The clarification of our concepts concerning hysteria / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1909
Catalogue details

Licence: In copyright

Credit: The clarification of our concepts concerning hysteria / by Tom A. Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    3/4 (page 3)
    neurasthenia, idio-obsessive psychosis, maladie de doubte, delire de toucher and latterly, psychasthenia are the antitheses of the hysterical, though many of their symptoms may be imitated by suggestion, and so removed. The essential psychasthenic characters, however, do not accompany a symptom simulated in this way. I cannot better contrast these characters than in the following extract from International Clinics:17 “The very important diagnosis between hysteria and psychasthenia depends upon the following: First, as to fixed ideas, their duration in hysteria tends to be long; for, though they are easily buried and forgotten, they are resus- citated with great ease ami infallibility, whereas in the psychasthenic the fixed ideas are very mobile, but keep recurring voluntarily, and indeed become cherished parts of the individual, and are far more difficult to eradicate than those of the hysteric. Second, hysterical ideas are evoked by well-defined and not numerous associations, ‘suggestions’; in the psychasthenic, they are often evoked by apparently irrelevant associations, which are searched for by the patient: thus the ‘points de repere’ are very numerous, cannot be predicted with certainty, and are often mere excuses for crises of rumination or tics. Third, in the hysteric, the ideas tend to become kinetic; whereas the psychas- thenic’s constant state of uncertainty causes him to oscillate between ‘I would’ and ‘I would not.’ Inhibition is too strong to allow an act, but not strong enough to dismiss the obsession. “The anorexia in hysterics is derived from a simple idea not to eat, sug- gested by imitation, extraneously or in a dream. Cases of true loss of the feeling of hunger are not hysterical, but accord with the ‘anorexia mentale’ of Les^gue,18 in whose days hysteria was poorly differentiated. The anorexia of the psychasthenic is secondary to an obsession, usually of shame of body, of being fat, or of the act of eating, and is accompanied by numerous stigmata of the psychasthenic state.”19 It must, however, be remembered that the neurasthenic state favors sug- gestibility, though it is not of the dynamic kind, which the hysterical manifests, but is of a passive, aboulic character. From the foregoing considerations it follows: (1) that from hysteria must be eliminated cases of trickery, simulation and mythomania; (2) that to the syndrome of hysteria do not belong modifications of reflectivity; (3) that the vasomotor and trophic neuroses have nothing to do with hysteria and (4) that ■other psychoneurotic states such as psychasthenia, neurasthenia, cenesthopathia, mental debility, and confusion, the early phases of dementia prsecox, dream-like •states, and emotional perversions must not be confounded with hysteria. Having eliminated these negative characters, there remain the very definite conclusions which I quote again from International Clinics:20 “1. That all the symptoms which may legitimately be included under hysteria are imposed by suggestion. “2. That the state of suggestibility derives from (a) faulty education, tending to perpetuate and fortify the natural suggestibility of the child; (b) cerebral modifications due to organic causes, the action of which necessarily varies among individuals in accordance with (c) the hereditary constitution.”