[Striving for power and aggression - underestimated aspects in the psychotherapy of hysteria]. / Machtstreben und Aggression ­ unterschätzte Aspekte in der psychotherapeutischen Behandlung der Hysterie.

Question: For decades hysteria has been psychodynamically interpreted sexualized as part of a frustrated desire with a depressive core. However, this "victim" side should be faced with the other often hidden aspects of hysteria with aggression and striving for power. Method: The basic hypothesis pursued here is that the hysterical/histrionic person was not primarily "disadvantaged" in his or her development, but that his or her striving for power and thus his or her potential for aggression is to be understood above all as a learned mode of global relationship that the adolescents have learned to respond and assert themselves to an intra-familiar situation of tension and pressure. Results: Any therapy that does not take this sufficiently into account falls short and reinforces the underlying mechanism of the therapeutic relationship dynamics. During treatment the patient must increasingly feel how much destruction and loneliness this global relationship implies. Conclusions: Only if the patient experiences that reduction of dominance and self-reference as well as increase of "true" felt empathy lead to more satisfying relations, the "imprisonment" in hysterical mode can be gradually lifted.

Sabina Spielrein: From Being a Psychiatric Patient to Becoming an Analyst Herself.

In this paper, I evaluate Sabina Spielrein's life and ideas from a contemporary understanding. I do this by considering the context and situation in which she lived: a journey from being a hospitalized psychiatric patient to becoming a psychoanalyst herself. From her crucial life experiences she learned that the main psychic conflicts stem from the struggle between life and death, and not from opposing ego drives and sexual desires. Spielrein's considerable creative potentials were nurtured, as well as blocked by her inner conflicts, but also by the enormous historical conflicts of her time.

Abrupt treatments of hysteria during World War I, 1914-18.

Case reports of the abrupt recovery of hysterical disorders during World War I (1914-18), though undoubtedly subject to publication bias, raise both aetiological and treatment issues regarding pseudo-neurological conversion symptoms. Published clinical anecdotes report circumstantial, psychotherapeutic, hypnotic, persuasive (and coercive) methods seemingly inducing recovery, and also responses to fright and alterations of consciousness. The ethics of modern medical practice would not allow many of these techniques, which were reported to be effective, even in the chronic cases.

Edgar Adrian (1889-1977) and Shell Shock Electrotherapy: A Forgotten History?

The English electrophysiologist Edgar Adrian (1889-1977) was the recipient of the Nobel Prize for physiology in 1932 for his research on the functions of neurons. During World War I, at Queen Square in London, he devised an intensive electrotherapeutic treatment for shell-shocked soldiers. The procedure, developed with Lewis Yealland (1884-1954), was similar to "torpillage," the faradic psychotherapy used in France. Adrian and Yealland considered that the pain accompanying the use of faradic current was necessary for both therapeutic and disciplinary reasons, especially because of the suspicion of malingering. According to Adrian, this controversial electric treatment was only able to remove motor or sensitive symptoms. After the war, he finally admitted that war hysteria was a complex and difficult phenomenon.

[When medicine appeals to our feelings: Charles de Villers' Le magnétiseur amoureux]. / Quand la médecine nous prend par les sentiments: Le magnétiseur amoureux de Charles de Villers.

This article analyses the representation of affective phenomena brought into play in Charles de Villers' Le magnétiseur amoureux (1787) as it helps to better understand the historical transition from the Galenic conception of the passions of the soul to the cerebral interpretation of emotions. While feelings became the condition of possibility in the occurrence of the therapy, passion is identified as the cause of the young woman's illness, Caroline, who according to the interpretation proposed in this article, suffers from what was identified in the eighteenth century medical tradition as "love melancholy" or "hysteric affection", which were both pathologies that alluded to vapors in order to explain their symptoms. The analysis of the logic of feeling running across Villers' novel impels us to interpret the magnetic fluid in terms of the sympathy created between the two main characters. The ambivalence expressed by Villers between the meaning of "love sentiment" and that of "love passion" allows us to finally understand the somnambulist therapy as erotic knowledge that implies a reflection on love codes in late eighteenth century France.

'Shell shock' revisited: an examination of the case records of the National Hospital in London.

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain's leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient's military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.

The girls of La Salpêtrière.

It was only by chance that French hospital authorities assigned Jean-Martin Charcot to the care of hysterics and epileptics, starting in 1870, at La Salpêtrière Hospital. The famous clinical work that resulted has been the subject of much discussion and, in many cases, misinterpretation. By referring to original sources, i.e., the medical observations written at the time by the department's staff, our aim is to bring the hospitalized patients to life. Many of these observations contain intimate details and reveal the painful experiences that led these young women to La Salpêtrière. To understand the gradual, 20-year evolution of Charcot's neurological thinking about hysteria, from organicity to psychology, in both clinical and therapeutic terms, it is more revealing to analyze all the physical and psychological miseries that make up this forgotten 'human material' than it is to examine the neurologist's famous lessons.

Public medical shows.

In the second half of the 19th century, Jean-Martin Charcot (1825-1893) became famous for the quality of his teaching and his innovative neurological discoveries, bringing many French and foreign students to Paris. A hunger for recognition, together with progressive and anticlerical ideals, led Charcot to invite writers, journalists, and politicians to his lessons, during which he presented the results of his work on hysteria. These events became public performances, for which physicians and patients were transformed into actors. Major newspapers ran accounts of these consultations, more like theatrical shows in some respects. The resultant enthusiasm prompted other physicians in Paris and throughout France to try and imitate them. We will compare the form and substance of Charcot's lessons with those given by Jules-Bernard Luys (1828-1897), Victor Dumontpallier (1826-1899), Ambroise-Auguste Liébault (1823-1904), Hippolyte Bernheim (1840-1919), Joseph Grasset (1849-1918), and Albert Pitres (1848-1928). We will also note their impact on contemporary cinema and theatre.

World War I psychoneuroses: hysteria goes to war.

During the First World War, military physicians from the belligerent countries were faced with soldiers suffering from psychotrauma with often unheard of clinical signs, such as camptocormia. These varied clinical presentations took the form of abnormal movements, deaf-mutism, mental confusion, and delusional disorders. In Anglo-Saxon countries, the term 'shell shock' was used to define these disorders. The debate on whether the war was responsible for these disorders divided mobilized neuropsychiatrists. In psychological theories, war is seen as the principal causal factor. In hystero-pithiatism, developed by Joseph Babinski (1857-1932), trauma was not directly caused by the war. It was rather due to the unwillingness of the soldier to take part in the war. Permanent suspicion of malingering resulted in the establishment of a wide range of medical experiments. Many doctors used aggressive treatment methods to force the soldiers exhibiting war neuroses to return to the front as quickly as possible. Medicomilitary collusion ensued. Electrotherapy became the basis of repressive psychotherapy, such as 'torpillage', which was developed by Clovis Vincent (1879-1947), or psychofaradism, which was established by Gustave Roussy (1874-1948). Some soldiers refused such treatments, considering them a form of torture, and were brought before courts-martial. Famous cases, such as that of Baptiste Deschamps (1881-1953), raised the question of the rights of the wounded. Soldiers suffering from psychotrauma, ignored and regarded as malingerers or deserters, were sentenced to death by the courts-martial. Trials of soldiers or doctors were also held in Germany and Austria. After the war, psychoneurotics long haunted asylums and rehabilitation centers. Abuses related to the treatment of the Great War psychoneuroses nevertheless significantly changed medical concepts, leading to the modern definition of 'posttraumatic stress disorder'.

History of physical and 'moral' treatment of hysteria.

This historical review presents the advances made mostly during the last 200 years on the description, concepts, theories, and (more specifically) cure of patients suffering from hysteria, a still obscure entity. The denomination of the syndrome has changed over time, from hysteria (reinvestigated by Paul Briquet and Jean-Martin Charcot) to pithiatism (Joseph Babinski), then to conversion neurosis (Sigmund Freud), and today functional neurological disorders according to the 2013 American Neurological Association DSM-5 classification. The treatment was renewed in the second half of the 19th century in Paris by Paul Briquet and then by Jean-Martin Charcot. Hysterical women, who represented the great majority of cases, were cured by physical therapy (notably physio-, hydro-, and electrotherapy, and in some cases ovary compression) and 'moral' therapies (general, causal therapy, rest, isolation, hypnosis, and suggestion). At the turn of the 19th and 20th centuries, psychotherapy, psychoanalysis, and persuasion were established respectively by Pierre Janet, Sigmund Freud, and Joseph Babinski. During World War I, military forces faced a large number of posttrauma neurosis cases among soldiers (named the 'Babinski-Froment war neurosis' and Myers 'shell shock', in the French and English literature, respectively). This led to the use of more brutal therapies in military hospitals, combining electrical shock and persuasion, particularly in France with Clovis Vincent and Gustave Roussy, but also in Great Britain and Germany. After World War I, this method was abandoned and there was a marked decrease in interest in hysteria for a long period of time. Today, the current treatment comprises (if possible intensive) physiotherapy, together with psychotherapy, and in some cases psychoanalysis. Antidepressants and anxiolytics may be required, and more recently cognitive and behavioral therapy. Repetitive transcranial magnetic stimulation is a new technique under investigation which may be promising in patients presenting with motor conversion syndrome (motor deficit or movement disorder). Functional neurological disorders remain a difficult problem to manage with frequent failures and chronic handicapping evolution. This emphasizes the need for therapeutic innovations in the future.

'Hysteria' today and tomorrow.

'Hysteria' (conversion disorder) remains in modern humanity and across cultures, as it has for millennia. Advances today in tools and criteria have afforded more accurate diagnosis, and advances in treatments have empowered patients and providers, resulting in a renewed interest in somatoform disorders. Future progress in understanding mechanisms may be influenced by developments in functional neuroimaging and neurophysiology. No animal model exists for somatoform symptoms or conversion disorder. Despite the absence of a known molecular mechanism, psychotherapy is helping patients with conversion disorder to take control of their symptoms and have improved quality of life, shedding light on what was once an enigma.

Hysterical identification in an eleven-year-old girl.

The concept of hysterical identification was reviewed and illustrated in child analytic process material obtained in the treatment of a latencyage girl. It is the author's contention that "hysteria" and its dynamics, for example, hysterical identification, have fallen into disuse, to the disservice of our child patients. This contribution is aimed at getting child analysts to reconsider the merits of this outcome.

Miraculous healings of paralysis: a preliminary study on sources.

The aim of the present paper has been to explore the medieval evidence on miraculous healings of paralysis and to confront it with modern medical knowledge. Paralysis has been selected as a model for such a study and St. Bernardino of Siena (1380-1444) as a model of a saintly healer. Analyzed were the primary sources and modern literature. Paralysis was found to be among the most frequent diseases in medieval miracle reports, including the healings by St. Bernardino. According to the hypothesis offered in the paper, the majority of medieval cases of "miraculously healed paralysis" was of conversive origin.