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Try out PMC Labs and tell us what you think. Learn More. Hysteria is undoubtedly the first mental disorder attributable to women, accurately described in the second millennium BC, and until Freud considered an exclusively female disease. Over years of history, this disease was considered from two perspectives: scientific and demonological.
It was cured with herbs, sex or sexual abstinence, punished and purified with fire for its association with sorcery and finally, clinically studied as a disease and treated with innovative therapies. However, even at the end of 19 th century, scientific innovation had still not reached some places, where the only known therapies were those proposed by Galen. During the 20 th century several studies postulated the decline of hysteria amongst occidental patients both women and men and the escalating of this disorder in non-Western countries. The first mental disorder attributable to women, and for which we find an accurate description since the second millennium BC, is undoubtedly hysteria.
The first description referring to the ancient Egyptians dates to BC Kahun Papyrus and identifies the cause of hysterical disorders in spontaneous uterus movement within the female body [ 2 , 3 ]. We also find indications of the therapeutic measures to be taken depending on the position of the uterus, which must be forced to return to its natural position.
According to Greek mythology, the experience of hysteria was at the base of the birth of psychiatry. Melampus cured these women with hellebore and then urged them to carnally with young and strong men. They were healed and recovered their wits. Thus arose the idea of a female madness related to the lack of a normal sexual life: Plato , in Timaeus , argues that the uterus is sad and unfortunate when it does not with the male and does not give rise to a new birth, and Aristotle and Hippocrates were of the same opinion [ 2 - 4 ].
Women suffering from hysteria could be released from the anxiety that characterizes this condition by participating in the Maenad experience. Trance status guided and cured by the Satyr, the priest of Dionysus, contributed to solving the conflict related to sexuality, typical of hysteria disease [ 6 ]. Hippocrates 5th century BC is the first to use the term hysteria.
The Greek physician provides a good description of hysteria, which is clearly distinguished from epilepsy. He emphasizes the difference between the compulsive movements of epilepsy, caused by a disorder of the brain, and those of hysteria due to the abnormal movements of the uterus in the body. Then, he s the idea of a restless and migratory uterus and identifies the cause of the indisposition as poisonous stagnant humors which, due to an inadequate sexual life, have never been expelled. For this reason, he suggests that even widows and unmarried women should get married and live a satisfactory sexual life within the bounds of marriage [ 2 - 4 ].
However, when the disease is recognized, affected women are advised not only to partake in sexual activity, but also to cure themselves with acrid or fragrant fumigation of the face and genitals, to push the uterus back to its natural place inside the body [ 2 - 4 ]. Aulus Cornelius Celsus 1 st century BC gives a good and accurate clinical description of hysterical symptoms.
Sometimes also, it so completely destroys the senses that on occasions the patient falls, as if in epilepsy. I have examined many hysterical women, some stuporous, others with anxiety attacks [ Fumigations, cataplasms and compressions are ineffectual, the hysterical body should be treated with care: hot baths, massages, exercise are the best prevention of such women' diseases [ 2 , 3 , 7 ]. Sometime before, Bishop Nestorius approx. The political events of the early Middle Ages caused a rupture between Christian Europe, with its auctoritas culture - in the hands of just a few scholars - and the Middle East of the Caliphs, where thanks to a climate of tolerance and cultural ferment, the texts of Hippocrates and Galen were translated and commented on in Arabic, becoming widespread and well-known [ 3 ].
In this context, two great scientists carry out their work : the Persian Avicenna [ 8 , 9 ] and the Andalusian Jew Maimonides [ 10 ]. In particular, the medical schools of Salerno and Montpellier were vehiclesfor the dissemination of these works [ 11 ]. In particular, this advocated the use of melissa as a natural remedy nerve comforter melissa was considered excellent even in cases of insomnia, epilepsy, melancholy, fainting fits, etc.
Besides the natural remedies, a sort of "psychotherapy" developed, practiced not only by Avicenna, but also for example by Arnaldus of Villa Nova But we cannot talk about women' health in the Middle Ages without citing Trotula de Ruggiero from Salerno 11 th century. While as a woman she could never become a magister, Trotula is considered the first female doctor in Christian Europe: she belonged to the ranks of famous women active in the Salerno School but discredited, among others, by Arnaldus of Villa Nova [ 14 ].
Called sanatrix Salernitana , Trotula was an expert in women' diseases and disorders. Her best known work, De passionibus mulierum ante, in et post partum , deals female problems, including hysteria. Trotula works at a time when women are still considered inferior to men because of their physiological and anatomical differences. Hildegard of Bingen , German abbess and mystic, was another female doctor. Her work is very important for the attempt to reconciliate science with faith, that happens at the expense of science.
In her view, melancholy is a defect of the soul originated from Evil and the doctor must accept the incurability of this disease. Her descriptions are very interesting. Melancholic men are ugly and perverse, women slender and minute, unable to fix a thought, infertile because of a weak and fragile uterus [ 16 ]. In the ideology of Hildegard, Adam and Eve share responsibility with respect to original sin, and man and woman - sexually complementary - are equal in front of God and the cosmos [ 17 ].
The mainstream view of the time is one in which the woman is a physically and theologically inferior being, an idea that has its roots in the Aristotelian concept of male superiority: St. The inferiority of women is considered a consequence of sin, and the solutions offered by St. In question , article 3, addressing the possibility that the human soul can change the substance, St. The ecclesiastical authorities try to impose celibacy and chastity on the clergy, and St.
From the thirteenth century onwards, the struggle with heresy assumes a political connotation: the Church aims tat unifying Europe under its banner, so breviaries become manuals of the Inquisition and many manifestations of mental illness are seen as obscene bonds between women and the Devil. If in early Christianity, exorcism was considered a cure but not a punishment, in the late Middle Ages it becomes a punishment and hysteria is confused with sorcery [ 19 , 20 ].
Although not an official Church manual, it takes on an official tone due to the inclusion of the papal Bull within the text. The devil is everywhere in these s: he makes men sterile, kills children, causes famine and pestilence and all this with the help of witches.
The compilers of the manual are familiar with the medicine of the age, and they investigate the relationship between sorcery and human temperaments: their descriptions rival those contained in the best psychopathology manuals [ 21 , 22 ]. The text is divided into three parts and aims at proving the existence of demons and witches warning the reader that anyone not convinced is also a victim of the Devil explaining how to find and punish sorcery. But what has this to do with women's health? It is quite simple: if a physician cannot identify the cause of a disease, it means that it is procured by the Devil.
The inquisitor finds sin in mental illness because, he says, the devil is a great expert of human nature and may interfere more effectively with a person susceptible to melancholy or hysteria. Hysteria is considered a woman's disease, and who more than women are prone to melancholy? Obviously, the women most affected are elderly and single, in most cases they have already been in mourning or victims of violence. At the end of the Middleage, journeys along the coasts of the Mediterrinean sea contributed to a quick diffusion of Greek Classics, preserved and disseminated by the Arabians.
The humanistic movement born with Dante, Boccaccio and Petrarch emphasized a respect for the writings of the Antiquity. During these centuries, a new realistic approach to man as a person was born, which opposed the scholastics and introduced a fresh point of view about nature and man [ 19 ]. Italian philosopher Giovanni Pico della Mirandola espoused the principle that each man is free to determinate his own fate, a concept that perhaps more than any other has influenced the developments of the last three centuries: only man is capable of realizing his ideal and this condition can, however, be achieved only through education [ 23 ].
Up to this time the medical vision of hysteria, inherited from the Hippocratic-Galenic tradition, continues to dominate [ 24 ]. At the end of the 16th century, in European countries affected by the Counter-Reformation, the theological vision tends to overwhelm the medical community. During this period the most intense activity of the Roman Inquisition, in which magic has replaced the fight against heresy, is recorded. Thus in these states, a new generation of physicians emerges, which is destined to be subordinated to inquisitors [ 24 ].
It is precisely the physician and theologian Giovan Battista Codronchi who, by criticizing the medical therapy of the time aimed at treating hysteria, give us a detailed description of them. The physician prohibited this treatment at all, an attitude due to the concern typical of that historical phase related to sex and sexual repression. The treatment for him must be practices by the spiritual guides [ 24 ]. Another important physician, the Dutch Johann Weyer intended to prove that witches were mentally ill and had to be treated by physicians rather than interrogated by ecclesiastics [ 19 ].
In he became the private physician of the Duke William of Cleves, who was a chronic depressive. The Duke observed that witches manifesedt many of the same symptoms as his relatives became insane. In , Weyer publishes De prestigiis Daemonum , which is a step-by-step rebuttal of the Malleus Maleficarum.
However, for the doctors of that time, the uterus is still the organ that allows to explain vulnerable physiology and psychology of women: the concept of inferiority towards men is still not outdated. Willis introduces a new etiology of hysteria, no longer attached to the central role of the uterus but rather related to the brain and to the nervous system [ 24 ]. In , another English physician, Thomas Sydenham , published a treatise on hysteria Epistolary Dissertation on the Hysterical Affections which refers back to natural history through describing an enormous range of manifestations and recognizing for the first time the fact that hysterical symptoms may simulate almost all forms of organic diseases [ 19 ].
However, the author fluctuates between a somatic and a psychological explanation [ 27 ]. Sydenham demonstrates that the uterus is not the primary cause of the disease, which he compares to hypochondria: his work is revolutionary as it opposes the prejudices, but it will take several decades for the theory of "uterine fury" to be dismissed [ 26 ].
The scientific development does not mark a dramatic shift from a demonological vision of medicine, but progresses hand in hand with evolution of theories on exorcism. The written records tell us of several outbreaks of hysteria, the most famous of which is undoubtedly the one occurred in the village of Salem Massachusetts in The texts recall an episode in which a slave originally from Barbados talks about the prediction of fate and some girls creat a circle of initiation.
This latter was formed by women yunger then twenty years of age and unmarried. The action of creating a circle of initiation was in itself an open violation of the precepts of the Puritans. There is no record of the first stages of the disease: the girls result "possessed" since February The symptoms described were staring and barred eyes, raucous noises and muffled, uncontrolled jumps, sudden movements etc.
The local doctor, William Griggs, referred the problem to the priest. The slave and two other women were summoned, and the former admitted witchcraft and pacts with the devil. Gradually they began to accuse each other. Eventually, 19 were hanged as "witches", and over were kept in detention. Only when the girls accused the wife of the Colonial Governor of being part of this circle herself, the latter forbade further arrests and trials for witchcraft [ 27 ].
Marion Starkey , at the end of World War II, reports the case comparing it with more contemporary events [ 27 ]. Her explanation of classical hysteria is that the illness manifested itself in young women repressed by Puritanism, and was aggravated by the intervention of Puritan pastors, this leading to dramatic consequences. The incident proves thus that hysteria could be seen as a consequence of social conflicts [ 27 ]. Social conflicts do not occur exclusively in closed societies, such as small communities such as puritanical circles, but they also occur in more open and dynamic societies asbig cities.
In Joseph Raulin published a work in which he defines hysteria as an affection vaporeuse and describes it as a disease caused by foul air of big cities and unruly social life. In theory, the disorder can affect both sexes, but women are more at risk for their being lazy and irritable [ 26 ]. Between the 17th and 18th centuries a trend of thought that delegated to the woman a social mission started developing.
If from a moral point of view she finds redemption in maternal sacrifice that redeems the soul but it does not rehabilitate the body, from the social point of view, the woman takes a specific role. In the physician-philosopher Pierre Roussel published the treatise "Systeme physique et moral de la femme" greatly influenced by the ideas of Jean-Jacques Rousseau.
Femininity is for both authors an essential nature, with defined functions, and the disease is explained by the non-fulfillment of natural desire. The excesses of civilization causes disruption in the woman as well as moral and physiological imbalance, the identified by doctors in hysteria [ 26 ]. The afflictions, diseases and depravity of women result from the breaking away from the normal natural functions. Following natural determinism, doctors confine the woman within the boundaries of a specific role: she is a mother and guardian of virtue [ 26 ].
Even more interesting is the fact that the causes and symptoms of hysteria and melancholy are linked to the humor theory. In the 18th century, hysteria starts being gradually associated with the brain rather than the uterus, a trend which opens the way to neurological etiology: if it is connected to the brain, then perhaps hysteria is not a female disease and can affect both sexes. But this is not such a simple shift as it may seem.
The German physician Franz Anton Mesmer found in suggestion a method of treatment for his patients suffering from hysteria, practicing both group and individual treatments. He identified in the body a fluid called "animal magnetism" and his method soon became famous as "mesmerism".
Indeed, it was thought that the magnetic action of the hands on diseased parts of the body could treat the patient, interacting with the fluid within the body. Only later we realized that this was a mere suggestion. Mesmerism had subsequent developments in the study of hypnosis [ 30 ].
Nonethelsess, Pinel too considered hysteria a female disorder [ 19 , 31 ]. Jean Martin Charcot the French father of neurology, pushed for a systematic study of mental illnesses. In particular, he studied the effectiveness of hypnosis in hysteria, which, from onwards, is distinguished from other diseases of the spirit.
Charcot argues that hysteria derives from a hereditary degeneration of the nervous system, namely a neurological disorder. By drawing graphs of the paroxysm, he eventually shows that this disease is in fact more common amongst men than women [ 32 - 36 ].
During the Victorian Age 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 Hipocrates, the wandering womb disliked the pungent odor and would return to its place, allowing the woman to recover her consciousness [ 34 ].
French neuropsychiatrist Pierre Janet , with the sponsorship of J. He convinced doctors that hypnosis — based on suggestion and dissociation — was a very powerful model for investigation and therapy. The chief patient I am worried about today is myself. In he published his Studies on Hysteria with Joseph Breuer The key-concepts of his psychoanalytical theory the influence of childhood sexual fantasies and the different ways of thinking of the unconscious mind have not yet been formulated, but they are already implicit in this text.
Among the cases presented, we find the hysteria of the young Katherina, who suffers from globus hystericus. The text does not refer to the famous Oedipus complex , which emerges through the study of male hysteria, developed after this treatise [ 36 - 38 ]. We now reach a crucial point: until Freud it was believed that hysteria was the consequence of the lack of conception and motherhood. Freud reverses the paradigm: hysteria is a disorder caused by a lack of libidinal evolution setting the stage of the Oedipal conflict and the failure of conception is the result not the cause of the deasease [ 36 - 38 ].
This means that a hysterical person is unable to live a mature relationship. Furthermore, another important point under a historical point of view is that Freud emphasizes the concept of "secondary advantage".Where are the legitimate ladies
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