HYSTERIA (MAL CADUCO, morbus sacer). - A psychoneurosis characterized by particular anomalies of the neuro-psychological equilibrium, of temperament, and of character, which, variously combining and reacting with one another, give rise to the most varied clinical symptomatology of a functional basis. U. Cerletti defines it as "a morbid syndrome characterized by a psycho-emotional complex that generates exaggerated or abnormal somatic and psychic reactions and tends to reproduce and fix them."
The hypotheses on the genesis of hysteria are innumerable. That of Hippocrates has historical value, accepted throughout the Middle Ages, who held the disease to be caused by the wanderings of the uterus (ὕστερος) raging through the abdomen and thorax. In 1618 Lepois was the first to classify hysteria among the nervous diseases. A little more than half a century later (1681) Sydenham, having noted the innumerable pictures with which the disease presents itself, affirmed that it was a functional nervous form. At the end of the nineteenth century a new impulse was given to the knowledge of hysteria by Charcot with his researches at the Salpêtrière Hospital in Paris. In 1908 Babinski named the hysterical manifestations "pithiatism" (πίδηνος = monkey), considering it a set of disturbances that it is possible to reproduce by suggestion or imitation in certain subjects, and that are susceptible to disappearing under the influence of a counter-suggestion. This conception of Babinski is incomplete, inasmuch as in hysteria there are found manifestations certainly not due to suggestion. For Janet the disintegration of consciousness and mental depression are important; Kraepelin makes it depend on intense and exaggerated sensations due to violent emotions. More recent authors (Haskovec, Pienkowski, Dezwarte) maintain the subcortical genesis of hysteria. In Italy, Buscaino maintains that hysteria originates in an abnormal condition of the midbrain and of the basal ganglia of the brain, capable of reacting in a paradoxical manner to psychic stimuli. According to others, hysteria is determined in individuals with a constitutionally labile nervous system, following emotions (anaphylactic shock from emotion); these would be capable of blocking the cortico-mesencephalic connections and inhibitions and of liberating the automatism of the subcortical nuclei. For Freud hysteria is provoked by the seething and the attempt to come to light of psycho-sexual complexes, distorted and badly badly oriented during infantile development, repressed in the subconscious (v. PSICANALISI). Even more recent authors exclude that it is a disease and admit only a hysterical character.
The disease is found by preference in the female sex, but it is not rare in men and can present itself from infancy (8-10 years); it spares neither race nor social category. Among the causal factors of hysteria figure: neuropathic heredity, the influence of the environment, faulty education; psychic traumas act rather as occasional factors triggering the hysterical episode. Physical traumas (falls, blows, accidents, etc.) act particularly through the disturbances of consciousness and the intense emotional states they are capable of arousing; thus arise accident neuroses and traumatic hysteria. Contributing causes can be infectious diseases (syphilis, tuberculosis, typhus, scarlet fever, etc.), intoxications (alcoholism, carbon monoxide poisoning), dysendocrinias (Flajani-Basedow disease). It is erroneous to give a preponderant causal value to affections concerning the sexual sphere; sexual abstinence should not be considered a cause, particularly if consciously and freely chosen and lived as a high ideal of life.
Hysteria presents a quite varied number of symptoms that have in common certain characteristics that make them recognizable. They do not depend on gross anatomical lesions of the nervous system; they can appear and disappear rapidly and as a whole, not presenting that constant and characteristic symptomatology linked to true anatomical alterations; the picture is usually extremely rich and highly variable.
The psychic disturbances are characterized by the notable influence that suggestion has in determining them, by the period of "expectation" that the psychic process presents, and by the tendency to reproduction.
Among the motor manifestations are frequent: hysterical torticollis, spasm of the glottis, of the pharynx, of the esophagus (globus hystericus), contractures, flaccid or spastic paralyses, localized or diffused to half the body (hysterical hemiplegia), of the vocal cords with sudden aphonia.
Among the sensory disturbances: the hysterical aberrations are innumerable and manifest themselves in the most bizarre ways, no territory of innervation and no sense organ being excluded.
Among the most frequent visual disturbances, due to autosuggestion, are achromatopsia, that is the loss of the sensation of colors, the narrowing of the visual field, diplopia, that is double vision, unilateral or bilateral blindness, etc. Regarding hearing, a diminution often presents itself, sometimes even to complete deafness. For taste and smell, anesthesias to certain substances are frequent: sugar, salt, vinegar, quinine, as likewise a diminution of the sensitivity of the mucous membranes (conjunctivae, throat). Important is the absence of the pharyngeal reflex, very frequent in hysteria. The sensory alterations of the skin present themselves in generalized form, sparing no territory; or in segmentary form, assuming a configuration like a glove, a stocking, a shoe, a star, a leaf, or over an entire half of the body, more often on the left, etc.; disturbances of sensitivity that always have the characteristic of not corresponding to those zones that should be in relation to the well-determined territories of distribution of the peripheral nerves or of the spinal roots.
The pains or algias, also very frequent, localize anywhere: in the head, vertebral column, limbs, joints, violent or simply in the form of hyperesthesia, that is exaggerated sensitivity; abnormal or paradoxical sensations are the paresthesias (formication, burning, sense of electric shock, of spasm particularly between the esophagus and the upper valve of the stomach (it is globus hystericus).
The secretory disturbances concern the accessional superabundance of saliva (ptyalism); or of sweat, often limited to a particular and well-configured cutaneous territory; or of urine (polyuria or oliguria or complete anuria); or of tears or of milk.
Particular phenomena are represented by the so-called hysterical fever, which some authors (Babinski) consider always simulated with skillful maneuvers during measurement, others think it is in relation to crises of violent hyper-emotivity or to nervous disturbances of the vasomotor and thermoregulatory centers; such fever can even assume the appearance and course proper to certain infectious diseases. Vasomotor phenomena, of dilation or spasm of the arterioles and cutaneous capillaries, can give rednesses or pallors, general or local, or irregular spots or figured patterns or streaks, raised or not, red or white, on the skin, which follow local mechanical stimulation (dermographism).
The hysteric is capable of a subjective sensation of the internal viscera, in their form, position, and function, and through this path comes to feign internal diseases of an organic order (gastro-duodenal ulcers, tumors, etc.), at times pregnancy itself. All this symptomatology can be permanent ("hysterical stigmata") or accessional.
The picture of hysteria is completed by the psychic symptoms, which are truly essential and constant, bound to the particular temperament and character of the hysteric. Among such symptoms the following should be noted: the tendency to draw and fix the attention of others upon oneself (egocentrism); to exaggeration, to systematized lying (mythomania, v.), to simulation; to being excessively influenced by one's own mental representations and to remaining influenced by suggestion, whether one's own (autosuggestion) or that of others; to the splitting and disintegration of the unity of the block of psychological consciousness. Particularly after the attacks, phenomena of dissociation, amnesia, sensory illusions and hallucinations follow. The individual, among his traits, further displays, with regard to affective tone, apathy or hyper-emotivity, a lack of energy and of persistence in the will (abulia).
Particularly in the past (in Charcot's time), the appearance of acute episodes in the form of "grand hysterical crises," recalling in their general outlines the epileptic attack, was easy. The individual, under the action of suggestion, or following occasional external causes (fright, anguish, etc.), begins to feel various disturbances, feels incapable of influencing his own body, complains of a sense of oppression, of anguish, labored breathing, a sense of palpitation, general tremor, noisy hiccuping; finally he is seized by the convulsive crisis. The hysteric thrashes about, shaken by tonic-clonic convulsions, contortions, contractures in acrobatic poses (hysterical arc de cercle); characteristic are the theatricality of the crisis, the need for an audience for it to unfold, the skill of doing himself no harm despite the falls and the violent beating. After a more or less long period, the hysterical attack ceases with a fit of weeping, or the patient falls asleep. In the hysteric, phenomena of catalepsy (v.), catatonia (v.), lethargy (v.) and hypnotism (v.) readily appear.
The moral personality of the hysteric is greatly altered; Krafft-Ebing asserts that hysterics are afflicted by a very great libidinous exaltation, although there is no lack of incredibly frigid ones. They no longer have the moral sense of charity and humanity, the will and moral energy are weakened and free will suffers thereby. The anomalies of sensation influence the moral order and the affective life. Thus there arise vehement impulses, passions and simulations. Not all acts committed by hysterics, however, are devoid of responsibility, since they are not always performed under the influence of the disease; indeed, many times they are done with freedom and knowledge, and the morbid influence is not always so grave as to eliminate all responsibility.
With regard to prognosis, hysteria must be considered, in the present state of medicine, incurable in its particular neuro-psychological constitution, especially if a badly conducted education has allowed the hereditary taints and the morbid tendencies of the character to develop and become fixed through the years. On the contrary, a well-conducted treatment and education can attenuate the morbid tendency, prevent or rapidly cut short the symptomatology and the crises in progress.
Apart from strictly medicinal treatment, which can at times give unexpected results, the greatest benefit can be derived from methods of suggestive or persuasive psychotherapy (v.), whose value is without doubt more bound to the intuition, the patience, often the heroic charity of the one who puts it into practice, rather than to the intrinsic value of this or that method. With regard to the possibilities of treatment of psychoanalysis (v.) and its moral character, this will be discussed under the corresponding entry.
In general one must beware of giving excessive weight to hysterical disturbances; yet one must not fall into the opposite excess of neglecting or, worse, of crudely mocking and maltreating the sick, accusing them of being visionaries or simulators. Inasmuch as the illness of hysterics, while acknowledging a purely ideational genesis, unfolds independently of the conscious will of the patients, for whom it represents a real cause of suffering. Moreover, the affectivity, always abnormally developed in hysterics, if badly checked, would interpose itself as an insurmountable barrier preventing every attempt at therapy.
Of the greatest importance is the prevention of hysteria in the children of hysterics. Their education must aim in particular at the suppression of excessive sensitivity, educating the young with energy, without harshness, but likewise without sentimentality, teaching them in good time the mastery of themselves and developing their too weak will. It is of great importance not to indulge the development of the imagination, especially by avoiding readings and spectacles capable of provoking violent emotions or strong suggestions. In cases of grave familial predisposition, education away from the environment and the influence of the relatives may be useful.
With regard to those hysterical manifestations that can simulate phenomena of a preternatural and supernatural order, or that, being really of such a nature, are falsely judged hysterical (stigmata, sweats of blood, mystical states, etc.) v.: DEMONIACHE MANIFESTAZIONI; MEDIANICHE MANIFESTAZIONI; METAPSICHICA; MIRACOLO.