Title

An Analysis of Hysteria

Submitted To-
Dr Isha Yadav
Assistant Professor
Submitted By-
Syed Mohammad Abbas Hasan
No – 240101160
B.A. LL.B (Hons).
2nd Semester
 Index

 Acknowledgement

 Abstract

 Introduction

 Historical Perspectives on Hysteria

 Ancient Theories of Hysteria

 Medieval and Renaissance Interpretations
 18th and 19th Century Developments in Hysteria

 DSM Classification of Hysteria

 Conversion Disorder
 Somatic Symptom Disorder
 Dissociative Disorders

 Causes of Hysteria

 Neurological Causes
 Psychological Causes
 Social and Cultural Influences

 Symptoms of Hysteria and Related Disorders

 Motor Dysfunction
 Sensory Disturbances
 Emotional Instability
 Dissociative Symptoms

 Hysteria Case Study

 Treatment Approaches

 Psychotherapy
 Medication

 Conclusion

 Bibliography
 Acknowledgement

Any accomplishment requires the effort of many people, and this work is no different. Firstly,
I would like to thank “Dr. Ram Manohar Lohiya National Law University" for allowing me
to do this project.
I give grateful acknowledgement to my psychology professor, Dr Isha Yadav, for her
guidance and support during the creation of this project.
Lastly, I would like to thank everyone who helped and supported me directly or indirectly
during the completion of this project, especially my parents and peers, who were a constant
source of motivation and support.
I humbly submit that all the references and links used to research for this project have been
duly acknowledged and recognized under the section of "Bibliography". This project is not
and won't be for any award or degree purpose in any other institution other than Dr Ram
Manohar Lohiya National Law University, Lucknow.

Syed Mohammad Abbas Hasan

No – 240101160
B.A. LL.B (Hons).
2nd Semester, Section B
 Abstract

Research objective:
This project discusses the definition of hysteria, the psychological symptoms, the aetiology,
and sometimes possible treatments tracing the history of the disease. It treats the view of
hysteria from an interaction of biological, psychological, and sociocultural elements, arguing
some modern-day therapies for related disorders. I would also be going through a modern
rendition of a case study conducted by Freud in order to understand the illness better.
Research Methodology
For this project, I shall be primarily relying on secondary review of literature.
Research Questions
1. What is Hysteria?
2. What is the Historical Background of this illness?
3. How is this disorder classified in the DSM V
4. What are the symptoms, causes and treatment of this disorder?
 Introduction

Hysteria has intrigued medical professionals, psychologists, and sociologists for centuries
because of its multifaceted and frequently mysterious symptoms. In the past, hysteria was
regarded as a female disorder, and it was initially explained as being caused by physical
factors, e.g., a "wandering uterus", or supernatural forces, e.g., demonic possession. The word
"hysteria" comes from the Greek word hysteria, meaning uterus, and this is because the
condition was initially thought to be specific to women. In Greece and Egypt, doctors had
thought that an out-of-position uterus was the reason for erratic behaviour, emotional
instability, and nervousness. Some treatments were as simple as using herbs for vaginal
fumigation to try and "entice" the uterus back where it belonged.
In the Middle Ages, hysteria was often linked with witchcraft and possession by demons
since spasms, convulsions, and incoherent speech were believed to be indications of spiritual
impurity. The time was superstitious, and patients suffered at the hands of exorcisms,
religious rituals, and even persecution. Medical treatment was scanty, and patients with
symptoms of hysteria were usually abused or executed on charges of witchcraft. Night terrors
usually affect children. Studies estimate that 1 to 6 per cent of children may be suffering from
night terrors. They are pretty frequent, happening for the first time around the age of 3 and
persisting up until about age 12. They can last for years, improving as a child ages. However,
some cases continue into adulthood, although rarely. Traditionally, what has been attributed
to it is the experience of nightmares- when a person has frightening dreams that occur during
REM sleep- to be remembered by that individual the following day. Although night terrors
and nightmares are horrifying, they differ in that they have fundamental physiological and
psychological manifestations.
French neurologist Jean-Martin Charcot's definition of hysteria as a neurological disorder
opened an important avenue for research. He made use of hypnosis as both a diagnostic and
therapeutic application, trying to prove that so-called hysterical symptoms could be produced
and cured by suggestion. This research would go on to establish a new field of
psychoanalysis.
Charcot's pupil, Sigmund Freud, went further in the explanation of hysteria by establishing its
psychogenic causes. Freud's hypothesis was that hysterical symptoms were really the
manifestations of memories and emotions repressed and brought into awareness through a
clinical psychotherapeutic approach.
Freud's case histories of hysterical women patients laid the ground for his psychoanalytic
theory, which emphasised the effect of the unconscious mind on mental pathology. Freud's
contribution also consists of arguing against framing hysteria as a disease which was
supernatural and physical and defining it as a psychic disorder which came from unexpressed
trauma and inner conflict.
 Historical Perspectives on Hysteria

Ancient Theories of Hysteria

Hysteria as a concept existed in ancient societies, where it was considered a mysterious and
ill-defined disorder, and by extension, was seen to be linked to women because it was thought
to be related to the uterus. The name itself comes from the Greek term hysteria, or uterus,
denoting early speculation that the illness was solely female.
It was the ancient Egyptians who first wrote down hysteria-like symptoms in women. They
explained the illness as being caused by a "wandering uterus" that would travel around the
body and disturb other organs. Treatments varied from fumigations to herbal remedies that
were intended to restore the uterus to its proper position.
In Mesopotamian medicine, the symptoms of hysteria were explained as being demonic
possession and were treated with rituals, prayers, and exorcisms to drive out the assumed evil
spirits. The medical theories of hysteria were significantly shaped by the ancient Greeks.
Hippocrates, the "father of medicine," invented the term "hysterical suffocation" and defined
it as a disease resulting from an upset or wandering uterus. According to him, sexual
abstinence led to the wandering of the uterus, causing physical and emotional symptoms like
fainting, dizziness, and anxiety. The treatments involved marriage, sexual intercourse, and
pessaries to immobilise the uterus.
Philosophers such as Plato and Aristotle added philosophical and ethical interpretations of
hysteria. Plato explained it as a psychosomatic illness brought on by emotional and spiritual
disorders, while Aristotle explained that female biological weakness predisposed them to
emotional instability, further de-stigmatising their psychological health. The Roman
physician Galen developed the Hippocratic theory in ancient Rome, connecting hysteria with
imbalances of bodily humours. He felt that too much black bile was responsible for
melancholy and nervousness, and this resulted in hysterical symptoms. Sexual release as a
cure was advocated by Galen, who used herbal remedies, massage, and aromatherapy to calm
the uterus and stabilise emotions.
In general, early theories of hysteria were misogynist and intrusive, frequently recommending
compulsory marriage or sex as cures. These initial medical and spiritual accounts were
reflective of gender biases and societal misinformation regarding women's mental health and
set the stage for centuries of pathologizing women's feelings.

Medieval and Renaissance Interpretations of Hysteria

In the Medieval and Renaissance eras, the comprehension and management of hysteria
became inextricably linked with mysticism, religion, and superstition. In contrast to the
comparatively biological explanations provided by the ancient Greeks and Romans, hysteria
was increasingly interpreted in spiritual and moral terms, commonly linked with witchcraft,
demonic possession, and corruption. This period was a dramatic departure from previous
medical hypotheses, with the symptoms of hysteria often being misinterpreted as evidence of
sorcery or divine affliction.

The Malleus Maleficarum, a bestselling witch-hunting guide of 1487 written by Heinrich

Kramer and Jacob Sprenger, solidified the link between witchcraft and female hysteria. The
text argued that women were more susceptible to being possessed by demons because they
had a "weaker, more impressionable nature". A number of the women accused of witchcraft
would have been experiencing hysteria, epilepsy, or insanity but were persecuted, tortured,
and put to death. The merging of hysteria with witchcraft led to the condemnation of
thousands of innocent women during the witch trials that ravaged Europe.
Medical treatment in the Medieval era was limited. Hysteria treatments involved prayers,
exorcisms, holy water, and fasting as a result of religious dominance in medicine. Because
hysteria was thought to be of supernatural origin, medical treatments were substituted by
spiritual interventions, and many people went untreated or were mistreated. By the
Renaissance era (14th to 17th centuries), a slow movement toward scientific and medical
causes of hysteria started to develop. Although religious explanations continued to hold sway,
early Renaissance doctors revived Hippocratic and Galenic hypotheses. Medical
professionals again attributed hysteria to imbalances in bodily humours, especially an
overabundance of black bile or uterine disturbances. Though the wandering womb theory
continued, there was renewed interest in naturalistic and anatomical explanations for hysteria,
marking a return to a more medicalised perspective.
Seventeenth-century physicians, including Paracelsus and Ambroise Paré, presented
alternatives to the solely supernatural explanations of hysteria. Paracelsus, a Swiss physician,
proposed that hysteria might be influenced by astral forces and physical imbalances, bringing
an element of astrology and medicine into the treatment of hysteria. Paré, a French surgeon,
highlighted the neurologic origins of hysteria and proposed that it may result from brain or
nerve malfunction instead of demon possession. Even with the increasing power of medical
science, hysteria in the Renaissance was still heavily rooted in cultural and gender prejudices.
Women were still considered more prone to hysteria because of their "weaker constitutions"
and reproductive systems. This gendered view led to the further mistreatment of women with
mental illnesses, who were frequently written off as irrational or morally debased.
The Renaissance treatments for hysteria represented both medical and mystical responses.
Doctors frequently prescribed herbal remedies, bloodletting, purging, and fumigation of the
uterus, which sought to restore the body's balance of humour. Simultaneously, religious
leaders persisted in advising confessions, prayer, and exorcism. The blending of medical and
spiritual treatments demonstrated the era's contradictory attitudes toward hysteria, as
medicine and mysticism existed side by side in treating the disorder. The Medieval and
Renaissance explanations of hysteria had long-lasting effects on how mental illness has been
perceived. The link to witchcraft and demonic possession helped stigmatise those with
psychiatric illnesses, whereas the sexism built on injurious myths regarding the emotional
instability of women. While the Renaissance saw the start of a slow shift toward scientific
explanation, hysteria continued to be inextricably linked with superstition, religion, and
sexism.
18th and 19th Century Developments in Hysteria

The 18th and 19th centuries were a turning point in the treatment and understanding of
hysteria. It was during these centuries that hysteria moved away from being considered a
spiritual or supernatural disorder to one understood by neurology, psychology, and
developing medical science. The era witnessed the development of clinical studies,
innovative therapeutic methods, and the formation of early modern psychiatry. During the
18th century, hysteria was more and more understood as a neurological condition as opposed
to a spiritual illness. Doctors were beginning to consider nervous system malfunction as a
potential cause of hysterical symptoms. William Cullen, a Scottish physician, introduced the
term "neurosis" to cover nervous system disorders, including hysteria. Hysteria was caused
by nervous irritability and malfunction, according to Cullen, an important move towards
medical causation.
In the late 18th and early 19th centuries, the French neurologist Jean-Martin Charcot also
made important contributions to the research on hysteria. According to Charcot, hysteria was
associated with neurological dysfunction and could be caused by trauma or stress. Charcot
employed hypnosis to cause and relieve hysterical symptoms in his patients, which proved
that the disorder was not imaginary but both physiological and psychological. Charcot's
hypnosis experiments formed the basis of the new psychotherapy field. Charcot had a
massive impact on Sigmund Freud, who further transformed the study of hysteria through the
invention of psychoanalysis. Freud introduced the theory that hysteria resulted from
suppressed trauma and unresolved emotional conflicts.
In his foundational book Studies on Hysteria (1895) with Josef Breuer, Freud put forward the
"talking cure", a kind of therapy that involved patients describing and reliving repressed
memories. Freud formulated the theory that hysterical phenomena resulted from unconscious
psychological pain rather than purely neurologic causes and that hysteria has psychogenic
and not just somatogenic causation. Treatment for hysteria became more varied at this time,
indicating the increasing power of medical science. Hypnosis and psychoanalysis were both
developed as methods of therapy, yet numerous patients continued to be subjected to severe
and useless treatments such as electrotherapy, hydrotherapy, and isolation. Women were
especially susceptible to abuse, as hysteria was still linked to femininity and emotional
inconstancy.
By the late 19th century, hysteria had become a central focus of psychiatry and psychology,
with the condition serving as a catalyst for modern theories of the unconscious mind. The
contributions of Charcot and Freud laid the groundwork for modern psychiatric practices,
transforming hysteria from a vague and misunderstood disorder into a foundation for
psychodynamic theory and the study of psychosomatic illness.
 DSM Classification of Hysteria

The DSM now no longer separately diagnoses hysteria. In the past, hysteria had been a
widely used and somewhat vague diagnosis encompassing symptoms such as paralysis,
seizures, forgetfulness, and emotional instability. As psychiatry has evolved, the DSM-III
(1980) did away with formal diagnosis of hysteria and substituted the more specific evidence-
based categories.
In DSM-5, the symptoms traditionally linked to hysteria are now identified under a range of
separate disorders:
1. Conversion Disorder (Functional Neurological Symptom Disorder): Features
neurological symptoms (e.g., paralysis, blindness) without medical aetiology,
frequently precipitated by psychological stress.
2. Somatic Symptom Disorder (SSD): Features repeated physical complaints with undue
health-related anxiety
3. Dissociative Disorders: Feature Dissociative Identity Disorder (DID), Dissociative
Amnesia, and Depersonalization-Derealization Disorder, all of which represent the
dissociative symptoms classically associated with hysteria.

Conversion Disorder

Conversion disorder (CD), previously known in the DSM-5 as Functional Neurological

Symptom Disorder (FND), represents a contemporary category of symptoms once associated
with hysteria. Previously, hysteria was attributed to a "wandering uterus" or religious illness.
But when medical science improved, these symptoms were redefined as neurological and
psychological expressions of trauma or stress. Conversion disorder today refers to patients
who have neurological symptoms for which there is no organic cause, a modern
reinterpretation of hysterical attacks.
Conversion disorder patients present with a variety of motor, sensory, and autonomic
symptoms similar to the physical symptoms of hysteria found in historical accounts. These
symptoms include paralysis, tremors, abnormal gait, and non-epileptic seizures, also known
as psychogenic seizures, which are similar to epileptic seizures but without abnormal brain
activity. Sensory symptoms like numbness, blindness, or deafness are frequent in the absence
of physical injury. Speech disorders, like aphonia (loss of voice) or dysphonia (change in
voice quality), also occur often. These represent the somatic manifestations of emotional
distress that used to be characteristically linked to hysterical fits.
The aetiology of conversion disorder is in keeping with the historical concept of hysteria as a
reaction to emotional trauma. People with a history of sexual trauma, neglect, or child abuse
are at greater risk of developing the condition. Emotional repression and repressed conflict,
central ideas in Freudian psychoanalytic theory, are still known to be the primary causes of
conversion disorder. Additionally, neuroimaging studies reveal functional abnormalities in the
limbic system and motor control areas of the brain, which may explain why patients
experience physical symptoms without neurological damage.
Diagnosing conversion disorder requires a clinical assessment and neurological tests to rule
out organic causes. The DSM-5 diagnostic criteria include:
 One or more neurological symptoms (e.g., motor or sensory impairment).
 Symptoms that are incompatible with recognised medical conditions.
 Symptoms that cause significant distress or impairment.
Conversion disorder treatment mirrors the development of hysteria treatment in contemporary
psychiatry and neurology. The initial treatment is psychotherapy, particularly Cognitive
Behavioural Therapy (CBT), which assists in the patient's identification and control over the
relationship between emotional distress and physical symptoms. Trauma-focused treatments,
including Eye Movement Desensitization and Reprocessing (EMDR), treat unresolved
trauma. Physical therapy can be employed for the treatment of motor symptoms, whereas
antidepressants or anxiolytics might be prescribed for the management of comorbid
psychiatric disorders such as depression or anxiety.

Somatic Symptom Disorder

Somatic Symptom Disorder (SSD) is another diagnosis that represents the contemporary
reinterpretation of hysteria because it entails bodily symptoms that are shaped by
psychological distress. Historically, patients presenting with inexplicable complaints of the
body were often diagnosed with hysteria because the relationship between psychological
issues and physical symptoms was not well understood. SSD now accounts for patients who
have persistent somatic symptoms that lead to excessive worry, even in the absence of a
specific medical cause.
Patients with SSD often experience persistent pain, fatigue, or gastrointestinal symptoms,
which were common complaints among individuals historically diagnosed with hysteria.
These physical symptoms are accompanied by emotional distress, health anxiety, and
frequent medical consultations, mirroring the preoccupation with bodily ailments that was
characteristic of hysterical patients in the 19th century. In spite of unfavourable medical
results, patients with SSD remain excessively concerned about their health, which increases
their distress and may cause recurrent medical interventions.
The aetiology of SSD, such as hysteria, is based on psychological and emotional issues.
Those with emotional repression or unresolved trauma can somaticise their suffering, leading
to physical complaints. Adversity in childhood, abuse, or chronic illness in childhood raises
the risk of SSD. Cognitive distortions, including catastrophic thinking and health anxiety,
also play a role in the maintenance of symptoms.
The DSM-5 criteria for diagnosing SSD are:
  One or more physical symptoms are associated with distress or impairment of
function.
 Excessive thoughts, feelings, or behaviour concerning the symptoms.
 Symptoms that are present for six months or more.

Treatment of SSD is centred on symptom management and psychotherapy, mirroring

contemporary psychiatric treatment of conditions previously diagnosed as hysteria. CBT is
the most successful intervention, assisting patients in decreasing catastrophic thinking and
health anxiety. MBSR and ACT are also employed to enhance emotional regulation.
Antidepressants, including SSRIs, are frequently prescribed to treat comorbid depression or
anxiety.

Dissociative Disorders

Dissociative disorders represent a contemporary category of symptoms that, in the past, were
found to be related to hysteria. In the 19th century, patients who had been diagnosed with
hysteria presented dissociative symptoms like memory loss, fragmentation of identity, and
changing consciousness. The symptoms were previously seen as hysterical neurosis, but they
are presently recognised as trauma-induced dissociative disorders.
The DSM-5 categorises dissociative disorders into three categories:
1. Dissociative Identity Disorder (DID): Once called multiple personality disorder, DID
has two or more personalities, gaps in memory, and confusion of identity, which were
once viewed as indicators of extreme hysteria.
2. Dissociative Amnesia: Characterised by forgetting personal facts, frequently
precipitated by trauma. In severe instances, people will be in a fugue state, walking
about with no recollection of who they are—a disorder previously referred to as
hysterical fugue.
3. Depersonalisation-Derealisation Disorder: Induces detachment from oneself or the
environment, as in the emotional numbness of cases of hysteria.

The aetiology of dissociative disorders, as in hysteria, is related to psychological trauma in

the form of child abuse, sexual abuse, or profound emotional distress. Clinical interviews and
psychological tests are used for diagnosis, with the DSM-5 criteria of pervasive memory
disruption, disturbance of identity, and emotional detachment.
Treatment involves trauma-focused psychotherapy, including TF-CBT and EMDR, which
assist the patient in integrating and processing traumatic memories. Antidepressants or mood
stabilisers can be given for comorbid conditions like depression or anxiety, which frequently
accompany dissociative disorders.
 Causes of Hysteria

Hysteria is a multifactorial illness with a variety of contributing factors, including an

interaction between neurological, psychological and sociocultural determinants. Historically a
mysterious and inexplicable disorder, hysteria was customarily accounted for in terms of
supernatural power or female anatomy. Modern studies, however, reveal that hysterical
symptoms have their roots in functional neurological defects, emotional trauma and social
learning. The disease is now understood as the manifestation of psychological trauma,
repression of feelings, and neurological damage, often precipitated or exacerbated by cultural
norms and social pressures. Awareness of the diverse aetiology of hysteria illuminates its
evolution from a vague diagnosis to its classification under modern psychiatric disorders such
as conversion disorder, somatic symptom disorder, and dissociative disorders.

Neurological Causes
A number of the neurology theories about hysteria have come under serious medical
examination as newer psychiatry started embracing the brain as an instrument of symptom
construction that had otherwise been within the domain of hysteria. While the hysterical
victims were thought to be suffering either purely psychologically or as creatures of some
state of religious state, more recent research has indicated neurological dysfunctions as
among the leading culprits. Patients with hysterical symptoms today fall into syndromes
commonly referred to as conversion disorder (Functional Neurological Symptom Disorder) or
dissociative disorders, with functional brain abnormalities in areas where structural damage is
absent.
Neuroimaging research has shown that hysteria patients have abnormal activity in the limbic
system, the origin of emotion. Hyperactivity or underconnectivity of the prefrontal cortex and
amygdala region of emotion regulation- leads to the development of inexplicable physical
symptoms. Neurologically, this explains the way in which a patient can be paralysed, blind,
or convulsive without a known pathophysiologic substrate.
Hysteria is also connected with functional sensory-motor disturbances. The patients will
exhibit deeply disturbed information exchange between the motor and the emotional
components of the brain that hinders normal neurological conduction. Such a disturbance will
result in random bodily symptoms: tremor, gait disorder, sensory disorder, etc. Such
neurophysiological trends would definitely support the belief that hysteria today is merely a
compromised brain function and not an artificial or illusory one.
Stress-induced neurological changes may also be the causative factor of hysteria. In research,
long-term exposure to emotional stress or trauma is claimed to alter the HPA axis. The HPA
axis modulates the body's response mechanism to stress. Alteration of HPA function may
render the patient emotionally vulnerable, while emotional distress may become converted
into somatic expression. This neurotic system reaction might explain why patients suffering
from post-traumatic disorders are so prone to the functional neurological manifestations of
hysteria.
Psychological Causes
Psychological mechanisms have traditionally been considered in the appraisal and
understanding of hysteria. This is, in fact, traditionally made well known with his
psychoanalytic theory of hysteria by Sigmund Freud, linking the phenomenon with repressed
trauma and unresolved intrapsychic conflicts. Freud postulated that hysterical manifestations
are the conversion of emotional distress into somatic symptoms. By this, it has been known
as psychogenic conversion. According to that theory, repressed memories or unconscious
desires create internal conflicts which manifest as somatic symptoms in the patient. Thus, an
individual with unresolved grief or suppressed anxiety may develop phenomena such as
paralysis, blindness, or seizures, even when there is no anatomical injury.
Besides Freud's investigations, hysteria symptomology is assumed to be related to emotional
dysregulation, unresolved trauma, and stress responses by modern psychology. Many have
histories of psychological traumatisation such as childhood physical abuse, sexual abuse, or
simply neglect. These traumatic experiences exceed the coping mechanism of the brain and
thus lead to dissociative or somatic expressions.
Emotional repression is thus another important psychological feature. People who cannot
express or process emotional pain manage to unconsciously convert emotional pain into
physical symptoms and use it as a defence mechanism mimicking symptoms in the historical
definition of hysteria. Somatisation enables people to express internal suffering through
bodily complaints.
There are also dissociative processes that play a significant role in hysteria-related disorders.
Dissociative identity disorder (DID), which used to be classified under hysteric neurosis, may
find an individual presenting often fragmented identities or gaps in memory as he/she acts as
a defence mechanism to severe trauma. Much like that, loss of memory following trauma was
once referred to as hysterical fugue, and the dissociation of memory and consciousness acts
as a psychological means to escape from overwhelming emotional pain.
Psychosocial stress from relationship problems, bereavement, and financial stresses can
trigger or aggravate hysteria-like symptoms. Chronic individuals tend to develop these
symptoms of conversion-like amplitudes with manifestations like shivering, fainting, or
stammering as an externalisation of their internal conflict. The whole phenomenon is a
testimony to the intrusion of emotional deficit and unresolved trauma in the aetiology of
hysteria.

Social and Cultural Influences

Additionally, the social and cultural implications regarding hysteria need to be viewed as
exceedingly important for the history of its diagnosis, understanding, and treatment. In
antiquity, hysteria was viewed as an imaginary disease affecting women; some say it is the
result of the agitation of the uterus or sexual starvation. The very concept of indulgence in
women's emotions received a foul stereotype from viably negative diagnoses where hysterical
symptoms were interpreted as being natural to women or their flighty emotions. With this
swift change of understanding of hysterical womanhood toward the medical and sexist shades
of diagnosis, more cases would appear among lady patients than would fit into purely male
ones in late Victorian Europe during the 19th century.
Fainting, tantrums, and other unconsciously willed manifestations of paralysis were
absolutely feminine in their signification. In all likelihood, unwanted behaviours from a
feminine perspective now became an expected marker for hysterics. Women in society were
too emotionally upset about their conditions to be viewed with anything except disgust or
even contempt; these were uproariously dubbed "hysteria" in a sexist manner. Laying in
therapy or hysterectomy was for sometimes calming into control, while in the extreme cases
where they could not be channelled more directly, becoming conveniently imposed from the
perspective of the society by spoken institutionalisation took place. Specific social-cultural
norms activated the actual shows of hysteria.
In certain cultures, hysteria was also deemed to be demon possession, especially when the
hysterics were under religious adherence. Exorcisms and religious rituals dealt with the
symptoms of hysteria in the system of Mesopotamian culture. Other times, women showing
hysteria-like symptoms in the Middle Ages were accused of witchcraft, thus affecting the
cultural association between emotional instability among women and supernatural forces. In
the late nineteenth and early twentieth centuries, hysteria became a figure of women's
repression in society.
An authoritarian extractive type of medical treatment was commonly applied to hysterical
women: electrotherapeutic treatment, coercive institutionalisation, and pelvic massage, also
said to "calm" them from hysteria. These interpretations, therefore, reflect the times: they
were in the background of a series of misogynist and patriarchal medical interventions, all
geared to contain and repress female sexuality and emotional expression. Cultural influences
allow expressive behaviour for hysteria-like symptoms even today. Even though hysteria is
not currently considered an official diagnosis, the term "hysteria" is very commonly
associated with functional neurological disorders, somatic symptom disorders, or dissociative
disorders category, wherein manifestations of psychological distress might be culturally
mediated. This could be a strong demarcation between cultures with more spiritually defined
parameters for psychogenic seizures or conversion symptoms and those with a more
biomedical view of them. Stigma and gender divide continue to shape the concepts and
constructs of hysteria in modern history.
 Symptoms of Hysteria and Related Disorders

Hysteria, now included among modern psychiatric disorders such as conversion disorder,
somatic symptom disorder, and dissociative disorders, has a vast expanse of expressions
ranging from physical to sensory, emotional, and even dissociative symptoms. Although
hysteria is no longer in modern clinical usage, the symptoms that were once associated with it
remain in current diagnoses. The symptoms that arise as a response to either psychological
trauma or emotional stress are sometimes evident in some neurologic or somatic manner. The
hysteria, along with the disorder, is associated with primary symptoms in this regard; the
clinical signs consist of motor impairments, sensory issues, emotional disorders, dissociative
symptoms, and severely restricted daily living and quality of life.

Motor Dysfunction
Impairment of movement is a key sign in hysterical disorders, especially conversion disorder
(Functional Neurological Symptom Disorder). The individuals would have a manifestly
impaired physical reality similar to paralysis, tremors, abnormal gait, and psychogenic
seizures with null obvious neurological explanations. While these mimic real, accepted
neurological illnesses, trauma, or stress rather than organic damage.
Paralysis and Weakness:
Among all motor features, paralysis or weakness is probably the most commonly found
symptom in hysteria and related conditions. This is the sudden emptying of arms, legs, or
even the whole body. It is called hysterical paralysis, and now it is attributed more to changes
in the brain signalling than damage to the brain itself; a functional neurological symptom is
what it has been termed. On the neurologic side, the signs would appear normal reflexes,
muscle tone, etc., would remain unaffected.
Abnormal Gait and Tremors:
Gait abnormality and tremors are very commonly associated with hysterical states. The
patient may display such symptoms with unsteady gait, trembling, or, unfortunately, totally
collapse on the floor. On the other hand, compared to typical neurological signs such as
Parkinson's, tremors cannot be constant but have these shoot-up periods within which the
severity can change, depending upon distraction: the hallmark of psychogenic tremors.
Psychogenic Non-Epileptic Seizures:
Psychogenic non-epileptic seizure (PNES): This category is another form of seizure related to
hysteria disorders. These seizures appear pretty similar to the ones in epilepsy, but the type of
brain activity is different from what is seen in epilepsy. The symptoms are profound or minor
convulsions, consciousness loss, or the patient's limbs on an episode of jerking, but most of
the confirmatory neurological assessments, EEGs, have gone blank. Then, this PNES has
associations with emotional stress as well as unresolved psychological conflicts and is a
direct reflection of the mind-body interaction in species like hysteria.
Speech and Swallowing Impairments:
These motor symptoms of hysteria-related disorders will frequently affect speech and
swallowing as well. Examples include presenting with aphonia (loss of voice) or dysphonia
(voice quality change) without any organic cause involving the vocal cords. Some even
develop swallowing difficulties or dysphagia because choking sensations then would arise
from psychological distress than through any identifiable physical abnormality.

Sensory Disturbances
Sensory disturbance issues are yet another interesting determining factor of hysteria-related
disorders whereby abnormal sensory perceptions exist without any applicable medical cause.
These symptoms represent the conversion of psychological stress into physical sensation,
something that had been described long ago in Freudian psychoanalytical theory.
Numbness and Loss of Sensation:
In hysteria-related conditions, numbness, tingling, or loss of sensation in various areas of the
body is usually complained about. Functional sensory loss is challenging to evaluate in these
cases due to the likelihood of it following atypical or even contradictory anatomical patterns.
For instance, a patient may declare numbness of an entire limb with no affected nerve
pathways. This inconsistency typifies psychogenic sensory disturbances wherein emotionality
is recognised as the prime factor accounting for the symptom.
Blindness and Visual Disturbances:
Historically, hysteria has been held accountable for psychogenic blindness or visual
impairment. Patients may present with complete or partial loss of vision, diplopia, and
blurred vision at will despite apparently standard tests in an ophthalmic workup. They occur
shortly after the trigger of psychological trauma or emotional stress, recalling once more the
effect of the mind over that of physical perception.
Hearing Loss and Auditory Symptoms:
Some persons with hysteria-related disorders develop functional hearing loss or auditory
hallucinations. They respond by describing states of deafness or distorting sounds that were
not provoked by any detectable harm to the ear, particularly after some stressful happening.
The hallmarks of hysteria-related disorders consist of emotional distress as a source of
sensory impairment.
Pain and Somatic Complaints:
A fair share of unexplained physical pains is also observed in hysteria-related disorders such
as headaches, muscle pain, or abdominal pain, which come without any apparent medical
cause. Such symptoms stem from emotions being repressed and unprocessed trauma, thus
supporting the psychobiological foundations of such disorders.
Emotional Instability

Severe Change in Emotions: The hysteria symptom becomes intense emotional instability.
Such people usually undergo intense moods, anxiety, depression, and emotional outbursts as
stressed from different psychological traumas.
Anxiety and Panic Attacks:
Anxiety, and especially panic attacks, go together with hysteria. Most people suffering from
hysteria symptoms would have encountered this bout of frightful and racing heart symptoms,
sometimes shortness of breath. In the modern context, these symptoms are classified as panic
attacks, often due to a former psychological trauma or emotional distress.
Emotional Lability and Depression:
This emotional instability tends to manifest itself most of the time in depression and mood
disturbances in hysteria-related disorders. Patients tend to have outbursts of emotions at
awkward times, like moods of weeping or perhaps a little touch of irritability, which are other
ways of understanding the type of emotional dysregulation that forms the basis for the
disorder. Quick changes in mood are viewed historically as a key symptom of hysteria;
however, the newest information now attributes this type of emotional lability to the
symptom of affective instability seen in diseases such as borderline personality disorder
(BPD) or somatic symptom disorder (SSD).
Increased sensitivity and Exaggerated Emotional Reaction:
These conditions have much poorer hysterical people and show very much evidence of
increased sensitivity to stress and exaggerated emotional reactions during small events.
Emotional hyperarousal may lead to psychosomatic symptoms or even fainting spells,
abnormal sensitivity (the fainting), or other sensory disturbances. Emotional lability reflects
the inner psychological turmoil that is manifested in physical aspects such as hysteria.

Dissociative Symptoms
The dissociative phenomena are one primary vehicle of presentation in hysteria-related
disorders, especially hysterical neuroses that were formally grouped into categories of
dissociative disorders. These phenomena tend to occur with high intensity for memory,
identity, or perception-related events and most often relate to trauma of some kind.
Amnesia and Memory Loss:
In instances involving hysteria-related disorders of dissociation, study shows that, in some
cases, memory lapses and amnesic events arise in the wake of traumatic happenings; with
respect to the last, such an amnesic event now occupies the place of hysterical fugue. Those
afflicted might then embark on a journey from their homes somewhere and lose track of their
identity in an emergence of psychogenic from emotional hurt.
Depersonalisation and Derealisation:
Hysteria-related disorders are also characterised by symptoms of depersonalisation or
derealisation, in which patients can feel disconnected from their bodies or surroundings.
Depersonalisation engenders feelings of unreality or emotional numbness; rather,
derealisation is known to turn the landscape into a dreamy or bizarre place. While previously
termed hysterical dissociation, it is now more appropriately considered as a reaction to
psychological trauma and to emotional dysregulation.
Dissociative Identity Disorder:
Formerly categorised as multiple personality disorder, DID used to be vastly seen as an
extreme form of hysteria. Casualties with DID present two or more distinct personalities,
sometimes with amnesia and disoriented identity. The trauma may be rooted in childhood
adversity or abuse that is so chronic that an identity is disintegrated for coping.
Emotional numbness and detachment: Sometimes, these people feel numb inside and
detached to cover unbearable emotional pain. This former hysterical anaesthesia is now better
seen as an emotional dissociation caused by trauma and extreme stress.
 Case Study on Hysteria

Sigmund Freud’s Fragment of an Analysis of a Case of Hysteria (1905), detailing the

treatment of 18-year-old Ida Bauer (‘Dora’), remains a seminal yet contentious text in
psychoanalytic theory. Naamah Akavia’s re-examination, grounded in Christopher Bollas’s
concept of hysteria as familial identification and Don D. Jackson’s ‘family homeostasis’,
posits that Dora’s symptoms emerged not merely from intrapsychic sexual conflict but from a
pathological familial system where illness functioned as a communicative currency. This
analysis explores the aetiology, symptomatology, and systemic dynamics underpinning
Dora’s hysteria, challenging Freud’s Oedipal framework while contextualising her condition
within broader familial and sociocultural norms.
Aetiology
Dora’s hysteria originated within a milieu saturated with physical and psychological illness.
Her father, a syphilitic serial invalid, engaged in an affair with Frau K., herself a former
hysteric who weaponised infirmity to evade marital duties. Dora’s mother, diagnosed with
‘housewife’s psychosis’, exhibited obsessive cleanliness, further embedding disease as a
normative familial discourse. Akavia argues that Dora’s role as her father’s confidante and
part-time nurse entrenched her identification with his hypochondriacal tendencies, while her
proximity to Frau K. normalised the performative use of illness.
Freud’s initial focus on repressed sexual desire—interpreting Dora’s cough as symbolic of
paternal intercourse and her aphonia as erotic inhibition—overlooked this systemic
pathology. Akavia contends that Dora’s symptoms instead reflected a ‘family law’ wherein
somatic complaints mediated relational power dynamics. Her father’s syphilis, a source of
familial shame and instability, catalysed Dora’s internalisation of disease as both identity and
protest. Bollas’s theory of hysterical identification elucidates this process: Dora ‘learnt’ to
somatise distress through mimicry of paternal and Frau K.’s behaviours, perpetuating a cycle
where pathology maintained familial equilibrium.

Symptomatology
Dora’s symptoms—chronic cough, aphonia, migraines, dyspnoea, and suicidal gestures—
functioned as somatic metaphors for repressed familial tensions. Her cough, initially
attributed by Freud to sublimated fellatio fantasies, paralleled her father’s tubercular
respiration, symbolising both identification and resentment towards his invalidism. Similarly,
her aphonia echoed Frau K.’s strategic muteness during marital conflict, reflecting a learnt
‘language’ of corporeal protest.
Akavia highlights Dora’s leucorrhoea (vaginal discharge) as pivotal: Freud dismissed it as
masturbatory residue, yet it mirrored her mother’s gynaecological ailments, underscoring
cross-generational identification. Dora’s dyspnoea, emerging during paternal absence,
signified a ‘homeostatic’ attempt to restore familial balance through shared infirmity. Her
suicide-note and fainting spells, meanwhile, constituted performative critiques of paternal
neglect, weaponizing vulnerability to reclaim agency within an oppressive system.
Analysis
Freud’s Oedipal lens reduced Dora’s hysteria to psychosexual conflict, neglecting systemic
contributors. His dismissal of her belief in inheriting paternal syphilis—attributing it to
‘layman’s confusion’—ignored the symbolic truth: Dora perceived her father as a pathogenic
force, whose negligence and infidelity infected the familial psyche. Akavia argues that
Freud’s therapeutic alliance with Dora’s father, a former patient, biased his analysis, leading
him to invalidate her accusations of paternal malingering and complicity in Herr K.’s
harassment.
Bollas’s framework repositions Dora’s hysteria as a ‘bitterly unconscious’ assimilation of
familial conventions. Her symptoms constituted a ‘performative-exhibitionistic’ dialogue
with a system that rewarded illness as a tool of manipulation. The dreams—of a burning
house and paternal death—reveal her ambivalent struggle to escape this system. The first
dream’s inverted rescue fantasy (father as saviour, mother as jeopardiser) expressed longing
for paternal protection, while the second dream’s imagery of flight and encyclopaedic reading
symbolised nascent autonomy, albeit marred by lingering guilt.
Akavia’s re-reading positions Dora’s hysteria not as Freudian sexual repression but as a
product of systemic pathology. Within a family that commodified illness, Dora’s symptoms
emerged as both protest and compliance—a ‘suicide by identification’ with paternal and
societal norms. Her eventual termination of analysis, framed by Freud as therapeutic failure,
instead signified a reluctant assertion of agency against reductive Oedipal narratives.
 Treatment Approaches

Although hysteria is no longer a formal diagnosis, the symptoms now reside within those of
psychiatric disorders- hysteria has, by and large, become adopted in present-day conversion
disorder (or Functional Neurological Symptom Disorder), somatic symptom disorder, and
dissociative disorders. Treatment for such disorders is carried out with a multi-disciplinary
approach, including psychotherapy, medication, physical therapy, and trauma-informed care
in treatment. Along with symptom relief, underlying trauma is addressed, and the emotional
regulation and functional living of an individual will be enhanced via the given treatment
approach.
Psychotherapy
The primary treatment of hysteria-related disorders is psychotherapy, based on the premise
that symptoms originate in a psychogenic way. The first preference among the two treatment
approaches would be Cognitive Behaviour Therapy (CBT), while the other is called
Psychodynamic Therapy. These two approaches seek to alleviate the impact of emotional
distress on physical and psychological symptoms.
Cognitive Behavioural Therapy: CBT would be most widely conducted for conversion,
somatic symptoms, and dissociative disorders- most of them were classified under hysteria in
times gone by. It is a focused therapy to disentangle maladaptive thinking and behaviour
underlying the symptoms while encouraging emotional recognition by the patient as
exercising a healthy coping style toward the physical symptom.
Patients would be utilising CBT techniques for conversion syndrome, which may involve
cognitive restructuring and exposure therapy aimed at decreasing the intensity and frequency
of neurologic PSS such as paralysis, tremors, and non-epileptic seizures. Patients are
supported in reframing or challenging their catastrophic thoughts and emotional responses
and, in the process, reducing the psychosomatic effect.
CBT would look at the anxiety and overthinking patients have concerning their somatic
symptoms in somatic symptom disorders. Abnormal relations with those sensations would be
developed in order to inhibit looking at any normal, minor physical sensations as serious
indicators of illness.
Psychodynamic therapy states that hysterical and hysteria-like disorders are cured by the
traumatic repression and mental conflict associated with them that have not yet reached
emotional resolution. Thus, it is really the extension of Freudian psychoanalysis, which
intends to make conscious the unconscious conflicts that underlie the symptoms.
Psychodynamic therapy will assist people with dissociative disorders in healing via the
retrieval of the memory associated with past trauma so that they can begin working through
the unacknowledged trauma. This type of therapy actually furthers emotional integration: it
enables people to reconnect fragmented memories and dissociated emotions back into a
coherent whole.
In practice, this would mean that through expressing feelings or emotional states instead of
repressing them, the patient would eventually get rid of physical symptoms- the conversion
phenomenon- as one of many possible symptoms. By free association, dream analysis, and
emotional processing, insight is gained into the emotional origin of the physical symptoms.

Medication
In the lowest of opinions, psychotherapy is never regarded by itself as being an effective
intervention for hysterias. Instead, it is often prescribed drugs to treat coexistent disorders
like mood changes, anxiety, and depression. Up to now, there have been no medications
specifically produced for conversion or dissociative disorders, and some tend to reduce
psychological suffering related to these disorders and, in some way, to help psychosocial
interventions.
Antidepressants:
Antidepressants are prescribed, particularly SSRIs and SNRIs, to obtain mood stabilisation
and decrease emotional reactivity in depressed, hysterical individuals, thereby decreasing the
chance of expression of psychogenic symptoms. Antidepressants may suppress inappropriate
health anxiety and aid in emotional modulation for somatic symptom disorders.
Anxiolytics and Benzodiazepines:
Sometimes, anxiolytics like benzodiazepines are prescribed as a short-term measure for acute
anxiety or panic attacks in truly hysterical individuals. They are generally used only in the
acute phase out of concern regarding possible dependence. The drugs, in fact, will
subsequently calm the nervous system and reduce psychogenic tremors or seizures.
Mood Stabilisers and Antipsychotics:
For DID or extreme emotional instability, mood stabilisers or antipsychotic medications may
be used to manage mood swings and reduce dissociative symptoms. While they are not
curative, these drugs provide a more emotionally stable soil on which the therapy will have a
better chance to bloom in individuals with severely poorly regulated emotions.
 Conclusion

The history of hysteria, once a pseudo-disease associated with mythical and misogynistic
doctrines, then changed profoundly through currents of medical, psychological, and cultural
paradigms. In ancient times, hysteria was seen as physical aberration that had to do only with
women, for example, the Greek theory of a 'wandering uterus, blamed for diverse behaviour.
Here, female biology was considered funnelled into pathology, which called for extreme
interventions such as vaginal fumigation or forced marriages to somehow 'anchor' the
wandering uterus. Such supposed medical treatments demonstrated the patriarchal mindset
narrowing emotional and mental anguish down to female reproductive anatomy. In Egypt and
Mesopotamia, it was conjectured that hysteria-like symptoms were the result of some
supernatural agency, giving rise to the occurrence of rituals and exorcisms that further
alienated and victimized sufferers. During the Middle Ages, hysterics were equated with
witches, with demons and moral corruption further weighing against the condition. The
demonized actions of women-such as spasms, emotional outbursts, or dissociative states-
were, rather, the fright of the unknown that society turned against its marginalized ranks.

The Renaissance, while yet tentative in its import, marked a revival of treatments considered
benign by Hippocrates and Galen and thus, essentially medical theories. Nevertheless, the
tradition of gender bias persisted, establishing women as fragile beings easily prone to
emotions. For hysteria, treatments were bloodletting, herbal remedies, or pelvic massages but
were more often concerned with removing female autonomy than with providing
psychological relief. The 18th and 19th centuries were certainly the period where hysteria
began to free itself from its supernatural and gendered baggage. What is certain is that leaders
such as Jean-Martin Charcot came along and redefined the disease as a neurological disorder;
Charcot used hypnosis as a tool to demonstrate its psychosomatic nature. Freud extended the
theory by explaining hysterical symptoms as rooted in repressed trauma and unconscious
conflicts. His psychoanalytic theories, particularly through the 'talking cure,' fostered an
emotional side to psychiatry and gave it a whole new turning by negating physical
interventions. He also was instrumental in disassembling the idea of hysteria as a unique
female malaise but nevertheless left traces of Victorian gender constrictions in his theories.

Modern psychiatry has dismantled hysteria and disperses its symptoms into evidence-based
diagnoses in the DSM-5. Conversion disorder (Functional Neurological Symptom Disorder)
includes those patients with physical symptoms of functioning such as paralysis or seizures
without any organic basis often in relation to psychological stress. Somatic symptom disorder
deals with patients who are excessively preoccupied with their bodily ailments and are
classically filled with health anxiety. Dissociative disorders include dissociative amnesia and
identity disorder, which embody trauma-induced fragmentation of consciousness. This
reclassification signals a certain scientific departure from stigmatizing titles to him more
nuanced conceptions of mind-body. Neuroimaging studies are now confirming functional
aberrations in brain pathways detecting specific bodily manifestations that, by firmly
conservative standards, should have been considered hysterical
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