The word ‘hysteria’, like ‘lunacy’, is evidence of a belief now discarded. When the theory of demoniacal possession ceased to satisfy the desire for reasons, and material explanations were sought for certain conditions, it was supposed that the uterus (Greek, _hystera_) came adrift from its position and wandered about the body, producing the condition thenceforward known as hysteria. Advancing knowledge killed this theory, but the influence of the word remained and the disease was attributed to some derangement or irritation of the uterus and its associated organs. Charcot, of Paris, showed the mental origin of hysteria, but, becoming lost in a maze of hypnotism and suggestion, he described as symptoms of the disease various manifestations which were really called up by himself or his assistants. There are medical men who still insist on a bodily cause, but such causes serve merely as pegs on which to hang the symptoms.
As usual, I shrink from a definition, but in this case I have good reason. Every writer who describes hysteria expresses his own ideas about it, and as the ideas of no two writers are alike some definitions scarcely seem to refer to the same subject.
Here is a definition by Babinski, a French writer of international reputation:–
‘Hysteria is a peculiar psychical state capable of giving rise to certain conditions which have features of their own. It manifests itself in primary and secondary symptoms. The former can be exactly reproduced by suggestion in certain subjects and can be made to disappear under the sole influence of suggestion.’
And here is one by Pierre Janet, a man of equal eminence:–
‘Hysteria is a form of mental depression characterised by retraction of the field of personal consciousness, and a tendency to complete division of the personality, and subconscious mental conditions grow and form a kind of second personality.’
And here are a few words from Ernest Jones, the chief exponent of Freud’s views in this country:–
‘It is in the excessive tendency to displace affects by means of superficial associations that the final key to the explanation of abnormal suggestion is to be sought. Even if it were true, which it certainly is not, that most hysterical symptoms are the product of verbal suggestion, the observation would be of hardly any practical or theoretical interest.’
When the reader has finished this chapter he will perhaps return to these definitions, and see how each represents one aspect, and how the best understanding is reached by a consideration of all of them.
The Great War has provided plenty of material for the study of hysteria, and French and German writers have dealt extensively with it. The paucity of English writings on the subject may indicate a smaller amount of material, but there has been sufficient considerably to increase our knowledge. The common form of hysteria is a mimicry of bodily disease; pains, paralyses, contractions and joint affections most often occur, though fits and trances are typical and there are few diseases which are not imitated. Hysteria therefore has a superficial resemblance to malingering, or the conscious simulation of disease for a definite end, and many people find it hard to conceive any difference between the two. Various criteria have been given to distinguish them, but, in my opinion, when the question arises the distinction can rarely be made upon physical grounds and is chiefly a matter of judgement concerning the honesty of the patient; that is to say, the hysteric believes in his disease as a reality, but the malingerer knows that it is fictitious. I believe there is no definite line between the groups, though some authorities assert that they are quite distinct. Practical experience proves that in many cases there is an intense desire for cure which cannot be reconciled with any consciousness of simulation, and the apparently heartfelt gratitude often shown by the patient on recovery is further proof of the reality of this desire.
It is a matter for regret that we have no word to take the place of ‘hysteria’, which is a mark of superstition; the only excuse for its use being that every one knows that it does not mean what it says. Popular and even professional ideas concerning hysteria are so far from the truth that it is a pity a new word is not employed. If a man has fought bravely for years and at last succumbed in his effort to forget the horrors he has seen, it sounds an insult to say he is suffering from hysteria. Yet the newer term of ‘shell-shock’ was worse, for it conveyed a totally false idea of causation and treatment: to regard as due to the concussion of a shell symptoms which are of purely mental origin led to muddled thinking.