Hysteria revisited.

Despite the attrition of psychoanalytic explanations for clinical conditions and the disappearance of “hysteria” from diagnostic lexicons, the phenomena first addressed in an orderly manner by Charcot and Freud continue to reassert themselves, as is apparent in the article by Vorhees in this issue of the JABFP. An elderly woman began to have spells of falling, paralysis, paresthesia, and uncontrollable movements of an extremity—from which she recovered completely until the next spell. She was taken to the local emergency facility by her children, where she had the good fortune to encounter a physician who could cure her symptoms by listening, talking, and physical examination. How easy; but how truly extraordinary! The therapeutic movements of the physician are instructive. He was available at the moment of need and performed the routine tasks of clinical evaluation. He listened to the patient’s exact words, touched her in the process of physical examination, paid attention to family members who accompanied her, and was verbally active in offering them his emerging understanding of her condition. He reviewed her previous medical record and did not feel compelled to repeat tests. He responded to the family’s request for a consultation but did not thereby lose interest in the patient. He engaged the patient in an interpretation of his understanding, even before she saw the neurologist, and broke through the mystery by imaginatively connecting her symptoms to her current life circumstance in a meaningful way that the patient and family members could accept. Ten days later, the patient had recovered her equanimity and her health, and the family living problem was resolved. Things do not always turn out so well. Pierre Janet, in his lectures on hysteria to Harvard Medical School faculty (1906), warned of the dangers: You must be able quickly to recognize this disease, to foresee its evolution, to provide against its dangers, and immediately to begin a rational treatment. This early diagnosis. . . will keep you, let me tell you plainly, from making blunders. . . what is always very serious is to mistake a hysterical accident for another one, and to treat it for what it is not. You cannot imagine the medical blunders, and too often, the medical crimes, committed in this way. . .