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WHEN it comes to the discussion of hysteria, it should be our first duty to make clear the distinction between hysterics and hysteria. Any person suffering from nervous instability may be at times more or less hysterical, but that is not necessarily a sign of genuine hysteria.
Hysteria is a disorder rather than a disease, and it involves not only the mind but both the sympathetic and general nervous systems. The physician is familiar with hysteria, and knows very well how to arrive at a diagnosis of this disorder when the condition seems to be complicated and unusual; but this same physician, who sees so much of hysteria, is more or less at a loss when it comes to undertaking to define or more fully explain the exact nature of hysteria.
One school of medical thought sought to explain hysteria on the ground of increased suggestibility, and it is true that hysterical patients are exceedingly suggestible. Janet holds to the theory that hysteria is the result of a loosely organized and poorly controlled mind. Indecision or lack of what he calls psychic tension is supposed to be the characteristic psychic state which predisposes to these attacks. In accordance with this theory, hysteria is a dissociation in the psychic state. It is believed that sometimes these dissociated psychic centers are loosely connected by bridges, deep down in the subconscious, and that it is this arrangement which accounts for the bizarre manifestations of various forms of hysteria.
Our Freudian friends are wont to account for hysteria on the ground of neurotic personality from infancy, and they explain the manifestations of the disorder on the theory of displacement and new association of ideas. They affirm, for instance, that the vomiting of hysteria is merely the desire to get rid of something, to dodge an issue, to avoid some disagreeable psychic situation, and that transference has merely taken place to the stomach. The psychoanalysts, in common with others, believe that many of the common hysteric symptoms are in reality the clandestine indulgence of some suppressed wish or the fulfillment of some submerged desire.
In the study of hysteria, as well as other forms of neurosis, the experiences of the World War did a great deal to upset the Freudian theory. The more these psychoneuroses are studied the more we are inclined to believe that they can be properly understood only by admitting the existence of several constellations or groupings of psychic impulses, as suggested in a former chapter, where I have undertaken to classify human emotions and impulses under the five great drives of human experience.
When we come to consider the causes of hysteria, I have no hesitancy in setting down the inheritance of an unstable nervous system as being first in order of importance, while next comes lack of proper training in the nursery. Much of our hysteria, after all, notwithstanding the hereditary predisposition, is the result of failure to learn self-control in childhood.
The question of mental stress and strain deserves next consideration. All sorts of psychic upsets predispose to both hysterics and hysteria. Disappointment in love, an unhappy marriage, desertion in family life, overambition, business cares, worries, fatigue, and exhaustion - all these contribute to an outbreak of hysteria. In the World War the condition called shell-shock was nothing more than a psychoneurosis, in no way different from hysteria and its associated states.
Age has a good deal to do with hysteria, as does also sex. Hysteric outbreaks are more likely to occur at adolescence and about the time of the menopause. Hysteria is less frequent before puberty and after forty.
Education has a great deal to do in determining whether or not a given individual will be able to live above the hysteria threshold. Nervous children who are brought up in narrow channels or who are subject to the teachings of faddists and extremists are almost certain to become victim s of hysteria. I know it is the custom, these days, to advocate raising children without corporal punishment. This plan is all right for children who are easy to raise - children who have well-balanced nervous systems and respond easily to teaching; but my advice to parents with constitutionally nervous children is to use discipline and get obedience early in the child's career, not hesitating to resort to the rod if that is necessary. Hysteria is bound to be the result in all those cases of erratic and neurotic children where the parents are too sparing of the rod. These children grow up without inhibitions, with uncontrolled temperaments, and if they are of the day-dreaming, artistic, temperamental type, they are going to be victims of hysteria early in life; and this psychoneurosis will plague them to the end of their days if they do not learn how to control their emotions and acquire the mastery of their wabbly nerves.
While suggestion plays a prominent part in hysteria, it is not the sole cause. Crude and unwise examinations on the part of careless physicians sometimes start hysterical patients on a new track. New symptoms are suggested and new diseases are put into the minds of these susceptible individuals. Hysteria is always increased by social upheavals - by the disturbed conditions which follow fires, earthquakes, and wars. Even religious revivals sometimes contribute enormously to the outward manifestation of hysterical tendencies. While social and economic conditions are indirect causes, they do not deserve much consideration as direct causes of hysteria. Hysteria appears more often in the extremes of society - among the wealthier classes and among the poorer classes. The middle classes are, comparatively speaking, free from this troublesome disorder.
All forms of organic disease, when they appear in these abnormally unstable individuals, have a tendency to augment the hysterical tendency. Anything which depletes physical strength or adds to psychic stress is sure to render hysteric patients more hysterical.
1. Simple Hysteria - In the more simple form of hysteria, which is little more than an hysterical outbreak, we are confronted with the manifestation of simple emotional excitement. In these cases there are often mild and convulsive seizures of laughing or crying. In the more violent form, the tendency may go on to the stage of scratching, biting, tearing, etc.; when such attacks are over, the patient is not left exhausted, as in epilepsy. In fact, sometimes hysteria patients feel better after an attack, and this is what has led to the belief that hysteria might possibly be the disguised gratification of repressed sex or other desires. This theory has also been partially sustained by the fact that many times when such repressed emotions or submerged desires are dug up and squarely faced - when they are put before the patient and their relation to hysteria properly explained, and when emotional elimination has taken place - the hysterical symptoms largely disappear or the attacks of hysteria are cured.
2. The Hysteria Fugue - Another form of hysteria is represented by sudden disappearances - otherwise normal individuals run away from home. This condition has already been alluded to. Periodic wanderlust of this sort is no doubt merely a mild form of hysteria with partial dissociation and more or less amnesia.
3. Hysteric Sleep - Hysteria appears in other individuals as fits of sleeping. This is pseudo sleeping sickness. During this sleep the patients sometimes are engaged in constant muttering.
4. Hysteric Paralysis - In other cases, we have hysterical paralysis - one or more limbs may be paralyzed, and the patients go around for years believing they are victims of a real, organic paralysis. They represent the large part of the miraculous cures that are made by faith healers and the high priests of the various religious healing cults.
5. Hysteric Anesthesia - We have, in other cases, the well-known hysterical anesthesia - parts of the body become more or less insensible to pain. But these disturbances of sensation represent skin areas which are not associated with any definite nerve supply. This form of sensory disturbance has been well called "glove anesthesia", since it seems to represent a more definite and local skin area of the body than it does a region supplied by any single nerve. We also have other sensory derangements, such as hysteric blindness and hysterical deafness, and their cure is sometimes most spectacular.
6. Other Hysteric Manifestations - Other forms of hysteric manifestation are the tics and contractures, and the troubles of those who complain of unusual sensations in the internal organs.
The Freudians are wont to classify hysteria into three groups - conversion hysteria, anxiety hysteria, and compulsion hysteria.
There is little doubt in the minds of medical men that a large part of the so-called "demoniacal possession" of the Middle Ages would to-day promptly be diagnosed as major hysteria, while the remainder would be regarded as some degree of insanity. Some of our present-day hysterics, had they lived in other centuries, would have been in grave danger of being burned for witchcraft.
In the past ages many a great religious movement has had its origin in the revelations and contortions of some earnest and conscientious, but manifestly hysterical, woman with strong religious tendencies. It is only in recent years that we have come to understand the relations of hysteria to religion, insanity, and far-reaching national upheavals.
The physician of olden times looked upon hysteria as a malady that was largely feigned - as a fictitious sort of performance on the part of certain types of nervous and emotional women. Men were not supposed to have this disorder, and if they had it, they met with scant courtesy at the physician's hands; they were looked upon as "effeminate". Even some modern authorities call neurasthenia a man's disease, and hysteria a woman's disease.
Human imagination is a marvelous actor. The ability to impersonate, the power to think and feel and act as another person would think and feel and act, constitutes both the stock in trade and the secret of success of the emotional actress. But what would be the result if the actress, while on the stage and in the midst of the play, should succumb to her imagination, and actually believe herself to be, in truth, the very character she was endeavoring to impersonate? That is exactly the sort of prank that suggestion and imagination play upon the hysterical patient. Hysteria is merely an actor who temporarily has lost his head but goes on playing his part thinking it to be real.
Hysteria is a breakdown in the normal and necessary cooperation and coordination between the sensory-motor or voluntary nervous system and the great sympathetic or involuntary nervous mechanism, thereby resulting in great disturbances of sensation and unusual disorder in the motor control of the body. Hysteric attacks might thus be regarded as a mild and temporary form of bodily insanity, resulting from the decreased or deranged control of the sympathetic (vegetative) nervous system on the part of the cerebrospinal system. And it is exactly this disturbance in the delicate balance between these two nervous systems that is responsible for the production of the whole vast concourse of hysteria symptoms - symptoms that are able so to group themselves as to suggest almost all forms of every known disease.
Young people, when associated together, as in boarding schools, may suffer from epidemic attacks of hysteria as a result of suggestion and imitation. Even predisposed adults, as a result of physical or mental overwork and under the influence of a powerful suggestion associated with some protracted religious meeting, may develop hysterical attacks and exhibit dancing spasms, crying, and other emotional manifestations that accompany intense religious excitement, especially in rural districts, which are ordinarily so quiet and tranquil.
The so-called accidental symptoms of hysteria are usually so grouped and manifested as to simulate the clinical picture of some other disease, and it will be best to consider them in that light. The fact that the patient is so largely self-occupied explains how these hysterical symptoms come entirely to fill up consciousness; and in accordance with the laws of the threshold of pain, previously considered, it will be easy to understand how the hysteric's common sensations may be transmuted into a veritable avalanche of suffering.
These patients are indeed a "fastidious" class. They are both unbalanced and erratic, and their life-experience is marked off by certain well-defined "crises". These characteristic and impulsive explosions are not at all unlike the periodical catastrophies of the inebriate, especially as regards the uncontrollable and rhythmic behavior of the attacks.
It should be remembered, as we now take up these hysterical attacks, that very often there exists some trifling physical basis for such manifestations, and that this, in connection with the nervous and mental state, is able to determine the particular and definite form which the hysterical manifestation assumes from time to time.
1. Gastric Crisis - There are sudden seizures of stomach pain, behaving almost identically with those of the gastric crises of loco-motor ataxia. Other cases are limited to a sudden and unusual appearance of gas in the stomach and bowels, accompanied by severe colic. These patients also sometimes suffer from a rectal crisis and experience great pain. Many of these individuals are chronic "air swallowers".
2. Vomiting Crisis - These attacks of repeated vomiting are very alarming to the patient's friends. They sometimes appear without the slightest excuse, but it is observed that they usually stop before the patient has experienced the loss of much flesh. Closely akin to this manifestation are the fasting fads of hysterical patients. They not infrequently go a week or ten days without eating. I am of the opinion that most of those who appear to have gone without eating for a longer period were probably getting food on the sly.
3. Secretory Crisis - Hysterical patients are subject to sudden attacks of both increase and decrease in the bodily secretions, accompanied by paroxysms of pain and attacks of vomiting; this condition may involve the stomach, liver, bowels, or kidneys; in the latter case the urine may become scant or be greatly increased in quantity.
4. Appendicitis Crisis - The patient is seized with the typical symptoms of acute appendicitis, and the puzzling part of the proposition is the fact that the patient's temperature may sometimes shoot right up to 102 N - 104 N F. I no longer doubt or question the existence of this so-called "hysterical fever". The diagnosis, of course, can be differentiated by the history of the case and an examination of the blood; however, there is a case on record of a hysterical patient who had five operations for appendicitis, during the last of which, the surgeon tatooed on the patient's abdomen this surgical warning, "No appendix here".
5. Gallstone Crisis - Fictitious gallstone colic has led careless surgeons into the performance of many a useless operation. It is very common for hysterical patients to think they have gallstones, and it is only by painstaking and thorough examination that the physician will be able to avoid serious diagnostic blunders in dealing with these deceptive sufferers.
6. Renal Colic Crisis - The patient is able to present all the symptoms of stone in the kidney and of stone passing down the ureter, with the exception that in a bona fide case the urine is suppressed, while in hysteria there is usually a greatly increased flow. In these cases, too, many an operation has been performed, but no stone has been found in the kidney.
7. The Headache Crisis - These attacks of headache are often so severe and persistent as to suggest brain tumor. It is a common experience to have a patient come to us who is rather undernourished, suffering from poor circulation, generally nervous, highly emotional, and giving a history of having frequent "nervous spells". Such an hysterical sufferer often complains of violent headaches which she describes as follows: "Doctor, when I get these dreadful headaches, it seems as if someone were driving a nail right into the top of my head. It is something terrible, and it nearly drives me crazy; I think it has a whole lot to do with my nervous spells". This is a characteristic description of the headache of hysteria, a rare form of nervous headache.
This hysterical headache is treated by applying very hot fomentations to the top of the head for ten or fifteen minutes. These applications should be repeated every hour or two, in connection with a very hot foot-bath. Such sufferers are usually greatly benefited by taking a warm bath at about 100/ F. This bath tends to quiet the nervous system and greatly relieves the patient's sufferings.
8. Pain Crisis - In other cases the hysterical outbreak manifests itself as an explosion of pain - an avalanche of suffering. It may be an earache, pains in the arms, legs, or some internal organ, or even in a joint. In the milder cases the pain may be described as a soreness or a "deep ache"; following these painful attacks the patient usually complains of great muscular fatigue. Pain may center in some internal organ, such as the heart, giving rise to pseudo-angina pectoris.
9. Motor Crisis - These are the fits, spells, and spasms of hysteria. They may imitate convulsions, St. Vitus' dance, or epilepsy. They embrace those cases of muscular paralysis, or hysteric palsy, in which the patient is sometimes unable to stand or walk; for years at a time he may suffer from hysteric joints, the hip and the knee being the joints usually involved. Such cases present tremors that resemble exophthalmic goiter. The victims experience laughing, crying, and choking, and often create internal tumors which are so hard and fixed as to deceive the surgeon into the performance of an operation - if he neglects the precaution of first putting the patient into a prolonged hot bath. This usually causes the tumor to vanish.
It should be made clear that shell-shock is not a new disease brought on by the W orld War. It is merely a military form of behavior, in which a man tries - subconsciously - to get away from an unpleasant or unbearable situation; and it is a good illustration of the fact that self-preservation, after all, is one of the dominant, if not the all-dominant psychic complex, instead of the Freudian sex theory's libido. The civilian recruit, when taken away from his home surroundings and placed under new and strange conditions - under new stress and strain, amid horrible sights and unpleasant sounds - soon began to sicken and experience extreme fatigue, and ere long the nervously unstable soldier blew up - went to pieces nervously. It makes no difference whether you call it hysteria, shell-shock, or military fugue, it was all a behavior reaction, nothing more nor less than a defense reaction - a conspiracy between the subconscious mind and the sympathetic nervous system to get the individual out of the fix he was in, away from danger, and into the sheltered atmosphere of the hospital.
The soldiers early learned that there were but two honorable ways of escaping - wounds and death. Any other method, by means of desertion or malingering, would be likely to result in detection and speedy punishment. Many a brave officer deliberately courted death in order to escape from the terrible situation he was in. In contrast with this, the mediocre and neurotic soldier blew up nervously, went into a fluke, threw a fit, and went back to the hospital. This was one way to get out of his dilemma without subjecting him self to court martial or otherwise endangering his self-respect or his military and social standing.
I am satisfied that the only time - Freud notwithstanding - that normal human beings experience the death-wish is when they are in some condition where life, for the time being, has become unbearable, just such a condition as we find at the front in modern military action.
Attention has already been called to the fact that the dream s of these wounded soldiers were about war, battles, and death - and not about sex matters, as the Freudian theory would presuppose.
Here is the case of a woman who was about thirty years old when she began her medical wanderings. She had been slightly nervous, more or less emotional, all her life, but had enjoyed fair health. She was married at twenty-five, and the responsibilities of a home seemed to make her more nervous. At about thirty she began to have dizzy spells. This meant, of course, consultation with many physicians, including eye and ear specialists; it also meant a great deal of introspection on her part, and as a result of this thinking about herself, she very soon began to experience vague and wandering pains in different parts of her body - which led to consultation with more doctors, including osteopaths. She was better at times - worse at others. Months passed, and the next thing she experienced was a feeling of nausea, with distress in the region of the stomach. This led to consultation with two or three stomach specialists, one of whom was bold enough to make a diagnosis of duodenal ulcer. The patient was put on a rigid diet, lost considerable flesh, and soon had become a confirmed semi-invalid - thought about nothing but herself. Almost a year of this dieting showed little improvement, and it was thought best to counsel with other physicians. Among the half-dozen new doctors to examine this woman, one was a surgeon who made a positive diagnosis of chronic appendicitis. He told her that all her trouble in the stomach was from the appendix, and that, in his opinion, she had never had an ulcer. An immediate operation was proposed, but her husband objected. He was reaching the conclusion that where so many doctors had disagreed on the diagnosis, it was not wise to rush into a major operation; so he sought still other physicians, including specialists, gynecologists, and so on.
After three years of this, you can imagine what a nervous wreck the patient had turned out to be. Her symptoms were no longer limited to dizziness and nausea. She had palpitation of the heart, shortness of breath, choking sensations, pulsations in the abdomen, numbness, chills, profound weakness, trembling, and betimes, convulsive attacks that bordered on unconsciouness. When these last-named attacks came, the neurologist finally had his turn. It was at this juncture that I met the patient, and I do not recall ever seeing another such an abject specimen of humanity up and about, able to walk into the doctor's office, or rather, stagger in and slump down on a chair, utterly exhausted.
I have not mentioned the fact that various health articles, health books, and faddish dietetic systems from two or three different sources, all had come in to complicate this case; but rest assured that they had, and that everything else that could be done to make a woman sick, psychologically, had been done. And now I had to tell her there was nothing at all wrong with her, organically; that in my opinion she had never had ulcers or appendicitis; that there was nothing wrong with her eyes, heart, liver, lungs, or kidneys - in fact, that, apart from her state of partial nervous exhaustion, with some anemia, she was in good health, and that if these conditions could be corrected she would be as healthy as she had been at any time in her life.
It required a great deal of faith upon her part to accept this diagnosis, and to agree to go into the fight for health; but she enlisted with her whole heart and soul. It was just about a year from the time we started in on this program of facing facts and getting control of her nerves and emotions, before she was back to normal, and was feeling as well as ever.
This case illustrates the too frequent mismanagement of the neurotic patient on the part of the medical profession. It must be remembered that hysteria can simulate almost any disease, and that it puts up such a good front that only the most experienced practitioner will be able to look beneath the surface and find that the real basis of all these symptoms is in the hysteric constitution of the patient.
A few years ago a middle-aged business woman came in, sat down in the office, and said, "Doctor, I am so nervous, I am afraid I am going to do something". Of course, I asked her what she felt she was going to do. "I don't know, but I am going to do something desperate. It just came over me the other day. Do you think I had better go away for a while, take a trip to Europe, or something?"
I told her that running away would do no good, because if the trouble was really in her own mind, she would take her emotions and feelings along with her. So she agreed to be examined and to take hold of the problem in the right way. It proved to be another case of hysteria. Without realizing it, she had been pampering her feelings and babying herself in more ways than one, and the results were now coming up to the surface. The notion that she couldn't do her work had got hold of her. She would do anything we asked except go back to work. For three months she persisted in her refusal, and for weeks, after she did go back, her condition was pitiful, she seemed to suffer so when she tried to do anything of a business nature. She would tremble, and the perspiration would stand out on her forehead. Little progress was made until we unearthed a group of emotional struggles - a tremendous conflict that was going on between her ideals and some of the realities that confronted her in her position. Some of these things were eliminated, others sublimated, and fortunately one of her male business associates, who was at the bottom of part of her troubles, resigned from the company; thus, after a period of almost a year, the woman was enabled to do her work again in the enjoyment of fair health.
Not long ago another woman in the early thirties - a college graduate, unmarried - came in, complaining of being nervous and of suffering from queer feelings and fears. Soon after awakening in the morning - or at any time during the day - strange sensations would creep over her, and her heart would immediately begin to beat rapidly. She was short of breath, dizzy, and sometimes nauseated, and would tremble from head to foot. She described herself as being on the verge of unconsciousness at times. She had frequently aroused the household and summoned physicians, but by the time the doctors got there, she had usually calmed down; in fact, she admitted that she began to feel better the moment she knew the doctor had been called. I remember I found her quite normal, except for profound exhaustion, when I arrived about an hour after being called. The house had been upset for more than three years, and the mother and other members of the family were all discouraged; but the patient was taken in hand, examined, studied; a diagnosis of hysteria was made, and treatment was begun. That was about three years ago, and to-day the patient, while not perfectly cured, is practically delivered from those troublesome seizures. To be sure, she still has queer sensations, but she knows what they are. She ridicules them when they appear - defies them. As far as lies within her power, she treats them with contempt, and the other members of the family do like-wise. She has been told that the whole performance was an effort to provide an alibi, to avoid doing certain disagreeable things. She understands that it was a working conspiracy between her subconscious and the sympathetic nervous system to enable her to retire from reality and to enjoy the sympathy and attention which nurses, doctors, and her family gave her as the result of these alarming nervous attacks. But, best of all, she has gone to work, has ceased to fritter away her time in nursing her neurotic symptoms. She is doing a real piece of work in the world and is happy, contented, being in the most ideal position, short of normal married life, to help her in remaining above the neurotic level where hysterical symptoms operate. She has acquired emotional immunity.
Many of our mildly neurotic patients do well during their early years, especially if they are not subjected to too much stress and strain; but the nervous young man, about thirty or thirty-five, who has not been able to earn enough to warrant him in getting married, who is going along in the same place, doing always the same work, begins to succumb to this monotony. He looks about and says to him self, "What is ahead of me? What future have I in this position?" The whole thing begins to pall on him. He becomes discouraged and begins to lose interest in his work. Various symptoms appear, and he consults the doctor. Perhaps the doctor advises him to change his work or take a vacation, but this, of course, affords no permanent help. Changing climate is of no real value in the treatment of psychoneuroses.
Here is a young woman I saw a few days ago - thirty-four years of age, private secretary to a prominent business man. She has been very happy, but now she begins to have a conflict with her ideals; she has begun thinking she ought to have a home of her own and be raising children. She is becoming discouraged with her position in life, and as a result of these conflicts between her ideals and the realities of the situation, she is getting nervous; headaches, dizziness, fatigue, and other nervous manifestations are beginning to appear.
On the other hand, a few days ago I saw a young woman of twenty-six who was married two years ago. Now she is missing the noise, bustle, and excitement of her former business life. She is out in the suburbs keeping house in a little bungalow. She is very lonely; her married life is becoming monotonous; she is starting in on her nervous career by having crying spells. She even doubts whether she is in love with her husband. This young woman had better go back to work for at least a part of each day, or begin to raise a family, and I have so advised her husband. She is not going to be happy unless she does one or the other. She has been in the business world since she was eighteen, and greatly enjoyed meeting people.
No one can stand introspection very long. Self-contemplation is fatal to the health and happiness of the average individual. We have to learn how to live our lives so that we can keep our minds off ourselves.
About five years ago, from a near-by sanatorium, there was brought to me a patient whom we will, for present purposes, call Frances. Frances was a beautiful girl, seventeen years of age, tall, slender, rather under-weight at this time; large eyes, peaches-and-cream complexion; intelligent, conscientious - almost over-conscientious; she seemed very anxious to get well. A year before she had been seized with a spell of weakness and trembling, with fluttering of the heart. She was dizzy most of the time, and the slightest exertion produced not only nausea but actual vomiting. She would vomit for days. Frances was an only child, and her parents were much alarmed; they consulted many physicians, and, of course, received many diagnoses. One or two physicians suggested that the condition was probably mostly one of nerves, and that she should take a long rest, spend the summer in the country, etc. This was done, but the patient was unimproved. In the autumn she was taken to a sanatorium, where she remained six months, gradually growing worse. The parents received the impression that there was probably something wrong with her mind. She was violent at times; she became alm ost unmanageable and had to be strapped down in bed. She would throw dishes about. One time she all but wrecked the place - broke up everything breakable in the room and smashed the front windows.
At times Frances acted like a little saint, and at other times she would fight her nurse and "raise Cain". Now, a careful examination revealed two things physically wrong - she was considerably under-weight, and had an anemic tendency. The girl was put to bed and given a milk-and-orange-juice diet, with intravenous injections of iron, and in about six weeks was in excellent physical condition; but she was no better nervously. She insisted that something was wrong. She always stuck to it that she wanted to get well, but the doctors had failed to find out the cause of her trouble.
For a few weeks she would center her attention on her heart, then on her stomach, with an increasing tendency to nausea and vomiting, and then on the queer feeling in her head. Week after week she harped on this headache - a feeling of emptiness - and she felt sure she was going crazy. Something must be done, she always insisted, but everything that was done seemed to give no relief - at least, only transient relief. After we had racked our brains and found some new treatment, for a few days she would feel better; but within a week she would be right back in her old groove and have the same old tantrums.
Everything seemed to center about the mother in this case. Frances couldn't be happy if she was away from her mother, and the mother had been around most of the time, so I decided to take her away from her mother; she was installed in a kitchenette apartment with a trained nurse, and her parents were not allowed to see her. It was a battle royal for three months. She refused to eat until she was threatened with a stomach tube. I never saw such a nice, beautiful girl who could so suddenly turn into such a veritable demon and be so mean, contrary, and cantankerous.
The question of diagnosis had been under consideration all this time, but the longer the patient was observed, the more it seemed there was nothing to do but call it major hysteria. The battle was continued along this line, and at length Frances was so much improved that she was sent, in company with her nurse, for a three months' trip in the East and South, going down through the Adirondacks, and thence, as the weather grew colder, south to Asheville, North Carolina. Another three months away from her mother, and she was doing finely. The nurse's reports looked sufficiently good to have the patient return to Chicago. I thought we had won our fight.
The parents were elated, to say the least, and the doctors were happy, so word was sent that Frances could come home. All went well until the train reached the suburbs of Chicago, when she had an attack of dizziness, followed by nausea. She said to her nurse, "I feel it is all coming back on me". And you may be sure it did all come back. She was a sick woman by the time she reached the station. These thirty minutes had changed her whole reaction to life. She had not acquired emotional immunity. After all, the cry-baby complex, the desire to have her own way, the impulse to flee from reality into the arms of her mother by means of these hysteric fits, had not entirely left her. Either we had not done our work thoroughly, or, as I rather think, we had never received the full cooperation of the mother. Frances always felt that her mother was on her side. So when she was returning to Chicago, she only needed to realize that she was coming back to her mother, and instantly the wicked conspiracy between the subconscious and the sympathetic nervous system gained the upper hand, and she threw a real, first-class nervous fit.
When Frances reached home, her parents telephoned us, and we had her come out with the nurse, and made ready to start the fight all over again. The next week was worse than any she had previously gone through. I remember one time, when food was offered to her, she threw it all over the floor; we stood right over her, and notwithstanding her delicate hands, made her get down and clean up every bit of it and mop the floor. It was at this point that the father awakened to the realization that her parents had a real part to act in the cure of the daughter. He was secretary of a large corporation, and had so neglected his business and depleted his bank account, as a result of these three years of furor, that he received a kindly intimation from one of his business associates that at the next annual meeting he was probably going to be relieved of his position. Now things began to happen. The mother came to me and said, "I am going to accept your diagnosis unqualifiedly; I am going to join you in a finish fight". And the mother did. From that time on she stood right behind everything which the doctors ordered done, and it was only ten days from the time she was converted to the diagnosis and enlisted in the fight with whole-hearted determination that the daughter was cured - practically cured. They were ten terrible days for all concerned, and it seemed cruel to put the poor girl through all she went through. How she did appeal to her mother and father to take her away from the doctors! When she saw her parents turn against her and join the doctors, then her only thought was to get new doctors. For more than two years she had been perfectly contented to go along with the same doctors, but when doctors and parents entered into a real and lasting cooperation to effect her cure, she sought to get out of our hands. Her parents, however, were adamant. So she surrendered and said: "I can't be right when my parents and the doctors are both against me. I give up. What do you want me to do?"
That was all there was to it. That was the end of the three years' struggle. That was nearly five years ago, and Frances has never had any serious trouble with herself since then. True, she gets dry in the mouth when she is surprised; her face flushes and her heart sometimes goes pitapat when she is out in public; sometimes she feels faint and at other times dizzy; but she goes on about her business. She can only do about one-half, socially speaking, that other girls can do, but otherwise is perfectly normal. She has now acquired emotional immunity. Her feelings are not controlling her; she is the boss - she is controlling her feelings.
Not long ago I had the case of a workman who had lost the sight of one eye when a small piece of steel was blown into it. The steel was removed, but the man could not see with that eye, although several expert oculists could find nothing wrong with it. It was evidently a case of "hysterical blindness" - a figment of the man's imagination. Therefore, remembering the rule that what is caused by the mind can be cured by the mind, I set to work to relieve him by that method.
The patient contended that the steel had not all been removed from his eye. Accordingly, I told him of a powerful magnet that could draw a piece of steel out of the eye from half-way across the room, and made elaborate preparations, calculated to prepare his mind. Three times a day I had him come to my office, and the nurse dropped a little boric acid into his eye. There happened to be an electrician working around the place, and the patient was given to understand that this was in connection with installing the wonderful magnet that was to restore his sight.
At the end of five days he was told that everything was ready. Meanwhile I had borrowed a magnet for the occasion. I carefully placed the patient and explained that when he saw some red lights go on, across the room, the magnet would be working and his sight would be instantly restored!
That is exactly what happened. When the red lights flashed on, he exclaimed, "Thank God! I can see!"
We had bandaged the other eye so that he would know he was cured. Of course, the magnet was not connected with the electrical circuit at all. It was a pure case of building up his expectation and his faith. Anything else that would have made him believe he was going to be cured would have done just as well.
This chapter could be filled with the recitation of remarkable cures of hysteric blindness and deafness, not to mention paralysis. The various healing cults and all schools of medical practice have benefited from remarkable hysteric cures. When the religious healers get hold of these cases they often effect such spectacular cures as to simulate miracles.
A psychic complex is a community or constellation of brain cells which are functionally more or less related and associated. These so-called complexes or aggregations of thinking units are more or less coordinated and loosely organized into working groups and systems.
Some authorities look upon hysteria as a temporary dissociation of certain important complexes or groups of complexes. The consciousness of the individual is thus deprived of the coordinate and simultaneous directing influence of these distracted and diverted mind centers; and this derangement is responsible for that demoralized, disorganized, and incoordinate mental and physical behavior which the patient exhibits in a typical hysterical attack. Severe hysteria, according to this theory, borders closely on the phenomena of dissociation of personality, multiple personality, etc.
If we accept this theory of temporary complex-dissociation, it would appear that in the case of highly suggestible individuals, some all-pervading idea - now free from natural restraints and customary restrictions - sweeps through the mind and out over the body, completely dominating and absolutely controlling the organism. In its physical manifestations it is able to produce cramps, paralysis, and fits, while, in a mental way, the patient may become as one possessed of the devil. Or, on the other hand, she may establish herself as a spiritualistic medium or go forth in some noble and daring role, as did the heroic maid of Orleans.
It is now believed by most specialists in abnormal psychology that somnambulism is due to the dissociation of a group of complex systems in the field of consciousness. There is little doubt in my mind that the majority of trance mediums belong to this group. In the case of many spirit mediums the dissociated complexes come to occupy the center of the stage and wholly to control the medium's flow of consciousness, completely dominating the talking, seeing, hearing, and thinking centers. For the time being, to all intents and purposes, the medium is a victim of double personality.
It is generally recognized by authorities on insanity that many of the noises and other hallucinations of the insane patient are due to dissociation. They seem intensely real to the patient, but to the on-looker they can but be regarded as figments of the imagination. It is unquestionably true, too, that in the case of many mediums we are dealing with a mental state that borders closely on the realms of insanity. But the recognition of this dangerous fact in no wise lessens the reality of the visions seen, or the voices heard, by the spirit medium. These things are all very real to the medium. They are dissociated portions of his own consciousness. That is, they are dissociated from the consciousness of personality, so that the medium does not recognize them as a part of his real self. Thus the dissociated complex can speak with its own voice to the medium's personality, and he recognizes it as something separate and apart from his own stream of consciousness, although he is aware that it arises within his own mind or brain. This splitting of the patient's stream of consciousness into two parts, so that he holds continuous conversation with himself, is a phenomenon to be seen any day in an insane asylum.
That mediums should "see things" as the result of dissociation is not strange. It is a well-known fact that vision, owing to its highly complicated nature, is one of the most common functions to experience disorder in hysteria, and one that is most markedly influenced by any serious form of psychic dissociation. In fact, the eye is so subject to disturbances of a psychic nature, that it is possible, through mental or hysterical influences, to produce actual functional blindness.
It should be borne in mind that long-continued psychic conflict, as well as over-concentration of mind, may lead to complex dissociation in certain hysterical types of individuals.
Hysteria is a form of mental depression and nervous derangement characterized by "retraction of the field of personal consciousness and a tendency to the dissociation and emancipation of the systems of ideas and functions that constitute personality".
It is going to be neither a small nor an easy task concisely to define hysteria for the layman; in fact, hysteria is a disease about which we doctors disagree probably more than about any other common disorder to which human flesh is heir; nevertheless, I am disposed to attempt to define this interesting and unique nervous malady. As I understand it, hysteria is some disorder in the personality, occurring in hereditary predisposed individuals who are highly suggestible, and who possess but a small degree of self-control. And just here is our difficulty in understanding hysteria - it has to do with personality, and that is a subject which none of us know much about. An eminent French physician once said that a definition of hysteria had never been given and never would be. Hysteria is a mental state - possibly a disease largely due to cerebral insufficiency, manifesting itself in so many ways and producing so many diverse symptoms as to impersonate almost every known form of human illness. It is certainly true that a diseased and uncontrolled imagination plays a large part in the cause and conduct of this perplexing disorder.
Briefly summarized, then, hysteria is a nervous disorder characterized by lack of control over the emotions and over certain physical acts, by morbid self-consciousness, by perversion of sensory impressions, and by an extraordinary ability subconsciously to simulate the symptoms of numerous minor and major diseases.
Hysteric patients in a former generation were burned at the stake as witches. To-day they preside over parlor séances and perform as spirit mediums. And to-day, as in olden times, their performances are characterized by falsehood and duplicity as well as by a continuous series of impersonations. It should be remembered that hysterical women are not only able to simulate serious diseases of the body, but are equally gifted in psychological legerdemain, in that they are able to impersonate, and otherwise make representations of, the spirits of departed human beings.
Speaking of hysterical temperaments, one writer (Tardieu) says:
"A common feature characterizes them, namely, instinctive simulation, the inveterate and incessant need of unceasingly lying, without reason, solely for the sake of lying; and this, not only in words but also in action, by a kind of parade in which the imagination plays the principal part, gives birth to the most inconceivable incidents and sometimes proceeds to the most disastrous extremities."
So falsehood becomes the stigma of hysteria. Janet, under the term "retraction of the field of consciousness", summarizes and includes the three major stigmata of hysteria, namely, suggestion, absent-mindedness, and alternation.
While the causes of hysteria are many, there is usually to be found both an hereditary basis and some exciting physical cause. It is about equally divided between the two sexes. In the lower classes of society more cases appear among men, while in the higher social classes, women predominate. The disorder appears in all countries and all races, but the Latin, Slavonic, and Jewish races seem to be most susceptible.
When it comes to the treatment of hysteria, we must do everything possible to improve the patient's general health and nerve tone. After a careful examination and study of the patient, the physician should sit down and tell him the truth about himself. Of all the neuroses, it is most highly important that hysterics should develop a passion for the truth, a real and sincere desire to know the facts about themselves and then to face these facts with courage and determination. The one thing the hysteric needs and lacks is stamina, and all our efforts at treatment should be directed toward the development of stamina.
During an attack an effort may be made to divert the patient's concentrated attention, but while dire threats and other spectacular stunts may produce effects when artfully employed, they soon lose their influence. It has been my experience that treatment is of little avail during an attack. I usually let the patient alone and do my reasoning with him subsequent to the hysterical spell.
The physical treatment of hysteria embraces general attention to good hygiene, proper physical exercise, fresh air, good food, and, if the patients are underweight, a modified form of the rest cure - employed early in the regime.
The mental treatment is all summed up in our attempt to explain the facts to them and to show them the real nature of their trouble, to assist them to isolate any exciting causes, such as love affairs, family troubles, unusual stress, as well as to help them in uncovering any hidden motive or long-suppressed emotion, which may be more or less concerned in the production of their hysteric spells. It is especially desirable that we should make an effort to search out, to isolate, and assist them in eliminating, any buried emotional experiences in connection with their early life, such as childhood frights, dreams, shocks, or emotional disappointments. And we must not overlook the value of diverting the patient's mind from herself to other people, such as helpless children, needy neighbors, civic enterprises, club work, and so on.
Many bothersome symptoms appear from time to time, chief of which is mucous colitis. This condition I have come to regard as being largely a nervous affair. Colitis of the simple variety is really a neurosis, one of the accompaniments of these neurotic states. In case colitis appears in connection with hysteria, I think it is best managed - after making proper dietetic suggestions - by giving a good dose of castor oil once a week, especially if the attacks persist for any length of time.
Since hysteria is largely a behavior reaction to maladjustment - a defense reaction to get away from some unpleasant situation - it is apparent that our first duty to the patient is to assist him in trying to adjust himself to his environment. Of course, sometimes we can make a compromise and try to change the environment somewhat to suit the likes and dislikes of the patient; very often, in fact, we work out a still further compromise in which the patient makes some changes and we also try to change the environment somewhat. This means, in reality, a process of reeducation, or what we sometimes call psychic and nervous reconstruction. The physician, before he gets through, finds that he is compelled to employ all the methods known to mental medicine, embracing suggestion, persuasion, instruction, and encouragement, not to mention inspiration and assurance on his part, coupled with the necessary discipline which enables these patients - after the real cause of their trouble has been fully explained to them - to indulge enough faith, hope, and courage to get well; and, on special occasions, our discipline may have to be extended far enough to embrace coercion, and, in some of the younger cases, even corporal punishment. In other words, anything and everything must be done that will help the patient to pry himself out of his habitual rut of fits and spells and enable him to get back on a basis of self-understanding and self-control.
Fortunately, most victims of hysteria are in a mental state bordering on the juvenile; they are, therefore, highly suggestible, and we should not fail to utilize this fact in planning the treatment; but great care must be exercised lest adverse suggestions be inadvertently dropped. Physicians, nurses, and the family must be very careful lest a careless remark or some thoughtless suggestion start them off on new lines of worry and tantrums of fear. It is fatal for the physician to give expression to doubt or to be inordinately perplexed; for this reason, repeated medical examination should be avoided as far as possible. I make it a practice to go over such patients "with a fine-tooth comb" when I take the case - get to the bottom of everything, make out written reports - and then, unless something new and acute arises, refuse to examine them within six months or a year, confining subsequent efforts merely to such physical and mental treatment as they may need.
Let us remember to treat our patients for what they have - hysteria. If that is the diagnosis, then let us confine all treatment to the real trouble and not be led astray into treating a thousand and one symptoms which appear as a part of the hysteria phenomenon. The thing that is needed in these cases is one thorough examination, and then treatment directed to whatever is actually wrong; if the condition is one that is exclusively hysteria, then no other treatment should be given except that which is directed toward the cure of hysteria.
Commenting on the nature of hysteria and the method of management, Dr. Hugh T. Patrick makes the following helpful observations:
"Now, our daily life is full of difficult situations; perplexities, disappointments, things that frighten us, things that disgust us; fights that we hate to make; labors that seem too heavy, problems we can't solve; luscious grapes beyond our reach; especially conflicts between our fundamental trends and the laws, edicts and tabus of the social cosmos. Some of us meet these manifold difficulties pretty well and an indulgent public calls us normal. Some of us can't or won't make this adjustment and we then are the unsuccessful, the unhappy, the cranks, the drunkards, the phobics, the hysterics; the dwellers in sanitariums; part of the throng that fills the reception room of specialists."
"A perfect type of the psychoneurosis is (in most instances) ambulatory automatism: what the newspapers call amnesia. The patient suddenly disappears from his ordinary haunts, wanders about or settles down elsewhere under another name until, sooner or later, he has doubts about his name, realizes that he doesn't remember his past, is curious about his identity and, quickly or slowly, recovers. What has happened? Such a patient has always run away from something. For adequate reasons he doesn't abscond or elope or run away in the usual conscious way. He passes into a state of secondary consciousness and in that runs away. The secondary consciousness is his alibi. Hysteria is just that; or just like that. If it happened to suit the purpose of this ambulatory automaton, he might just as well have hysterical blindness or paralysis or fits or vomiting. For instance:"
"The right arm of a farmer's hard-working faithful wife had suddenly become paralyzed; apparently a stroke. But it wasn't that at all. Some weariness of her unending job; some, possibly well-founded, discontent with her husband; a little domestic friction; a little soreness in the arm; and the paralysis was a temporary way of settling all her difficulties. She didn't have to work, her husband became most affectionate and attentive; the entire family, not to mention neighbors, became solicitous. Life was easy, and relatively pleasant."
"A young lady of eighteen had lost her voice three years before; since then she could speak only in a whisper. And during most of that time she had been making daily visits to a doctor's office for electric treatment. No results. What was the matter? A sensitive girl, a rather difficult situation at home, trouble in school, then a bad cold making her quite hoarse and suggesting loss of voice; and the partial solution of most of her problems by becoming voiceless."
Not long ago I ran across a very interesting case of hysteria - a woman some fifty years of age, with a family of five or six children, largely grown up but most of them living at home. Her husband was stricken with Bright's disease and he lingered along at the point of death for a number of months. There were trained nurses in the house, sometimes both day and night attendants, and of course this anxious wife and mother labored under a severe strain on her nervous system. She was naturally of a hysterical type. Many years before she had been bothered with hysterical paralysis, which had been almost miraculously cured by giving her treatments two or three weeks, at the same time assuring her that a cure would be brought about.
After several months of this stress and strain the poor woman must have subconsciously come to crave some attention for herself. At least, one afternoon she just up and swooned, fainted dead away, was apparently unconscious for more than twenty-four hours. The family was greatly excited; doctors and nurses were called; and there was a great hubbub. No doubt she was conscious of almost everything that was being said in her presence, and she gave every evidence of enjoying the attention she was receiving. The following day she gradually came to and began to take an interest in things. She inquired very minutely as to what had happened. When it was explained to her that she had simply been overdoing and had collapsed, she was entirely satisfied with the diagnosis. And when she asked when she could get up, she was greatly relieved when told she would have to remain in bed a week or ten days to rest. Within a few hours she became quite cheerful; was reconciled to her rest in bed; began to make inquiries about other members of the family, including her sick companion. She then expressed a desire to get up and look after his food, but when she was told she must carry out the doctor's orders and remain in bed, she was readily reconciled to her fate.
This is a typical illustration of what happens in hysteria, and it does not mean that the patient is a fraud. This woman was not at all guilty of consciously doing this. It was all a wicked conspiracy between her subconscious and the sympathetic nervous system. I do not mean to imply that certain slightly hysterical patients do not utilize these spells consciously for the accomplishment of their ends, even as spiritualistic mediums may sometimes accentuate some of the symptoms associated with their experience of going into trances. Undoubtedly the hysterical girl often uses these spells to impress both her parents and her lover; but as a rule these blow-ups are not faked, the patient is not malingering. This is all genuine as far as they are concerned, and even the state of unconsciousness or partial consciousness which they enter into and during which they hear everything that is said in their presence, is not a "put on" affair; it is all a genuine part of the hysteric attack.
We are all entitled to regress now and then to the free and easy life of childhood. We all crave to get back to the play-life of our earlier years, and so we are entitled to our annual vacations, with their enjoyment, as well as our other periods of relaxation and merriment. We are all entitled to sympathy, love, and affection, as well as admiration and praise for the things we accomplish; but the way in which to obtain all this is not to have a hysterical fit; that is getting it by false pretenses. Rather, let us escape from the stress and strain of living and the realities of a "hard boiled" world by our regular, natural, and legitimate play-life. Let us get sympathy, love, and devotion from our families and friends by developing a personality of poise, and exhibiting that degree of self-control which will make us beloved by all who come in contact with us. Let us honestly earn the sympathy of our associates, and then by means of application in our chosen path of life, let us act so as to merit their admiration. We can all learn to do something well - as well as the average, or perhaps even better - and this will entitle us to that distinction of attainment which we all crave, and which so many seek to obtain in an undeserving manner by means of hysteric spells.
Now we com e to the case of a woman around forty-five years of age, who had unfortunately, fifteen years before, as the result of an infection, lost both of her ovaries, so that her neurotic tendencies were complicated by this endocrine disturbance. The giving of ovarian extract and other efforts to counteract her endocrine shortage afforded but little help. She had queer heart attacks, notwithstanding the fact that more than a dozen physicians had pronounced her heart organically sound. She seemed to be cheerful and ambitious, but attacks of weakness intervened; while taking a telephone message or writing a letter, she would have to stop in the midst of it. She would take to her bed and remain there for days at a time. She would implore us to find out the cause of her trouble. After many years of this she was persuaded to undergo a thorough examination, and, aside from being a trifle overweight, was found to be entirely sound. Much to her dislike, the doctors started in to explain to her the nervous nature and origin of her trouble; but she was an educated woman, and presently was converted to the idea that she was a victim of hysteria.
This woman is in the midst of her course of training, which is designed to provide emotional immunity. We are trying so to vaccinate her mind that she will be immune, emotionally speaking, to the various sensations and queer feelings that come into her brain from different parts of her body. This is the only thing that can save her from chronic invalidism, and she is progressing very favorably, notwithstanding the complications which are the result of the earlier surgical operation.
In this connection, let me emphasize the fact that many a neurotic reader of this book may just as well make up his or her mind to start right in on this program of acquiring emotional immunity. This is the goal which chronic hysterics must attain before they can hope to enjoy good health and reasonable happiness.