Epilepsy, Hysteria, and Neurasthenia Part 5

HYSTERIA

"Diseased nature oftentimes breaks forth In strange eruptions; ..."

"King Henry IV."

Hysteria, recorded in legend and law, in ma.n.u.script and marble, in folk-lore and chronicle, right from history's dawn, is still a puzzle of personality, and only equalled by syphilis in the protean nature of its manifestations.

The sacred books of the East said delayed menstruation due to a devil was its cause; the thras.h.i.+ng-out of the devil its cure. Chinese legends describe it, and its symptoms were ascribed by the Inquisition to witchcraft and sorcery.

Old Egyptian papyri tell how to dislodge the devil from the stomach, and there were hysteria specialists in 450 B.C. All old theories fix on the womb as the seat of the disease. The name hysteria is the Greek word for womb, and 97 per cent of patients are women.

A few of the very numerous modern theories may be noticed.

The unconscious (or the subconscious) and the conscious are only parts of one whole. Our "conscious" activities are those which have developed late in the history of the race, and which develop comparatively late in the history of the individual. The "conscious" is the product of the racial education of the "unconscious"; the first is the man, the modern, the civilized; the last is the child, the primitive, the savage. Between the two there is no gulf fixed, and the Oxford metaphysician need not go to Timbuctoo to seek a superst.i.tious savage; he may find one within himself.

In hysteria, Janet says, the field of consciousness is narrowed, and the patient lives through subconscious experiences, which she forgets when she again "comes to". She journeys back into the past, back a few years individually, back centuries or aeons racially, and becomes a savage child again.

Normally, when anything goes wrong, or we suffer from excessive emotion, we give vent to our feelings by tears, abuse, anger, or impulsive action; in some way we "hit back", and relieve ourselves of the feeling of oppression.

Then we forget, which heals the sore, and closes the experience.

If, at the moment, we bottle up our emotions, they obtrude later at inconvenient times until we "get them off our mind" by confiding in some one, when we get peace of mind. Open confession _is_ good for the soul, and it is better to "cry your eyes out" than to "eat your heart out".

There are some experiences, however, to which we cannot react by anger or confidence, and so we imprison our emotions, and try to obtain peace of mind by forgetting the irritation.

Freud thinks perverted s.e.x ideas are thus repressed, and cause hysteria by coming into conflict with the normal s.e.x life. If these old sores can be laid bare by psycho-a.n.a.lysis, and the mental abscess drained by confession and contrition, cure follows.

The biologists consider hysteria as an adult childishness, a primitive mode of dodging difficulties. Victims cannot live up to the complicated emotional standard of modern life, and so act on a standard which to us seems natural only in children and uncivilized races.

Savill gives the following differences between neurasthenia and hysteria:

NEURASTHENIA HYSTERIA

s.e.x Both s.e.xes equally. 97 per cent females.

Age Any age. First attack before page of 25.

Mental Intellectual weakness; Deficient will power, peculiarities bad memory Want of control and attention. over emotions.

Causes Overwork; dyspepsia; Emotional upset or accident; shock.

nervous shock.

Course Fairly even. Paroxysms. Vary from hour to hour.

Mental Mental exhaustion; Emotional; wayward; Symptoms unable to study; no self-a.n.a.lysis, restless; sad; living by irritable; not rule or reading equal to medical books; amus.e.m.e.nt. May Fond of gaiety; be suicidal. sad and joyous by turns. Never suicidal.

General Occasional giddiness; Flus.h.i.+ng; convulsions Symptoms fainting rare; and fainting convulsions; common; no headache; backache; symptoms between sleeplessness; no attacks; local loss of feeling. anaesthesia or hyperaesthesia.

Termination Lasts weeks or Lasts lifetime in months. spasms.

CURABLE. TEMPORARILY CURABLE.

Hysteria is a disease of youth, usually ceasing at the climacteric. Social, financial and domestic worries are exciting causes, a happy marriage often curing, and an unhappy one greatly aggravating the complaint. It is most common among the races we usually deem "excitable", the Slavs, Latin races and Jews, and is often a.s.sociated with anaemia and pelvic disorders.

Symptoms. Changeability of mood is striking. "All is caprice. They love without measure those they will soon hate without reason."

Sensationalism is manna to them. They _must_ occupy the limelight. Pains are magnified or manufactured to attract sympathy; they pose as martyrs--refusing food at table, and eating sweets in their room, or stealing down to the larder at night--to the same end. If mild measures fail, then self-mutilation, half-hearted attempts at suicide, and baseless accusations against others are brought into play to focus attention on them.

Minor attacks usually commence with palpitation and a "rising" in the stomach or a lump in the throat, the _globus hystericus_, which the patient tries to dislodge by repeated swallowing. This is followed by a feeling of suffocation, the patient drags at her neck-band, throws herself into a chair, pants for breath, calls for help, and is generally in a state of great agitation. She may tear her hair, wring her hands, laugh or weep immoderately, and finally swoon. The recovery is gradual, is accompanied by eructations of gas, and a large quant.i.ty of pale, limpid, urine may be pa.s.sed later.

Major attacks have attracted attention through all ages, ancient statues showing the same poses as modern photographs. The beginning stage--which may last a few moments or a few days--is one of mental unrest, the victim being irritable and depressed. In some cases a warning aura then occurs; clutchings at the throat, or the _globus hystericus_, palpitation, dizziness, sounds in the ears, spots dancing before the eyes, or feelings of intense "_tightness_" as if the skin is about to tear or the stomach to burst.

The victim throws herself on a chair or couch, from which she slides to the floor, apparently senseless, the head being thrown back, the arms extended, the legs held straight and stiff. The face is that of a dreamer, and the crucifix position is not uncommon. This stage is a gigantic s.e.xual stretch.

Next comes the convulsive stage, but the convulsions are not the true jerky movements of epilepsy, but are bilateral tossing, kicking, and rolling movements, interspersed with various irregular pa.s.sionate att.i.tudes. There is great alteration but _not loss_ of consciousness. The patient struggles with those about her, bites them, but never her own tongue, shrieks and fights, but never pa.s.ses urine, throws things about, and arches the back until the body rests on head and feet (_opisthotonos_). The stretching and convulsive stages alternate, and the attack lasts a long time, being stopped by pain or by the departure of onlookers. During this stage the face may reflect the various emotions pa.s.sing through the mind--with a fidelity that would rouse the envy of an Irving.

The patient gradually calms down, and a fit of tears or a scream ends the attack, after which the worn-out victim is depressed but not confused, though memory for the events of the attack may only be partial. The patient sometimes pa.s.ses into the "dream state", described in Chapter II, for some hours or occasionally for far longer; these are the women described with much gusto in the local Press as being in a trance--"the living dead".

The victim of these attacks _is_ suffering from a disease, for she shows many temporary mental symptoms which could not possibly be feigned, while there is often a genuine partial forgetfulness of the incidents of an attack. She says she cannot help it; candid friends say she will not. The truth is that she cannot _will_ not to help it; for though intelligence and memory are often good and sometimes abnormal, the judgment and will are always weak--indecision, obstinacy, and doubt being common.

Treatment. A thorough examination by a doctor is _absolutely essential_, to prove that the patient is merely hysterical, and not the victim of unrecognized organic disease. In a few cases, skilled attention to some minor ailment will result in an apparently miraculous cure.

Many who habitually "go into hysterics", are merely grown-up "spoiled children", and in all cases, the basic factor is a lack of control and self-discipline.

Unfortunately, these tainted individuals who are so exquisitely sensitive that any reproof brings floods of tears, turn with mercurial rapidity from pa.s.sionate fury to pa.s.sionate self-reproach, and a.s.suage by impa.s.sioned protestations of affection the distress they have carelessly inflicted, and, as a consequence of their momentary but undoubtedly sincere contrition, escape blame and punishment.

Harmful sympathy is thus subst.i.tuted for helpful discipline, and the more stable members of the family are often made slaves to the whims and caprices of the hysterical member.

The usual home treatment of the victim pa.s.ses through various stages, and lacks persistence. Violent methods are succeeded by studied indifference; and that again by reproaches and recriminations.

Greene's remarks are very pertinent: "The condition must be regarded as an acquired psycho-neurosis to be ameliorated, and perhaps removed, by suggestion and a complete control, which, though kind, is firm, persistent, insistent, and _lacking in every element that enters into the upbuilding of the hysterical temperament_."

For anaemic patients, the following is a useful prescription:

R.

Quininae valerianatis gr. xx Ferri valerianatis gr. xx Ammon. valerianatis gr. xx Misce et fiant pilulae no. xx Sig.: One or two three times a day, after meals.

As far as the minor symptoms are concerned, the disease is usually chronic, for as soon as one symptom has been overcome another takes its place, and there is little hope of cure save when the case is taken vigorously in hand in childhood, treatment being best given in a home or hospital. Home treatment consists in an attempt to inculcate the lost or never-acquired habit of self-control, and in the hygienic measures laid down for neuropaths in general in the rest of this book.

In a major attack, _show no sympathy_. Let every one leave the room, save one attendant, whom the victim knows to be of firm character, and calm but determined disposition. This attendant should get a jug of water, and threaten to douche the victim unless she makes vigorous efforts to control herself. If she cannot, or will not, _douche her_, then hold a towel over her nose and mouth, and she will perforce cease her gymnastics to breathe, though the attendant must be prepared for an outburst of abuse when she has recovered her breath. Between attacks, all who are brought into contact with the victim, must adopt a tolerant but unsympathetic att.i.tude, while efforts are made to inculcate habits of control.

CHAPTER IX

ADVICE TO NEUROPATHS

"Great temperance, open air, Easy labour, little care."

The above quotation epitomizes the cure for neurasthenia, for as Huxley said:

"Our life, fortune, and happiness depend on our knowing something of the rules of a game far more complicated than chess, which has been played since Creation; every man, woman and child of us being one of the players in a game of our own. The board is the world, the pieces the phenomena of the universe, while the rules of the game are the laws of nature. Though our opponent is hidden, we know his play is fair, just and patient, but we also know to our sorrow that he never overlooks a mistake or makes the slightest allowance for ignorance. To the man who plays well, the highest stakes are paid with that overflowing generosity with which the strong show their delight in strength. The one who plays badly is checkmated; without haste, but without remorse. Ignorance is visited as sharply a as wilful disobedience; incapacity meets with the same punishment as crime."