DEFINITION.—Hysteria is a functional disease of the cerebro-spinal axis, characterized either by special mental symptoms or by motor, sensory, vaso-motor, or visceral disorders related in varying degree to abnormal psychical conditions.
This, like all other definitions of hysteria, is imperfect. No absolutely satisfactory definition can well be given. It is not abnormal ideation, although this is so often prominent; it is not emotional exaltation, although this may be a striking element; it is not perversion of reflexes and of sensation, although these may be present. Some would make it a disease of the womb, others an affection of the ovaries; some regard it as of spinal, others as of cerebral origin; some hold it to be a disease of the nerves, others claim that it is a true psychosis; but none of these views can be sustained.
Sir James Paget1 says of hysterical patients that they are as those who are color-blind. They say, “I cannot;” it looks like “I will not,” but it is “I cannot will.” Although, however, much of the nature of hysteria is made clear in this explanation, hysteria is not simply paralysis of the will. A true aboulomania or paralysis of the will occurs in non-hysterical patients, male and female, and of late years has been studied by alienists.
1 “Clinical Lecture on the Nervous Mimicry of Organic Diseases,” Lancet for October, November, and December, 1873.
In many definitions the presence of a spasmodic seizure or paroxysm is made the central and essential feature; but, although convulsions so frequently occur, typical hysterical cases pass through the whole course of the disorder without suffering from spasm of any kind.
In a general neurosis a definition, well considered, should serve the purpose of controlling and guiding, to a large extent at least, the discussion of the subject.
The definition given asserts that hysteria is a functional disease. In the present state of knowledge this is the only ground that can be taken. It is claimed that in a strict sense no disease can be regarded as functional; but it is practically necessary to use such terms as functional in reference to affections in which disordered action without recognizable permanent alteration of structure is present. Temporary anatomical changes must sometimes be present in hysteria; organic disease may be a complication in special cases; post-mortem appearances may occasionally be found as accidents or coincidences; it is possible that structural alterations may result from hysteria; but no pathologist has as yet shown the existence of a special morbid anatomy underlying as a permanent basis the hysterical condition.
The mental, motor, sensory, and other phenomena of hysteria cannot be explained except by regarding the cerebro-spinal nervous system as the starting-point or active agency in their production.
The term vaso-motor is used in a broad sense to include not only peripheral vascular disturbances, but also cardiac, respiratory, secretory, and excretory affections of varying type. Some of these disorders are also visceral, but under visceral affections are also included such hysterical phenomena as abdominal phantom tumors, hysterical tympanites, and the like.
That all hysterical phenomena are related in varying degree to abnormal psychical conditions may perhaps, at first sight, be regarded as open to dispute and grave doubt. It is questionable whether in every case of hysteria the relation of the symptoms to psychical states could be easily demonstrated. I certainly do not look upon every hysterical patient as a case of insanity in the technical sense, but hold that a psychical element is or has been present, even when the manifestations of the disorder are pre-eminently physical. James Hendrie Lloyd,2 in a valuable paper, has ably sustained this position, one which has been held by others, although seldom, if ever, so clearly defined as by this writer.