12ĭuring the First World War, ‘hysterical’ motor symptoms such as paralysis and movement disorders were attributed to a diagnosis of ‘shell shock’. Savill's breakdown of ‘hysterical’ symptoms was similar to that described by Briquet half a century earlier. 11 Contrasting this against Schofield's data from the same time indicates the importance of the setting when considering the incidence of a condition.
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10 Savill, at Paddington Infirmary and the West End hospital for Nervous Disease in 1909, recorded 500 patients with hysteria (including 28% with weakness). In 1891 Guinon recorded ‘hysteria’ as the diagnosis in 8% of 3168 patients attending Charcot's outpatient clinic. What numerical data there are, although sparse, actually suggest that the rate of presentation of ‘hysteria’ in neurological practice has remained stable over time. But the evidence for a decline in hysteria in neurological practice is less compelling, coming from Israel Wechsler, a professor of neurology at Columbia in 1929, and from Schofield, a Harley Street doctor, in 1906. He provides good data to support the hypothesis that hysteria declined in psychiatric practice. What is the evidence for a decline in the frequency of hysteria since the 19th century?Įdward Shorter, in his scholarly history of psychosomatic medicine From Paralysis to Fatigue, 1 uses quotes from neurologists and psychiatrists to support his claim that ‘fits and paralyses that had been summoned from the symptom pool since the Middle Ages - spreading almost epidemically during the nineteenth century.virtually came to an end by the 1930s’. 9 We argue that it was not hysteria that disappeared, but rather medical interest in hysteria. Scientific obliteration had become almost complete by the 1960s when flawed data was published which appeared to indicate that the diagnosis of hysteria usually turned out to be incorrect.
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Neurologists were not interested in seeing the patients and the patients were mostly not interested in seeing psychiatrists. Instead, we propose that when the neurological study of disease and the psychiatric study of neurosis became divergent endeavours at the start of the 20th century, hysteria fell into a no-man's land between these two specialities. We conclude that there is no good evidence for a change in the frequency with which conversion symptoms (neurological ‘hysteria’) have presented to neurologists over the last 120 years. So what has happened? Did hysteria wane and is it now increasing again? Or has it always been common? In this essay we explore, using data where possible, some of the factors at work in this story. It is puzzling, to say the least, that there should be such a discrepancy between medical historians and clinical neurologists. 4 Ample data exists to show that conversion symptoms remain very common in neurological practice, 5 - 8 a clinical reality that is curiously not reflected in research activity, teaching or public awareness. 2īut as Jan van Gijn, Professor of Neurology in Utrecht, has recently commented, anyone who thinks that hysteria disappeared with the death of Charcot cannot know what goes on in neurology outpatient clinics. Mark Micale, another historian of hysteria, also accepts the view that the more ‘florid’ types of hysteria are ‘regarded today as extreme rarities’. 1 Common theories given for this ‘disappearance of hysteria’ include societal emancipation from repressive Victorian culture, increasing ‘psychological literacy’ in the 20th century and advances in understanding of neurological disease.
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1 - 3 For example, in From Paralysis to Fatigue, his history of psychosomatic medicine, Edward Shorter argues that symptoms such as hysterical paralysis, which were common in the 19th century and famously demonstrated by Charcot, have now given way to more elusive symptoms such as fatigue. There is a widespread belief that the symptoms of ‘hysteria’, as used to describe neurological symptoms such as paralysis or blackouts unexplained by disease, has become less common over the last 100 years.