Issues in Interdisciplinarity 2019-20/Truth in the treatment of hysteria at the end of the 19th century

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Introduction[edit]

Nowadays hysteria is defined as a psychological disorder characterized by conversion of psychological stress into physical symptoms or a change in self-awareness.

The treatment of hysteria has been the object of multiple experimentation. It has always been known throughout history by doctors and researchers under different names and under different forms. What led to such a confusion within the scientific community is the lack of knowledge about the cause of such mental disorder.

Ever since the ancient Egyptian and Greek societies, diverse truths within multiple disciplines, were enlightened with the objective of coming up with the definitive cure.


Social perspective on hysteria[edit]

Historical approach of hysteria[edit]

Bertha Pappenheim also known as Anna O. in Studies on Hysteria

The first officially submitted explanation of hysteria goes back to the 4th Century B.C, in Ancient Greece; they believed that its cause was the instability of the uterus, which was applying pressure on other organs. The first form of treatment was to place “good smells” near women’s vagina.[1] Multiple theories quickly emerged, linking the hysteria with the retention of menstrual blood, which led to the emergence of marriage as a cure for hysteria. Later on they started to believe that sex was the cure since semen was thought to have healing and purification properties. [2] These treatments are an example of a social truth determined by ancient history.

Religious perspective influenced by misogyny[edit]

The medieval most common approach to hysteria was highly influenced by religion; it was considered from a demonological perspective[3]. Women were considered inferior to men, a popular assertion was the statement of Thomas Aquinas, “the woman is a failed man”[3]. Physicians could not find a physical cause of the disease, then they assumed it was related demonological causes for the association of women to the sin. Thus these women were tortured or directly sentenced to death. This approach to the mental disorder within women evinces a misogynistic truth in the medieval society.

Feminist reading on hysteria cases[edit]

Bertha Pappenheim (Anna O) was diagnosed with hysteria in 1880 when she was twenty one years old. Pappenheim could speak Italian, French and English in addition to her mother language. During her hysterical crisis she was unable to speak German but was spontaneously fluent in foreign languages[4]. During childhood the capacity to formulate sentences coincides with the realization of the patriarchal structure within the family. From a psychoanalytic feminist perspective of the aphasia of Pappenheim it is possible to read her rejection of a cultural identity[4]; her inferior position in a patriarchal society represented by the structure of her orthodox family. She was an intelligent educated woman assigned to the monotonous activity of nursing her father for her gender condition while her younger brother was studying in university, restricted to women at that time. Later on, she became an important activist feminist and grew apart from the patriarchal values of her orthodox family[4].

The case study of Anna O is an example of the relegation of feminine subjectivity. If we take a feminist analysis on hysteria cases we can find an overlooked truth of patriarchal societies; the body of a hysteric might be signifying social untoward feelings in some cases. The expression “hysteric” is used in the popular culture to discredit feminine anger or frustration. Although feminist are plenty conscious of what is frustrating them they are often associated with hysterics.


Jean-Martin Charcot

Questioning the Ancient truth (a medical perspective)[edit]

In the identification of the causes[edit]

The Ancient explanation reached consensus during more than a millennium, until Jean-Martin Charcot (1825 – 1893), a French neurologist, decided to tackle conflicting theories about hysteria’s causes. First of all, he refuted the dogma that hysteria was an exclusively feminine disorder.[5] Nevertheless, he conceived a classification which went against the Ancient truth of hysteria, since he discovered that it could take numerous forms, hence it could not be treated as one unique disease. Thanks to his experiments, Charcot reached a truth closer to reality than it was before. He maintained the idea that causes of hysteria were organic and physical but added that a psychological approach had to be taken in account.

In the treatment method[edit]

He mentioned a “psychogenetic origin”[5]. Using hypnosis, he managed to prove his statement, making his patients forget their trauma and noting that the hysteria had disappeared. However, hypnosis, even though it worked, could not be considered as a proper treatment since it was only temporary. Hence, hypnosis drew the path to prove that there were psychological implications of hysteria, and not only physical ones. In this case, the treatment method has been used as a tool to reach truth, and not as a way to heal patients.


Sigmund Freud, by Max Halberstadt

A psychological perspective on Hysteria: the creation of psychoanalysis.[edit]

From October 1885 until February 1886, Freud was the pupil of Charcot. He was immensely impressed by the work of his mentor, but later on he started think critically about the medical approach of his time and began to develop his own ideas. The case study of Anna O, whose real name was Bertha Pappenheim, published in Studies on Hysteria, inspired him. Dr Breuer, while treating Pappenheim, established the psychoanalytical strategy of the “talking cure”[6].

Freud started to see a common pattern in the patient’s backgrounds and symptoms. He explained that the cure for hysteria was about uncovering the traumatic incident which had supposedly given rise to the symptoms.

Freud transformed Breuer’s strategies into a discipline which goal was to reconstruct repressed memories through interpretation and free-association. He developed a ‘pressure technique’, a system of free-association[7]. Freud considered this technic very effective and completed it with the ‘mental pressure’ technique when he started to analyze the hysteria case of Elisabeth von R.

His patients were healing thank to his therapy which was very shocking at that time. It was reasonable for him to believe in the effectivity of his technique. Freud explained that ‘we can guess the ways in which things are connected up and tell the patient before we have uncovered it’[8].

With this new definition and treatment of the hysteria, Freud created a new truth, which we defined later as psychoanalysis; a treatment of mental harms governed by what we define as psychology: the scientific study of how the human mind works and the way it influences behavior, or the influence of a particular person's character on their behavior[9].

Freud didn’t create the psychoanalysis in opposition to the work of Charcot on hysteria, but as a complement of his approach[10]. Indeed, the failure of the medical community at diagnosing correctly hysteria is also one of the main events that led to the development of this new truth.

MRI of the patient's brain - the yellow coloration corresponds to the activation of the cortex parts implied in her paralysis

Conclusion[edit]

The multiple truth relatives to the treatment of hysteria create a case study in which disciplines clash. The social truth on the treatment hysteria is, in his construction, the result of a conflict between a feminist, a religious and an historical point of view. Furthermore, this social truth isn’t compatible with a scientific approach, that was, later, completed by a psychological truth. Recent neurological studies have proved, in 2007, that the hysteria have psychological causes, checking the thesis of Freud and Charcot[11].

References[edit]

  1. Ada McVean. The History of Hysteria. McGill University; 2017.
  2. Parker, Robert. Miasma: Pollution and Purification in Early Greek Religion. Oxford University Press. 1996.
  3. a b Cecilia Tasca, Mariangela Rapetti, Mauro Giovanni Carta, and  Bianca Fadda, Women And Hysteria In The History Of Mental Health Clin Pract Epidemiol Ment Health. 2012
  4. a b c Dianne Hunter, Feminist Studies, Vol. 9, No. 3 (Autumn, 1983), pp. 464-488
  5. a b Georges Didi-Huberman, Invention de l'hystérie : Charcot et l'iconographie photographique de la Salpêtrière, éditions Macula, Genève, 2012. (ISBN 978-2-86589-004-0)
  6. Freud S. Breuer J. Studies on Hysteria. Leipzig and Vienna: Franz Deuticke;1895.
  7. Bachner-Melman. R & Lichtenberg. P. Freud's Relevance to Hypnosis: A Reevaluation. American Journal of Clinical Hypnosis [Internet]. 2001[cited 2019 Dec 01]. Available from: https://www.asch.net/portals/0/journallibrary/articles/ajch-44/bachner.pdf44:1, 37-50 DOI:
  8. Webster R. Freud, Charcot and hysteria: lost in the labyrinth. 2003 Apr 10 [cited 2019 Dec 1]. In: Freud (Great Philosophers). RICHARDWEBSTER.NET [Internet]. London: Weidenfeld & Nicolson. 2003 - [about 5 screens]. Available from: http://www.richardwebster.net/freudandcharcot.html.
  9. Cambridge dictionary [Internet]. Cambridge: Cambridge University Press; 2008. Psychology; [cited 2019 Dec 01]; [about 1 screen]. Available from: https://dictionary.cambridge.org/dictionary/english/psychology
  10. De Marneffe, D. (Looking and Listening: The Construction of Clinical Knowledge in Charcot and Freud. Signs. 1991.  17(1) : 71-111.
  11. Kanaan RA, Craig TK, Wessely SC, David AS. Imaging repressed memories in motor conversion disorder. Department of Psychological Medicine, King's College London, Institute of Psychiatry; 2019