Phenomenon of Nightclub Shots: Mass Psychogenic Disease?

BACKGROUND: This article examines the possibility that the "nightclub shots" epidemic is a "mass psychogenic disease" phenomenon, by comparing the various cases of "mass sociogenic diseases" reported in the literature. We carried out a literature review on PubMed. The keywords used were "mass hysteria", "mass sociogenic disease", "mass psychogenic disease" and "epidemic of multiple unexplained symptoms". RESULTS: Our review of the literature revealed several elements common to the various "mass hysterias" we identified. These phenomena generally appear in a climate of anxiety specific to the era in which they occur, in this case the fear of bioterrorism in the 21st century. Symptoms are generally benign and transient, appearing and resolving easily without the identification of an organic cause. They usually occur in a small group of individuals, and more frequently in young people and women. The media can exacerbate the phenomenon. CONCLUSION: The phenomenon of epidemics of nightclub shots seems to fit into the common framework of "mass psychogenic diseases" identified in the literature. This diagnosis could therefore be evoked, in the absence of any other objective somatic explanation.

From hysteria to gait dementia: History of the concept of astasia-abasia.

Paul Blocq (1860-1896) and his teacher Jean-Martin Charcot (1825-1893) introduced the expression "astasia-abasia" into medical terminology in 1888 to designate a pathology they believed to be caused by hysteria. This condition makes it impossible to remain erect and to walk, whereas the ability to move the legs while lying down remains normal. At the turn of the 20th century, and now almost exclusively, this motor disturbance is recognised as a syndrome with multiple possible organic causes, and now described as "higher-level gait disorder". After briefly mentioning earlier descriptions by other authors, I will review Charcot's Tuesday lessons in 1889 that covered astasia-abasia and elucidated the beginnings of the breakdown into organic aetiologies: medial-frontal and corpus callosum tumors, damage to the cerebellar vermis, lacunar state as described by Pierre Marie (1853-1940), Parkinson's disease, and Parkinson-plus syndrome. The long history of astasia-abasia reveals a cluster of neurologists, often emerging from oblivion herein and all of whom, through the precision of their clinical examinations and their pathophysiological findings, helped advance the understanding of the mechanisms by which human beings are the only erect, constantly bipedal mammals, whether immobile or walking.

The natural history of terms describing functional (neurological) disorders in the medical literature of the last 60 years.

BACKGROUND: Functional neurological disorders (FND), a subtype of functional disorders (FD), are a frequent motive for neurology referrals. The various presentations and the unknown physiopathology of FD have led to the multiplication of terms describing these disorders over the years. METHODS: We examined the FD-related articles published from 1960 to 2020 in PubMed and PsycINFO databases. We searched for: psychogenic, somatization, somatoform, medically unexplained symptoms, hysteria, conversion disorder, dissociative, functional neurological disorder, and functional disorder. Use rates in the title, abstract, keyword, or MeSH fields were collected over successive 5-year periods. After correcting for off-topic results, we examined proportional distribution over time, term associations, and disciplinary fields (neurology and psychiatry). Term impact was estimated via H-index and number of citations. RESULTS: We found that none of the terms is prevailing in the recent medical literature. We observed three trends in the use rates: stability, increase, and decrease of use over time. While most of the terms were present in a stable proportion of the publications, hysteria and psychogenic lost popularity over time. We found a differential preference for terminology between disciplines. Functional neurological disorder showed the highest citation impact, yielding 10% of highly cited publications. CONCLUSION: We found a dynamic and evolving use of the different terms describing FD in the last 60 years. Despite the tendency to use the term functional in the recent highly cited publications, its low prevalence and coexistence with several other terms suggest that a precise, explanatory and non-offensive term remains yet to be found.

What Has Happened to Hysteria?

This article traces the history of the diagnosis of hysteria from the earliest medical formulations in the 17th century to the present, including the presence of this diagnosis in the five iterations of the Diagnostic Statistical Manual (DSM) of the American Psychiatric Association. Several different types of hysteria are discussed, with alternative causal explanations. Research focusing on this disorder is summarized.

La histeria clásica y moderna: una visión sinóptica Parte II Diagnóstico / Classic and modern hysteria: a synoptic view. Part II Diagnosis

Todo diagnóstico de un problema descubierto lleva implícito un proceso de análisis y síntesis. Todavía no se ha logrado encontrar una clara definición de la histeria, precisamente por su "psicoplasticidad", es decir, por la infinidad de expresiones clínicas en que se puede presentar. Además su eliminación de los códigos diagnósticos la fragmentó en diversos síndromes o conjuntos sintomáticos. El psicoanálisis, asociado al concepto, fue desperfilado por la psiquiatría americana con el advenimiento de la investigación biológica sobre trastornos mentales y nuevos descubrimientos como los sistemas de neurotransmisores. Quedaron atrás los criterios de Feighner, que abarcaban los diagnósticos de neurosis de ansiedad, neurosis obsesivo-compulsiva, neurosis fóbica, histeria. Se analiza clasificaciones CIE y DSM, en las que se puede rastrear la histeria. Palabras claves: histeria, neurosis, diagnóstico, CIE-10.

Every diagnosis of a discovered problem implies a process of analysis and synthesis. A clear definition of hysteria has not yet been found, precisely because of its "psychoplasticity", that is, by the infinity of clinical expressions in which it can be presented. In addition its elimination of the diagnostic codes fragmented it in diverse syndromes or symptomatic sets. Psychoanalysis, associated with the concept, was unburied by American psychiatry with the advent of biological research on mental disorders and new discoveries such as neurotransmitter systems. Feighner's criteria, which included diagnoses of anxiety neurosis, obsessive-compulsive neurosis, phobic neurosis and hysteria, were left behind. We analyze CIE and DSM classifications, in which hysteria can be traced.

Diferentes destinos de lo no neurótico: introducción al tema monográfico / No disponible

No disponible

Sexual Trauma at the Salpetriere.

Jean-Martin Charcot who studied hysteria at the Salpetriere hospital in Paris late in the nineteenth century is often portrayed as a great neurologist. According to standard accounts, his female hysterical patients imitated the seizures of epileptic patients at the Salpetriere in order to get attention because of their dramatic, self-centered natures. They were also prone to making false allegations of childhood sexual abuse. In fact, the so-called hysterical seizures were often abreactions of rapes. The patients commonly had extensive childhood sexual abuse histories, and sexual misconduct by doctors was endemic at the Salpetriere. The pathological counter-transference towards "hysterical women" at the Salpetriere has been repeated in the twentieth and twenty-first centuries in attitudes expressed towards dissociative identity disorder.

Mitchell's case of "pendulum spasms": psychogenic movement disorder considered as male hysteria.

BACKGROUND: In the late 19th century, a man with a psychogenic movement disorder was evaluated by many of the Philadelphia neurologists associated with Silas Weir Mitchell. In 1885, prior to the development of movie cameras or projectors, the patient was photographed by pioneering photographer Eadweard Muybridge, in collaboration with neurologist Francis Dercum, using arrays of sequentially triggered single-image cameras. The photographic sequences are among the first motion picture sequences of patients with neurologic disorders. METHODS: Examination of extant primary source documents concerning this patient, including published writings and photographic sequences by Muybridge and Dercum, the original clinical descriptions, Mitchell's documentation of the patient's later clinical course, and results of the autopsy. RESULTS: Mitchell and his colleagues concluded that this was a "case of undoubted hysteria" in a man. Support for this contention includes the following: protracted course, spanning decades with temporary remissions; inconsistent character of the movement and features incongruous with typical "organic" tremors; complex, bizarre movements that are difficult to classify; increase in movements with attention; alteration in frequency of the movements with movement of the opposite arm; ability to trigger or temporarily stop the movements with unusual or nonphysiologic interventions; involvement of the opposite arm in a synchronous abnormal movement later in the course; remission with hypnotic suggestion; absence of other neurologic signs; and normal brain autopsy. CONCLUSION: The clinical history, serial examinations, photographic documentation, and autopsy results support Mitchell's contention that this was a case of male hysteria, or, in modern terminology, a psychogenic movement disorder.

[Pseudodementia, what are we talking about? Part I: In search of Wernicke's pseudodementia]. / Pseudodémence, de quoi parle-t-on ? Partie I : à la recherche de la pseudodémence de Wernicke.

OBJECTIVE: The authors explore the history of pseudodementia in the elderly; an issue with growing momentum in a world where life duration expectancy has been constantly growing and the management and treatments of dementias has imposed an equally increasing burden. Although the issue is mainly therapeutic, some of the main tenets of the current approaches rest heavily on historical issues. The invention of the term pseudodementia (Pseudodemenz) is usually credited to Wernicke. However, the exact circumstances and the debates that have accompanied the emergence of the term have never been fully uncovered, and the references are not accurate. Most of the recent literature cites Kiloh as the key influence in structuring the current uses of the term, but the relationship between both sources is not clear. METHODOLOGY: A research of anteriority has been conducted on the basis of Medline via Pubmed, PsychINFO and google book, using the following keywords: pseudodementia, pseudodementia, depressive pseudodementia, pseudodémence, Pseudodemenz. We have researched the quotations to localize the origin of the concept. Complementarily, we have attempted to clarify the nature of the debates by exploring the relevant German psychiatric literature at the end of the XIXth century and the beginning of the XXth. RESULTS: We have found that the very first occurrences of the notion appeared in a debate between the following authors: Ganser S.J.M. 1898, 1903; Wernicke C. 1898; Raecke J. 1901; Nissl F. 1902; Jung C.G. 1902, 1903; Stertz G. 1910; Bonhoeffer K. 1911; Schuppius S. 1914. We found that the term Pseudodemenz never appears in Wernicke's written works, although he was credited of its invention by his most direct students. It seems that the term was thought by the time it emerged to have originated in Wernicke's discussion of Ganser's syndrome. DISCUSSION: Ganser's syndrome, often defined as carceral psychosis, is a specific hysterical twilight state characterized by "talking past the point" (Vorbeireden), amnesia and hysterical stigmas, in which some trauma was thought to be causative. Wernicke presented it as determined by a "restriction of the field of consciousness", echoing Janet's theory (École de la Salpêtrière). He rejected the twilight characteristic: this differential point seems to have initiated the introduction of the concept of pseudodementia. Raecke argued that such states should not be understood as forms of simulation thus contributing to a heated debate of the time. Referring to Janet's works and expanding the syndrome of "traumatic hysteria", he argued in favor of a specific inhibiting factor which disturbs the process of associations. Jung, refusing Nissl's article dismissing Ganser, Wernicke and Raecke's views, confirmed the hysterical hypothesis. In a new contribution to the debate, Ganser contested Wernicke's differential point, arguing that in Vorbeireden, there was a Benommenheit - some sort of giddiness - and a "superficiality of the contents of consciousness" rather than a limitation of consciousness. It has been rightly argued that Wernicke's view of the pseudodementia issues was mainly related to the debates on hysteria and trauma, and that no relationship with old age symptomatology was established by him. However, we have found that he alluded to at least one case in which such a relationship was hypothesized. Moreover, one should note that Wernicke's views on hysteria included the rather pervasive notion of "hysterical psychosis", exhibiting "allopsychosis", which could include what would nowadays be seen as schizophrenia or psychotic mood disorders. CONCLUSIONS: First of all, the term Pseudodemenz, if it was ever used by Wernicke verbally, never appears in his published works. Besides, the debates concerning Ganser's syndrome, which served as a first paradigm to discuss pseudodementia, were highly influenced by the discussions on traumatic disorders, hysteria and simulation. Finally, although no direct connection is made between disorders of the senium and Pseudodemenz, the fact that Wernicke included both in what he termed "allopsychic disorders" seemed to indicate that some kind of relationship could not be absolutely excluded in Wernicke's mind.

Minnesota Multiphasic Personality Inventory profile in patients with restless legs syndrome.

INTRODUCTION: Restless legs syndrome (RLS) is associated with psychiatric disorders. We aim to investigate the personality traits of RLS patients using the Minnesota Multiphasic Personality Inventory. METHODS: Twenty adult patients with RLS (14 females and 6 males) and 20 healthy controls (14 females and 6 males) who were referred to university neurology were enrolled in the present study. Diagnosis of RLS was established using International Restless Legs Syndrome Study Group. Psychometric evaluation was made with the Turkish version of the Minnesota Multiphasic Personality Inventory. RESULTS: RLS patients have significantly higher absolute and clinical elevation scores on hypochondriasis and hysteria, and clinical elevation scores on psychasthenia, compared with the controls. Absolute scores on depression were higher at the border in RLS patients compared with the controls. DISCUSSION: RLS patients have hypochondriac, hysterical, depressive, and anxious personality traits.

Clinical manifestations of hysteria: an epistemological perspective or how historical dynamics illuminate current practice.

Hysteria has generated the most heated debates among physicians, from antiquity to the present day. It has been long confused with neuroses and neurological pathologies such as Parkinson's disease and epilepsy, principally associated with women and sexual disorders. The clinical manifestations must first be seen in their historical context, as interpretation varies according to the time period. Recently, the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association marked a break in the consensus that previously seemed to apply to the concept of hysteria and approach to the clinical manifestations. The clinical manifestations of hysteria are numerous and multifaceted, comprising 3 main classifications: paroxysms, attacks, and acute manifestations; long-lasting functional syndromes, and visceral events. Each main classification can be subdivided into several subgroups. The first main group of paroxysms, attacks, and acute manifestations includes major hysterical attacks, such as prodrome, trance and epileptic states, minor hysterical attacks such as syncope and tetany, twilight states, paroxysmal amnesia, and cataleptic attacks. The second group includes focal hysterical symptoms, paralyses, contractures and spasms, anesthesia, and sensory disorders. Visceral manifestations can be subdivided into spasms, pain, and general and trophic disorders. The diversity of the symptoms of hysteria and its changing clinical presentation calls into question the same hysterical attacks and the same symptoms, which have had only a few differences for over 2,000 years. A new definition of hysteria should be proposed, in that it is a phenomenon that is not pathological, but physiological and expressional.

'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.

'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.

Cuando despertó, la histeria todavía estaba allí. Globus hystericus en la hipermodernidad y relato de una psicoterapia / Upon waking, hysteria was still there. Globus hystericus in hypermodernity and a psychotherapy case report

La histeria, inmortal e irreductible, habituada a declararse una y otra vez en rebeldía cuando intenta ser ninguneada y expulsada de las nosografías contemporáneas, se ha mostrado siempre fugaz y proteica, capaz de evolucionar en sus expresiones clínicas y de adaptarse con brillantez a los cambiantes escenarios culturales con que se ha topado a lo largo de la historia. Así, resulta poco probable que la modernidad líquida en la que ha triunfado la fibromialgia asista a espectaculares ataques "à la Sapêtrière". Y, sin embargo, siguen apareciendo en ocasiones llamativos y deliciosamente anticuados cuadros como el bolo histérico que presentamos y que suscita el abordaje psicoterapéutico del que se da cuenta a continuación (AU)

Hysteria, immortal and elusive, has since forever tended to insurrection against the stablished order, specially when contemporary nosographies have tried to ignore and throw it out. Shooting and protean, it has shown the ability to evolve and adapt itself to changing cultural settings throughout history. Thus, it is strange that in liquid modernity, in which fibromyalgia reigns, severe attacks "à la Salpêtrière" happen. Nevertheless, delicious oldfashioned syndromes like globus hystericus show up in clinical settings, and they provoke psychotherapeutic approaches like the one described bellow (AU)

[Neurology of hysteria (conversion disorder)].

Hysteria has served as an important driving force in the development of both neurology and psychiatry. Jean Martin Charcot's devotion to mesmerism for treating hysterical patients evoked the invention of psychoanalysis by Sigmund Freud. Meanwhile, Joseph Babinski took over the challenge to discriminate between organic and hysterical patients from Charcot and found Babinski's sign, the greatest milestone in modern neurological symptomatology. Nowadays, the usage of the term hysteria is avoided. However, new terms and new classifications are complicated and inconsistent between the two representative taxonomies, the DSM-IV and ICD-10. In the ICD-10, even the alternative term conversion disorder, which was becoming familiar to neurologists, has also disappeared as a group name. The diagnosis of hysteria remains important in clinical neurology. Extensive exclusive diagnoses and over investigation, including various imaging studies, should be avoided because they may prolong the disease course and fix their symptoms. Psychological reasons that seem to explain the conversion are not considered reliable. Positive neurological signs suggesting nonorganic etiologies are the most reliable measures for diagnosing hysteria, as Babinski first argued. Hysterical paresis has several characteristics, such as giving-way weakness or peculiar distributions of weakness. Signs to uncover nonorganic paresis utilizing synergy include Hoover's test and the Sonoo abductor test.

Predictive validity of neurotic disorders: a 50-year follow-up study.

INTRODUCTION: In 1965, Erling Jacobsen (1919-1988) defended his doctoral thesis on neurosis in which he tested the psychoanalytic theory of eridophobia as an internalising hostility factor with a specific causality for anxiety neurosis. He found no marked difference between anxiety neurosis and obsessive-compulsive neurosis, which, however, both differed from hysterical neurosis. The aim of this follow-up study was to evaluate to which extent anxiety neurosis and obsessive-compulsive neurosis when compared with hysterical neurosis co-existed with depression, both at the level of diagnostic behaviour, including committed suicide, and with regard to symptom profile. MATERIAL AND METHODS: A total of 112 patients were followed on the Danish Central Psychiatric Research Register and the Danish Cause of Death Register with regard to their diagnostic behaviour. In a subset of the sample (n = 24), the patients were assessed using the Hopkins Symptom Checklist (SCL)-90. RESULTS: Both at the diagnostic level, including suicide rate, and at the level of symptom severity (SCL-90), anxiety neurosis and obsessive-compulsive neurosis were similar, in contrast to hysterical neurosis which had no more association with the other two categories of neurosis than would be expected by chance. CONCLUSION: Anxiety neurosis and obsessive-compulsive neurosis are more severe disorders than hysterical neurosis, both in terms of symptom profile and depression, including suicidal behaviour. The identified suicides were committed within the first two decades after discharge from the index hospitalisation. FUNDING: Poul M. Færgemann's Grant and the Neurosis Grant of 22 July 1959. TRIAL REGISTRATION: not relevant.

Histeria e diagnóstico psiquiátricona contemporaneidade: tensões com a psicanálise / Hysteria and psychiatric diagnosis in contemporary times: tensions with Psychoanalysis

Este trabalho apresenta uma breve apresentação crítica da história do DSM. A partir de fragmentos de um caso clínico atendido em um Centro de Atenção Psicossocial (CAPS) e com base nas controvérsias criadas em torno da classificação DSM, faz-se uma comparação entre um diagnóstico concebido pelo DSM e um diagnóstico realizado pelo viés da Psicanálise com o objetivo de demonstrar que diferentes razões diagnósticas acarretam distintas conduções do tratamento. Demonstram-se ainda as consequências clínicas do modus operandi da Psicanálise com o sujeito histérico, cujo cerne é fazer emergir o sujeito a partir de sua fala. Apontam-se algumas consequências da razão diagnóstica predominante na Psiquiatria contemporânea com sua lógica diagnóstica que desconhece a singularidade do sujeito em seu jogo com o sintoma. Conclui-se que o sintoma histérico pode funcionar como um convite para que o médico ocupe uma posição subjetiva em relação ao sujeito, afastando-se do discurso científico e objetivo,característico da instituição médica.(AU)

This paper presents is a brief critical presentation of the history of DSM. From fragments of a clinical case treated at a Psychosocial Care Center (CAPS) and based on the controversy created around the DSM classification, it is performed a comparison between diagnosis made from the perspective of DSM and Psychoanalysis in order to demonstrate that different diagnostic reasons entail distinct clinical interventions. We also demonstrate the clinical consequences of the Psychoanalysis modus operandi with the hysterical subject, whose core is to emerge the subject from his/her speech. We point out some consequences of the prevailing diagnostic reason in contemporary psychiatry with its diagnostic logic that ignores the singularity of the subject in his/her game with the symptom. We conclude that the hysterical symptom may work as an invitation for the physician to occupy a subjective position in relation to the subject, thus departing from the scientific and objective discourse, which is characteristic of the medical institution.(AU)

Histeria e diagnóstico psiquiátricona contemporaneidade: tensões com a psicanálise / Hysteria and psychiatric diagnosis in contemporary times: tensions with Psychoanalysis

Este trabalho apresenta uma breve apresentação crítica da história do DSM. A partir de fragmentos de um caso clínico atendido em um Centro de Atenção Psicossocial (CAPS) e com base nas controvérsias criadas em torno da classificação DSM, faz-se uma comparação entre um diagnóstico concebido pelo DSM e um diagnóstico realizado pelo viés da Psicanálise com o objetivo de demonstrar que diferentes razões diagnósticas acarretam distintas conduções do tratamento. Demonstram-se ainda as consequências clínicas do modus operandi da Psicanálise com o sujeito histérico, cujo cerne é fazer emergir o sujeito a partir de sua fala. Apontam-se algumas consequências da razão diagnóstica predominante na Psiquiatria contemporânea com sua lógica diagnóstica que desconhece a singularidade do sujeito em seu jogo com o sintoma. Conclui-se que o sintoma histérico pode funcionar como um convite para que o médico ocupe uma posição subjetiva em relação ao sujeito, afastando-se do discurso científico e objetivo,característico da instituição médica.

This paper presents is a brief critical presentation of the history of DSM. From fragments of a clinical case treated at a Psychosocial Care Center (CAPS) and based on the controversy created around the DSM classification, it is performed a comparison between diagnosis made from the perspective of DSM and Psychoanalysis in order to demonstrate that different diagnostic reasons entail distinct clinical interventions. We also demonstrate the clinical consequences of the Psychoanalysis modus operandi with the hysterical subject, whose core is to emerge the subject from his/her speech. We point out some consequences of the prevailing diagnostic reason in contemporary psychiatry with its diagnostic logic that ignores the singularity of the subject in his/her game with the symptom. We conclude that the hysterical symptom may work as an invitation for the physician to occupy a subjective position in relation to the subject, thus departing from the scientific and objective discourse, which is characteristic of the medical institution.