18 APRIL 1958, Page 23

A Doctor's Journal

Hysteria

By MILES HOWARD

LEVEN girls were taken to hospital lately at EiNottingham for fainting attacks after a hockey match; carbon-monoxide poisoning was at first suspected, but later one of the hospital staff diagnosed hysteria. Some of the parents were angry : the father of one of the girls protested that it was ridiculous to talk of them 'putting it on.' Another father said, 'Girls don't go fainting all over the place just for the fun of it.'

The episode reflects the muddle in people's• minds over what hysteria really is. The most clear-cut examples of hysterical illnesses I have seen were combat-reactions in raw troops. During the battle of Normandy a stream of men with paralysis of the limbs, blindness, deafness, loss of speech and other disabilities, all of emotional origin, flowed back through the clearing stations to the base psychiatric hospital in Bayeux. At one time I had my 'office' in a screened-off corner of the ward, and most of what went on in the office was audible to the rest of the patients. A soldier would be carried in on a stretcher, unable to move his legs but not at all anxious. 'I don't know what's up, sir,' he would say, 'I just came over weak and collapsed.' The loss of power in his legs was genuine; his conscious control of movement had, for the 'time being, left him.

Such patients were readily susceptible to hyp- nosis and went into a trance in a moment; at this point, I noticed, silence would fall in, the ward outside, since everyone was listening to hear what the man would say under hypnosis. As a rule, he could be made to relive a terrifying ex- perience he had undergone in the line; we would find that just when the tension of feeling was at its greatest, his legs had given way, he could no longer fight alongside his mates and he was taken back to hospital. The paralysis provided a quite adequate reason for his incapacity as a soldier and was a defence against unwelcome emotions. When it had been removed by hypnotic suggestion, the defence went with it and the man became very anxious indeed. The hysterical symp- tom is real : I recall letting off a rifle behind the head of a soldier with hysterical deafness and he didn't bat an eyelid—that loud bang would have broken through any mere simulation of deafness; the 'break in the circuit' is outside con- scious awareness.

Major hysteria of this kind—paralyses, muscu- lar spasms, loss of sensation and the like—is much less common now that it was in the early years of the century. Indeed, in hospital out-patient clinics it is quite rare. The gross hysterical illness is, in fact, going out of fashion. Anxiety and depression, and the bodily disorders that go with them, are what bring the people of Britain to their doctors in 1958. The woman who complains of backache during an, attack of depression is not 'hysterical'—she has tension pain. A thump- ing headache after a spell of high pressure at the office is not a hysterical symptom—it is a member of that large family of illnesses that are grouped together under the general heading of migraine. The girl who pretends to faint, the pretence being deliberate, is not a hysteric : she is a malingerer. But straightforward malingering is, I believe, very uncommon. The patient at a time of crisis 'loses himself' and goes wandering; on being found he says he cannot recall what happened over the last three days—he is not lying there is a genuine, if temporary, 'blocking' of memory.

The term 'hysterical' is often used by doctors and laymen as a term of abuse, just as the patient with pain is told her pain is 'imaginary' —this kind of misuse of words is a sign of loose thinking, as well as being unwise and unkind. If the term is going to be used at all, it must be assigned an exact meaning. In medicine, 'hysteria' is used to cover a category of stress responses which have these four features in common : (1) absence of overt and consciou, anxiety, (2) lack of awareness on the part of the patient of the nature of his illness, (3) existence of a purpose for the illness (usually manifest to everyone except the patient), and (4) symptoms are produced through the agency of that part of the nervous system which looks after seeing, feeling, moving the limbs and the other conscious and voluntary activities; the other part, which looks after the automatic self-regulation of the body, is only involved in a secondary way.

'In many psychiatric hospitals in the USA and Europe, I have seen what appears to be a most sincere attempt to give the patient the best pos- sible treatment, spoiled by a failure to distinguish between a hospital role and a normal community role. In these hospitals everything was done to make the patient's stay pleasant and interesting; even when he was nearing discharge, the day was planned to please him rather than to prepare him for his outside role. The result frequently was that the patient was unable to settle down at home, and soon found his way back to hospital. In our unit we have tried to avoid this error.' (Maxwell Jones, writing on the Industrial Neurosis Unit, in Social Psychiatry, 1952.)