Hysteria: Understanding the complex condition

Back in high school it was a commonly talked about condition with its probable causes discussed in hushed tones.

During our early years of clinical practice, a shift wouldn’t end without a case of a seemingly semiconscious patient mostly females, brought around by their panicky teachers or relatives.

Hysteria is a description with long history of use, and it comes from the Greek word ‘hystera’ meaning uterus, hence was more diagnosed in women.

The condition is characterised by wide ranging and varied ungovernable symptoms including fainting, shortness of breath, paralysis, spasms, pain, convulsions, irritability, delirium, cold extremities yawning and stretching among others.

Historically while Greeks associated it with uterus and lack of sexual activity in females, the ancient Egyptians believed the uterus could detach and wander around hence causing the symptoms.

Treatments involved coaxing the uterus back into place by use of foul or strong pungent smells, a practice that is erroneously replicate even in some modern clinical settings.

With advancing knowledge, hysteria is no longer considered a medical diagnosis.

This shift in knowledge began in the 19th Century with scholars like Jean-Martin Charcot describing it as psychological rather than physical illness, and Neurologists Sigmund Freud opining that the condition resulted from repressed psychological trauma.

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With this knowledge the conditions symptoms have been replaced by conditions such as somatization disorders, characterized by multiple physical symptoms that cannot be explained by any medical findings, yet they cause significant distress and impairment.

Dissociative disorders, presenting with disturbances in consciousness, memory, identity and trance states.

Conversion disorders presenting with neurological symptoms like paralysis, blindness or even sensory loss, with no clear organic signs with patients deemed to be “converting” a suppressed psychological trauma to the stated physical symptoms.

One of the most interesting conditions physicians, neurologists and psychologists diagnose in clinical settings, is the functional neurological symptoms disorder (FNSD).

Though similar to conversion disorder with the terms being interchangeably used, and with presenting with neurological signs, such as weakness, paralysis, abnormal movement, or sensory disturbances, that cannot be explained by a recognized neurological or medical disorder.

These symptoms are not consciously fabricated or feigned and appear as a result of the impact of mental disorder or interference with the brain function.

Whereas the conversion disorder diagnosis criteria require presence of a trauma or a psychological stressor preceding the symptoms onset, FNSD does not require the psychological stressor to be present.

There is no single cause of these disorders, but multiple risk factors predisposing one to them.

The risk factors may include mental or physical trauma, stressful events, family issues, changes or disruptions in the brain, mental health conditions like anxiety and depression, other neurological disorders, combat trauma, peer pressure and bullying, other biological, psychological and social factors.

Treatment for these conditions involves a multidisciplinary approach tailored to the individual’s specific symptoms and needs, after thorough investigations via medications, psychotherapy, physical and occupational therapies.

- The writer is a licensed psychologist/psychiatrist clinical officer and lecturer KMTC Meru Campus