It was middle of night at district hospital Baramulla, I came across scary screams from outside. Night duties are very fearful as quite often some untoward happenings are expected. A huge rush of people entered the night duty room carrying a young unconscious female patient. With fear inside, under loud shouting of mob I examined the patient’s vitals and called for an urgent ECG. Meanwhile I asked her crying mother sitting beside her, what has happened? She replied and said this has been happening past so many years and we have left no Peer (faith healer) in vicinity without consultation. On their advice we have scarified an animal and donated many chickens with short time relief but such ugly happenings continued with her. Yes, I got it and said thank God I am in safe zone. In the mean time ECG was done and all vitals checked were normal. No medicine was given but simply her pain points were stimulated to make her open the eyes. It was nothing but Hysteria.
What is Hysteria
Hysteria is an ancient disorder. Hysteria is derived from a Greek word Hysteron, meaning uterus. In the past many manifestations of mental illness were seen as obscene bonds between women and the Devil. “Hysterical” women were subjected to exorcism: the cause of their problem is found in a demonic presence. In early Christianity, exorcism was considered a cure but not a punishment, in the late Middle Ages it becomes a punishment and hysteria was confused with sorcery (the use of magic, especially black magic).
During the Victorian Age (1837-1901) most women carried a bottle of smelling salts in their handbag: they were inclined to swoon when their emotions were aroused, and it was believed, that, as postulated by Hippocrates, the wandering womb disliked the pungent odor and would return to its place, allowing the woman to recover her consciousness. This is a very important point, as it shows how Hippocrates’ theories remained a point of reference for centuries.
With the flowering of empiricism and science during the Renaissance, hysteria was again rediscovered as a disease. It is interesting that in the eighteenth century its main cause was attributed to emotions, passions, and human suggestibility, and in the early nineteenth, to organic dysfunction. It fell to Charcot, Janet, and Freud to clarify the distinction between neurological illness and hysteria. They showed that hysteria is a condition resembling physical disease that occurs in persons with healthy bodies.
Presently the name hysteria is given to a form of mental disorder, a loss or disturbance of normal function which initially appears to have a physical cause but is attributed to a psychological cause. The patient loses control over his or her acts and emotions and it is usually accompanied by sudden seizures of unconsciousness with emotional outbursts. It is often due to repressed conflicts within the person. Though the disease may occur in both sexes, it is common in young women between fourteen to twenty five years of age. Hysteria is uncommon after the age of forty five years. The terms conversion disorder and dissociative reaction are other names given to these phenomena.
Symptoms of Hysteria
A hysterical personality typically displays symptoms like seductive behaviour, high level of emotional dependency, platonic friendships, intolerance, frustration, capriciousness and irritability.
During fits, such a person becomes hyper-emotional. He exhibits exaggerated feelings like spells of crying spells and tantrums marked with symptoms like:
- Increasing Abdominal constriction
- Severe cramps and heaviness in the limbs
- Suffocation and headache
- Clenched teeth
- Swelling of the neck
- Feeling of a foreign body lodged in the throat
- Laughing or crying without cause
In severe cases the symptoms may be wild and painful cries, enormously swollen neck, and incomplete loss of consciousness, violent movements, violent and tumultuous heartbeat and convulsions. The hysteria patient usually has a weak will power, craving for love and sympathy and has a tendency towards emotional instability. Hysteria trances may last for days or weeks. A patient in trance may seem to be in deep sleep but the muscles are not usually relaxed.
Causes of Hysteria
The main cause of hysteria is idleness, sexual repression and perverted habits of thought. Heredity may also be a cause for hysteria. A nervous family background and faulty emotional training. Suppressed emotions or feelings, physical abuse that too from someone close in relationship is often observed to be an important cause in conservative societies .
People in Kashmir are still in the grip of superstitious beliefs though many things have changed over past several decades. Most of the faith healers (Peer) still make lucrative business out of ignorant people by claiming the demonic presence in females having psychological disorder like hysteria. A mufti from a reputed darul-uloom of Baramulla once told me: “the presence of jinn is our faith and its understanding needs a special education. In my carrier of 25 years I have come across the demonic influence in less than 1% of females and 99% of females might have one or other type of psychological problem”
Current understanding of the phenomenon of Hysteria (conversion disorder) implicates some role of the unconscious in the pathophysiology of this condition. Many patients who experience a Hysteria (conversion disorder) are unable to understand this inner conflict, which is perhaps occurring on an unconscious level. They may achieve resolution of the conflict, as well as their physical symptoms, once they are gently made aware of this connection. Once the patient is aware of this, the psychologic currency of the symptom loses value, and the symptom may be allowed to improve.
Hospital admission may be considered in some cases. For example, for a patient that seems likely to not return for follow-up after being given a psychiatric diagnosis. A more rapid completion of the diagnostic workup is possible in the hospital setting. In addition, a parallel investigation of physical and psychologic factors can concomitantly be pursued. Avoid invasive diagnostic and therapeutic interventions.
Supportive psychotherapy and presentation of the diagnosis to the patient includes the following:
- Avoid giving the patient the impression that you feel there is nothing wrong with them.
- Do not inform the patient of the diagnosis on the first encounter.
- Reassure the patient that the symptoms are very real despite the lack of a definitive organic diagnosis.
- Provide socially acceptable examples of diseases that often are deemed stress-related (eg, peptic ulcer disease, hypertension).
- Provide common examples of emotions producing symptoms (eg., feeling of nausea when talking in front of an audience, heart racing when asking someone for a date).
- Provide examples of how the subconscious influences behavior (eg, nail biting, pacing, foot tapping).
- Provide reassurance that no evidence of an underlying neurological disorder is present based on the tests that were performed and that the prognosis for recovery is very good.
- Provide positive reinforcement that the symptoms can improve spontaneously.
- Inform patients that the symptoms are not volitional, and no one believes that they are faking.
- Institute patient and family education sensitively.
Provide a graceful way for the patient to improve from the symptoms. (Allow for the symptom to get better over time, just as an organic entity might improve.) This is perhaps the most important point. No specific pharmacologic therapy is available for conversion disorder; however, medications for comorbid mood and anxiety disorders should be considered. Studies reveal the efficacy of homeopathic medicine in different presentation of this disorder.
From the print edition of 15-21 march 2017.