From Delphi to the prefrontal cortex: a historical journey through the theories of hysteria

M. Arias Gómez
Neurosciences and History 2022;10(4):167-177

Type of article: REVIEW

AUTHOR

M. Arias Gómez
Neurology Department. Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
The contents of this article were partially presented as a lecture in the Seventh Neurohistory Course held in the modern town of Delphi (Greece) by the Spanish Society of Neurology.

ABSTRACT

Introduction. The Egyptian papyri of Kahun and Ebers introduce the idea of the wandering uterus, according to which the uterus, craving for gestation, caused a distinct condition (suffocated sensation, palpitations, choking) that the Greeks called hysteria (from ὑστέρα, uterus). The name and pathophysiology of hysteria have changed over the centuries, but even today the condition continues to be studied in the field of neuroscience.

Objective. This historical review analyses the different definitions and concepts of hysteria in Western civilisation over the centuries.

Development. For centuries, Greek and Roman physicians (Hippocrates, Galen, Soranus, Celsus) believed that hysteria originated in the uterus, although some disagreed with the concept of the wandering womb. In the Middle Ages, and in the context of Christianity, hysteria was attributed to demonic possession and witchcraft. During the Renaissance, Willis and Sydenham regarded hysteria as a nervous and emotional disorder; before them, Sylvius described how women presented hysteria and men hypochondriasis. During the Classical period, Whytt wrote about hysteria and hypochondriasis, stressing their emotional component, while Mesmer formulated the outlandish theory of magnetism. In the 19th century, Briquet provided a detailed description of the wide range of manifestations of hysteria, while Charcot used hypnosis to diagnose (induce) and treat the condition. Influenced by Charcot, Freud used introspective hypnotism and free association to cure the patient Anna O., who had chronic cough. The hypothesis of sexual frustration as the cause of hysteria was widespread during the first third of the 20th century; with the First World War, new forms appeared in men. The term “hysteria” was removed from successive editions of the Diagnostic and Statistical Manual of Mental Disorders, and the concepts of dissociative disorder (mind) and somatoform disorder (body) were introduced.

Conclusions. Functional disorder is the current preferred term: the pathogenesis of this condition involves the prefrontal cortex, which is connected to other regions of the brain (limbic system, hippocampus, motor and sensory cortex, etc), decreasing the patient’s will and consequently suppressing (vision loss, amnesia, aphasia, paralysis) or potentiating the function of other brain regions (pseudocrises).

KEYWORDS

Hysteria, conversion disorders, functional disorders, neurohistory

Neurosciences and History 2022;10(4):167-177