Medicalizing disabled people's emotions-Symptom of a dis/ableist society

The theoretical-conceptual article at hand explores how emotional discourses shape social relations by specifically focusing on the medicalization of disabled- and chronically ill-people's emotions. Medicalization is a concept from medical sociology that describes medicine's expansion into non-medical life areas, for instance into the realm of emotions, sometimes in order to challenge this expansion. The emotions of disabled people are often presented as a medicalized problem, rather than recognizing their embeddedness in a dis/ableist socio-cultural context. Such discourses instrumentalize feelings in order to individualize the responsibility for disability. For a contextualized and emancipatory approach, this study reviews papers on medicalized emotions from Disability Studies-a research program that can provide a rich archive of experiential accounts yet to be theorized through a comprehensive emotional perspective. The medicalization of disabled people's emotions can manifest in different ways: (1) In a dis/ableist society, able-mindedness is compulsory; i.e., we fail to question that a healthy mind is the norm and something to strive for unconditionally. This is also true on an emotional level; after all, some medical diagnoses are based on the wrong degree or temporality of emotionality. (2) Unpleasant feelings such as sadness are misunderstood as symptoms of impairment rather than effects of discrimination. (3) The expression of hurt feelings, e.g., related to discrimination, can easily be dismissed as hysterical. This assumption epistemologically disables patients. (4) Love and desire are delegitimized as fetish, for example, the desire for a disabled lover or the wish to start a family despite a chronic illness. The medicalization of disabled people's emotions individualizes and delegitimizes unpleasant emotions that emerge in a dis/ableist society. Different facets of medicalization enforce medical treatment instead, albeit in different ways. Disabled and sick people are cast as not feeling and desiring the right way, while hegemonic discourse prescribes psychological treatment against the effects of discrimination and bodily symptoms it cannot explain. Beyond the dismissal of disabled people's experience, adverse effects on healthcare delivery and health outcomes can be expected.

The Most Hysterical Psychoanalyst

This paper is an investigation into the prominence of hysteria in Lacan's work and the enduring significance of the diagnosis for contemporary practice. Beginning with Lacan's theory of neurosis, the importance of language, and symbolic functions, we will begin to understand why the hysterical symptom is the symptomatic structure par excellence. Lacan lauds hysteria as the neurosis in direct dialogue with a given historical moment, teaching the psychoanalyst where we are in the unfolding struggle between neurosis and civilization. He returned to the case of Dora throughout his twenty-eight years of teaching to refine his work. He even saw psychoanalysis as the progressive "hystericization" of the patient and depicted himself as an hysteric walking around on a stage, not knowing what he was saying, while attempting to teach the psychoanalysts. Lacan's reading of Dora seems to mark important shifts in his own life, from his beginning to write as a psychoanalyst, to being thrown out of the IPA, to struggling with his own school and the ensuing political eruptions in France in 1968. By tracking his elaboration of Dora we can witness the evolution of Lacan's work and how he uniquely positions the analyst in the transference.

The Hysteric and the HSP

This paper examines twenty-first-century research on sensory processing sensitivity (SPS) alongside mid-nineteenth-century research on hysteria. Doing so sheds light on how we have long thought of sensorial-emotional experience as progressing along a medical narrative from cause to cure. Today's rhetoric around the highly sensitive person (HSP) begins to diverge from the rhetoric around hysteria through the theorized cause and the dismissal of the need for a cure. When current perspectives remove the emphasis on a cure, the narrative emphasizes a broader need for social-emotional learning and cultural revision to stigma around sensitivity.

Dismissal informs the priorities of endometriosis patients in New Zealand

Introduction

Endometriosis is a common condition with average delays to diagnosis in New Zealand of almost 9 years.

Methods

In total, 50 endometriosis patients participated in anonymous, asynchronous, online group discussions about their priorities, and their experiences with the development of symptoms, seeking a diagnosis, and receiving appropriate treatment.

Results

Higher subsidy of care was the top change endometriosis patients wanted, followed by more research funding. When asked to choose whether research should be focused on improving diagnosis or improving treatment methods, the results were evenly split. Within this cohort, patients highlighted that they did not know the difference between normal menstrual discomfort and pathological endometriotic pain. If, upon seeking help, medical practitioners classified their symptoms as "normal," these dismissals could instill doubt in patients, which made it more difficult for them to continue to seek a diagnosis and effective treatments. Patients who did not express dismissal had a significantly shorter delay from symptom onset to diagnosis of 4.6 ± 3.4 years vs. 9.0 ± 5.2 years.

Conclusion

Doubt is a frequent experience for endometriosis patients in New Zealand, which was reinforced by some medical practitioners who were dismissive of their pain and thus prolonged the patient's delay to diagnosis.

CULTURAL HISTORY OF PSYCHOANALYSIS IN THE AGE OF NEUROSCIENCE

In this paper I have chosen the topic of psychoanalysis in the age of neuroscience, with the aim of showing why the cultural history of psychoanalysis still matters. To make myself better understood I shall refrain from evaluating the current findings in neuroscience and limit myself to reporting briefly on them. Although I do not regard myself by any means as an expert in that field, I may be permitted to offer a few ideas about it. In this regard, there is presently a significant predominance of biological ideologies and practices regarding the treatment of mental illness, which implies an increase in the interest in etiology, nosology, definitions, and the effectivity of treatments. Even so, those psychoanalytic historians and/or analysts among us who are committed to psychoanalysis and its therapeutic implications, irrespective of what drugs might be prescribed and what the research findings might conclude, believe that patients still want to be listened to in depth and always will. For that reason, it is justified to ask why the cultural history of psychoanalysis still matters in a contemporary mental health environment that is ever more oriented towards the neurosciences.

The story of Freud's patient Anna von Lieben - as told by Anna von Lieben

Anna von Lieben (Cäcilie M.) was treated for some 5 years by Sigmund Freud who discussed her case in Studies on Hysteria. This article presents an alternative view of the case based on the discovery of new primary material, principally, a handwritten corpus of confessional poetry by Anna herself. The poems were studied using a qualitative research methodology, interpretative phenomenological analysis (IPA), the findings of which were then further explored through the lens of her husband's unpublished diary entries. On this basis, it is suggested that Anna's ill-health appears to have been due mainly to chronic gynaecological disease, morphinism, troubles of iatrogenic origin and possibly phenomena similar to what are now termed psychogenic non-epileptic seizures (PNESs). Overall, the findings contradict Freud's account of satisfactory therapeutic progress culminating in a cure.

[Borderline regions between neurology and psychiatry, focusing particularly on the functional neurological disorders]

Neurology in Japan did not develop from the separation of neuropsychiatry into neurology and psychiatry, which casts a shadow on the present situation of Japanese neurology. Functional neurological disorder (FND; hysteria) is a typical link between neurology and psychiatry. FND is a common disorder, which has been described from the ancient times and has also been the headstream of neurology. FND is not diagnosed by exclusion or by psychiatric causes, but should be actively diagnosed based on the neurological signs themselves (= positive signs of FND) as early as possible, with minimal ancillary tests. This opinion has been supported by the newest Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Many positive signs have been described. Assessment by a neurologist also becomes a treatment.

What are the neural correlates of dissociative amnesia? A systematic review of the functional neuroimaging literature

AIM

Dissociative amnesia is an emblematic psychiatric condition in which patients experience massive memory loss ranging from focal to global amnesia. This condition remains poorly understood and this review aims to investigate the neuroanatomical feature of this disease.

METHODS

We conducted a systematic review of the scientific literature available on PubMed, up to December 1, 2022, using a combination of keywords referring to dissociative amnesia. We included every scientific report involving patients undergoing a functional imaging procedure.

RESULTS

Twenty-two studies met our inclusion criteria (gathering 49 patients). Only one was a controlled study with a large sample. The other 21 were case reports and case series. In resting state, neuroimaging studies mostly showed a hypo-activated right inferolateral prefrontal cortex, associated with limbic hypoactivity and lesser activation of the hippocampal and para-hippocampal structures. The patients also presented abnormal patterns of cerebral activation when performing memory tasks. When testing recognition of memories from the amnestic period, patients showed increased activation across temporal areas (hippocampal and para-hippocampal gyri) and the limbic network. When trying to recollect memories from an amnestic period compared to a non-amnestic period, patients failed to activate these structures efficiently. Most of these patterns tended to return to normal when symptoms resolved.

CONCLUSION

This review identified a paucity of controlled studies in the field of dissociative amnesia neuroimaging, which restricts the extrapolation of results. Patients with dissociative amnesia present a broad prefronto-temporo-limbic network dysfunction. Some of the brain areas implicated in this network might represent potential targets for innovative treatments.

Les démoniaques dans l'art: Charcot and the "hysterical saints"

Professor Jean-Martin Charcot was the founder of clinical neurology and one of the prominent researchers in the field of hysteria in the 19^th century. His book Les démoniaques dans l'art is a representation of hysterical symptoms in religion and religious art. This paper aims to discuss Charcot's descriptions of hysteria in religion and his "hysterical saints".

Safety: From the Paris Morgue to Oxytocin

On Tuesday April 21, 1896, Freud gave a lecture to the Viennese medical community arguing that "hysteria," as it was then known, was caused by memories of actual physical and sexual abuse suffered in childhood. Freud rightly felt that he had made a major discovery about the science of hysteria, of psychotherapy, and of the mind. However, his idea was ridiculed. Freud's reaction to his detractors was swift: "They can go to hell." Freud withdrew "into a cocoon." When he emerged a year later, he brought with him a new science-the "science" of psychoanalysis, which for all its creativity and imagination, was devoid of science. One of the core concepts that would be sacrificed was safety itself. The "reality" of safety (and thus the reality of danger) was replaced by the "phantasy" of safety (and thus the phantasy of danger). This article reexamines some of the science that psychoanalysis took out. In particular the article looks at early attachment, safety, oxytocin, and the role of the autonomic nervous system. The reintroduction of science to psychotherapy is critical if psychotherapy is to be a science of the mind.

Conversion disorder upon emergence from general anesthesia-A case report and review of literature

Conversion disorder (CD) is a neurological symptom that is not related to any medical or neurological disease. Symptoms can range from sensory complaints to loss of consciousness. Psychological stressors such as surgery and anesthesia are considered a precipitating factors. Early diagnosis is crucial to prevent unnecessary interventions. Here, we report a case of a patient who developed CD upon emergence from general anesthesia.

Psychedelic-assisted therapy for functional neurological disorders: A theoretical framework and review of prior reports

Functional neurological disorders (FNDs), which are sometimes also referred to as psychogenic neurological disorders or conversion disorder, are common disabling neuropsychiatric disorders with limited treatment options. FNDs can present with sensory and/or motor symptoms, and, though they may mimic other neurological conditions, they are thought to occur via mechanisms other than those related to identifiable structural neuropathology and, in many cases, appear to be triggered and sustained by recognizable psychological factors. There is intriguing preliminary evidence to support the use of psychedelic‐assisted therapy in a growing number of psychiatric illnesses, including FNDs. We review the theoretical arguments for and against exploring psychedelic‐assisted therapy as a treatment for FNDs. We also provide an in‐depth discussion of prior published cases detailing the use of psychedelics for psychosomatic conditions, analyzing therapeutic outcomes from a contemporary neuroscientific vantage as informed by several recent neuroimaging studies on psychedelics and FNDs.

Hypnosis

Clinical hypnosis is an important therapeutic tool with an increasingly understood cognitive and neurobiological basis, and evidence for efficacy. Hypnosis involves controlled modulation of components of cognition-such as awareness, volition, perception and belief-by an external agent (the hypnotist) or by oneself (self-hypnosis) employing suggestion. In this article, we describe what hypnosis is, how it can be used in clinical settings, and how it is done.

[From "hysterical anorexia" to anorexia nervosa]

Anorexia nervosa and hysteria are two entities whose concepts have evolved through the ages, from "hysterical anorexia" to become distinct both in their presentations and in the representations within the community. Today, the psychiatric approach has been enriched by the contribution of neuroscience. Hospital treatment of anorexia nervosa allows intervention on the symptoms of the disease, but also takes into account the associated needs and disorders.

[Hysteria: history of a concept and its clinical reality]

Hysteria is one of the oldest and best known clinical terms. Its history reveals the extent to which pathological entities, some more than others, are the fruit of successive conceptions of experts, themselves undoubtedly influenced by the prevailing currents of thought of their time. From its uterine origin to its psychogenic etiology, here is the history of hysteria and its controversies. A history that belongs to that of medicine, neurology, psychiatry, psychology and psychoanalysis.

[Hysteria in the 19th century]

At the beginning of the 17th century, well before the time of Jean-Martin Charcot, numerous medical theses related to hysteria were defended, particularly in Paris. Among these theses, the work of Auguste Lepecq de la Clôture stands out for a controversy that questions the "matrix" origin of hysteria. Although Charcot, Babinski and Freud showed considerable interest in this pathology, its source remained mysterious to the point of disappearing from the Diagnostic and Statistical Manual of Mental Disorders. In this turmoil, women, reduced to the world of silence, have been tossed around throughout history, abused by politicians. While some have tried to make themselves heard, no one seems to have heard them.

[Reconversions of hysteria]

What has become of the hysterics of yesteryear? Despite the evolution of nosographic categories, their symptoms cannot be reduced to this, and they invite all clinicians to listen to the power of their words to express the effects of the unconscious. Disappointed lovers, worshippers of knowledge, they challenge those who would try to squeeze them into overly restrictive diagnostic boxes, to silence their truth. For they embody in their tribulations the effects of language on the being, a metonymy that they wear on their bodies. Their posture invites us to listen to the singularity of each case by highlighting the dignity of the symptom.

[The hysterical 'truth strike' and the questions it addresses to the contemporary master]

Today's hysteria, contemporary with its clinical disappearance from current nomenclatures relayed by neuroscience, is scattered in the 'catch-all' categories of conversion disorders, histrionic personality, etc. These approaches convey what Jacques Lacan called the foreclosure of the subject, or what amounts to saying, its rejection or oblivion, in particular in the relationship to knowledge and to the jouissance of the symptom. The Freudian discovery of the unconscious, and its studies on hysteria, which made hysterical conversion a message to be deciphered, is reduced in the contemporary clinic to the dimension of a disorder to be and no longer to be interpreted, because interpretation implies the subject, its word. Fortunately for the clinic, hysteria has other strings to its bow in which the subject ultimately finds his word.

[Hysteria, a product of society]

According to Ernest-Charles Lasègue (1878), "the definition of hysteria has never been given and never will be". The plurality of symptoms and clinical manifestations accounts for the polymorphism of this disease. From the first descriptions in antiquity to the present day, hysteria remains unclassifiable and defies the laws of medicine. Yet there is a continuous thread to its history: each conception of hysteria reflects the cultural and social concerns of the time. The disease affects both men and women. Nevertheless, the etymology of the concept points to the female gender. The place of the woman, in public and in private, is to be compared with the treatment of these patients, ill in a body, in a gender, in an era.

[Functional neurological disorders]

This paper reviews the literature on functional neurological disorders (Dissociative (conversion disorders - F44). The authors present a change in views on the etiology and the main mechanisms of the pathogenesis of this pathology during the period of its study. The modern ideas about the types of cerebral dysfunction characteristic of functional neurological disorders are considered. The description of the most characteristic mental and somatic symptoms observed in dissociative disorders and the features of their clinical manifestations are given. The current approaches to the therapy of functional neurological disorders are considered.

Hurst Rehabilitated: the treatment of functional motor disorders by Arthur Hurst during the First World War

Arthur Hurst was a British First World War physician, best known for his films of shell shock, 'War Neuroses'. He has often been portrayed an innovative pioneer of somewhat mysterious 'suggestion' techniques for functional motor disorders but also as an ambitious clinician who exaggerated the effectiveness of his treatments and failed to address psychological factors. His use of suggestion, persuasion and re-education together with occupational therapy, for chronic or severe cases of shell shock stirred controversy at the time because of the dramatic nature of some of his treatment responses and lack of outcome data. In part, this was a turf war between neurologists and psychiatrists for a dominant therapeutic model. A re-evaluation of his publications and new research into soldiers treated at Seale Hayne in Devon show that Hurst pioneered multidisciplinary and empathetic treatments for functional motor disorders with good short-term outcomes, though insufficient data survives to assess longer term outcomes.

Jean-Martin Charcot´s medical instruments: Electrotherapeutic devices in La Leçon Clinique à la Salpêtrière

In the famous painting La Leçon Clinique à la Salpêtrière (A Clinical Lesson at the Salpêtrière) by André Brouillet (1857-1914), the neurologist Jean-Martin Charcot (1825-1893) is shown delivering a clinical lecture in front of a large audience. A hysterical patient, Marie Wittman (known as "Blanche"; 1859-1912) is leaning against Charcot's pupil, Joseph Babinski (1857-1932). Lying on the table close to Charcot are some medical instruments, traditionally identified as a Duchenne electrotherapy apparatus and a reflex hammer. A closer look at these objects reveals that they should be identified instead as a Du Bois-Reymond apparatus with a Grenet cell (bichromate cell) battery and its electrodes. These objects reflect the widespread practice of electrotherapeutic faradization at the Salpêtrière. Furthermore, they allow us to understand the moment depicted in the painting: contrary to what is sometimes claimed, Blanche has not been represented during a hysterical attack, but during a moment of hypnotically induced lethargy.

Seeking double personality: Nakamura Kokyō's work in abnormal psychology in early 20th-century Japan

This paper examines Nakamura Kokyō's study of a woman with a split personality who lived in his home as a maid from 1917 until her death in 1940. She was his indispensable muse and assistant in his efforts to promote abnormal psychology and psychotherapy. This paper first explores the central position of multiple personality in Nakamura's theory of the subconscious, which was largely based on the model of dissociation. It then examines how it became a central issue in Nakamura's disputes with religions including the element of spirit possession, which invoked Western psychical research to modernize their doctrines. While both were concerned with the subconscious and alterations in personality, Nakamura's psychological view was distinguished from those spiritual understandings by his emphasis on individual memories, particularly those that were traumatic, and hysteria. The remaining sections of the paper will examine Nakamura's views on memory and hysteria, which conflicted with both the academic mainstream and the established cultural beliefs. This conflict may partly explain the limited success of Nakamura's academic and social campaigns.

Unconscious Emotion and Free-Energy: A Philosophical and Neuroscientific Exploration

Unconscious emotions are of central importance to psychoanalysis. They do, however, raise conceptual problems. The most pertinent concerns the intuition, shared by Freud, that consciousness is essential to emotion, which makes the idea of unconscious emotion seem paradoxical. In this paper, I address this paradox from the perspective of the philosopher R. C. Roberts' account of emotions as concern-based construals. I provide an interpretation of this account in the context of affective neuroscience and explore the form of Freudian repression that emotions may be subject to under such an interpretation. This exploration draws on evidence from research on alexithymia and utilises ideas from free-energy neuroscience. The free-energy framework, moreover, facilitates an account of repression that avoids the homunculus objection and coheres with recent work on hysteria.

Battey's operation as a treatment for hysteria: a review of a series of cases in the nineteenth century

Ovarian resection as a treatment for hysteria, called 'Battey's operation' or 'normal ovariotomy', was performed in the nineteenth century. Battey later reported that the resected ovaries appeared to have 'cystic degeneration'. Currently, patients with acute neuropsychiatric symptoms are screened for teratomas for the differential diagnosis of anti-NMDA receptor encephalitis. There is now a hypothesis that ovarian lesions resulting in paraneoplastic encephalitis were among the patients who underwent Battey's operation. We identified 94 published cases of Battey's operation for neuropsychiatric symptoms in the late nineteenth century. Among 36 cases with detailed descriptions, we found 3 patients who showed acute onset neuropsychiatric symptoms with macropathological ovarian findings that were compatible with teratoma. They showed favourable prognoses after surgery and might have motivated the surgeons to perform the operation.

Herbal and Holistic Solutions for Neurodegenerative and Depressive Disorders: Leads from Ayurveda

Neuropsychiatric and neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, schizophrenia, epilepsy, depression and anxiety pose a sizable global health problem, accompanying substantial burden of disorders, suicides, physical comorbidities, high fiscal expenses, and poor quality of life. There is a recent upsurge in global interest toward the area of traditional therapies and phytomedicines are widely admired by researchers owing to their natural source and fewer side effects. On the contrary, conventional synthetic drugs have been reported with undesirable but inevitable ill effects having poor patient compliance. Thus, herbal medicines are being preferred over synthetic drug therapies as an effective remedy for many brain disorders. Ayurveda provides a holistic approach to treatment along with several nootropic herbs having multi-dimensional bioactivities in various disorders. Scattered information is available pertaining to traditional Ayurvedic remedial options for various mental disorders. Present review encompasses: (i) common brain disorders and the associated changes (ii) Ayurvedic holistic approach to manage neurodegenerative and depressive disorders, and (iii) important Ayurvedic single herbs and polyherbal formulations with description of their traditional usage and administration. Concomitantly, it opens up for future investigations and standardization on Ayurvedic nootropic herbs.

[Doctrine of psychopathies: K. Conrad's concept of constitutional types]

The author analyzes K. Conrad's concept of constitutional types based on the suggested differences in ontogenetic development of picnic and leptosomic physique, athletics and asthenics and also dysplastics. K. Conrad's typology is compared with the typology of Italian school of clinical anthropometry and E. Kretschmer's concept of constitutions. K. Conrad's criteria for the division of primary and secondary constitutions are delineated, one of the basic criteria are set by the differences in the physique proportions and tissue development. The different physiological characteristics of picnic and leptosomic constitutions as well as their cardinal mental differences are described. The special description of mental characteristics of the asthenic-hypoplastic type and some dysplastic constitutions is presented. Manic-depressive psychosis is considered by K. Conrad as a diathesis because due to the conservative constitutional development the mental disease in picnics is capable for compensation, schizophrenia is related to the system diseases, the normal leptosomic constitution is a 'milieu' which contributes to the manifestation of schizophrenia due to the peculiarities of ontogenetic constitutional development designated by K. Conrad as propulsive. As a result of this, the disease leads to the defect.

Female anatomy and hysterical duality

This article attempts to add another layer to our understanding of the phenomenon of hysterical duality. The author postulates that hysterical duality can be explained based on the dual-aspect model of feminine sexuality, which exhibits two initially contradictory paths: one derived from primary vaginal sensations and the other from clitoral pleasure. At first, these two paths create a fundamental split between representations of internal space, containment and motherhood and representations related to auto-eroticism and the effacement of the Other's presence and needs. The author argues that this manifest contradiction makes the attainment of integration in feminine development an intricate and protracted process, which involves an act of inversion. This inversion entails a post-Oedipal disavowal of primary vaginal sexuality, pending its rediscovery through the encounter with the Other. Hysteria is thus viewed as the result of a failure to perform this inversion and an inability to extract oneself from the position of a "Vaginal Girl", who defines herself through the desire of the other. This pathological course of development leaves the hysteric's sexuality in a split state and traps her in the duality of clitoral pleasure versus penetration, which unconsciously represents humiliation and exploitation.

The case for the Freud-Breuer theory of hysteria: A response to Grünbaum's foundational objection to psychoanalysis

In his influential critique of psychoanalysis, philosopher Adolf Grünbaum has repeatedly objected that the psychoanalytic enterprise has a foundational flaw in that its fundamental claim that repressed thoughts can be pathogenic cannot be sustained. His criticism focuses on Freud and Breuer's reasoning toward this claim in Studies on Hysteria, which Grünbaum rejects mainly on the ground that there is an alternative explanation, the placebo hypothesis, that Freud and Breuer have failed to rule out. I argue against this by showing in detail why Freud and Breuer's claim about the pathogenicity of repressed thoughts can be sustained on the evidence presented in Studies. Providing such a detailed response to Grünbaum's objection is important for several reasons, including that it illustrates how the possibility of the influence of suggestion that critics often bring against psychoanalysis need not be fatal, thereby offering an alternative, complementary solution to the problem of suggestion to one recently proposed.

Does Sex Bias Play a Role for Dissatisfied Patients With Hypothyroidism?

The current state of the diagnosis and management of thyroid disease cannot be separated from the larger context of women’s health for the following reasons: (1) the disproportionate incidence and prevalence of functional and structural thyroid diseases among women vs men; (2) the role of thyroid health on fertility, pregnancy, and postpartum; and (3) the challenge posed in managing the nonspecific symptoms of functional thyroid disease in the context of menopause. Here, we explore the hypothesis that sex bias has played a role in the management of thyroid diseases historically and has extended into the modern medical era. Once knowledge gaps that may have resulted from sex bias are recognized, we can strive to overcome this bias and develop better treatments to improve patient outcomes universally.

Abrupt treatments of hysteria during World War I, 1914-18

Case reports of the abrupt recovery of hysterical disorders during World War I (1914-18), though undoubtedly subject to publication bias, raise both aetiological and treatment issues regarding pseudo-neurological conversion symptoms. Published clinical anecdotes report circumstantial, psychotherapeutic, hypnotic, persuasive (and coercive) methods seemingly inducing recovery, and also responses to fright and alterations of consciousness. The ethics of modern medical practice would not allow many of these techniques, which were reported to be effective, even in the chronic cases.

Quetiapine versus Haloperidol in Controlling Conversion Disorder Symptoms; a Randomized Clinical Trial

INTRODUCTION

About 5% of visits to emergency departments are made up of conversion disorder cases. This study was designed with the aim of comparing the effectiveness of quetiapine and haloperidol in controlling conversion disorder symptoms.

METHODS

The present single-blind clinical trial has been performed on patients with conversion disorder (based on the DSM-IV definition) presenting to emergency department of 9-Day Hospital, Torbat Heydariyeh, Iran, from January 2017 until May 2018.

RESULTS

73 patients were allocated to haloperidol and 71 to quetiapine group. Mean age of these patients was 32.03 ± 12.80 years (62.50% female). Two groups were similar regarding the baseline characteristics. Within 30 minutes, 90.41% of haloperidol cases and 91.55% of quetiapine cases were relieved (p=0.812). The most common side effects after 30 minutes were extrapyramidal symptoms (9.59%) in the haloperidol group and fatigue and sleepiness (7.04%) in the quetiapine group. Extrapyramidal symptoms was significantly higher than the quetiapine group (p=0.013).

CONCLUSION

The results of the present study showed that although quetiapine and haloperidol have a similar effect in relieving the patients from conversion disorder symptoms, the prevalence of extrapyramidal symptoms is significantly lower in the group under treatment with quetiapine. Therefore, it seems that quetiapine is a safer drug compared to haloperidol.

Hypnosis and Psychoanalysis: Toward Undoing Freud's Primal Category Mistake

Hypnosis predates psychoanalysis, when autohypnotic pathologies were identified through the lens of hypnosis, and labeled "hypnoid hysteria" in the language of the day. The broad spectrum of disorders then subsumed under that term is still reflected in ICD-10's subset, "F44-Dissociative (Conversion) Disorders." Freud initially embraced both hypnoid hysteria and hypnosis, but came to abandon hypnosis and, by extension, hypnoid hysteria as well. Since that fateful decision, which I term herein Freud's "Inaugural Category Mistake," references to both hypnosis and hypnoid pathology largely vanished from the psychoanalytic mainstream, thereby neglecting conditions afflicting a significant portion of the mentally ill, and needlessly restricting the therapeutic repertoire of psychoanalysis. This contribution argues that psychoanalysis could best re-embrace hypnosis and hypnoid pathology together, as a related pair, and would benefit from doing so. Two examples of the differences of understanding and interventions such a rapprochement might encourage are offered: (a) how hypnoid pathology alters the transference and countertransference; and (b) how the appropriate use of hypnosis alters the nature of interpretation.

Intravenous Haloperidol versus Midazolam in Management of Conversion Disorder; a Randomized Clinical Trial

INTRODUCTION

Conversion disorder is a condition in which the patient shows psychological stress in physical ways. This study aimed to compare the effects of haloperidol versus midazolam in patients with conversion disorder.

METHODS

This double-blind randomized clinical trial was conducted on patients with conversion disorder who had presented to the emergency department, throughout 2015. Patients were randomly divided into two groups and were either treated with 2.5 mg of intravenous (IV) haloperidol or 2.5 mg of IV midazolam. Recovery rate, time to recovery, and side effects of both drugs 1 hour, 24 hours, and 1 week after treatment were compared using SPSS19.

RESULTS

140 patients were divided into two groups of 70. There were no significant differences between the groups regarding the baseline characteristics. 12 (17.1%) patients who were treated with IV haloperidol experienced drug side effects within 1 hour and 12 (17.1%) within 24 hours, while only 3 (4.3%) patients in IV midazolam experienced side-effects within 1 hour after drug administration (p = 0.026). The symptoms of the disease subsided in 45 (success rate: 64.3%) patients in midazolam and in 64 (success rate: 91.5%) participants in haloperidol group (P<0.001). Mean recovery time was 31.24 ± 7.03 minutes in IV midazolam and 30.53 ± 7.11 minutes in IV haloperidol group (p = 0.592). Absolute risk reduction (ARR) of treating patients with haloperidol compared to midazolam is about 27%.

CONCLUSION

The response of patients to treatment with haloperidol is clearly better than midazolam. Although more transient and minor side-effects were observed in the group treated with haloperidol compared to midazolam group, serious side-effects were rare for both treatments.

Pierre Janet and Auguste Forel: Two Historical Contributions

This paper discusses two 19th century French-speaking authors, Pierre Janet and Auguste Forel, who both employed hypnosis and in various ways were early influences on psychoanalysis. To acquaint the reader with the clinical works of these pioneers, a long case history by Janet, and a case history by Forel are presented. The connections between these two authors and modern developments are discussed. Both historical figures were contemporaries of Freud and their at times contentious relationships became part of their legacy.

Cesare Lombroso on mediumship and pathology

During the nineteenth century and the first decade of the twentieth, students of pathology such as Cesare Lombroso (1835-1909), the author of the excerpt presented here, became involved in observing, investigating and theorizing about the phenomena of Spiritualism, and mediumship in particular. The Classic Text presented here consists of an excerpt from Lombroso's writings which focus on the Italian medium Eusapia Palladino (1854-1918), who greatly influenced Lombroso's beliefs. Lombroso illustrates neglected theoretical ideas combining the interaction of pathology and what seem to be real psychic phenomena that have not received much attention in historical studies.

The 'secret' source of 'female hysteria': the role that syphilis played in the construction of female sexuality and psychoanalysis in the late nineteenth and early twentieth centuries

In the late nineteenth and early twentieth centuries, the unspoken fear of syphilis played a significant role in the development of beliefs about female sexuality. Many women were afraid of sexual relationships with men because they feared contracting syphilis, which was, at that time, untreatable. Women also feared passing this disease on to their children. Women's sexual aversion, or repression, became a focus for Freud and his colleagues, whose theory of psychosexual development was based on their treatment of women. This article examines the case of Dora, the memoirs of Mabel Dodge Luhan and other sources to argue that the fear of syphilis was a significant factor in upper- and middle-class women's avoidance of heterosexual relationships. The fear of syphilis, in turn, became a significant factor in the psychoanalytic construction of female sexuality. The social suppression of the fear of syphilis has had a profound impact on theories of women's development. The implication for psychiatry is that our models of psychological development occur within a sociocultural milieu and cannot escape suppressed aspects of our culture.

Beyond the Impasse - Reflections on Dissociative Identity Disorder from a Freudian-Lacanian Perspective

Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.

Neurologic approaches to hysteria, psychogenic and functional disorders from the late 19th century onwards

The history of functional neurologic disorders in the 20th century from the point of view of the neurologist is U-shaped. A flurry of interest between the 1880s and early 1920s gave way to lack of interest, skepticism, and concern about misdiagnosis. This was mirrored by increasing professional and geographic divisions between neurology and psychiatry after the First World War. In the 1990s the advent of imaging and other technology highlighted the positive nature of a functional diagnosis. Having been closer in the early 20th century but later more separate, these disorders are now once again the subject of academic and clinical interest, although arguably still very much on the fringes of neurology and neuropsychiatry. Revisiting older material provides a rich source of ideas and data for today's clinical researcher, but also offers cautionary tales of theories and treatments that led to stagnation rather than advancement of the field. Patterns of treatment do have a habit of repeating themselves, for example, the current enthusiasm for transcranial magnetic stimulation compared to the excitement about electrotherapy in the 19th century. For these reasons, an understanding of the history of functional disorders in neurology is arguably more important than it is for other areas of neurologic practice.

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Zusammenfassung. Dieser Mini-Review präsentiert die nosologische Entwicklung der Hysterie. Ein Schwerpunkt liegt bei der Freud’schen Konzeptualisierung der hysterischen Disposition wie der Konversion psychischer Fantasien in Körpersymptome, ferner werden aktuelle Hysteriemodelle vorgestellt und diskutiert, weshalb die Hysterie heute nosologisch nicht mehr relevant zu sein scheint, gleichwohl aber Patienten weiterhin an hysterischen Symptomen leiden. Unabhängig von der jeweiligen Perspektive ist das Leid der Patienten ernstzunehmen: ihre existentiellen Ängste vor Ablehnung, Ausgeschlossensein und mangelnder Liebe, und ihr körpersymbolisches Ringen um Zuwendung und Hilfe. Die Hysterie-Debatte wird durch aktuelle neurobiologische Befunde abgerundet, welche die psychoanalytischen Konzepte aus heutiger Perspektive bestätigen. Der Artikel schliesst mit Hinweisen zur ärztlichen Grundhaltung und dem psychotherapeutischen Vorgehen.

Roots and vicissitudes of psychic bisexuality

Sigmund Freud considered the difficulty in defining masculinity and femininity from a psychic point of view as a hiatus in psychoanalytic theory. I contend that masculinity pertains to the centrifugal (to that which goes out, and ultimately to that which one loses), and femininity to the centripetal (to the appetency for taking the object into one's own internal space), whether one is considering their archaic roots or their genitalized culmination. The masculine/feminine pair draws support from the body (and, through anaclisis, from the subjective space), identified with a container that is liable already in the first psychic stages of life to empty itself of its own content and to be filled by a foreign content: the content is subjective in the masculine and object-related in the feminine. The conflicts of ambivalence related to these two movements (desire/anxieties linked to active and passive penetration) lead to the setting up of the rigid and labile poles of the personality, and they are liable to give rise to obsessional and hysterical solutions respectively. My hypotheses will be examined in the light of the two key cases of hysteria and obsessional neurosis in Freud's work: Dora (1905e) and the Rat Man (1909d).

Freud's "Project": The Mind-Brain Connection Revisited

Freud's "Project for a Scientific Psychology" (1895) reflected his attempt to explain psychic phenomena in neurobiological terms. The recent discovery of the neuron motivated him to embark on this endeavor. His basic hypothesis was that neurons were vehicles for the conduction of "currents" or "excitations," and that they were connected to one another. Using this model, Freud attempted to describe a number of mental phenomena, including: consciousness, perception, affect, self, cognition, dreaming, memory, and symptom formation. However, he was unable to complete his exploration of these mental processes because he lacked the information and technology that became available over the following century. Subsequent discoveries, including fMRIs, PET scans, EEGs, synapses, neural networks, genetic factors, neurotransmitters, and discrete brain circuits facilitated a significant expansion of our knowledge of mind-brain phenomena. As a result, effective pharmacological treatments have been developed for schizophrenia, mood and anxiety disorders. Moreover, changes in brain function can be measured that reflect successful pharmacologic and psychotherapeutic treatment. Despite these advances, there remain limitations in our understanding of the relationship between mind and brain functions. More than a century after Freud began the "Project," the neurobiology underlying the phenomena of consciousness, unconsciousness, qualities of subjective feelings, thoughts, and memories is still not fully understood. Can we expect to reach a more comprehensive integration of mind and its neurobiological substrate a century from now? The purpose of this article is to update our knowledge of the neurobiology associated with the specific mental functions that Freud examined in the "Project," and to pose questions concerning mind-brain phenomena that will hopefully be answered in the future.

Sexuality and its object in Freud's 1905 edition of Three Essays on the Theory of Sexuality

Freud's Three Essays on the Theory of Sexuality is one of the grounding texts of 20th century European thinking. In it Freud develops a highly original theory of sexuality for which hysteria (and pathology in general) serves a model to understand human existence. Freud published this text five times during his lifetime. This article wants to reconstruct the first edition with regard to the status and nature of (infantile) sexuality in relation to its object. It investigates how and why this relation changes in the different versions of the text. The reconstruction of the first edition is a crucial, but often forgotten task to understand the genesis of Freudian thinking.

Hypnosis as therapy for functional neurologic disorders

Suggestion in hypnosis has been applied to the treatment of functional neurologic symptoms since the earliest descriptions of hypnosis in the 19th century. Suggestion in this sense refers to an intentional communication of beliefs or ideas, whether verbally or nonverbally, to produce subjectively convincing changes in experience and behavior. The recognition of suggestion as a psychologic process with therapeutic applications was closely linked to the derivation of hypnosis from earlier healing practices. Animal magnetism, the immediate precursor of hypnosis, arrived at a psychologic concept of suggestion along with other ideas and practices which were then incorporated into hypnosis. Before then, other forms of magnetism and ritual healing practices such as exorcism involved unintentionally suggestive verbal and nonverbal stimuli. We consider the derivation of hypnosis from these practices not only to illustrate the range of suggestive processes, but also the consistency with which suggestion has been applied to the production and removal of dissociative and functional neurologic symptoms over many centuries. Nineteenth-century practitioners treated functional symptoms with induction of hypnosis per se; imperative suggestions, or commands for specific effects; "medical clairvoyance" in hypnotic trance, in which patients diagnosed their own condition and predicted the time and manner of their recovery; and suggestion without prior hypnosis, known as "fascination" or "psychotherapeutics." Modern treatments largely involve different types of imperative suggestion with or without hypnosis. However, the therapeutic application of suggestion in hypnosis to functional and other symptoms waned in the first half of the 20th century under the separate pressures of behaviorism and psychoanalysis. In recent decades suggestion in hypnosis has been more widely applied to treating functional neurologic symptoms. Suggestion is typically applied within the context of other treatment approaches, such as cognitive-behavioral, rehabilitative, or psychodynamic therapy. Suggestions are generally symptom-focused (designed to resolve a symptom) or exploratory (using methods such as revivification or age regression to explore experiences associated with symptom onset). The evidence base is dominated by case studies and series, with a paucity of randomized controlled trials. Future evaluation studies should allow for the fact that suggestion with or without hypnosis is a component of broader treatment interventions adapted to a wide range of symptoms and presentations. An important role of the concept of suggestion in the management of functional neurologic symptoms is to raise awareness of how interactions with clinicians and wider clinical contexts can alter expectancies and beliefs of patients in ways that influence the onset, course, and remission of symptoms.

Charcot, hysteria, and simulated disorders

Jean-Martin Charcot (1825-1893) was the 19th-century's premier international neurologist. One of his areas of focused interest was the neurologic disorder, hysteria, a condition with distinctive neurologic signs, but no established structural lesions identified at autopsy. Charcot considered hysteria as a physiologic disorder that affected specific neuroanatomic areas of the brain comparable to the same areas that were damaged by structural neurologic disorders provoking the same or similar signs. He considered hysteria primarily a hereditary disorder, but environmental factors including physical and emotional stress served as provoking factors. Charcot drew the strict distinction between hysteria and consciously simulated neurologic disorders, although he was keenly aware that the two disorders could occur in the same patients or be difficult to distinguish at times. He developed specific experimental techniques to separate hysteria from simulation. His studies of hysteria and simulation offer a basis for studies of functional neurologic disorders applicable to the 21st century.

Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders

Functional neurologic disorder (FND), also known as conversion disorder, is common and often associated with a poor prognosis. It has been relatively neglected by research and as such there is a conspicuous lack of evidence-based treatments. Physical and psychologic therapies are the main treatment modalities, over and above reassurance and sensitive explanation of the diagnosis. However there are two other historic treatments that have seen a recent resurgence of interest and use. The first is electric stimulation, which was initially pioneered with direct stimulation of nerves but now used indirectly (and therefore noninvasively) in the form of transcranial magnetic stimulation (TMS). The second is (therapeutic) sedation, previously known as "abreaction," where it was mostly used in the context of psychologic investigation and treatment, but now increasingly advocated during rehabilitation as a way to therapeutically demonstrate reversibility of symptoms. This chapter introduces the background of these treatment modalities, their evolution into their current applications before critically evaluating their current evidence base and exploring possible mechanisms of action. It also tentatively suggests when they should be considered in current practice and briefly considers their future potential. In summary there is encouraging preliminary evidence to suggest that both TMS and sedation may be effective treatments for FNDs.

Hypnosis as a model of functional neurologic disorders

In the 19th century it was recognized that neurologic symptoms could be caused by "morbid ideation" as well as organic lesions. The subsequent observation that hysteric (now called "functional") symptoms could be produced and removed by hypnotic suggestion led Charcot to hypothesize that suggestion mediated the effects of ideas on hysteric symptoms through as yet unknown effects on brain activity. The advent of neuroimaging 100 years later revealed strikingly similar neural correlates in experiments matching functional symptoms with clinical analogs created by suggestion. Integrative models of suggested and functional symptoms regard these alterations in brain function as the endpoint of a broader set of changes in information processing due to suggestion. These accounts consider that suggestions alter experience by mobilizing representations from memory systems, and altering causal attributions, during preconscious processing which alters the content of what is provided to our highly edited subjective version of the world. Hypnosis as a model for functional symptoms draws attention to how radical alterations in experience and behavior can conform to the content of mental representations through effects on cognition and brain function. Experimental study of functional symptoms and their suggested counterparts in hypnosis reveals the distinct and shared processes through which this can occur.