hysteria

Hysteria!
Finals at Bryn Mawr is generally one of the busiest times of the year for our health center, often times filled with students complaining of stomach ailments and headaches. As one of those students that tends to fall ill during particularly stressful periods in the academic year, I often wonder if we are simply "worrying ourselves sick”. However, this connection between stress and poor health is not limited to the college community- the American Psychological Association states that 43% of all adults suffer adverse health effects due to stress [1]. Unfortunately nausea and migraines are merely the tip of the iceberg when it comes to ill effects of stress, anxiety, and other troubling emotions. Individuals that suffer from somatoform disorders can be afflicted with seizures, paralysis and a multitude of other very serious, but seemingly inorganic symptoms [2]. Despite the widespread ill effect of stress on human health, the scientific community still has incomplete understanding of the connection between mental and physical health.
Somatoform disorders (which include somatization and conversion disorders) cause chronic illness that seem to have no physical root cause, and often seem to be worsened by stress [2]. Somatization disorders generally manifest themselves as gastro intestinal or pain symptoms, such as vomiting, diarrhea, and abdominal pain [3]. Conversion disorders, however appear as a total loss of a bodily functions, such as paralysis, blindness, and numbness [4]. Conversion disorder usually occurs with sudden onset symptoms, after a particularly stressful event [4]. While these illnesses are currently understood to be psychological, and occur in both genders for over two thousand years somatization disorders were referred to as hysteria, an illness believed to be solely feminine [5]. Because somatization disorders are most common in women under the age of 30, ancient physicians generally attributed hysteria to a malfunctioning of the female sex organs [5]. Two popular theories were the illness was caused by misdirected blood flow from the uterus or a "wandering womb", meaning the uterus would move throughout the body and damage other organs [5]. The main treatment for hysteria from this era until the 19th century was sexual intercourse, preferably resulting in pregnancy.
During the Victorian era, hysteria was not considered to be a serious illness caused by a renegade womb, instead it was thought to be "feminine nervousness". A popular Victorian treatment for hysteria was the "rest cure", developed by Silas Weir Mitchell [6]. Women treated with the rest cure were confined to their beds for a period of six to eight weeks, and were not allowed to read or write. In extreme cases the women were told not move at all [6]. Dr. Mitchell believed that this severe restriction of stimulus would be restorative and calming to women who were suffering from hysterical symptoms [6]. However the rest cure often greatly exacerbated the mental illness of the patient, an issue Charlotte Perkins Gilman brought to attention in her 1899 short story, The Yellow Wallpaper [7].
However, the first time hysterical illness became associated with emotions, rather than femininity was with the infamous case of Bertha Pappenheim, commonly known as "Anna O" [8]. Pappenheim suffered from paralysis on the right side of her body, blindness, a severe cough and difficulty eating and drinking, and was a patient of Austrian physician Josef Breuer [8]. Pappenheim became ill while she was nursing her dying father. Breuer would hypnotize Pappenheim, and discuss the origins of her symptoms [8]. Through these hypnotized therapy sessions, Dr. Breuer was able to discover many of the stressful events that had triggered Pappenheim's symptoms, and found that after they were discussed the symptoms abated [8]. This caused Breuer and Sigmund Freud, who was also in correspondence with Pappenheim to believe that hysterical symptoms were not caused a physical weakness [8]. Instead the doctors believed that hysteria was in fact an emotional illness, that "their symptoms are residues and mnemic symbols of particular (traumatic) experiences." [8]
Currently, the scientific community is developing a larger understanding of the connection between the brain and physical symptoms. There are numerous instances in which we have observed psychological conditions affecting physical symptoms. For example, people with depressive disorder often hypersecrete cortisol [9]. High levels of cortisol can cause fatigue, muscle weakness, increased urination, along with a number of other physical symptoms. Despite this increased understanding of how the brain can interact with the immune and digestive systems, our understanding of somatoform disorders is still somewhat ambiguous. This is especially problematic, as it is difficult for doctors to communicate effectively with patients with somatoform disorders- as there is usually frustration felt on both sides [12]. Somatic patients are generally treated with anti anxiety or anti depression medication, along with talk therapy [3].
There have, however been studies further illuminating aspects of conversion disorder. Neurophysiologists from the UK conducted a study in 1997 of the brain functions of a woman paralyzed on the left side of her body with no identifiable physical causes [10]. When the patient was asked to will her left leg to move, the area of her brain associated with emotion was triggered, rather than the region affiliated with movement planning and coordinating [10]. This study essentially confirmed Freud and Breuer's belief that the emotional trauma Pappenheim suffered caused her symptoms, as the brain functions of the test subject showed that emotions were responsible for counteracting the signal to move the left leg [10].
It seems as if part of the confusion and difficulty understanding and treating somatoform disorders stems from our idea of the mind and the body as separate entities, despite the fact that we have seen time and again that this is not true. Physical symptoms can often affect our emotions just as easily as emotions affect physical symptoms (people recovering from strokes often feel depressed, as strokes can alter chemical pathways in the nervous system) [11]. If one believes Emily Dickinson's idea of the brain as "wider than the sky", to be true, than it would make sense that the brain (a physical entity that generates emotions) would have a reciprocal effect on the functions of other organs in the body. It seems that the treatment of somatic illnesses could be further improved upon if the medical and psychological communities attempted to further understand the role of the brain in physical symptoms as a non distinguished organ. References:
1. "Stress: How Does Stress Affect Us?" http://helpcenter.apa.org/articles/article.php?id=11
2. "Introduction: Somatoform Disorders" http://www.merck.com/mmhe/sec07/ch099/ch099a.html
3. "Somatization Disorder" https://health.google.com/health/ref/Somatization+disorder
4. "Conversion Disorder" https://health.google.com/health/ref/Conversion+disorder
5. Lefkowitz, Mary "The Wandering Womb" http://www.newyorker.com/archive/1996/02/26/1996_02_26_194_TNY_CARDS_000373322
6."Silas Weir Mitchell on His Rest Cure" http://www.chsbs.cmich.edu/Melinda_Kreth/Silas%20Weir%20Mitchell.pdf
7. Gilman, Charlotte "The Yellow Wallpaper by Charlotte Perkins Gilman" http://www.gutenberg.org/catalog/world/readfile?fk_files=1048618
8. "Anna O. Case by Freud" http://www.freudfile.org/psychoanalysis/annao_case.html
9. P.J. COWEN "Cortisol, serotonin and depression: all stressed out?"
The British Journal of Psychiatry, Feb 2002; 180: 99 - 100.
10. Kinetz, Erica "Is Hysteria Real? Brain Images Say Yes. " http://www.nytimes.com/2006/09/26/science/26hysteria.html?pagewanted=1&_r=1
11. Pies, Ronald "Redefining depression as mere sadness" http://www.nytimes.com/2008/09/16/health/views/16mind.html?_r=1&fta=y
12. Lipowski, Z J. (1988). Somatization: The Concept and Its Clinical Application. The American Journal of Psychiatry, 145(11), 1358. Retrieved February 23, 2010, from Research Library. (Document ID: 1775887).