HYSTERIA, a term applied to a mental affection which occurs usually in individuals of neurotic and unstable constitu tions. It is manifested by an undue susceptibility to external impressions, emotional episodes, and marked sensory, psychic and motor disturbance. Though classed among so-called "nerv ous" diseases, it is functional in origin, and no organic change in the nervous system is known to exist. Physicians of the past sup posed that hysteria occurred only in women and resulted from a wandering of the uterus or womb ; hence its name ; but after the experiences of the World War it has been more and more clearly realized that men may be as much affected as women.
Though heredity has a definite influence, modern knowledge has shown that environmental factors in early life and faulty educa tion are of main importance.
The modern period in the history of hysteria may be said to have begun with Charcot ; since, many physiological and psychologi cal theories have been put forward. The most fruitful work was done by Pierre Janet, who regarded it as a purely mental malady. He believed that the disorder lay in a poor synthesis of the per sonality so that certain ideas became split off from the main por tion of the personality, and in a subconscious region of the mind independently produced these results. Various other theories of such mental dissociation have been formulated and the most important and interpretative is that of Sigmund Freud of Vienna. According to this worker, the hysterical symptom is the result of a conflict between the personality and some "wish" which is out of harmony with the personal ego, and is therefore repressed. (See PSYCHO-ANALYSIS.) The repression, however, is not entirely suc cessful, and the wish in the unconscious mind, being dynamic, forces its way into consciousness in a symbolic and disguised form. The symptom is thus a compromise between the two urges at play. Much of the "wish" material which is repressed Freud believed to be related intimately to the sexual instinct.
The symptoms of hysteria are manifold and complex and may appear in many combinations. They may be physical or mental. Among the former we may note paralysis of limbs, spasms of muscles, tremors, loss of voice or speech, loss of sensation in the skin, blindness, vomiting, etc. The hysterical fit is a convulsive attack which is well known and liable to be confused with epilepsy. There are, however, paints of differentiation which careful investi gation will usually reveal. The mental symptoms can all be looked upon as the result of the independent functioning of a dissociated part of the content of the mind. The chief are memory gaps, sleepwalking, fugues (wandering attacks of which there is no sub sequent recollection), trances, hallucinations, deliria, and dream states. Double personality would be explained on a similar basis. In such a condition the split-off mental functions are so extensive that a second complete personality is formed. Freud classifies hys teria into two forms—conversion hysteria, when the psychic exci tation is converted into some bodily innervation, and anxiety hysteria, when the symptoms are purely mental. In the latter cate gory are included those cases evidencing anxiety, depression and morbid fears. In the minor form of hysteria the individual tends to be nervous and excitable, show exaggerated emotion, lack of control, with a liability to phantasy, egoism, and craving for atten tion and sympathy. Hysteria may be so severe as to constitute insanity. In many of its manifestations its diagnosis is by no means easy and its physical symptoms are not infrequently taken as evidence of bodily disease. Treatment involves the use of some form of psychotherapy. Drug administration is not in the main scientifically admissible. What method of psychotherapy should be applied will vary according to the type of case and other cir cumstances. Suggestion, hypnotism, and persuasion are of value in properly selected patients. If possible, the psychic cause should be discovered. This may be sought through some form of psycho logical analysis or through the Freudian technique of psycho-an alysis. An education in mental hygiene will generally be indicated.