Hysterical Psychosis

A Historical Survey

Katrien Libbrecht

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781560001812
• eBook ISBN: 9781351293785
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Hysteria as a neurosis seems to have disappeared altogether from the psychiatric manuals; but there are articles here and there, particularly in the United States and France, which advocate the existence of hysteria as a psychosis. Hysterical psychosis is the clinical combination of a hysterical personality with a seemingly psychotic state. Looking back to nineteenth-century psychiatry, Katrien Libbrecht attempts to answer the question: Is there such a thing as a hysterical psychosis or are we dealing with hysteria exhibiting psychotic features?

Hysterical Psychosis is divided into three sections. The first part of the book carries the reader back to the second half of the nineteenth century, the heyday of the study of hysteria on the eve of the discovery of psychonanalysis. The second part of the book discusses the implications of the generalized impact of Bleuler's concept of schizophrenia during the interbellum period. The last section of the book deals with the current reemergence of hysterical psychosis from the 1960s to the 1990s.

Libbrecht provides a historical survey of the most important psychiatric and psychoanalytic references on hysterical psychosis, as well as a review of current research on the matter. She sheds new light on reasons for the disappearance of the diagnosis of hysteria rn the 1950s and the emergence of the notion of hysterical psychosis during the 1960s. Hysterical Psychosis is a landmark study that is essential for psychoanalysts, psychiatrists, clinical psychologists, medical practitioners, and historians of psychology.

Part One
The Turn of the Century
Recognition of Hysterical Madness, Heyday of the Hysterical Fit

Introduction

The period from the second half of the nineteenth century up until the first years of the twentieth century is marked by dialogue and exchange of clinical and nosological concepts between the two great schools that are at the cradle of clinical psychiatry. They are the French and the German Schools, both in their meaning of nationality and tongue.¹ The fact that the German theoretical textbooks are laced with French clinical material is a concrete trace of this exchange.

The originality of the German works lies in the strength of their attempts at synthesis and in dominance of theory in approaching psychopathological problems. The Germans, whose minds focused on systematicity, excelled in exhaustive, dogmatic classification systems and were disposed to a strong conceptual framework.²

In spite of a rather meagerly turned out conceptual armature the French revealed an extremely pregnant positivistic mind. They were clearly ahead as far as the clinical method was concerned. Above all, description was their forte. Closely in keeping with clinical practice, they tried to arrive at general features. This clinical development was accompanied by extremely vague and broad doctrinal options. The French eschewed dogmatic and rigid systems. One French criticism of the Germans therefore was that every German-speaking psychiatrist of any importance constructed his own classification system, typified by personal neologisms and newly fleshed-out, already existing categories. There simply was no consensus.³

In the year 1860 on French soil we note the birth of the folie hystérique, as a specific form of madness, namely mental illness issuing from hysterical neurosis. Characteristic are mental aberrations, without any exception linked with an inherent mental weakness. Clinically it comprises the most diverse phenomena. This form of madness, peculiar to hysteria, is acknowledged during that same period in German-speaking territory. With this, under one signifier or another, hysterical madness near the end of the nineteenth century is a unanimously accepted and studied entity within clinical psychiatry. Although the psychiatrists still argue over the definition of hysteria, the link between hysteria and madness is unmistakable. This denotation of hysterical madness as a distinct clinical entity precedes the neurological emancipation of hysteria, in line with what psychoanalysis will develop.

In France, this neurological emancipation is here and there precedented and the uncoupling of hysteria from madness and also of neurosis from psychosis is initiated: madness as an affiliated disorder of hysteria. German influences are present in the coupling of hysteria to confusion, characterized by dream-like delusions. Finally, there is the French publication in 1910 of a final monograph on folie hystérique. Hysterical madness is thus carried to its grave without having theoretically demonstrated its clinical singularity.

However, where the French systematically describe the clinical manifestations of hysterical madness, the German psychiatrists develop classification systems in which hysteria is allocated a position both as a distinct form of madness and as a precursor of it. It is a marked German tendency to let the hysterical character or the hysterical nature (be it acquired or not) prevail over the hysterical symptoms which demonstrate little coherence. In it the disorders revolve around a congenital hysterical nucleus. What is emphasized in German-speaking circles is the evolution of the clinical picture rather than the terminal demential state. This reveals itself in widely ramified classification systems. This classification-character of German textbooks sharply contrasts with the explicit monograph-nature of French works.

Towards the turn of the century hysteria as neurosis will let itself be characterized more and more clearly by physical disorders and psychosis more and more by mental disorders. Hysteria will however continue to comprise, albeit in a limited sense, mental disorders next to the already explicitly studied physical complaints. A second shift concerns the range of the mental disorders which initially referred to disorders of the intelligence. These mental disorders are expanded to include disorders of the intelligence, the will, and the character. The seeds of the present era of personality disorders are already present here.

Notes

1. P. Bercherie (1988), Géographie du champ psychanalytique, Bibliothèque des Analytica, Paris, Navarin, p. 137.

2. This is connected with German university psychiatric training, in which scientific and philosophical formation remain strongly associated. P. Bercherie (1980), Les Fondements de la clinique, La Bibliothèque d’Omicar?, Analytica no. 20-21, Paris, pp. 66-67.

3. See for example Annales médico-psychologiques, 1881, 6, 5, pp. 335-341. A certain doctor Châtelain discusses Krafft-Ebing’s textbook and highly appreciates its frugality, in particular regarding the use of neologisms.

1
The Psychiatric Coordinates

The French Alienists

Let us first and foremost state a few concepts that color the discourse of the French physicians during this period.

Under the heading of aliénation mentale(mental derangement),which during those days has the same meaning as folie or madness, used in a vulgarizing sense, the entire gamut of mental illnesses is brought together. It is the only classification which is applied at that time and it is essentially characterized by what are called disorders of intellectual functions. When a condition of mental alienation becomes habitual it results in dementia—a general regression of the mental functions. What is notable is the secondary importance assigned to the presence of delusion. The paralysie générale (general paralysis) applies as a paradigm.¹ This instantly implies that in the first instance mental disorders of an organic origin find accommodation under that heading. Next to this general paralysis there is the gradual development of a series of symptomatic types of mental derangement which, apart from organically determined entities, also start including functional disorders. Hysteria for example.²

Neurosis, the neuropathologist’s specific object of study, in its initial, wider sense encompasses all disorders of the nervous system without a known anatomical basis or assignable neurological damage. To this end Charcot introduces the concept of the dynamical (ephemeral) lesion. The School of the Salpêtrière, of which Charcot was the figurehead and founding father, strictly limits the definition of neurosis. The basic model for this is essential epilepsy.

To further elucidate this we would also like to establish the position of the physician-alienist and that of the physician-neuropathologist in their mutual relationship. In nineteenth-century France the physician who devotes himself to the study and treatment of mentally ill patients or aliénés in the asylums is given the title of physician-alienist, the specific tag alienist clearly conjures up images of mental estrangement. With the rise of psychiatry the title of alienist is more strictly reserved for the medical-judicial sector.³ On the other hand, there is the fact that neuroses which, strictly speaking, are on one side of the boundary of neuropathology, gradually become the exclusive study and therapy field of the physician-neuro(patho)logist. The entourage of Charcot, during the second half of the nineteenth century, is particularly authoritative both with regard to research into and treatment of neurosis.

Birth of a New Entity

Depending on the source consulted it is either Bénédict-Augustin Morel (1809-1873) or Jacques Moreau de Tours (1804-1884) who get the honor of first reporting and clinically describing the folie hystérique (hysterical madness).⁴ This means that in 1860 hysterical madness is described for the first time as a separate entity and given credence as an identity. Prior to this it vanished in the amalgam of mental disorders.

In 1860 Morel’s Traité des maladies mentales was published as the implementation of his innovative vision on pathogenesis.⁵ Within madness two groups are distinguished on the basis of etiology. The first of these two groups can be characterized as those forms of madness in which the madness as an original phenomenon fully ties in with the actions of the cause. Among others it comprises madness stemming from the major neuroses (hysteria, hypochondria, epilepsy). Hysterical madness, too, as a transformed hysteria, finds its place there. Transformed means that the somatic disorders typical of neurosis feature less prominently. They make way for mental disorders which mark the transition to mental derangement. As long as the periods of delusion can be distinguished and intelligence and affective life in between those periods remain unaffected there can be no question of true hysterical madness but of hysterical delusion. “Hysterical” in this sense therefore relates to the origins; the madness is the result of hysteria, it is consecutive to hysteria.⁶ The second group finds its definition in hereditary degeneration, a concept which, in substitution of moral cause, will have great impact on the further development of theoretical concepts with regard to psychopathology.⁷ Morel’s observations of folie hystérique impel the conclusion that the image, to him, is protean.⁸ Specific characteristics are: the linking up of the delusion with neurological disorders that are typical of hysteria, sudden impulsive and potentially dangerous behavior, briefness of occurrence and disappearance of the delusion, and, in conclusion, awareness of the delusion. A terminal demential state is not excluded; hysterical madness is (but) one form of madness.⁹

In 1869, after eight years at the Salpêtrière, Jacques Moreau de Tours, a student of Esquiro’s, published his Traité de la folie névropathique (vulgo hystérique).¹⁰ This frequently quoted clinical reference is marked by the confrontation of Moreau as an alienist with the physician-neuropathologists in residence at the Salpêtrière who take the classical neuroses and in particular hysteria as their object of study and therapy.¹¹ In it Moreau now brings what was still called folie hystérique in his first publication, under the heading of folie névropathique (neuropathic madness). Hysteria becomes a synonym for neuropathy or neurosis —one for the entirety—whilst Morel still subsumes, next to hysterical madness, epileptical and hypochondriac madness under the same category.¹²

Moreau divides neuropathic madness into three categories, the first of which comprises the phenomena which pertain to hysterical delusion rather than to hysterical madness. With this it is made abundantly clear once more that the hysterical delusion is treated separately from hysterical madness. The second category constitutes actual hysterical madness. The third category covers the cases of hereditary transformation of a hysterical nature (Morel’s hysterical madness). The work is, however, essentially devoted to the second category, actual hysterical madness determined by a material neurological disorder. The elaboration is analogous to the previous study. The typification which we include for the sake of completeness, is situated on the same line as Morel’s. There is always a certain awareness of the brief, acute state; there are obvious analogies with both the delusion (artificially) induced by narcotics, and the somnambulistic state and stupor where the delusion is intermittent, and finally there is also the presence of various, violently acute ideas and impulses.¹³

With regard to the earlier mentioned analogy with artificial delusion, we would like to add here that Moreau de Tours puts folie on a par with the state of dreaming, which implies an alteration with regard to how Morel described folie.¹⁴

Falret and Legrand du Saulle

In Jules Falret (1824-1902), who follows in the path of his father Jean-Pierre Falret, we hear a different and older tale. In 1866 he took part in a discussion before the Société médico-psychologique on folie raisonnante, which to his mind is not a separate mental illness but an artificial patchwork of disparate facts belonging to distinct categories. Hysterical madness is also lodged under this heading. He reduces it to two main types, namely the manie hystérique and the folie raisonnante hystèrique. The first ca...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Foreword
• Introduction and Acknowledgements
• Part One The Turn of the Century:Recognition of Hysterical Madness, Heyday of the Hysterical Fit
• Part Two The Interbellum:Hysteria in the Margin, Schizophrenia as a Refuge of Hysterical Madness
• Part Three The 1950s to the Present: The Marginal Psychotic Existence of Hysterical Madness, The Numerical Diaspora of Hysteria
• Conclusion
• Bibliography
• Index