The more recent conceptions regarding hysteria and their relation to the traumatic neurosis / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1909
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Licence: In copyright

Credit: The more recent conceptions regarding hysteria and their relation to the traumatic neurosis / by Tom A. Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    who became paralyzed after a slight shock experienced while crossing an electric tramway in repair. It developed on inquiry that some six months pre- viously, she had overheard some mecha- nicians discussing the injurious effects of electric shocks. She had, however, entirely forgotten this circumstance until a careful psycho-analysis revealed it. Space does not permit a doctrinal dis- cussion of the relation of suggestibility to hysteria; for this, the reader is re- ferred to an article of the writer in the current International Clinics, to the often-expressed views of Babjnski, and to the recent discussion upon hysteria at the Paris Neurological Society. The conclusions which emerge from this study and the intelligent observation of patients may be expressed as follows: (1) That all the symptoms which may legitimately be included under hysteria are imposed by suggestion. (2) That the state of suggestibility is derived from (a) faulty education, tend- ing to perpetuate and fortify the natural suggestibility of the child; (b) cerebral modifications due to organic causes, the action of which necessarily varies among individuals in accordance with the he- reditary constitution. (3) Those symptoms which do not derive froi^i this process do not properly belong to hysteria, but originate from causes which former observers had not ascertained. (4) The success of the treatment as judged by the permanence of its results strongly corroborates this view of the pathogenesis of hysteria. It must be remembered that- suggesti- bility not only varies from individual to individual, but does so from time to time in the same individual. Without enlarg- ing upon the well-known suggestibility of childhood and youth, I wish to em- phasize the changes in this susce]:)tibility due to fatigue, want of sleep, slight dis- orders of digestion, alimentary and chemical intoxications, as well as those due to the slighter infections. The cli- macteric periods’ episodes, in disturbing the accustomed rhythm of the organism, very frequently modify the suggesti- bility. Nor must it be forgotten that the sub- jective sym])toms of the neurasthenic state may be acquired by suggestion, and that a number of cases of so-called neu- rasthenia are purely imaginary. It is to the neglect of this consideration that we Qwe the erroneous common opinion that neurasthenia is curable by suggestive therapy; whereas the truth is that such treatment cures only cases of false neu- rasthenia. It ma}', however, assist neu- rasthenics by stinndating the motor activities, which, in turn, may hasten the metabolic processes upon the dis- order of which the disease depends. The outstanding corollary of these doctrines is the tremendous power of the medical attendant to imjjose or not upon his patient an idea which may create such a derivative of the imagina- tion as a gastric “neurosis,” a syphilo- phobia, astasia-abasia, a paralysis or weakness of an extremity, or any of the numerous imaginary diseases suggested by medical men by injudieious question- ing or advice. I need not here discuss the deliberate venalit}' which arouses fear for its own profit; for that fear is often allayed by the ingenuity by which it has been incited. I speak only of the blunderer in whose mind the idea of organic disease permeates his conduct so as to alarm the patient. (See Will- iams, “The False or Psychic Gastro- pathies,” Old Dominion Journal, Nov., and Medical Record.) A false and exaggerated optimism is in this respect as fertile in unfortunate suggestions as in the jireceding method: for the patient quickly perceives the in- sincerity of his attendant’s remarks. Both attitudes arise from the want of precision in methods and consequent un- certainty of diagnosis. To the doctor’s temporising thus en- gendered, we must attribute the birth and evolution of the so-called traumatic neurosis. Now, Pathology has taught us that spinal and cerebral commotion cannot give rise to symptoms of the character and duration complained of by the victims of ‘railway spine ;’ and that hematomyelia is a very different clinical picture. Chemistry has taught us that no constant change occurs in the secre- tions of these patients. From Biology, we learn that other organisms suffer from just such disabilities independent of trauma: and from Kthnology. that other races and peoples show a similar syn- drome though the thought of a railway train has never entered their heads. Psychology has taught us that such