HYSTERIA
"Diseased nature oftentimes breaks forth
In strange eruptions; ..."
"King Henry IV."
Hysteria, recorded in legend and law, in manuscript and marble, in
folk-lore and chronicle, right from history's dawn, is still a puzzle of
personality, and only equalled by syphilis in the protean nature of its
manifestations.
The sacred books of the East said delayed menstruation due to a devil was
its cause; the thrashing-out of the devil its cure. Chinese legends
describe it, and its symptoms were ascribed by the Inquisition to
witchcraft and sorcery.
Old Egyptian papyri tell how to dislodge the devil from the stomach, and
there were hysteria specialists in 450 B.C. All old theories fix on the
womb as the seat of the disease. The name hysteria is the Greek word for
womb, and 97 per cent of patients are women.
A few of the very numerous modern theories may be noticed.
The unconscious (or the subconscious) and the conscious are only parts of
one whole. Our "conscious" activities are those which have developed late
in the history of the race, and which develop comparatively late in the
history of the individual. The "conscious" is the product of the racial
education of the "unconscious"; the first is the man, the modern, the
civilized; the last is the child, the primitive, the savage. Between the
two there is no gulf fixed, and the Oxford metaphysician need not go to
Timbuctoo to seek a superstitious savage; he may find one within himself.
In hysteria, Janet says, the field of consciousness is narrowed, and the
patient lives through subconscious experiences, which she forgets when she
again "comes to". She journeys back into the past, back a few years
individually, back centuries or æons racially, and becomes a savage child
again.
Normally, when anything goes wrong, or we suffer from excessive emotion, we
give vent to our feelings by tears, abuse, anger, or impulsive action; in
some way we "hit back", and relieve ourselves of the feeling of oppression.
Then we forget, which heals the sore, and closes the experience.
If, at the moment, we bottle up our emotions, they obtrude later at
inconvenient times until we "get them off our mind" by confiding in some
one, when we get peace of mind. Open confession _is_ good for the soul, and
it is better to "cry your eyes out" than to "eat your heart out".
There are some experiences, however, to which we cannot react by anger or
confidence, and so we imprison our emotions, and try to obtain peace of
mind by forgetting the irritation.
Freud thinks perverted sex ideas are thus repressed, and cause hysteria by
coming into conflict with the normal sex life. If these old sores can be
laid bare by psycho-analysis, and the mental abscess drained by confession
and contrition, cure follows.
The biologists consider hysteria as an adult childishness, a primitive mode
of dodging difficulties. Victims cannot live up to the complicated
emotional standard of modern life, and so act on a standard which to us
seems natural only in children and uncivilized races.
Savill gives the following differences between neurasthenia and hysteria:
NEURASTHENIA HYSTERIA
Sex Both sexes equally. 97 per cent females.
Age Any age. First attack before
page of 25.
Mental Intellectual weakness; Deficient will power,
peculiarities bad memory Want of control
and attention. over emotions.
Causes Overwork; dyspepsia; Emotional upset or
accident; shock.
nervous shock.
Course Fairly even. Paroxysms. Vary
from hour to hour.
Mental Mental exhaustion; Emotional; wayward;
Symptoms unable to study; no self-analysis,
restless; sad; living by
irritable; not rule or reading
equal to medical books;
amusement. May Fond of gaiety;
be suicidal. sad and joyous by
turns. Never
suicidal.
General Occasional giddiness; Flushing; convulsions
Symptoms fainting rare; and fainting
convulsions; common; no
headache; backache; symptoms between
sleeplessness; no attacks; local
loss of feeling. anæsthesia or
hyperæsthesia.
Termination Lasts weeks or Lasts lifetime in
months. spasms.
CURABLE. TEMPORARILY
CURABLE.
Hysteria is a disease of youth, usually ceasing at the climacteric. Social,
financial and domestic worries are exciting causes, a happy marriage often
curing, and an unhappy one greatly aggravating the complaint. It is most
common among the races we usually deem "excitable", the Slavs, Latin races
and Jews, and is often associated with anæmia and pelvic disorders.
Symptoms. Changeability of mood is striking. "All is caprice. They love
without measure those they will soon hate without reason."
Sensationalism is manna to them. They _must_ occupy the limelight. Pains
are magnified or manufactured to attract sympathy; they pose as
martyrs--refusing food at table, and eating sweets in their room, or
stealing down to the larder at night--to the same end. If mild measures
fail, then self-mutilation, half-hearted attempts at suicide, and baseless
accusations against others are brought into play to focus attention on
them.
Minor attacks usually commence with palpitation and a "rising" in the
stomach or a lump in the throat, the _globus hystericus_, which the patient
tries to dislodge by repeated swallowing. This is followed by a feeling of
suffocation, the patient drags at her neck-band, throws herself into a
chair, pants for breath, calls for help, and is generally in a state of
great agitation. She may tear her hair, wring her hands, laugh or weep
immoderately, and finally swoon. The recovery is gradual, is accompanied by
eructations of gas, and a large quantity of pale, limpid, urine may be
passed later.
Major attacks have attracted attention through all ages, ancient statues
showing the same poses as modern photographs. The beginning stage--which
may last a few moments or a few days--is one of mental unrest, the victim
being irritable and depressed. In some cases a warning aura then occurs;
clutchings at the throat, or the _globus hystericus_, palpitation,
dizziness, sounds in the ears, spots dancing before the eyes, or feelings
of intense "_tightness_" as if the skin is about to tear or the stomach to
burst.
The victim throws herself on a chair or couch, from which she slides to the
floor, apparently senseless, the head being thrown back, the arms extended,
the legs held straight and stiff. The face is that of a dreamer, and the
crucifix position is not uncommon. This stage is a gigantic sexual stretch.
Next comes the convulsive stage, but the convulsions are not the true jerky
movements of epilepsy, but are bilateral tossing, kicking, and rolling
movements, interspersed with various irregular passionate attitudes. There
is great alteration but _not loss_ of consciousness. The patient struggles
with those about her, bites them, but never her own tongue, shrieks and
fights, but never passes urine, throws things about, and arches the back
until the body rests on head and feet (_opisthotonos_). The stretching and
convulsive stages alternate, and the attack lasts a long time, being
stopped by pain or by the departure of onlookers. During this stage the
face may reflect the various emotions passing through the mind--with a
fidelity that would rouse the envy of an Irving.
The patient gradually calms down, and a fit of tears or a scream ends the
attack, after which the worn-out victim is depressed but not confused,
though memory for the events of the attack may only be partial. The patient
sometimes passes into the "dream state", described in Chapter II, for some
hours or occasionally for far longer; these are the women described with
much gusto in the local Press as being in a trance--"the living dead".
The victim of these attacks _is_ suffering from a disease, for she shows
many temporary mental symptoms which could not possibly be feigned, while
there is often a genuine partial forgetfulness of the incidents of an
attack. She says she cannot help it; candid friends say she will not. The
truth is that she cannot _will_ not to help it; for though intelligence and
memory are often good and sometimes abnormal, the judgment and will are
always weak--indecision, obstinacy, and doubt being common.
Treatment. A thorough examination by a doctor is _absolutely essential_, to
prove that the patient is merely hysterical, and not the victim of
unrecognized organic disease. In a few cases, skilled attention to some
minor ailment will result in an apparently miraculous cure.
Many who habitually "go into hysterics", are merely grown-up "spoiled
children", and in all cases, the basic factor is a lack of control and
self-discipline.
Unfortunately, these tainted individuals who are so exquisitely sensitive
that any reproof brings floods of tears, turn with mercurial rapidity from
passionate fury to passionate self-reproach, and assuage by impassioned
protestations of affection the distress they have carelessly inflicted,
and, as a consequence of their momentary but undoubtedly sincere
contrition, escape blame and punishment.
Harmful sympathy is thus substituted for helpful discipline, and the more
stable members of the family are often made slaves to the whims and
caprices of the hysterical member.
The usual home treatment of the victim passes through various stages, and
lacks persistence. Violent methods are succeeded by studied indifference;
and that again by reproaches and recriminations.
Greene's remarks are very pertinent: "The condition must be regarded as an
acquired psycho-neurosis to be ameliorated, and perhaps removed, by
suggestion and a complete control, which, though kind, is firm, persistent,
insistent, and _lacking in every element that enters into the upbuilding of
the hysterical temperament_."
For anæmic patients, the following is a useful prescription:
R.
Quininæ valerianatis gr. xx
Ferri valerianatis gr. xx
Ammon. valerianatis gr. xx
Misce et fiant pilulæ no. xx
Sig.: One or two three times a day, after meals.
As far as the minor symptoms are concerned, the disease is usually chronic,
for as soon as one symptom has been overcome another takes its place, and
there is little hope of cure save when the case is taken vigorously in hand
in childhood, treatment being best given in a home or hospital. Home
treatment consists in an attempt to inculcate the lost or never-acquired
habit of self-control, and in the hygienic measures laid down for
neuropaths in general in the rest of this book.
In a major attack, _show no sympathy_. Let every one leave the room, save
one attendant, whom the victim knows to be of firm character, and calm but
determined disposition. This attendant should get a jug of water, and
threaten to douche the victim unless she makes vigorous efforts to control
herself. If she cannot, or will not, _douche her_, then hold a towel over
her nose and mouth, and she will perforce cease her gymnastics to breathe,
though the attendant must be prepared for an outburst of abuse when she has
recovered her breath. Between attacks, all who are brought into contact
with the victim, must adopt a tolerant but unsympathetic attitude, while
efforts are made to inculcate habits of control.
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