health articles:Women And Hysteria In The History Of Mental Health

Hysteria is undoubtedly the first mental disorder attributable to women, accurately described in the second millennium BC, and until Freud considered an exclusively female disease.
Over 4000 years of history, this disease was considered from two perspectives: scientific and demonological.
It was cured with herbs, sex or sexual abstinence, punished and purified with fire for its association with sorcery and finally, clinically studied as a disease and treated with innovative therapies.
However, even at the end of 19th century, scientific innovation had still not reached some places, where the only known therapies were those proposed by Galen.
During the 20th century several studies postulated the decline of hysteria amongst occidental patients (both women and men) and the escalating of this disorder in non-Western countries.
The concept of hysterical neurosis is deleted with the 1980 DSM-III. The evolution of these diseases seems to be a factor linked with social “westernization”, and examining under what conditions the symptoms first became common in different societies became a priority for recent studies over risk factor.
Keywords: History, Hysteria, Mental Health, Psychiatry, West, Woman.
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We intend to historically identify the two dominant approaches towards mental disorders, the “magic-demonological” and “scientific” views in relation to women: not only is a woman vulnerable to mental disorders, she is weak and easily influenced (by the “supernatural” or by organic degeneration), and she is somehow “guilty” (of sinning or not procreating).
Thus mental disorder, especially in women, so often misunderstood and misinterpreted, generates scientific and / or moral bias, defined as a pseudo-scientific prejudice [1].
19-20th centuries’ studies gradually demonstrate that hysteria is not an exclusively female disease allowing a stricter scientific view to finally prevail.
20th century’s studies have also drawn on the importance of transcultural psychiatry, in order to understand the role of environmental factors in the emotive evolution and behavioral phenomenology and in modifying the psychopathology, producing the hypotheses of a modification to hysteria from the increase of mood disorders.

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Ancient Egypt

The first mental disorder attributable to women, and for which we find an accurate description since the second millennium BC, is undoubtedly hysteria.
The first description referring to the ancient Egyptians dates to 1900 BC (Kahun Papyrus) and identifies the cause of hysterical disorders in spontaneous uterus movement within the female body [2, 3].
In the Eber Papyrus (1600 BC) the oldest medical document containing references to depressive syndromes, traditional symptoms of hysteria were described as tonic- clonic seizures and the sense of suffocation and imminent death (Freud’s globus istericus).
We also find indications of the therapeutic measures to be taken depending on the position of the uterus, which must be forced to return to its natural position.
If the uterus had moved upwards, this could be done by placing malodorous and acrid substances near the woman’s mouth and nostrils, while scented ones were placed near her vagina; on the contrary, if the uterus had lowered, the document recommends placing the acrid substances near her vagina and the perfumed ones near her mouth and nostrils [2, 3].

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The Greek world

According to Greek mythology, the experience of hysteria was at the base of the birth of psychiatry.

The Argonaut Melampus, a physician, is considered its founder: he placated the revolt of Argo’s virgins who refused to honor the phallus and fled to the mountains, their behavior being taken for madness.

Melampus cured these women with hellebore and then urged them to join carnally with young and strong men. They were healed and recovered their wits. Melampus spoke of the women’s madness as derived from their uterus being poisoned by venomous humors, due to a lack of orgasms and “uterine melancholy” [2-4].

Thus arose the idea of a female madness related to the lack of a normal sexual life: Plato, in Timaeus, argues that the uterus is sad and unfortunate when it does not join with the male and does not give rise to a new birth, and Aristotle and Hippocrates were of the same opinion [2-4].

The Euripidy’s myth says that a collective way of curing (or, if we prefer, preventing) melancholy of the uterus is represented by the Dionysian experience of the Maenads, who reached catharsis through wine and orgies [5].

Women suffering from hysteria could be released from the anxiety that characterizes this condition by participating in the Maenad experience. Trance status guided and cured by the Satyr, the priest of Dionysus, contributed to solving the conflict related to sexuality, typical of hysteria disease [6].

Hippocrates (5th century BC) is the first to use the term hysteria. Indeed he also believes that the cause of this disease lies in the movement of the uterus (“hysteron”) [2-4].

The Greek physician provides a good description of hysteria, which is clearly distinguished from epilepsy. He emphasizes the difference between the compulsive movements of epilepsy, caused by a disorder of the brain, and those of hysteria due to the abnormal movements of the uterus in the body.

Then, he resumes the idea of a restless and migratory uterus and identifies the cause of the indisposition as poisonous stagnant humors which, due to an inadequate sexual life, have never been expelled.

He asserts that a woman’s body is physiologically cold and wet and hence prone to putrefaction of the humors (as opposed to the dry and warm male body). For this reason, the uterus is prone to get sick, especially if it is deprived of the benefits arising from sex and procreation, which, widening a woman’s canals, promote the cleansing of the body.

And he goes further; especially in virgins, widows, single, or sterile women, this “bad” uterus – since it is not satisfied – not only produces toxic fumes but also takes to wandering around the body, causing various kinds of disorders such as anxiety, sense of suffocation, tremors, sometimes even convulsions and paralysis.

For this reason, he suggests that even widows and unmarried women should get married and live a satisfactory sexual life within the bounds of marriage [2-4].

However, when the disease is recognized, affected women are advised not only to partake in sexual activity, but also to cure themselves with acrid or fragrant fumigation of the face and genitals, to push the uterus back to its natural place inside the body [2-4].

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Rome

Aulus Cornelius Celsus (1st century BC) gives a good and accurate clinical description of hysterical symptoms. In De re medica Celsus, he wrote “In females, a violent disease also arises in the womb; and, next to the stomach, this part is most sympathetically affected or most sympathetically affects the rest of the system [7].
Sometimes also, it so completely destroys the senses that on occasions the patient falls, as if in epilepsy. This case, however, differs in that the eyes are not turned, nor does froth issue forth, nor are there any convulsions: there is only a deep sleep”.
Claudius Galen’s theories on hysteria (2nd century AD) are comparable to those of Hippocrates. Furthermore Galen says of hysteria “Passio hysterica unum nomen est, varia tamen et innumera accidentia sub se comprehendit” (hysterical passion is the name, but various and several are its symptoms), highlighting the variety of hysterical events [7].
In his work In Hippocratis librum de humoribus, Galen criticizes Hippocrates: “Ancient physicians and philosophers have called this disease hysteria from the name of the uterus, that organ given by nature to women so that they might conceive [7].
I have examined many hysterical women, some stuporous, others with anxiety attacks […]: the disease manifests itself with different symptoms, but always refers to the uterus”. Galen’s treatments for hysteria consisted in purges, administrations of hellebore, mint, laudanum, belladonna extract, valerian and other herbs, and also getting married or repressing stimuli that could excite a young woman [2, 3, 7].
Hysterical cures are only revolutionized by Soranus (a Greek physician from the 1st half of 2nd century AD, practicing in Alexandria and Rome), who wrote a treatise on women’s diseases and who is considered the founder of scientific gynecology and obstetrics : women’ disorders arise from the toils of procreation, their recovery is encouraged by sexual abstinence and perpetual virginity is women’ ideal condition.
Fumigations, cataplasms and compressions are ineffectual, the hysterical body should be treated with care: hot baths, massages, exercise are the best prevention of such women’ diseases [2, 3, 7].
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