Therapeutic function of diagnostic label 'hysteria'

Hysterics are not uncommonly believed by others to be deliberate malingerers; they may be accused of being sick for a purpose. Such an assumption has come to be considered as showing naivete on the part of the accusers from the formal psychiatric point of view. The case histories of two hysterical in-patients who conducted themselves 'hysterically' on the ward are cited. It is a noteworthy paradox that their hysterical symptoms faded away when they were able to assume the role of a 'hysteric'. The current report explores the meaning of the diagnostic label of 'hysteria' and the possibility of taking advantage of the very fact that a 'hysteric' can develop into a 'malingerer' through therapy. The authors recommend that the diagnostic label of 'hysteria' be investigated not merely in terms of communication, but also in terms of its therapeutic function.

[Practical aspects of the care of immigrant patients in a psychiatric milieu]

The institutional psychiatric treatment of migrant workers is difficult. But it is also necessary: the most dangerous evolutions happen when there is no intervention or during long breaks of therapy. From their own experience, authors ask themselves about what, in usual attitudes of psychiatrist, can drive into blind-alleys. The symptomatology shown by maghrebian migrant has implications in fields of sociology, culture and psychology, with wide extensions in politics, economics, etc. In front of symptoms (described there), different persons give different institutional answers, described too. Each pathological situation is either revelating of migrant's contradictions or origin of new contradictions.

The hysteric's use and misuse of observation

In this paper we have examined the hysterical patients' capacity to observe themselves and others and what they make of these observations. On the one hand they distort them or blur them by rapid acting, dramatic exaggeration, a quick shift in identification from one object to another; on the other hand they use some of their perceptions for a fine observation of the analyst's responses in order to involve him (or her) in their particular pathological relationship: dramatic, sensuously exciting, and one that arouses the highest expectations, only to frustrate them subsequently.

[Clinical experience in communication in autogenous psychotherapy and hypnosis]

Questions relating to communication and metacommunication during two forms of directive psychotherapy (Schultz's autogenous training and hypnosis) are examined. The concept of rigidity and cognitive flexibility with regard to the physician-patient relationship is discussed: abstract-concrete dynamics, abstract generalisation of diagnosis, linguistic egocentricity, stereotypical adaptation to conventional language. Some attention is devoted to Heider's balance theory as the first approach to psychological understanding of the therapeutic relationship. The communicative and metacommunicative process described by the Palo Alto (California) school is discussed. Autogenous psychotherapy and hypnosis extend through the concepts of symmetrical relation and inferior complementarity. The criteria for reaching these objectives are stated, along with the pragmatic methods devised for decoding messages and gaining access to metacommunication. Three clinical cases treated through autogenous training and one with hypnosis are analysed with respect to communication and from the relational standpoint. The patient's messages are decoded, the ambiguity of the communication is detected, and the physician's possible answers are examined at both the technical and the emotive level. It is felt that the correct use of the communicational perspective greatly extends the possibilities of autogenous training and hypnosis. It is not a question of combining relational and autogenous management, but of using the Palo Alto discoveries in the more complete understanding of cases in which psychotherapy is employed.

Healing and transculturation in Xhosa Zionist practice

The process of transculturation of healing is considered in the cultural belief system and practice of a Xhosa Zionist community. At present in the throes of rapid socio-cultural transition, this community operates with a holistic understanding of health and sickness in which all levels of existence, including the superempirical, are held to be in dynamic mutual interrelationship. The paper examines categories of illness, diagnostic procedures and therapeutic practices in relation to converging traditional Xhosa and Western Christian frames of reference and two illustrative case histories are presented. The use made of heightening of individual and group consciousness is briefly assessed. The Zionist belief system and therapeutic practices are evaluated in terms of cultural accessibility and sociopolitical influences.

[Various aspects of the pathogenesis and treatment of hysterical neurosis and hysterical neurotic personality development]

The authors studied 53 patients with hysterical neurosis and 66 with hysterical neurotic development of personality. Factors contributing to an unfavourable course of neurosis and its transformation into a hysterical development were elicited; clinical variants of the formation of the hysterical neurotic personality development are described. A study was carried out aimed at comparing the functions of the serotoninergic and cholinergic systems in patients with hysterical neurosis, hysterical development and hysteroid psychopathy at the stage of decompensation. An increase in the changes in these systems in the "neurosis-development-psychopathy" series and their time-course were defined in the process of treatment. On the basis of the clinical and laboratory data, a conclusion was drawn about the advantage of treating the hysterical development with phenothiazine drugs as compared with tranquilizers.

[Reflexotherapy of neurotic patients with depressive-hypochondriacal manifestations]

Forty-one neurotic patients with pronounced depressive-hypochondriac symptomatology were treated by acupuncture. A decrease in the psychoemotional and algetic symptoms (sleep restoration, increased working capacity) following acupuncture was attended by certain changes in the nocturnal and diurnal EEG with the prevailing activation of the synchronizing mechanisms of nonspecific brain systems which suggests that the structures of the thalamo-cortical and nonspecific cerebral level are involved in the realization of the acupuncture therapeutic effect and that it is advisable to activate the synchronizing cerebral mechanisms.

Management of hysterical seizures in epileptic patients

Intensive behavioral psychotherapy for hysterical seizures was carried out in nine epileptic patients, after video-EEG confirmation of diagnosis, during four to nine weeks of hospitalization in a specialized seizure unit. During a four-year follow-up, a significant reduction in hysterical seizures was noted in seven patients. Only one patient remained refractory to treatment and was hospitalized a number of times for hysterical seizures. One patient was lost to follow-up. Four patients showed significant and two patients showed slight improvement in psychosocial status. There was no behavioral improvement in one patient while another patient, who was severely retarded, showed temporary worsening of behavior, with decrease in frequency of hysterical seizures. Principles of managing hysterical seizures emphasize early diagnosis and vigorous supportive-reed-ucative psychotherapy.

[Hypnosis, hysteria, psychoanalysis. Apropos of 5 cases]

Five cases, chosen for their illustrative value and for the perspectives they open up for clinical and theoretical research, show that hypnosis does sometimes produce lasting results in patients who have failed to respond to all other forms of treatment; after all these centuries, this form of therapy is alive and well. Further, hypnosis offers an excellent opportunity of studying suggestion, which lies at the heart of the psycho-therapeutic process in general, and which is still little known. The strength of still-surviving prejudice on this subject are an obstacle to greater understanding.