’t embrace that idea too much but focused more on the  humors (bile, blood, secretions etc)  and up to the Middle Ages, hysterical symptoms were attributed to the retention of ‘sexual fluid’, which was most common in ‘passionate’ young women and widows. So one can assume that the diagnosis (by men of course) meant that treatment should be along the lines of carnal knowledge.

Indeed it was cured with herbs, sex or sexual abstinence or punished and purified with fire for its association with sorcery-read witchcraft. Now on that subject back in the day, I  read a book called the Malleus Maleficarum written in 1487  by two German Dominican friars. It was a manual for seeking out witches but it had some detailed early depictions of contemporary psychiatric disorders-Tourette syndrome, melancholia, anorexia nervosa and hysterical manifestations.

All were signs of demonic influences of course and found in or caused by bewitched females. The manual displayed a sexist tone  brought on by fears of women and the harm they could inflict on men by virtue of their unbridled and unGodly carnal desires. Of course these were just denied male sexual temptations projected onto women. One anecdote concerns a man whose wife drowned in a river and his friends’ found him looking for her body upstream. When confronted with this contradiction his reply was ” she was contrary in life, so it must be also in death.”

The mainstream view at the time, complements of Thomas Aquinas, was one in which the woman is was a physically and theologically inferior being.  This alleged inferiority of women was considered a consequence of original sin.
By the 17th century a newer view of hysteria based on a better understanding of anatomy and physiology, was introduced and it was no longer attached to the central role of the uterus but rather related to the brain and to the nervous system. Nevertheless many Victorian women carried smelling salts in their handbags:they were inclined to swoon when their emotions were aroused and the uterus needed to be tamed. By the late 19th century the French neurologist  Charcot who was studying  multiple sclerosis  argued that hysteria derived  from a hereditary degeneration of the nervous system. Now one of his students happened to be S. Freud who believed hysterical symptoms developed when memories too painful or too embarrassing to talk about were converted into bodily symptoms – like blindness or paralysis.

It turned out that some of these memories were of paternal sexual abuse. Such cases were classed as “hysterical neurosis” and psychoanalysis was born. Modern classification focuses on hysteria as conversion (paralysis), or dissociation (zone outs). Indeed  most cases I have seen of both were found in women and were the result of sexual trauma.

The histrionic personality however is a caricature of women (Scarlett O’Hara syndrome) and such women are described as lively, dramatic, vivacious, enthusiastic, and flirtatious. The male equivalent is a variant of narcissism known as the Don Juan syndrome. Both are attention seeking variants and extremes on normal female-male personality traits.

This review demonstrates the changing nature of our understanding of psychiatric diagnosis and by virtue of its descriptive nature, how it reflects fashion and sexist attributions. At least as applies to women. The latter made up at least 2/3 of my case load and not because they are crazier or not because men make them so (which feminists  argue)  but because they are more emotive and able to better communicate feeling states with less shame or stigma. As for the  uterus, many men, particularly of the reactionary Conservative-Republican persuasion, still can’t seem avoid probing it’s hidden inner secrets.

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