HYSTERIA (MORBUS CADUCUS, morbus sacer).
A psychoneurosis characterized by particular anomalies of neuro-psychological balance, temperament, and character, which, in various combinations and interactions, give rise to the most varied clinical symptomatology of functional origin. U. Cerletti defines it as «a morbid syndrome characterized by a psycho-emotional complex that generates exaggerated or abnormal somatic-psychic reactions and tends to reproduce and fix them.»
There are countless hypotheses regarding the genesis of hysteria. Hippocrates’ theory, which was accepted throughout the Middle Ages, holds that the disease is caused by the wanderings of the womb (ὑστέρα) as it rages through the abdomen and chest. In 1618, Lepois was the first to classify hysteria among nervous diseases. A little more than half a century later (1681), Sydenham, noting the countless forms in which the disease presents itself, affirmed that it was a functional nervous disorder. At the end of the 19th century, Charcot’s research at the Salpêtrière Hospital in Paris gave new impetus to the understanding of hysteria. In 1908, Babinski termed hysterical manifestations «pithiatism» (πτῄγμα = monkey), considering them a set of disturbances that can be reproduced through suggestion or imitation in certain subjects and that can disappear under the influence of counter-suggestion. Babinski’s conception is incomplete, however, since hysteria includes manifestations that are certainly not due to suggestion.
Janet emphasized the disintegration of consciousness and mental depression, while Kraepelin attributed it to intense and exaggerated sensations arising from violent emotions. More recent authors (Haskovec, Pienkowoski, Dezwarte) support the subcortical origin of hysteria. In Italy, Buscaino argues that hysteria originates from an abnormal condition of the midbrain and the basal ganglia of the brain, capable of reacting paradoxically to psychic stimuli. According to others, hysteria develops in individuals with a constitutionally labile nervous system, following emotional shocks (anaphylactic shock from emotion), which can block cortico-mesencephalic connections and inhibitions, thereby releasing the automatism of subcortical nuclei. For Freud, hysteria is provoked by the turmoil and attempted emergence of psycho-sexual complexes, distorted and poorly oriented during childhood development and repressed in the subconscious (v. PSYCHOANALYSIS). Even more recent authors deny that it is a disease at all and admit only a hysterical character.
The disease is encountered most frequently in females, though it is not rare in males and can appear even in childhood (ages 8–10); it spares no race or social class. Among the causal factors of hysteria are neuropathic heredity, environmental influence, and faulty upbringing; psychic traumas act rather as occasional triggers of hysterical episodes. Physical traumas (falls, blows, accidents, etc.) act particularly through disturbances of consciousness and intense emotional states capable of provoking them; thus arise traumatic neuroses and traumatic hysteria. Co-factors may include infectious diseases (syphilis, tuberculosis, typhoid, scarlet fever, etc.), intoxications (alcoholism, carbon monoxide poisoning), and endocrine disorders (Flajani-Basedow disease). It is erroneous to assign a predominant causal role to affections of the sexual sphere; sexual abstinence, especially when consciously and freely chosen and lived as a high ideal of life, should not be considered a cause.
Hysteria presents an extremely varied array of symptoms that share certain characteristics making them recognizable. They do not depend on gross anatomical lesions of the nervous system; they can appear and disappear rapidly and collectively, without exhibiting the constant and characteristic symptomatology linked to true anatomical alterations; the clinical picture is usually rich and highly variable.
Psychic disturbances are characterized by the significant role of suggestion in their determination, by the period of «expectation» that the psychic process exhibits, and by the tendency toward reproduction. Among motor disturbances, the following are common: hysterical torticollis, spasm of the glottis, pharynx, or esophagus (hysterical globus), contractures, flaccid or spastic paralysis, localized or affecting half the body (hysterical hemiplegia), and paralysis of the vocal cords with sudden aphonia.
Among sensory disturbances, hysterical aberrations are innumerable and manifest in the most bizarre ways, with no territory of innervation or sensory organ excluded.
Among visual disturbances, which are often due to autosuggestion, the most frequent are achromatopsia (loss of color sensation), constriction of the visual field, diplopia (double vision), unilateral or bilateral blindness, etc. Regarding hearing, there is often diminished acuity, sometimes progressing to complete deafness. For taste and smell, localized anesthesias are common—e.g., to sugar, salt, vinegar, quinine—as well as diminished sensitivity of the mucous membranes (conjunctivae, throat). The absence of the pharyngeal reflex is important and very frequent in hysteria. Sensitive alterations of the skin may appear in generalized form, sparing no territory, or in segmental form, assuming configurations such as glove, stocking, shoe, star, leaf, or an entire half of the body—more often the left side. These sensory disturbances always have the characteristic of not corresponding to the zones that should be related to specific peripheral nerve or spinal root territories.
Pain or algias, also very frequent, may occur anywhere: in the head, spine, limbs, joints, severely or simply as hyperesthesia (exaggerated sensitivity). Abnormal or paradoxical sensations include paresthesias (tingling, burning, electric shock-like sensations, spasms), particularly between the esophagus and the upper stomach valve («hysterical globus»).
Secretory disturbances include excessive salivation (ptyalism), localized sweating in well-defined cutaneous areas, polyuria, oliguria, or complete anuria, as well as excessive lacrimation or lactation.
Particular phenomena include the so-called hysterical fever, which some authors (Babinski) consider always simulated through clever manipulation during measurement, while others relate it to crises of hyper-emotionality or to nervous disturbances of vasomotor and thermoregulatory centers; such fever can even mimic the course of specific infectious diseases. Vasomotor phenomena, such as dilation or spasm of cutaneous arterioles and capillaries, may cause general or local redness or pallor, irregular spots, or raised or flat red or white streaks on the skin following local mechanical stimulation (dermographism).
The hysteric is capable of a subjective sensation of internal organs in terms of their form, position, and function, and through this pathway may feign organic internal diseases (gastro-duodenal ulcers, tumors, etc.), or even pregnancy. This entire symptomatology may be permanent (hysterical stigmata) or paroxysmal.
The psychological symptoms, truly essential and constant, linked to the particular temperament and disposition of the hysteric, complete the picture. Among such symptoms, one should note the tendency to attract and fix others’ attention on oneself (egocentrism); the exaggeration and systematized lying (pseudomania, v.); simulation; being excessively influenced by one’s own mental representations and remaining susceptible to suggestion, whether self-induced (autosuggestion) or from others; and the fragmentation and disintegration of the unity of the psychological consciousness. Particularly after attacks, phenomena of dissociation, amnesia, sensory illusions, and hallucinations follow. The individual also exhibits, in matters of affective tone, apathy and hyperemotionality, lack of energy, and weakness of will (abulia).
In the past, particularly in Charcot’s time, the appearance of acute episodes in the form of major hysterical crises was common, resembling epileptic attacks in general outline. Under the influence of suggestion or due to occasional external causes (fright, anxiety, etc.), the individual begins to experience various disturbances, feels incapable of controlling their own body, complains of oppression, anxiety, labored breathing, palpitations, general trembling, and noisy hiccups; finally, they are seized by a convulsive crisis. The hysteric thrashes about in tonic-clonic convulsions, contortions, and contractures in acrobatic poses (arc de cercle); characteristic are the theatricality of the crisis, the need for an audience for it to unfold, and the ability to avoid injury despite falls and violent thrashing. After a more or less prolonged period, the hysterical attack ends with a crying fit or the patient falls asleep. In the hysteric, ACATALESSIA (v.), catatonia (v.), lethargy (v.), and impotence (v.) easily occur.
The moral personality of the hysteric is greatly altered. Krafft-Ebing asserts that hysterics are affected by an extremely heightened libido, although some are incredibly frigid. They lose the moral sense of charity and humanity; willpower and moral energy weaken, and free will is impaired. Abnormalities in sensation influence moral order and affective life, giving rise to 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 illness; indeed, many are done with full awareness and freedom, and the morbid influence is not always so severe as to eliminate all responsibility.
As regards prognosis, hysteria must be considered, in the current state of medicine, incurable in its particular neuro-psychological configuration, especially if poor education has allowed hereditary defects and morbid tendencies of disposition to develop and become fixed over time. Conversely, proper care and education can mitigate the morbid tendency, prevent or quickly interrupt active symptomatology and crises.
Apart from strictly medicinal treatment, which can sometimes yield unexpected results, the greatest benefit comes from suggestive or persuasive psychotherapeutic methods (v.), whose value is undoubtedly more tied to the insight, patience, and often heroic charity of those who apply them than to the intrinsic value of any particular method. Regarding the possibilities of cure through psychoanalysis (v.) and its moral implications, this will be addressed in the corresponding entry.
In general, one must be cautious not to overestimate hysterical disturbances; yet one must also avoid the opposite extreme of neglecting or, worse, mocking and roughly mistreating patients, accusing them of being visionaries or malingerers. Although hysteria arises from purely ideational origins, it unfolds independently of the patient’s conscious will and represents a real cause of suffering for them. Moreover, the affectivity, always abnormally developed in hysterics, if poorly restrained, would present an insurmountable barrier to any therapeutic attempt.
Of the greatest importance is the prevention of hysteria in the children of hysterics. Their education should aim especially at suppressing excessive sensitivity, training the young with firmness but without harshness, avoiding sentimentality, teaching self-control early, and strengthening their too-weak will. It is important not to indulge the development of fantasy, particularly by avoiding readings and spectacles capable of provoking violent emotions or strong suggestions. In cases of severe familial predisposition, education outside the family environment and influence may be useful.
Regarding those hysterical manifestations that may simulate preternatural or supernatural phenomena or that, being genuinely of such nature, are falsely judged hysterical (stigmata, sweating of blood, mystical states, etc.), see: DEMONIAC MANIFESTATIONS; MEDIUMISTIC MANIFESTATIONS; METAPSYCHICS; MIRACLE.
Thus the principle is firmly established that instigation, in and of itself, is not punishable. Only by way of exception does the penal code recognize cases of instigation that are punished not as a form of complicity, but as a distinct crime. This is the case, in particular, of public instigation to crime in general, even in the indirect form of support for a crime, to disobey laws of public order or to commit crimes against the State (arts. 414, 415, 303). The same applies to instigation of soldiers to disobedience and indiscipline (art. 266), of public officials to corruption (art. 322), of anyone to contempt or vilification of institutions, laws, or acts of a public official or minister of worship (art. 327), or to suicide (art. 580), prostitution (art. 531), corruption of minors, and practices against procreation (arts. 530, 553).
The *Codex Iuris Canonici* does not provide a distinct figure of instigation, but considers it under the generic heading of inducing others to commit a delict (can. 2209 § 3), including not only instigation properly so called, but also determinatio. Canonists generally equate instigation with *consilium*, which is in reality only one form of II.
Canonically, the imputability of the instigator is equal to that of the principal executor if the instigation proved to be the principal efficient cause without which the delict would not have been committed. In such a case, the instigator, in accordance with the principle of the communicability of punishment, is liable to the same penalty as the principal executor (can. 2209 § 3, 2231). Effective instigation is treated as an attempt, distinct from the imputability that may attach to the executor (can. 2212 § 3). If, however, the instigation is a secondary cause, limited to facilitating a pre-existing intent that would have taken effect even without it, the imputability of the instigator is lesser and is punished, in the same manner as ineffective cooperation, either with a specific penalty where this is expressly provided, or with a penalty to be imposed *pro prudenti superiorum arbitrio* (can. 2209 § 4, 2231, 2212 § 3, 4). The instigator who has effectively contributed to the delict is jointly liable for the expenses and damages arising therefrom (can. 221). Full retraction of the instigation, made in a timely and effective manner, absolves from all imputability; if partial or imperfect in its efficacy, it diminishes but does not remove imputability (can. 2209 § 5).
From a theological-moral standpoint, it must be borne in mind that instigation, even if ineffective or simply unheeded, creates a moral responsibility in the internal forum against the virtue of charity, more or less grave according to its object, and entails the obligation in conscience to retract it in order to prevent its harmful effects; if, however, it proved effective, the sin is against justice, and the instigator is bound in conscience, independently of any act of the judge, to make full restitution for the damages caused (v. COOPERAZIONE, II).
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