Hysteria: Is the Medical Condition Mental, Physical, or Made Up?

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Made famous in the 19th century by doctors like Jean-Martin Charcot and Sigmund Freud, hysteria was a fairly common diagnosis in that era. Symptoms included sudden seizures, partial paralysis, and temporary blindness. No one knew the cause—there was no brain lesion to be found, no chemical imbalance to blame. It was unclear whether the condition was neurological or psychological.

Today, the condition remains a mystery. It has a new name—conversion disorder—and it accounts for 1 to 3 percent of all diagnoses in hospitals, making it more common than either multiple sclerosis or schizophrenia. Yet it is still poorly understood, and often misdiagnosed.

Unlike its fictional portrayal—such as in the new film A Dangerous Method, in which Keira Knightley screams and quivers as a Carl Jung patient suffering from hysteria in the early 1900s—the condition can be much more debilitating, involving muscle spasms and twisted limbs.

The symptoms seemingly come from nowhere. That’s what happened to Susan Thomas (whose name has been changed to protect her privacy), a mother of two young children in Virginia. She was with a friend one day in 2004 when suddenly, she says, "My left eye started feeling like it was pulling toward my nose." Her friend reared back. Thomas’s eyeball had rolled completely inward.

They rushed to the emergency room. Thus began a mystifying few years of bizarre symptoms such as involuntary spasms in Thomas’s face, some of which would leave the left side of her face pulled upward into a chilling grin, "like the Joker," she says. The doctors did endless scans and biopsies. They found nothing. "After they didn’t see any neurological changes, they started invalidating me—their whole mannerism with me changed," she says. She began to wonder if she was somehow causing the whole thing herself.

This kind of self-doubt is common for patients with conversion disorder. They are vulnerable to the implied message they often get from doctors: there is nothing physically wrong with you, so you must be faking it.

Fortunately for Thomas, she found her way to a clinical trial at the National Institutes of Health, where, after two weeks of biofeedback—a technique that involves deep breathing and meditation—she began to improve. This treatment has not been shown to be universally effective, however; due to a lack of research on the condition, there is not a wide array of treatment options.

For much of the 20th century, the disorder has fallen through the cracks, as medical experts have remained unable to determine whether it is based in psychiatry or neurology. Mark Hallett, a neurologist at the NIH, says any mention of the condition all but disappeared from both psychiatry and neurology textbooks for nearly 50 years, starting around 1940.

However, things are starting to slowly change. Thanks to new brain-scanning technology, there has been a small resurgence of interest among neurologists. Valerie Voon, a scientist at Cambridge University, is among those leading the charge. In one study, she found an amped-up connection between the emotion-producing regions of the brain and those that control motor activity—substantiating one theory that conversion disorder can be triggered by stress. Studies like this could help doctors figure out possible treatments.

Jon Stone, a neurologist at the University of Edinburgh, became interested in conversion disorder when he saw the "appalling" attitudes of many neur- ologists who treated people with hysteria. Because the symptoms had no discernible physical cause, the condition was often regarded as "bogus," he says. "Like if they didn’t have a disease, then they must be making it up."

One of his patients, a former nurse, developed an extreme conversion disorder in which her muscles involuntarily contracted into abnormal positions. "Her left leg is literally upside down," Stone says, so that "her toe is pressing into her buttock. She’s now been in bed for 25 years." Stone does not believe the condition can be boiled down to any one particular cause. "There isn’t a single answer," he says. "Everyone wants there to be. You’d like to think, everyone’s got a conflict, or everyone’s been abused, or everyone’s had a trauma. But the reality is that it’s a really varying group of people, all with quite different reasons potentially for being unwell." He adds, "There’s no one-size-fits-all etiology."

Stone hopes that conversion disorder will regain the legitimacy it once held—back in the 19th century.

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