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.

Edgar Adrian (1889-1977) and Shell Shock Electrotherapy: A Forgotten History?

The English electrophysiologist Edgar Adrian (1889-1977) was the recipient of the Nobel Prize for physiology in 1932 for his research on the functions of neurons. During World War I, at Queen Square in London, he devised an intensive electrotherapeutic treatment for shell-shocked soldiers. The procedure, developed with Lewis Yealland (1884-1954), was similar to "torpillage," the faradic psychotherapy used in France. Adrian and Yealland considered that the pain accompanying the use of faradic current was necessary for both therapeutic and disciplinary reasons, especially because of the suspicion of malingering. According to Adrian, this controversial electric treatment was only able to remove motor or sensitive symptoms. After the war, he finally admitted that war hysteria was a complex and difficult phenomenon.

[When medicine appeals to our feelings: Charles de Villers' Le magnétiseur amoureux]

This article analyses the representation of affective phenomena brought into play in Charles de Villers' Le magnétiseur amoureux (1787) as it helps to better understand the historical transition from the Galenic conception of the passions of the soul to the cerebral interpretation of emotions. While feelings became the condition of possibility in the occurrence of the therapy, passion is identified as the cause of the young woman's illness, Caroline, who according to the interpretation proposed in this article, suffers from what was identified in the eighteenth century medical tradition as "love melancholy" or "hysteric affection", which were both pathologies that alluded to vapors in order to explain their symptoms. The analysis of the logic of feeling running across Villers' novel impels us to interpret the magnetic fluid in terms of the sympathy created between the two main characters. The ambivalence expressed by Villers between the meaning of "love sentiment" and that of "love passion" allows us to finally understand the somnambulist therapy as erotic knowledge that implies a reflection on love codes in late eighteenth century France.

'Shell shock' revisited: an examination of the case records of the National Hospital in London

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain's leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient's military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.

Hysterical identification in an eleven-year-old girl

The concept of hysterical identification was reviewed and illustrated in child analytic process material obtained in the treatment of a latencyage girl. It is the author's contention that "hysteria" and its dynamics, for example, hysterical identification, have fallen into disuse, to the disservice of our child patients. This contribution is aimed at getting child analysts to reconsider the merits of this outcome.

History of physical and 'moral' treatment of hysteria

This historical review presents the advances made mostly during the last 200 years on the description, concepts, theories, and (more specifically) cure of patients suffering from hysteria, a still obscure entity. The denomination of the syndrome has changed over time, from hysteria (reinvestigated by Paul Briquet and Jean-Martin Charcot) to pithiatism (Joseph Babinski), then to conversion neurosis (Sigmund Freud), and today functional neurological disorders according to the 2013 American Neurological Association DSM-5 classification. The treatment was renewed in the second half of the 19th century in Paris by Paul Briquet and then by Jean-Martin Charcot. Hysterical women, who represented the great majority of cases, were cured by physical therapy (notably physio-, hydro-, and electrotherapy, and in some cases ovary compression) and 'moral' therapies (general, causal therapy, rest, isolation, hypnosis, and suggestion). At the turn of the 19th and 20th centuries, psychotherapy, psychoanalysis, and persuasion were established respectively by Pierre Janet, Sigmund Freud, and Joseph Babinski. During World War I, military forces faced a large number of posttrauma neurosis cases among soldiers (named the 'Babinski-Froment war neurosis' and Myers 'shell shock', in the French and English literature, respectively). This led to the use of more brutal therapies in military hospitals, combining electrical shock and persuasion, particularly in France with Clovis Vincent and Gustave Roussy, but also in Great Britain and Germany. After World War I, this method was abandoned and there was a marked decrease in interest in hysteria for a long period of time. Today, the current treatment comprises (if possible intensive) physiotherapy, together with psychotherapy, and in some cases psychoanalysis. Antidepressants and anxiolytics may be required, and more recently cognitive and behavioral therapy. Repetitive transcranial magnetic stimulation is a new technique under investigation which may be promising in patients presenting with motor conversion syndrome (motor deficit or movement disorder). Functional neurological disorders remain a difficult problem to manage with frequent failures and chronic handicapping evolution. This emphasizes the need for therapeutic innovations in the future.

'Hysteria' today and tomorrow

'Hysteria' (conversion disorder) remains in modern humanity and across cultures, as it has for millennia. Advances today in tools and criteria have afforded more accurate diagnosis, and advances in treatments have empowered patients and providers, resulting in a renewed interest in somatoform disorders. Future progress in understanding mechanisms may be influenced by developments in functional neuroimaging and neurophysiology. No animal model exists for somatoform symptoms or conversion disorder. Despite the absence of a known molecular mechanism, psychotherapy is helping patients with conversion disorder to take control of their symptoms and have improved quality of life, shedding light on what was once an enigma.

The girls of La Salpêtrière

It was only by chance that French hospital authorities assigned Jean-Martin Charcot to the care of hysterics and epileptics, starting in 1870, at La Salpêtrière Hospital. The famous clinical work that resulted has been the subject of much discussion and, in many cases, misinterpretation. By referring to original sources, i.e., the medical observations written at the time by the department's staff, our aim is to bring the hospitalized patients to life. Many of these observations contain intimate details and reveal the painful experiences that led these young women to La Salpêtrière. To understand the gradual, 20-year evolution of Charcot's neurological thinking about hysteria, from organicity to psychology, in both clinical and therapeutic terms, it is more revealing to analyze all the physical and psychological miseries that make up this forgotten 'human material' than it is to examine the neurologist's famous lessons.

Public medical shows

In the second half of the 19th century, Jean-Martin Charcot (1825-1893) became famous for the quality of his teaching and his innovative neurological discoveries, bringing many French and foreign students to Paris. A hunger for recognition, together with progressive and anticlerical ideals, led Charcot to invite writers, journalists, and politicians to his lessons, during which he presented the results of his work on hysteria. These events became public performances, for which physicians and patients were transformed into actors. Major newspapers ran accounts of these consultations, more like theatrical shows in some respects. The resultant enthusiasm prompted other physicians in Paris and throughout France to try and imitate them. We will compare the form and substance of Charcot's lessons with those given by Jules-Bernard Luys (1828-1897), Victor Dumontpallier (1826-1899), Ambroise-Auguste Liébault (1823-1904), Hippolyte Bernheim (1840-1919), Joseph Grasset (1849-1918), and Albert Pitres (1848-1928). We will also note their impact on contemporary cinema and theatre.

Miraculous healings of paralysis: a preliminary study on sources

The aim of the present paper has been to explore the medieval evidence on miraculous healings of paralysis and to confront it with modern medical knowledge. Paralysis has been selected as a model for such a study and St. Bernardino of Siena (1380-1444) as a model of a saintly healer. Analyzed were the primary sources and modern literature. Paralysis was found to be among the most frequent diseases in medieval miracle reports, including the healings by St. Bernardino. According to the hypothesis offered in the paper, the majority of medieval cases of "miraculously healed paralysis" was of conversive origin.

Alternatives for hand over mouth exercise after its elimination from the clinical guidelines of the american academy of pediatric dentistry

PURPOSE

The purpose of this study was to survey the alternative behavior management techniques that might be utilized by pediatric dentists in place of hand over mouth exercise (HOME) after its elimination from the clinical guidelines of the American Academy of Pediatric Dentistry (AAPD).

METHODS

A questionnaire was electronically mailed to 2,600 AAPD members. The survey included items related to HOME alternatives after the elimination, concerns with its use, and if the elimination had affected access to care for children.

RESULTS

Seven hundred four respondents (30%) completed the survey. Voice control was the first alternative, and minimum/moderate sedation was the second most common. Three hundred fifty respondents (50%) believed that HOME is an acceptable behavior management technique, and 290 (41%) believed it should be continued to be recognized by the AAPD. Only 7% believed that HOME elimination affected access to care for some children.

CONCLUSION

Advanced behavior management techniques will be utilized more by pediatric dentists after the elimination of the hand over mouth exercise from the American Academy of Pediatric Dentistry's clinical guidelines.

Beyond Lawrence v. Texas: crafting a fundamental right to sexual privacy

After the watershed 2003 U.S. Supreme Court decision Lawrence v.Texas, courts are faced with the daunting task of navigating the bounds of sexual privacy in light of Lawrence's sweeping language and unconventional structure. This Note focuses on the specific issue of state governments regulating sexual device distribution. Evaluating the substantive due process rights of sexual device retailers and users, this Note ultimately argues that the privacy interest identified in Lawrence is sufficiently broad to protect intimate decisions to engage in adult consensual sexual behavior, including the liberty to sell, purchase, and use a sexual device.

Mass psychogenic illness (epidemic sociogenic attacks) in a village in Lebanon

Mass psychogenic illness (epidemic sociogenic attacks/mass hysteria) refers to a rapid spread of well-described signs and symptoms affecting members of a group. It might be difficult to differentiate at first from illnesses due to infections, intoxications or "bio-terrorism." We investigated such an occurrence in a small village in Lebanon chronically under threat of war. A 16-year-old single female, school student, was referred to Saint George Hospital University Medical Center, Beirut, for attacks of shortness of breath, muscle cramps, tremors and dizziness, for several days. She was referred because she was the first of eight cases from the same village to have similar symptoms. In parallel to an inpatient multidisciplinary evaluation and treatment, meetings were held with the crisis group comprising members of the hospital Psychiatry and Psychology Department, a public health representative of the Ministry of Health of Lebanon, physicians who were taking care of the other cases and a psychologist working in the area where these cases were declared. The diagnosis of mass psychogenic illness (epidemic sociogenic attacks) was reached. A common strategy was adopted in an effort to control the epidemic. Several explanations had been put forward initially by the community : bioterrorism, noxious fumes and "bad spirits." At the time of writing this report--nine months later--, the epidemic, which had abated within six weeks, was still inactive.

[Psychiatric disorders in non demented elderly people]

Psychogeriatrics is a rapidly growing field. In France, the focus is currently on targeted education and specific management. Psychiatric disorders may be atypical in the elderly, and may also be difficult to distinguish from the effects of aging or somatic disorders. The principal disorders observed in old age are depression, late delusion, anxiety disorder, hysteria, delirium and mania. Depression has specific features, depressive equivalents, particular risk factors, and a categorical and dimensional therapeutic approach. Diagnosis and screening must be improved Late delusion is organized around a notion of injury, and is an active attempt to deal with isolation, depression and anxiety. The term "very late-onset schizophrenia-like psychosis" has been proposed. Anxiety also has specific features in the elderly and is intimately related to depression. If left untreated, the consequences can be severe. Hysteria is pathoplastic with time, age and educational status. Pseudocognitive conversions are starting to be seen in old age. Delirium is very frequent in the elderly; it is often multifactorial, but psychosocial factors must not be underestimated. Mania can also be provoked by somatic disease, and mixed syndromes are far from rare. Dementia can be approached from its psychopathological dimension, particularly in terms of psychosocial risk factors and protective factors relating to the individual's biography and personality. Thus, psychogeriatrics is an integrated medical discipline in which psychiatric disorders are approached through specific clinical management, oriented research and structured training.

Benjamin Franklin and the neurosciences

Benjamin Franklin (1706-1790), who is better known in other fields, especially colonial politics and international diplomacy, was an early, major contributor to the neurosciences from the New World. Among his accomplishments are: experiments on medical electricity as a possible cure for the palsies and hysteria; the first descriptions of how electricity affecting the brain can cause a specific type of amnesia; supporting the idea that cranial shocks might provide a cure for melancholia; showing that the cures performed by the Mesmerists to remove obstructions, including nerve blockages, rest on gullibility and suggestion, and recognizing the dangers, including those to the nerves, posed by exposure to lead. Franklin?s neuroscience was firmly based on experiments, careful observations, and hard data ? and finding clinical relevance for new discoveries was always on his mind.

Belief, hope and faith

A case of hysteria is presented in order to create a frame of reference for the author's approach to the concepts of hope, belief and faith. A difference between hope as a 'sad passion' (which is here called regressive hope) and hope as a principle of mental functioning is established. The concept of hope will at first always be based on beliefs--either beliefs organised in the paranoid-schizoid position (called here fragmented and delusional beliefs)--or those organised from the depressive position (complex systems of beliefs, which end up being dogmatic); the latter typically occur in neurotics. It is suggested here that there is another possibility for hope, which is based on faith. The meaning of faith is considered here externally to the religious sense. The solid establishment of hope as a principle--based on faith--can be viewed as responsible for the opening up of creative potentials and as one of the main aims of analysis. Such an aim, however requires the establishment of a deep relationship, both in theory and in clinical practice, between the Kleinian question of the depressive position and the Freudian question of the Oedipus complex.

Existential Analysis and Psychoanalysis: Specific Differences and Personal Relationship between Ludwig Binswanger and Sigmund Freud

The concise curriculum vitae of the founder of existential analysis is followed by an exact comparison of the polarity (homo natura versus homo cultura) between Binswanger and Freud. Then the five stages in the development of (Existential Daseinsanalysis Analysis) are described: the stage of learning, of practice, of criticism, of the alternative to psychoanalysis, and of reconciliation. The criticism is aimed especially at Freud's naturalism and at the concept of drive. These concepts are opposed by ontoanalytic doctrines derived from Heidegger's ontoanalysis. The differences are further exemplified by the comparison of the existentialanalytical and the psychoanalytical view of the unconscious. A presentation of the treatment of a "hysterical phobia," which is first explained in psychoanalytic terms and later in existentialanalytic terminology (mainly concerning the world-projects) makes the difference between the two schools of thought explicit.

Pierre Janet and Félida Artificielle: multiple personality in a nineteenth-century guise

In the wake of the recent epidemic of multiple personality phenomena, it is important to get a clear idea of what similar phenomena looked like in previous centuries. Pierre Janet's detailed description of his discovery, made during the 1880s, that he could cure hysteria by creating a healthy second personality offers a close look at a form of multiple personalities very different from what has recently been described. His description of the factors that influenced his discovery allow one to see his work in a historical context and to appreciate his confrontation with the paradoxes that this discovery revealed.

[Treatment of hysteria in the 19th century--in which way did German psychiatrists view castration?]

Until the late 19 th century treatment of hysteria, this inhomogeneous group of somatic, neurological and psychiatric symptoms, hardly differed from the methods of the Greco-Roman epoch. Dietetics, physical applications, and smaller surgical operations made up the standard forms of intervention for this illness which was regarded as belonging to the field of gynecology. Thus, it is not astonishing that oophorectomy (ovariectomy) was included into the therapeutic spectrum for hysteria both in Germany and beyond at the end of the 19 th century. It was above all gynecologist Alfred Hegar (1830 - 1914) who tried to extend the application of this method to nervous illnesses. This therapeutic alternative did not, however, meet with an unanimously positive response among psychiatrists. Richard von Krafft-Ebing (1840 - 1902) as a follower of the degeneration theory as well as Paul Flechsig (1847 - 1929) supported it, applying it as the ultima ratio. But since these operations produced no lasting curative impact, functional neurological disorders were regarded more important. From Emil Kraepelin (1856 - 1926) then, psychiatrists began to understand the psychological component of this illness, for which Leipzig neurologist Paul Julius Möbius (1853 - 1907) had made major contributions. Thus, surgical interventions were rejected and conservative methods of treatment were developed further considering psychological aspects. It was Adolf Strümpell (1853 - 1925) who had laid the basis for this postulating a "psychic trauma" as the cause for hysteria as early as in 1884. On the other hand, Möbius had developed a psychotherapeutic concept for the treatment of these disorders long before Sigmund Freud (1856 - 1939) came out with his psychocathartic method.

Hysteria. Pretending to be sick and its consequences

Hysteria, as it involves the medical profession, is a form of sickness that is defined as being without disease or illness. This lack of a biomedical explanation has limited progress in its understanding. In this essay we propose that hysteria might be better thought of as a form of pretending, elaborated in transaction with the medical system. In medicine, to pretend usually means to deceive. From the perspective of play, however, pretend is a state more akin to acting, magic, belief, and hypnosis. We provide a number of reasons why sickness is an attractive focus for pretending. We show how enactments of sickness can be scripted by a group of involved persons, each contributing from their own perspective, as occurs in the parlour game of 'Consequences', except in hysteria the consequences are often dire.

Distinguishing the drama from the histrionics in a case of hysteria with multiple tics

The author describes a clinical experience with a hysterical patient with multiple tics, an upper-middle class, married woman, who when she started analysis at the age of 30 was in a state of profound tension and anxiety. The first eight years of this analysis are presented in order to describe how the analyst came to identify the dynamics of unconscious phantasies in a situation where analyst and patient found themselves involved in several roles of a drama dominated by theatrics. The insights and therapeutic benefits suggested that this patient unconsciously experienced her oral needs as intensely destructive and cruel, an experience she felt to have been exacerbated by her mother's lack of response to her emotional needs. This primitive cruel orality was accompanied by a split-off experience of a secret, mystical union with the primitive idealised mother. The author considers that this split experience of cruel and idealised orality suffused the patient's genital sexuality, hindering the evolution and realisation of her adult sexuality, giving her a distorted view of the primal scene as an impenetrable fused amalgam acting as an omnipotent, self-sufficient, excluding phallus. Gradually analysis enabled the patient to transform her bodily theatrics into thoughts and to broach the difficult task of relating to others instead of being either fused with them or totally excluded by them.

Follow-up study of hysterical psychosis, reactive/psychogenic psychosis, and schizophrenia

The present study was undertaken to learn more about the longer-term course of nonaffective functional psychoses, including hysterical psychosis. A group of 48 female patients diagnosed with hysterical psychosis, nonhysterical reactive/psychogenic psychosis, and schizophrenia at their first admission were reassessed after an average follow-up period of 11.6 years. Seventy-five percent were receiving outpatient treatment; less than half were on neuroleptics, and only 35% were rehospitalized. The patients suffered from a few, mostly unspecific, symptoms and were relatively well adjusted socially. No differences were found between original diagnostic categories regarding all variables studied. Hysterical psychosis does not appear to be a special clinical entity, distinguishable from other reactive/psychogenic psychoses in the short term and from other nonaffective functional psychoses in the longer term. The symptomatology and clinical presentation of nonaffective functional psychoses at first admission do not allow any prognostic longer-term forecast, and the initial differences between individual psychoses tend to disappear over time.

Mass psychogenic illness: role of the individual physician

Mass psychogenic illness is characterized by symptoms, occurring among a group of persons with shared beliefs regarding those symptoms, that suggest organic illness but have no identifiable environmental cause and little clinical or laboratory evidence of disease. Mass psychogenic illness typically affects adolescents or children, groups under stress and females disproportionately more than males. Symptoms often follow an environmental trigger or illness in an index case. They can spread rapidly by apparent visual transmission, may be aggravated by a prominent emergency or media response, and frequently resolve after patients are separated from each other and removed from the environment in which the outbreak began. Physicians should consider this diagnosis when faced with a cluster of unexplained acute illness.

'My bad diagnostic error': once more about Freud and Emmy v. N. (Fanny Moser)

The author examines two aspects of the case of Fanny Moser (Emmy von N. in the 'Studies on Hysteria'): first, a hitherto unknown letter written by Sigmund Freud to Fanny Moser's daughter in 1935, in which he revises his diagnosis of half a century before, describing it as 'a bad diagnostic error' and apologising to the daughter; second, the dates of Fanny Moser's treatment. All previous attempts have failed to date it consistently. The author combines all the information about the case of Fanny Moser and the circumstances of Freud's life in that period and shows that Freud took over the case in 1888, not in 1889. In addition, he suggests that Emmy von N. has had a significant influence on Freud's papers on 'Hysteria' and on his comparative study 'Organic and hysterical motor paralyses'.

Getting in on the act: the hysterical solution

The author recounts the case of Anna O from a contemporary psychoanalytic viewpoint, incorporating the additional information now available to us about Breuer's treatment of Bertha Pappenheim. Now the erotic transference and Anna O's 'oedipal illusion', which culminated in her hysterical pregnancy and labour, is evident to us, as it was to Freud, who did not publicly share his knowledge of Breuer's unhappy experience with this patient. Ernest Jones, in whom Freud did confide, wrongly dated the conception of the Breuer's baby in his biography of Freud describing it as a sequel to Anna O's treatment. In fact Mrs Breuer's pregnancy was concurrent with the treatment and the author suggests that it significantly influenced its course. Using the case of Anna O and one of his own the author postulates that a feature of hysteria is the use of projective identification by the patient to become in phantasy one or other member of the primal couple. A symbolic version of the primal scene between patient and analyst may then be enacted in the context of the erotic transference-countertransference that characterises these cases.

Disguised hysteria in a child psychosis?

In this paper the stages are presented in the psychoanalysis of an eight-and-a-half-year-old boy consulting with a worsening symptomatology that has been evolving for more than one year. The trigger element seems to have been the birth of a brother. During the analysis the relation was clear between this brother's birth, the mother's abortions, and the previous death of a brother. The interpretation of the homicidal omnipotent fantasies and the analyst's reception of projective identifications, destructive anxieties, and castrating anxieties of the patient produced, apparently, an unimagined fast improvement of the psychotic symptoms. This took the authors retrospectively to raise the hypothesis that this patient's psychosis could be a disguised child hysteria.