[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.

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.

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.

[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.

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.

Etiology, pathogenesis, and therapy according to Pierre Janet concerning conversion disorders and dissociative disorders.

Pierre Janet's works on conversion disorders or dissociative disorders has mainly fallen to the wayside in favour of Freud's works. In the first part of this paper, Janet's conception of hysteria is discussed and his place in French psychiatry described. Different aspects of Janet's diathesis-stress approach are presented (particularly the pathogenic concept of fixed ideas), which refer not only to a conception of hysteria but also to traumatic (stress) disorders and other psychological disturbances. The second part of the paper details the varieties of Janetian therapeutic treatments of these disorders: the "liquidation" of fixed ideas by hypnosis and suggestion, confrontation techniques, which resemble contemporary cognitive behavioural approaches, and special cognitive ("logagogic") interventions. Finally, we discuss the various treatment strategies based on psychoeconomic considerations such as physical or psycho-phyical therapies, psychoeducation, treatment through rest, and simplification of life for dealing with basic disturbances of psychic disorders.

[Hysterical mutism]. / Le mutisme hystérique.

BACKGROUND: Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose, and whose treatment is poorly codified. Hysterical mutism is a disorder of the vocal function without changing the integrity of the body, resulting in loss of voice. Identified at all times, hysterical mutism entered the medical field in the late nineteenth century, under the direction of Jean-Martin Charcot (Salpêtrière School). Since then, although the disorder has emerged as a clinical entity, it remains little known. METHOD: A systematic review of the literature. We performed electronic literatures search of relevant studies using Medline, SUDOC, and BIUM. Search terms used were mutism, functional aphonia, conversion disorder, hysteria. RESULTS: The epidemiology of hysterical mutism is difficult to assess. The first limitation is the lack of consensensual diagnostic criteria. An estimate of its frequency may be advanced through registries consultation of otolaryngology-head and neck surgery. Through a literature review, emerges a rare disorder, about 5% of functional dysphonia. The sex-ratio is in favour of women. Regarding age of onset of disorder, functional aphonia mainly concerns adults with an average around the age of 30-40 years. The onset of the disorder typically involves a sudden onset and a recent stressful event. The duration of the disorder is difficult to specify. It appears that this dysfunction is rapidly reversible and that the majority of patients are in remission of this disorder within three months. The recurrence of dysfunction seems to be frequent. The existence of psychiatric comorbidity did not appear to be the rule. The natural history of this disorder is not known making it tricky to evaluate the efficiency of therapeutic approaches. CONCLUSION: Today the term hysterical mutism does not appear as an entity in either international classification. It belongs to the category of conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Identified as a medical entity described by the school of the Salpêtrière, this disorder has raised little interest. The medicalization of the condition remains difficult because of the importance of stigma associated with it, which contributes to the rejection rather than support of patients with mutism. To better understand this disorder and improve the care of patients who suffer, renewed interest is warranted.

Alternatives for hand over mouth exercise after its elimination from the clinical guidelines of the american academy of pediatric dentistry.

PURPOSE: The purpose of this study was to survey the alternative behavior management techniques that might be utilized by pediatric dentists in place of hand over mouth exercise (HOME) after its elimination from the clinical guidelines of the American Academy of Pediatric Dentistry (AAPD). METHODS: A questionnaire was electronically mailed to 2,600 AAPD members. The survey included items related to HOME alternatives after the elimination, concerns with its use, and if the elimination had affected access to care for children. RESULTS: Seven hundred four respondents (30%) completed the survey. Voice control was the first alternative, and minimum/moderate sedation was the second most common. Three hundred fifty respondents (50%) believed that HOME is an acceptable behavior management technique, and 290 (41%) believed it should be continued to be recognized by the AAPD. Only 7% believed that HOME elimination affected access to care for some children. CONCLUSION: Advanced behavior management techniques will be utilized more by pediatric dentists after the elimination of the hand over mouth exercise from the American Academy of Pediatric Dentistry's clinical guidelines.

Beyond Lawrence v. Texas: crafting a fundamental right to sexual privacy.

After the watershed 2003 U.S. Supreme Court decision Lawrence v.Texas, courts are faced with the daunting task of navigating the bounds of sexual privacy in light of Lawrence's sweeping language and unconventional structure. This Note focuses on the specific issue of state governments regulating sexual device distribution. Evaluating the substantive due process rights of sexual device retailers and users, this Note ultimately argues that the privacy interest identified in Lawrence is sufficiently broad to protect intimate decisions to engage in adult consensual sexual behavior, including the liberty to sell, purchase, and use a sexual device.

Pierre Janet's addition to Charles-Hubert-Antoine Despine's "Old but very curious" Estelle L'Hardy monograph.

In the magisterial book The Discovery of the Unconscious, Ellenberger (1970) showed a keen appreciation for practitioners of many schools of therapy, including those who practiced animal magnetism (hypnotism). He credited Despine and Janet for their contributions to dynamic psychiatry and documented Janet's intellectual debt to Despine's successful magnetic treatment of 11-year-old Estelle's hysteria (dissociative disorder). No scholarship, however, has identified Janet's unique addition to Despine's 1838/1839 monograph--written decades before Janet's birth. Supplementing Despine's account of Estelle's minor fall that precipitated her paralysis, Janet reported that Estelle disobeyed her mother by quarreling with a friend, soiled her frock, experienced fright and shame, and sought to conceal everything from her mother. The author argues (a) that Despine knew yet wisely excluded Janet's data lest Estelle's family prevent his publishing the case; (b) that Janet's published data about the youngster's fall reached him through a professional network; and (c) that Janet's plausible addition comports well with his theoretical psychology of action--used in this article to explain the fine-grained parsing of Estelle's inner processes during the milliseconds of her fall: her vehement affect substituted for adaptive behavior. This article deepens the understanding of the Despin-Janet connection; maintains that Janet's addition deserves a place in the tradition of the medical case report; encourages trauma specialists to become familiar with their pioneers; and highlights the clinical continuity from Janet's affirmation of Despine's pioneering treatment strategies with the chronically traumatized to contemporary treatment for the same population, conceptualized along Janetian lines.

A further excavation of seduction, seduction trauma, and the seduction theory.

Freud's pre-analytic concept of seduction trauma was interwoven with the emerging concepts of an unconscious pathogenic past, repression, and reconstruction. The formulation of this theory of neurosogenesis involved important current, as well as past, determinants. Freud was psychologically seduced by Fliess and unwittingly colluded in the nearly fatal surgery Fliess performed on Emma Eckstein. The formulation and subsequent repudiation of the seduction theory approximated the period from the traumatic experience of Freud with his patient Emma Eckstein to her apparent recovery. Freud's seduction theory, with its focus on childhood sexual abuse, simultaneously defended against both aggression and the current traumatic situation. Defenses against aggression were intensified in an atmosphere of virulent anti-Semitism. The seduction theory is relevant to contemporary issues concerning psychic trauma, psychic reality and objective reality, memory, and reconstruction.

Mass psychogenic illness (epidemic sociogenic attacks) in a village in Lebanon.

Mass psychogenic illness (epidemic sociogenic attacks/mass hysteria) refers to a rapid spread of well-described signs and symptoms affecting members of a group. It might be difficult to differentiate at first from illnesses due to infections, intoxications or "bio-terrorism." We investigated such an occurrence in a small village in Lebanon chronically under threat of war. A 16-year-old single female, school student, was referred to Saint George Hospital University Medical Center, Beirut, for attacks of shortness of breath, muscle cramps, tremors and dizziness, for several days. She was referred because she was the first of eight cases from the same village to have similar symptoms. In parallel to an inpatient multidisciplinary evaluation and treatment, meetings were held with the crisis group comprising members of the hospital Psychiatry and Psychology Department, a public health representative of the Ministry of Health of Lebanon, physicians who were taking care of the other cases and a psychologist working in the area where these cases were declared. The diagnosis of mass psychogenic illness (epidemic sociogenic attacks) was reached. A common strategy was adopted in an effort to control the epidemic. Several explanations had been put forward initially by the community : bioterrorism, noxious fumes and "bad spirits." At the time of writing this report--nine months later--, the epidemic, which had abated within six weeks, was still inactive.

Benjamin Franklin and the neurosciences.

Benjamin Franklin (1706-1790), who is better known in other fields, especially colonial politics and international diplomacy, was an early, major contributor to the neurosciences from the New World. Among his accomplishments are: experiments on medical electricity as a possible cure for the palsies and hysteria; the first descriptions of how electricity affecting the brain can cause a specific type of amnesia; supporting the idea that cranial shocks might provide a cure for melancholia; showing that the cures performed by the Mesmerists to remove obstructions, including nerve blockages, rest on gullibility and suggestion, and recognizing the dangers, including those to the nerves, posed by exposure to lead. Franklin?s neuroscience was firmly based on experiments, careful observations, and hard data ? and finding clinical relevance for new discoveries was always on his mind.

[Psychiatric disorders in non demented elderly people]. / Troubles mentaux non démentiels des personnes agées.

Psychogeriatrics is a rapidly growing field. In France, the focus is currently on targeted education and specific management. Psychiatric disorders may be atypical in the elderly, and may also be difficult to distinguish from the effects of aging or somatic disorders. The principal disorders observed in old age are depression, late delusion, anxiety disorder, hysteria, delirium and mania. Depression has specific features, depressive equivalents, particular risk factors, and a categorical and dimensional therapeutic approach. Diagnosis and screening must be improved Late delusion is organized around a notion of injury, and is an active attempt to deal with isolation, depression and anxiety. The term "very late-onset schizophrenia-like psychosis" has been proposed. Anxiety also has specific features in the elderly and is intimately related to depression. If left untreated, the consequences can be severe. Hysteria is pathoplastic with time, age and educational status. Pseudocognitive conversions are starting to be seen in old age. Delirium is very frequent in the elderly; it is often multifactorial, but psychosocial factors must not be underestimated. Mania can also be provoked by somatic disease, and mixed syndromes are far from rare. Dementia can be approached from its psychopathological dimension, particularly in terms of psychosocial risk factors and protective factors relating to the individual's biography and personality. Thus, psychogeriatrics is an integrated medical discipline in which psychiatric disorders are approached through specific clinical management, oriented research and structured training.

Psychodynamic changes in untreated neurotic patients. II. Apparently genuine improvements.

This work is part of a study of 45 neurotic patients who were seen for consultation at the Tavistock Clinic but who never received treatment, and who, by the time they were asked to come for follow-up, had never been interviewed by a psychiatrist more than twice in their whole lives. In a previous report, we described 13 patients who were at least "improved" on purely symptomatic criteria but whom we did not regard as improved on dynamic criteria. Here, we describe 11 patients who were judged to be improved on dynamic criteria. These patients are of extraordinary interest, providing not only direct evidence of therapeutic mechanisms in everyday lifean answer to a question posed by Strupp and Bergin in 1969but also, quite unexpectedly, evidence about the therapeutic effects of single interviews.