Abstract
The textbooks of a hundred years ago considered the conditions we would call psychotic to be largely psychogenic, the conditions we would call neurotic to be associated with organic diseases, and those we would call hysterical to be due to a special sensitivity of the nervous system or to gynaecological disorders. The conditions corresponding to the neuroses as we know them today, apart from “hysterical insanity” do not seem to have been part of the province of the alienist but of the general physician and later the neurologist. Towards the end of the last century, it was suggested that the term neurosis should apply to a disordered physiological state and the term psychosis to a disordered mind. Psychiatric textbooks of a century ago did not concern themselves with neuroses. The medical textbooks described hysteria in great detail, usually manifestations of a gross kind. The idea of hysteria having something to do with the uterus persisted, Cullen ascribing it to amenorrhoea or too great a salacity. Later, when theories of exhaustion of the nervous system in neurasthenia became popular, the exhaustion was held by some to be caused by the “irritation” of the nervous system by gynaecological disorders. Neuroses with somatic symptomatology tended to be classified under a somatic label. Anxiety states with somatization were attributed either to the common diseases of the day, such as gout or dyspepsia, or to dysfunction of the nervous system. The rest therapy popularized by Weir Mitchell in 1875 got its results through suggestion and the anaclitic meaning it carried. Although popular for “neurasthenia” it was widely used for all mental disorders, and in its day was as revolutionary as shock therapy or the tranquilizers. Focal sepsis and auto-intoxication provided theories which led to the surgical treatment of neuroses. Present day fashions in diagnosis of the neuroses vary with the orientation of the diagnostician: in terms of reaction of a personality, in terms of dynamics, or in terms of symptom groupings.
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