Julio Torres, Intern
Carol S. North and Sean H. Yutzy edited the sixth edition of Goodwin and Guze’s Psychiatric Diagnosis, which provides an overview of major psychiatric disorders, covering the definition, historical background, epidemiology, clinical picture, natural history, complications, family studies, differential diagnosis, and clinical management of each disorder.The excerpts bellow recount the place in history of panic disorders and phobias, and hysteria —what’s fascinating about both histories is the cultural emphasis in women as bearers of these disorders. In both cases, earliest observations (even in their most primitive, often inaccurate form) dealt almost exclusively with women and were constantly paired with superstitions of the time. The trend articulates the phenomenon of sexism in early psychological research.
Panic Disorder and Phobias
My cheek is cold and white, alas!
O lift me from the grass!
I die! I faint! I fall!
My check is cold and white, alas!
My heart beats loud and fast.
Percy Bysshe Shelley,
The Indian Serenade
It has been suggested that Shelly was having a panic attack when he wrote these lines. If so, he probably would have called it something else. In the nineteenth century, “anxiety reactions’ referring to fainting—which was fashionable among women in the era—were called “vapors.” Modern patients with panic disorder also sometimes faint—probably from hyperventilating. In Victorian times the prototype of a refined young woman was a “sooner, pale and trembling, who responded to unpleasant or unusual situations by taking to the floor in a graceful and delirious maneuver, in no way resembling the crash of an epileptic”… A Jane Austen heroine found one social situation “too pathetic for the feelings of Sophie and myself. We fainted alternately on a sofa.” Overly tight corsets may have been responsible for some of the fainting. A nineteenth-century physician, Dr. John Brown, cured fainting by “cutting the stay laces, which ran before the knife and cracked like a bow string”…
One of the first medical terms to describe anxiety disorders was “neurasthenia,” defined by an American physician, G.M. Beard, in 1869… Neurasthenia broadly included patients with hysteria, obsessional illness, and anxiety disorders, as well as hypochondriacs and swooners… The term “anxiety neurosis” was first used by Freud in 1895. It was not until 1980 that the concept of neurosis was dropped form American Psychiatric Association general nomenclature, and the term “panic disorder” replaced the older term “anxiety neurosis” as the disorder’s official name… Panic disorder was later subdivided into two types, with and without agoraphobia…, a distinction that still holds today.
The term phobia originates from the name of a Greek god, Phobos, whose likeness was painted on masks and shields for the purposes of frightening the enemy… The word phobia first appeared in medical terminology in Rome 2,000 years ago, when hydrophobia was used to describe a symptom of rabies. Hippocrates also described cases of phobic fears.
During the nineteenth century, the term phobia appeared increasingly in descriptions of morbid fears, beginning with syphilophobia, defined in a medical dictionary published in 1848 as “a morbid dread of syphilis giving rise to fancied symptoms of disease.” Later authorities compiled a long list of phobias, naming each Greek and Latin terms after the object or situation feared. Thus, as Nemiah pointed out, “the patient who was spared the pangs of taphaphobia (fear of being buried alive) or ailurophobia (fear of cats) might yet fall prey to belonphobia (fear of needles), siderodromophobia (fear of rail-ways) or triskaidekaphobia (fear of thirteen at table), and pantaphobia was the diagnostic fate of that unfortunate soul who feared them all”…
Somatization Disorder (Hysteria)
The concept of hysteria, which probably originated in Egypt, is at least 4,000 years old. The name hysteria has been in use since the time of Hippocrates. The original Egyptian approach to hysteria was perhaps the most fanciful. Believing that physical displacement of the uterus caused the varied symptoms; physicians treated the patient by trying to attract the “wandering uterus” back to its proper site. Sweet-smelling substances were placed in the region of the vagina to attract the errant organ; unpleasant materials were ingested or inhaled to drive it away from the upper body…
Although Egyptian and Greek physicians applied the diagnosis whenever they believed that unusual symptoms were caused by a displaced uterus, the available records do not provide explicit diagnostic criteria. This state of affairs persisted, although various speculations about pathogenesis have been offered over the centuries… In particular, witchcraft, demonology, and sorcery were associated with hysteria in the Middle Ages… Mysterious symptoms, spells, and odd behaviour were frequently considered manifestations of supernatural, evil influences. Hysterical patients were sometimes perceived as either the active evil spirit (witch, sorceress, or demon) or as the passive victim of such an evil being, Since the Middle Ages there have been speculations of many kinds about the cause of hysteria. Such speculations have included ideas about neurological weakness, neurological degeneration, the effects of various toxins, and disturbances of what Mesmer called “anima magnetism.”
Hysteria became Freud’s central concern during the early years of psychoanalysis … That interest had developed while Freud was working in Paris with Charcot, who was treating hysteria with hypnosis. The psychoanalytic concept of conversion was an ego defense mechanism, referring to unconscious conversions of “psychic energy” into physical symptoms, ultimately led to the identification of conversion symptoms with hysteria in a psychoanalytic practice. Many psychoanalysts considered hysteria a simulation of illness designed to work out unconscious conflicts, partially through attention-getting and “secondary gain,” a term that refers to the possible advantages of illness such as being sympathy and support, including financial support, from relatives and friends and being excused from various duties…