Hysteria--multiple manifestations of semantic confusion.

Abstract

‘Hysteria' is a term with confusing uses covering a variety of conditions often with little or no functional relationship. Some salient historical aspects of the term are reviewed. The three listed categories of so-called hysterical reaction are: Dysmnesic and Conversion Reactions and Hysterical Personality. The first is discussed in summary form; the second and third in greater detail. Dysmnesic reactions such as amnesia, fugue, twilight and trance states and multiple personality are explained on the basis of gross dissociation. Somnambulism, once included here, has now been shown to be associated with gross EEG. changes, and suggests that modern neurophysiological techniques may yet contribute factual data on the nature of presently obscure cerebral events. Conversion reactions still remain explicable only in psychological terms, such as suggested by Freud. Present-day views include a wide range of interpersonal events as causal. The tacit association of conversion symptoms with the hysterical personality is no longer tenable. Such symptoms occur in many diagnostic categories. Organic brain disease may favour a predilection to the formation of conversion symptoms. Pain, as a common conversion phenomenon, should be labelled ‘psychogenic regional pain’, as suggested by Walters, but never ‘hysterical’. While conversion may be part of a communication process and often symbolic, it is not necessarily restricted to somatic motor and sensory systems. Certain symptoms, mediated in part or totally by autonomic pathways, may be symbolic or include conversion reactions in their chain of events. The psycho- or physiodynamics of conversion remain obscure. Attempts to hew a syndrome out of the coincidence of multiple conversion symptoms in women with so-called hysterical personalities are unjustified and becloud thinking about the events involved. The type of personality called ‘hysterical' or ‘histrionic' is only related to the dysmnesic or conversion categories by the semantic misdemeanor of confused usage of the word hysteria. It impies a person with childlike egocentricity and affective lability, on which is superimposed the more adult skills of melodrama and coquettishness. The psychodynamics of such personalities is discussed and a comparison made to Harlow's parent-deprived monkeys. The common difficulties in sexual relationships are commented on.