hysteria

More about Hysteria: Causes and symptoms Diagnosis Treatment Prognosis Resources

Definition

The term "hysteria" has been in use for over 2,000 years and its definition has become broader and more diffuse over time. In modern psychology and psychiatry, hysteria is a feature of hysterical disorders in which a patient experiences physical symptoms that have a psychological, rather than an organic, cause; and histrionic personality disorder characterized by excessive emotions, dramatics, and attention-seeking behavior.

Description

Hysterical disorders

Patients with hysterical disorders, such as conversion and somatization disorder experience physical symptoms that have no organic cause. Conversion disorder affects motor and sensory functions, while somatization affects the gastrointestinal, nervous, cardiopulmonary, or reproductive systems. These patients are not "faking" their ailments, as the symptoms are very real to them. Disorders with hysteric features typically begin in adolescence or early adulthood.

Histrionic personality disorder

Histrionic personality disorder has a prevalence of approximately 2–3% of the general population. It begins in early adulthood and has been diagnosed more frequently in women than in men. Histrionic personalities are typically self-centered and attention seeking. They operate on emotion, rather than fact or logic, and their conversation is full of generalizations and dramatic appeals. While the patient's enthusiasm, flirtatious behavior, and trusting nature may make them appear charming, their need for immediate gratification, mercurial displays of emotion, and constant demand for attention often alienates them from others.

— Paula Anne Ford-Martin

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n.

1. Behavior exhibiting excessive or uncontrollable emotion, such as fear or panic.
2. A mental disorder characterized by emotional excitability and sometimes by amnesia or a physical deficit, such as paralysis, or a sensory deficit, without an organic cause.

[New Latin : HYSTER(IC) + -IA¹.]

Since the rise of the so-called ‘psychodynamic psychiatries’ early in the twentieth century, hysteria has been regarded as a psychological malady par excellence. Through most of its long medical history, however, the concept was interpreted as a disorder purely of the body, with specific causes, symptoms, and treatments that were organic.

The modern English word ‘hysteria’ derives from the Greek ‘hystera’ — uterus — which in turn derives from the Sanskrit word for stomach or belly. Inherent in these simple etymological facts is the meaning of the earliest views on the nature and origin of the disease. According to some historians, an Egyptian medical papyrus dating from around 1990 bc — one of the oldest surviving documents known to medical history — records a series of curious behavioural disturbances in adult women. As the ancient Egyptians interpreted it, the cause of these abnormalities was the movement of the uterus, which they believed to be an autonomous, free-floating organism that could move upward from its normal pelvic position. Such a dislocation, they reasoned, applied pressure on the diaphragm and gave rise to bizarre physical and mental symptoms. Egyptian doctors developed an array of medications to entice the errant womb back down into its correct position. Foremost among these measures were the vulvar placement of aromatic substances to draw the womb downward, and swallowing foul-tasting substances to repel the uterus away from the upper parts.

Hysteria in ancient history

This ancient Middle Eastern source furnished the basis for classical Greek medical and philosophical theories of hysteria. The ancient Greeks adopted the notion of the migratory uterus and embroidered upon the connections between hysteria and sexual dissatisfaction. In an often-cited passage in the Timaeus, Plato wrote colourfully about the vagaries of female reproductive physiology:

‘the animal within them [women] is desirous of procreating children, and when remaining unfruitful long beyond its proper time, gets discontented and angry, and wandering in every direction through the body, closes up the passages of the breath, and by obstructing respiration, drives them to extremity, causing all varieties of disease …’

Various texts of the school of Hippocrates, from the fifth century bc onward, explain similarly that a mature women's deprivation of sexual relations causes a restless womb to move upward in search of gratification. As the female reproductive parts move or function irregularly — ascending or descending, convulsing or prolapsing — they cause dizziness, motor paralyses, sensory losses, and respiratory distress (including globus hystericus, the sensation of a ball lodged in the throat) as well as extravagant emotional behaviours. Ancient Greek therapies included uterine fumigations, the application of tight abdominal bandages, and a regular regimen of marital fornicatio.

Traditional historical accounts of the disease observe that ancient Roman physicians, too, wrote about hysteria. With the growth of anatomical knowledge, the literal hypothesis of the morbidly wandering womb became increasingly untenable. However, Roman medical authors continued to associate hysteria exclusively with the female generative system. The principal causes of hysterical disorders, they conjectured, were ‘diseases of the womb’ and disruptions of female reproductive biology, including amenorrhea, miscarriage, premature births, and menopause. Galen of Pergamon formulated a particularly popular theory tracing the origins of the malady to the retention of excessive menstrual blood. Engraved in the Corpus Hippocraticum and the Galenic writings, these hypotheses formed a medical ideology that remained influential for millennia of medical history. Descriptive and theoretical details evolved, but the basic doctrine of gynaecological determinism — the crux of the classical heritage in the history of hysteria — endured until remarkably late into the modern medical period.

Christian attitudes

The coming of Christian civilization in the Latin West initiated a major paradigm shift in the history of hysteria. From the fifth to the thirteenth centuries, naturalistic pagan construals of the disease were increasingly displaced by supernatural formulations. In the writings of St Augustine, human suffering, including organic and mental illness, was perceived as a manifestation of innate evil consequent upon original sin. Hysteria in particular, with its shifting and highly dramatic symptomatology, was viewed as a sign of possession by the devil. The hysterical female was now interpreted alternately as a victim of bewitchment, to be pitied, or the devil's soulmate, to be despised. No less powerfully mythopoetic than the classical image of the disease, the demonological model envisioned the hysterical anesthesias, mutisms, and convulsions as stigmati diaboli or marks of the devil.

This sea change in thinking about the disorder brought with it changes in treatment. The elaborate pharmacopeia of ancient times was now replaced by supernatural invocations — prayers, incantations, amulets, and exorcisms. Furthermore, with the demonization of the diagnosis came the widespread persecution of the afflicted. During the late medieval and Renaissance periods, the scene of interrogation of the female hysteric shifted from the hospital and sick bed to the church and the court room, which now became the loci of spectacular interrogations. Official manuals for the detection of witches, often virulently misogynistic, supplied instructions for the detection, torture, and at times execution of the witch/hysteric.

Early medical theories

The late Renaissance, which witnessed the height of the witchcraft craze in continental Europe, also produced in reaction several substantial efforts to renaturalize the idea of hysteria. Advances in understanding the structure and function of the human nervous system provided a new model for many previously baffling nervous disorders, including hysteria. Gynecological and demonological theories waned; in their place, new neurocentric theories combined with fashionable mechanical and iatrochemical ideas from the physical and chemical sciences.

In Britain, which dominated medical thinking about the subject during the early modern period, the neuroanatomist Thomas Willis propounded a theory according to which an excess of ‘animal spirits’ was released from the brain and carried by the nerves to the spleen and abdomen, where it entered the bloodstream to circulate through the body. Robert Whytt thought the disorder was caused by a weakness of the nerve fibres, and William Cullen attributed it to a slowing of the nervous fluids through the brain. In the 1680s, the famous physician Thomas Sydenham hypothesized that the condition was caused by an imbalance in the distribution of the animal spirits between body and mind, brought on by sudden and violent emotions, such as anger, fear, grief, and love. English and Scottish medical literature about hysteria during the seventeenth and eighteenth centuries offers memorable clinical descriptions of classic hysterical phenomena, including the hysterical attack in the arched back position and the clavus hystericus, or feeling of a nail being driven into the forehead. In the 1700s in particular, in France and Britain, these ideas provided the basis for an entire ‘nervous culture’ in which men and women of high society fashioned themselves as refined, sensible, and civilized.

The 1800s brought a multiplication of theories about hysteria, including new uterine, neurological, and characterological models. During the final quarter of the century — hysteria's famous heroic age — the centre of attention shifted to France. In the 1880s, the Parisian clinical neurologist Jean-Martin Charcot, formulated a comprehensive, neurogenic model of ‘the great neurosis’. For Charcot, hysteria was strictly a dysfunction of the central nervous system, akin to epilepsy, syphilis, and other neurological diseases. Like these ailments, hysterical neuropathy, he held, was the result of a lesion of an undetermined structural or functional nature that could be studied through the methods of pathological anatomy and that resulted from defective heredity. Charcot lavished his attention on the descriptive neurosymptomatology of his cases. He developed a schematized, four-stage model of the hysterical fit, and he mapped a series of ‘hysterogenic zones’ onto the body of the hysteric.

Emergence of psychology

Socially, the late nineteenth century witnessed the appearance of ‘the Victorian nervous invalid.’ Significant numbers of men and women modelled their sickness behaviour on the contemporary teachings of hysteria doctors like Charcot until these nervous disorders seemed to reach epidemic proportions. Culturally, the character of the nervous invalid figured prominently in fictional prose writing of the time. By the time of Charcot's death in 1893, medical thinking about hysteria had reached an impasse. The search for the missing lesion of hysteria, and therefore for its somatic basis, remained fruitless. As a consequence, physicians turned to alternative conceptualizations of these mysterious, multiform disorders, including to psychological theories.

The psychologization of the hysteria concept a century ago is associated foremostly with Sigmund Freud, who worked in Vienna in the late Victorian mould of the private nerve specialist. Psychoanalysis began as a theory and therapy of hysteria. In a series of essays and monographs written between 1885 and 1900, Freud radically reconceptualized hysteria. He reversed the previously projected direction of mind-body causality, claiming that hysteria was a psychological disease with quasi-physical symptoms. Furthermore, Freud placed the emphasis on the psychological mechanism of hysterical symptom formation. According to his formulation, hysterogenesis rests in the repression of traumatic memories. These memories are usually remote in the emotional past of the individual and invariably libidinal, or sexual, in content. Because these remembrances are painful or unpleasant, they are unable to find conscious psychological expression. Freud postulated further that the negative emotional energy, or ‘strangulated affect’, associated with these memories is then unconsciously converted into the somatic manifestations of hysteria. Moreover, in this process of hysterical conversion, symptoms are not arbitrary and meaningless phenomena but complex symbolizations of repressed psychological experiences. In psychoanalytic psychology, the body is the physical field on which the wishes, anxieties, and traumas of the hysteric are dramatized.

Recent trends

The most consequential development in the history of hysteria in the last century was the rapid decline in the medically recorded incidence of the disorder. In part, this diminution is due to the liberalization of gender norms, permitting freer social, emotional, and sexual expression among women. It also traces to a process whereby many symptoms and behaviours formerly constitutive of hysteria have been reassigned to other diagnostic categories, including organic disorders, psychoses, and psychoneuroses. Since the 1970s, hysteria as an independent diagnostic entity has been deleted from the official manuals of medical diagnosis. In Anglo-American psychiatry, much of what was characterized as conversion hysteria in psychodynamic psychiatry is now classified under the more scientific-sounding rubric of somatization disorder. An exception to this rule can be found in French medicine, which continues widely to employ the concept of hysteria in psychological theory and clinical practice.

Conclusions

Several conclusions may be drawn from hysteria's long and colourful past. First, it is most likely impossible in this instance to project a single, unchanging pathological entity through history. The clinical descriptions lumped under the heading through the ages have been highly diverse, and the theoretical structures for understanding these behaviours have varied enormously. Many different morbid phenomena have no doubt been gathered under the umbrella of ‘hysteria’. Second, what has been called hysteria in the past may clearly be read as a kind of cross-gender portraiture in the field of medicine. To a very great extent, ‘the history of hysteria’ consists of a body of writing by men about women. Feminist-informed scholars of the later twentieth century emphasize that this literature often depicts, in the descriptive language of the clinic, features of the opposite sex that male élites in past patriarchal societies found irritating, incomprehensible, or unmanageable. Hysteria theory literally embodies these ideas, attitudes, and biases.

A third conclusion concerns the distinctive blend of science, sexuality, and sensationalism in the story of hysteria. Given the extravagant physical symptoms, emotional outbursts, and erotic undercurrents involved in many cases carrying this label, it is hardly surprising that hysterics have often been forced into lurid roles and vaudevillian performances. In short, hysteria has been the vehicle for astute clinical observation, pioneering neuropathological research, and brilliant psychological theorizing; it has equally been the site of much misogyny, sensationalism, and mistreatment. Fourth and finally, hysteria's history may be read as an ongoing attempt to theorize the mind-body relation within the medical sciences. Is hysteria fundamentally a psychological disorder with physical manifestations; an organic disease with mental and emotional epiphenomena; or some inseparable intermixture of the two? Studying the subject through the ages has involved a continual, relational reconfiguring of the role of psyche and soma in human mental life. Within the clinical human sciences, hysteria represents the shifting and diversely theorized interface between the history of the body and the history of the mind.

Some scholars have argued that hysteria is the oldest and most important category of neurosis in recorded medical history. Similarly, perhaps no non-fatal disorder boasts a richer metaphorical and mythological past. Over the centuries and in many different cultures, thinking and writing about the subject has mirrored dominant attitudes about health and sickness, the natural and the supernatural, the sexual and the spiritual, mind and body, and masculinity and femininity. Now, it appears, hysteria — construed variously as a term, theory, and behaviour — is vanishing. Given the remarkable cultural indispensability of the concept in the past, readers can only speculate on what will take its place in the future.

— M. S. Micale

Bibliography

• Gilman, S. L., King, H., Porter R., Rousseau, G., and Showalter, E. (1993). Hysteria beyond Freud. University of California Press, Berkeley.
• Micale, M. (1995). Approaching hysteria: disease and its interpretations. Princeton University Press, Princeton.
• Veith, I. (1965). Hysteria: the history of a disease. University of Chicago Press, Chicago

See also nervousness; psychological disorders.

n

Definition: state of extreme upset
Antonyms: calm, calmness, control, self-possession, sereneness

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(hister'ē-ə)
n

1. a disease or disorder of the nervous system, more common in females than males, not originating in lesions and resulting from psychic rather than physical causes. n 2. a psychoneurosis characterized by lack of control over emotions or acts, exaggeration of sensory impression, and simulation of disease or pain associated with disease. In some patients, trismus, neuralgia, and temporomandibular joint disturbance may be hysterical in origin.

1. A temporary state of tension or overexcitement in which there is loss of control over emotions.

2. A neurotic condition marked by emotional instability, which may be converted into physical symptoms such as paralysis of an arm or leg.

Hysteria refers both to a personality type and to a cluster of psychoneurotic symptom formations. Its manifestations—dramatic, physical, and affective—may be viewed as an attempt to express and symbolize a psychosexual conflict and, at the same time, to defend against acknowledging that conflict. Symptoms range from mental anxiety and phobia to the physical signs of conversion disorder.

The term derives from hustera, the Greek word for uterus, and was historically considered a female disorder. Writings on hysteria date to ancient Egypt and the Kahun papyrus (ca.1900 BCE), which described the disturbances caused by the "wandering uterus" that manifested as symptoms in various parts of the body. Greco-Roman doctors continued to associate hysteria with the uterus and to treat it as a female complaint. From the end of antiquity through the Middle Ages and the Inquisition, recourse to supernatural explanations made it possible to consider hysteria a form of demoniacal possession or witchcraft. The theatrical and contagious nature of hysterical symptoms may have been at the root of phenomena such as the "possessed" nuns of Loudun, the convulsionaries of Saint-Médard, and the Salem witches. Hysterics and their putative victims were often burned at the stake.

Identification of hysteria as a distinct entity dates to 1870, when Jean Martin Charcot, a doctor at the largest hospice in France, the La Salpêtrière, segregated hysterics from other mental patients for purposes of research and investigation.

As a concept hysteria acquired several meanings:

1. Conversion hysteria was a convulsive attack characterized by paralysis, muscular contractions and bodily contortions, visual disturbances, including hallucination, pain and anesthesia, and so on.
2. As a psychoneurosis, studied by psychoanalysis, it was manifested by various symptoms and inversion of affect. Thus, Sigmund Freud's patient Dora experienced sexual excitation not as desire but as disgust, a hysterical displacement of a genital sexual conflict (1905e).
3. The term "hysteric" also qualifies, pejoratively, a certain type of distaff personality in which prominent use is made of dramatization, emotional exuberance, colorful and exaggerated language, continuous erotization, and seductiveness.
4. Finally, in everyday language, hysteria is the stuff of "emotional outburst" and "making a scene."

Broadly speaking, conversion hysteria led to the discovery of psychoanalysis as a method of understanding and treating psychopathological symptoms. Freud, who famously attended clinical demonstrations by Charcot, was struck by the indifference that hysterical patients displayed toward their suffering. Although for a time he suspected traumatic childhood seduction to be at the root of hysteria, he came to view such patients suffering "mainly from reminiscences" (1895d, p. 7)—that is, from a repressed traumatic event that remained mnemonically unintegrated, and could therefore only be expressed by conversion—through a corporeal memory, so to speak.

The death of his father in 1897 and subsequent self-analysis with Wilhelm Fliess led Freud to the discovery of his childhood passion for his mother and of his hostile feelings toward his father. Although the Oedipus complex did not appear as part of Freudian theory until later, he abandoned the theory of traumatic seduction; his key discovery was the notion of infantile sexuality, together with the importance of fantasy as a force that was both creative and disorganizing. At the same time he developed the concept of psychic defense and discovered in dreams and dream-work a link with hysteria.

In psychoanalytic theory, a hysterical crisis might be thought of as the embodiment of a dream. Its symptoms included the same mechanisms of condensation, displacement, symbolization, and disguise through censorship. Hysteria expressed a conflict that, incapable of being elaborated mentally, is translated in altogether enigmatic fashion into physical symptoms. The associative method of psychoanalysis could be used to identify the fantasies and symbolic pathways within it. Thus Freud described a hysterical woman who, with one hand, tore off her clothes, and with the other, held them against her body, simultaneously expressing the struggle between impulse and defense, enacting in effect a sexual scene in which she represented partners of both sexes (1908a). Hysterical neurosis and hysterical relationships involve identification, constant repression, and counter-cathexis that uses the Other as the theater of conflict.

Due to the absence of an organic lesion and the tendency for symptoms to disappear without a trace, as mysteriously as they came, hysterical conversion represented a provocative challenge to medicine. In general, hysterics have historically triggered irritation, accusations of lying and malingering, and rejection.

Hysteria has always defied medicine and the social order because sexuality is mixed up in it—in particular, female sexuality and the associated desire for sexual pleasure. Freud, in 1937, referred to the "repudiation of femininity" (p. 252) in both sexes as "bedrock," a stumbling block because of the mental association of the female with castration. Symptomatically, hysteria is an illness of repudiated femininity. More specifically, the anxiety that leads to this repudiation reflects the considerable libidinal energy required by the constant pressure of libido, a pressure that may be destructive of the ego.

Bibliography

Freud, Sigmund. (1937). Analysis terminable and interminable. SE, 23: 209-253.

Freud, Sigmund, and Breuer, Josef. (1895d). Studies in hysteria. SE,2.

Jeanneau, Augustin. (1985). L'hystérie, unité et diversité. Revue française de psychanalyse, 49 (1), 258-283.

Schaeffer, Jacqueline. (1986). Le rubis a horreur du rouge. Relation et contre-investissement hystériques. Revue française de psychanalyse, 50 (3), 923-944.

——. (1997). Le refus du feminine. Paris: Presses Universitaires de France.

Further Reading

Britton, Ronald. (1999). Getting in on the act: The hysterical solution. International Journal of Psychoanalysis, 80, 1-14.

Halberstadt-Freud, Hendrika. (1996). Studies on hysteria one hundred years on: a century of psychoanalysis. International Journal of Psychoanalysis, 77, 983-996.

Kohon, Gregory. (1984). Reflections on Dora: The case of hysteria. International Journal of Psychoanalysis, 5, 73-84.

—JACQUELINE SCHAEFFER

A complex neurosis in which psychological conflict is turned into physical symptoms, such as amnesia, blindness, and paralysis, that have no underlying physical cause. Early in his career, Sigmund Freud worked on hysteria.

Long-supposed a disease of women, hysteria was attributed by Hippocrates to the movement of the womb (hystera) from its normal anatomical site into other parts of the body. The feelings of constriction in the throat, so typical of hysteria (The Suffocation of the Mother, by Edward Jorden, 1603), were thought to be caused by the uterus becoming lodged in that region. It followed, therefore, that men, since they do not have a womb, would not be affected by this disease, although Thomas Sydenham (1682) maintained that they were able to suffer from the symptoms experienced by the opposite sex. The belief that hysteria was a disorder confined to women had a long innings, and Freud's report to the Vienna Medical Society in 1886 that men too could be affected by it was not well received. As an elderly surgeon remarked, 'But my dear sir, how can you talk such nonsense? Hysteria means the uterus. So how can men be hysterical?' (Stafford Clark 1967).

Like many other words used in psychiatry, hysteria has been given many meanings. The following list shows how a disease that was once considered to be a single entity has been given different interpretations according to the nature of the symptoms and the theories proposed to explain them. (i) Hysteria as a personality disorder: for example, histrionic personality, or attention-seeking personality. (ii) Conversion hysteria, presenting a variety of neurological disturbances such as paralysis, convulsions, losses of sensation, blindness, speech abnormalities, and ataxic gait. (iii) Hysteria as a dissociation phenomenon manifested as fugues, twilight states, amnesias, and multiple personality. (iv) Hysteria as a disease entity affecting women. There is also (v) hysteria as a term of abuse.

(i) Hysteria as a personality disorder. Hysterical personality is one of those misnomers that bedevils the subject, largely because it is often assumed that individuals showing the features of it are liable to develop other forms of hysteria. On the whole, the evidence does not favour this belief, and the term should be discarded in favour of one of the synonyms. The dominant characteristics are shallow, labile emotions, manipulative behaviour, a tendency to overdramatize situations, a lack of self-criticism, and a fickle flirtatiousness with little capacity for sustained sexual relationships. It has been said that these qualities add up to a caricature of femininity; and as men are rarely labelled hysterical personalities it is likely that the old association of hysteria with uterine disturbance is responsible for the transformation of hysteria as a disease into an adjectival description of a constellation of certain behavioural characteristics.

(ii) Conversion hysteria. Freud's theory of hysteria, based largely on his treatment of female patients in late 19th-century Vienna, proposed that repressed sexual conflicts, which, if brought to consciousness, would arouse anxiety and distress, were converted into physical symptoms that symbolized the repressed wish and permitted the anxiety to be dispelled — the so-called primary gain. As Fenichel (1955) wrote, 'In conversion, symptomatic changes of physical function occur which, unconsciously and in a distorted form, give expression to instinctual impulses that previously had been repressed.' The lack of emotional response of the patient to her symptoms, for example a paralysed limb, was referred to by Janet as 'la belle indifference des hystériques'. In fact hysterics are by no means as free from anxiety as they might appear to be. Understandably, considering the time and place of Freud's original communications on hysteria, his emphasis on repressed sexuality in the female as a cause of neurosis aroused a good deal of hostility. But Charcot once remarked, 'Hystérie, c'est toujours la chose sexuelle' — a point re-emphasized by Freud when he wrote, 'I do not think I am exaggerating when I insist that the great majority of severe neuroses in women have their origin in the marriage bed'.

As time has gone by this emphasis on repressed sexual drives as a cause of conversion hysteria has declined. Some writers have considered the roles of anxiety and depression in the genesis of hysterical symptoms, and others have stressed the importance of secondary gain, particularly when symptoms persist in compensation cases following accidental injury. The hysteric is nothing if not suggestible, and susceptibility to suggestion, especially in those of a relatively unsophisticated nature, could be an important determinant of the site and type of a conversion symptom.

(iii) Hysteria as a dissociation phenomenon. Janet considered dissociation to be an important component of some hysterical symptoms. These include fugues (wandering away from one's usual environment, with subsequent amnesia), trances, multiple personality, and twilight states. The individual who enters into a fugue state is sometimes escaping from an intolerable situation or suffering from a severe depression. This wandering behaviour has been equated with an act of suicide, with the patient seeking some state of nirvana which will free him from his worldly cares and responsibilities.

Much attention has been given to the phenomenon of multiple personality, and the famous case of Sally Beauchamp, described by Morton Prince (1854–1929), has been succeeded by other well-publicized examples. There is reason to think that the subject's suggestibility and the amount of attention focused on the alleged change of personality to some extent perpetuate and elaborate the phenomenon. Multiple personality can sometimes be of forensic interest when the defendant blames her alter ego for the offences of which she is accused. Obviously it is difficult to prove beyond reasonable doubt claims of this kind. In any case, multiple personality is a rare condition, and only its dramatic and bizarre nature is reason for the disproportionate interest in it. (See dissociation of the personality.)

(iv) Hysteria as a disease entity. The old concept of hysteria as a disease peculiar to women was gradually abandoned in the face of evidence that a great variety of hysterical symptoms affect men as well as women. The revival of the disease entity concept by psychiatrists in St Louis, USA, under the label Briquet's syndrome — the name derives from a French author who published a monograph on hysteria in 1859 — has been criticized on the grounds that it appears to be resurrecting the ancient myth of a sexually determined illness confined to women. Indeed, many of its symptoms are functional disorders of the female reproductive system. Multiple surgery to treat such symptoms, and a variety of other abdominal complaints of a psychogenic nature, result in what is known in some hospitals as 'the thick file syndrome'. This is largely because of the sheer number of the patient's records and reports on multiple investigations that accumulate over the years. It could be argued that 'thick files' could not develop in a society which did not have well-developed medical and surgical technology, but all the same such patients are not the most welcome in busy outpatient departments, not only because of the time required to unravel their histories but also because of the sense of therapeutic and diagnostic hopelessness that overcomes the examining physician.

(v) Hysteria as a term of abuse. The layman — and sometimes the medical practitioner — faced by tiresome, noisy, and overdramatic behaviour may be inclined to react with 'Pull yourself together and don't be so d — hysterical'. As the behaviour that provokes this kind of response has much in common with the chief characteristics of the hysterical personality, it is more likely to arouse antipathy when the subject is a woman. An 'attack of the vapours' is an older term used to describe such 'hysterical' behaviour by women; when the 'wandering womb' hypothesis of hysteria was discarded, it was replaced by the notion that noxious vapours could rise up from the womb to the brain and produce symptoms which today would be called conversion hysteria, especially hysterical convulsions.

Although there can be no doubt that psychological disturbances play a considerable part in the genesis of hysterical symptoms, it is important to realize that, in nearly two-thirds of patients presenting to hospital with such symptoms, there will be some evidence of pre-existing or developing brain injury or disease (Slater 1965, Whitlock 1967, Merskey and Buhrich 1975). It has been suggested that the capacity for manifesting acute hysterical illness is something which is built into the central nervous system to protect it from overwhelming stress. If the brain is damaged or diseased, there is an increased possibility for this innate mechanism to spring into action, especially if an added psychological stress serves as a trigger. Thus hysterical symptoms may be the first indication that some hitherto unsuspected brain disease is developing. Conversion hysteria in older patients with no previous evidence of psychiatric morbidity should alert the physician to this possibility. Indeed, given the high incidence of brain disease in patients with hysteria, it has been suggested that the time has come for the word as a noun signifying a disease entity to be relegated to psychiatric history. But this is unlikely to happen for, as Lewis (1975) has written, 'A tough old word like hysteria dies very hard. It tends to outlive its obituarists'.

(Published 1987)

— F. A. Whitlock

Bibliography
• Fenichel, O. (1955). The Psychoanalytic Theory of Neurosis.
• Lewis, A. (1975). 'The survival of hysteria'. Psychological Medicine, 5.
• Merskey, H., and Buhrich, N. A. (1975). 'Hysteria and organic brain disease'. British Journal of Medical Psychology, 48.
• Slater, E. (1965). 'The diagnosis of hysteria'. British Medical Journal, 1.
• Stafford Clark, D. (1967). What Freud Really Said.
• Whitlock, F. A. (1967). 'The aetiology of hysteria'. Acta psychologica Scandinavica, 43.

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A state of excitement or tension in which there is a temporary loss of control over the emotions. The term is probably an inappropriate one for use in animals. It has common usage for conditions in which animals are assumed to have lost control of their emotions because of their atypical, excessively active behavior, e.g. a sow savaging her piglets at parturition. See also farrowing hysteria.

• canine h. — a disease characterized by fits of frantic running, terminating in convulsions. Reported in dogs fed biscuits made of flour whitened by the agene process. The process is no longer used and the disease has disappeared.

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Dansk (Danish)
n. - hysteri

Nederlands (Dutch)
hysterie, uitzinnigheid, zenuwziekte

Français (French)
n. - hystérie

Deutsch (German)
n. - Hysterie

Ελληνική (Greek)
n. - υστερία

Italiano (Italian)
isterismo, frenesia

Português (Portuguese)
n. - histeria (f) (Psiq.)

Русский (Russian)
истерия

Español (Spanish)
n. - histeria, histerismo, ataque de nervios

Svenska (Swedish)
n. - hysteri

中文（简体）(Chinese (Simplified))
歇斯底里症, 不正常的兴奋

中文（繁體）(Chinese (Traditional))
n. - 歇斯底里症, 不正常的興奮

한국어 (Korean)
n. - 히스테리, 병적 흥분, 광란

日本語 (Japanese)
n. - ヒステリー, 病的興奮, 熱狂

العربيه (Arabic)
‏(الاسم) الهستيريا أو الهرع, اضطراب عصبي يسبب نوبات عنيفه من الضحك أو البكاء أو يسبب ضروبا من الامراض الوهميه, أو فقدان السيطرة على الذات, خوف أو اهتياج عصبي لا سبيل إلى كبحه‏

עברית (Hebrew)
n. - ‮היסטריה, התפרצות רגשות, יפחת, הפרעה פסיכו-נאורוטית בתיפקוד מערכת העצבים‬

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