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Hysteria

From: Neuropsychiatry, Neuropsychology, Clinical Neuroscience (Lippincott, Williams & Wilkins)
by Rhawn Joseph, Ph.D.




PARIETAL LOBE HYSTERIA

Parietal lobe injuries (particularly when secondary to tumor or seizure activity) can give rise to sensory misperceptions such as pain, swelling, twisting, burning, and so on (Davidson & Schick, 1935; Hernandez-Peon et al. 1963; Ruff, 1980; Wilkinson, 1973; York et al. 1979). That is, patients may experience sensory distortions that concern various body parts due to abnormal activation of those neurons subserving and maintaining the somesthetic body image (Joseph 1988a).

Unfortunately, when the patient's symptoms are not considered from a neurological perspective, their complaints with regard to pain may be viewed as psychogenic in origin. This is because the sensation of pain, stiffness, engorgement, is, indeed, entirely "in their head" and based on distorted neurological perceptual functioning. Physical exam will reveal little or nothing wrong with the seemingly affected limb or organ, unless significant neocortical tissue damage is present. Thus such patients may be viewed as hysterical or hypochondriacle, particularly in that right hemisphere dysfunction also disrupts emotional functioning and as right cerebral lesions are the most likely to induce somesthetic distortions.

In this regard, it is noteworthy that individuals suspected of suffering from hysteria are two to four times more likely to experience pain and other distortions on the left side of the body (Axelrod et al. 1980; Galin et al. 1977; Ley, 1980; D. Stern, 1977); findings which in turn, suggest that the source of the hysteria may be a damaged right hemisphere. At least one investigator, however, reporting on psychiatric patients has attributed hysteria to left cerebral damage (Flor-Henry, 1983).

SEX DIFFERENCES, THE AMYGDALA & HYSTERIA

Although some patients with parietal lobe abnormalities may be misdiagnosed or viewed as hypochondriacal and hysterical, it is likely that hysteria is directly related to abnormal as well as normal functioning of the temporal lobe and amygdala, and indirectly, the hypothalamus and HPA axis. As detailed in chapters 5 and 7, the amygdala is responsive to tactile input, assists in the mediation of somesthetic sensation, and also directly influences the hypothalamus as well as the HPA axis. Under conditions of fear, anxiety, or chronic stress, these nuclei may therefore become abnormally activated and produce somesthetic, autonomic, gastrointestinal, as well as convulsive disorders which when prolonged may give rise to a variety of related and unrelated physical symptoms coupled with emotional disorganization. Afflicted individuals may therefore be diagnosed as "hysterical."

However, the amygdala is not only involved in all aspects of emotional expression, but attachment and the desire for close social-emotional relations, as well as sexuality, aggression, and the desire not just for group affiliation but dominance. In consequence, some "hysterical" disorders also arise in and afflict individuals involved in group activities; e.g. mass hysteria. In addition, because the limbic system (and probably the temporal and parietal lobes) are sexually differentiated, men and women sometimes manifest certain hysterical symptoms in a completely and sexually differentiated manner.

For example, due in part to sex differences in the amygdala, anterior commissure, and hypothalamus, females are more emotionally expressive and perceptive, and in this regard much more sensitive and far more likely than males to become upset and to experience fear (see chapters 13). Because for much of their evolutionary history females foraged and gathered in groups, and as they are more socially emotionally inclined with a greater expressed need for social emotional contact comfort, they are also more solicitous of nurturance and are more sensitive to the feelings and the fears of other group members; i.e. females. They are also more likely to affirm these feelings and to behave in a collective and cohesive, i.e. similar manner. This also includes becoming "ill" if close friends are also suddenly and mysteriously incapacitated (e.g. Moss & McEvedy 1966; Small et al. 1991).

In consequence, females are not only more emotionally sensitive, they are also more likely to respond to even subtle social-emotional nuances, and are therefore more subject to temporary emotional disorganization and far more likely than males to develop mood disorders and/or physical symptoms requiring medical attention, including certain forms of hysteria. Because women are so in tune and responsive to the feelings of other women, in consequence, when in large groups, the tendency to develop hysterical disorders is sometimes heightened, particularly if they perceive that other women are upset, excited, or frightened (e.g. Moss & McEvedy 1966; Small et al. 1991).

MASS HYSTERIA

It is noteworthy that mass outbreaks of crying and screaming frenzies are typical of large groups of young women when in the presece of musicians, actors, and even politicans and dictators (e.g. Hitler). Consider, for example, the mass outbreaks of hysteria among young women and girls during the 1960's when the rock and roll group, the Beatles, made appearances in this or other countries. In situations such as these, many women and girls behave as if attempting to outdo one another in their attempts to demonstrate who is the most emotionally affected. In this regard, they reinforce and support their mutual hysteria.

However, under some conditions it sometimes happens that a single woman can induce fear and anxiety in many of the other female group members, rather than adoring, screaming, adulation. That is, if one female becomes sufficiently upset or stressed, even if there is no apparent cause, it sometimes happens that some (but not all) of the other women will also begin experiencing tremendous amounts of anxiety or fear such that they respond in a likewise (cohesive) manner.

However, in some cases, one female member of a group might not only become afraid, but she may respond as if physically sick, which in turn results in other female group members developing the same symptoms ( Colligan & Murphy, 1979; Kerckhoff, 1982; Sirois, 1982). Of course, be it a rock and roll concern of mass hysterical epidemic in a factory or school recital, these girls and women are mutually supportive of one another and are thus able to mutually validate their illness, fear, anxiety, or their excited devotion (Stahl, 1982).

Of course, men are not immune to emotional infection and can likewise become upset, or angry, or yell and scream in a likewise fashion when in large groups (e.g. a football stadium) or when congregating in mobs. However, whereas women are more likely to display physical symptoms (e.g. fainting, convulsing, crying, screaming), males are more likely to respond physically (e.g. charging, attacking, hitting, yelling, screaming). Consider, for example, during the 1930's the hysterical and irrational response of adult German men, and in fact, one third of the German nation, to the hysterical rantings of the girlish Adolf Hitler: a mass hysteria (or psychosis) which resulted in World War II, and over 40 million deaths. Indeed, throughout history men have commonly become caught up in mass (or mob) hysteria and have then proceeded to irrationally kill and maim, often indiscriminately.

MASS "FEMALE" HYSTERIA

Outbreaks of "mass hysteria" and the development of "mass" physical (conversion) symptomology, be it in America (e.g. Montana Mills), Europe, Asia, or Africa, characteristically involve large groups of women (Colligan & Murphy, 1979; McGrath, 1982; Sirois, 1982) or young females (Moss & McEvedy 1966; Small et al. 1991). Onset may be quite rapid, or take place over the course of several days, with the "illness" being transmitted by sight or sound. Usually recovery is just as swift and no physical basis for the illness can be found.

For example, in the famous Montana Mills incident (Colligan & Murphy, 1979; Sirois, 1982), over the course of approximately a week over 50% of the female work force developed severe and disabling imaginary illness. However, male employees were generally not effected. This is because mass hysteria involving mass physical and associated emotional upset, is generally a disorder involving large groups of females.

Indeed, it has been repeated reported that in cases of "mass hysteria" over 80-90% of those initially affected, and 80-90% of those who may be subsequently effected are women (see Colligan & Murphy, 1979; Sirois, 1982). Although the work force may in fact be 1/5 to 1/3 male, men are by and large unaffected (see McGrath, 1982). Even though large numbers of (female) employees may be suddenly stricken with a variety of mysterious physical ailments heterosexual males tend to be immune or any symptoms they develop are quite mild.

Similarly, among school and college aged individuals, girls (Small et al 1991) and young women (Shelokov et al. 1957) are predominately affected. Females show a higher rate of "illness," more severe symptoms, and are affected longer than males who are also much less likely to become emotionally upset even though their female classmates are quickly becoming incapacitated.

In numerous cases of "mass hysteria" although males may be largely immune, many of the women will begin crying, screaming, hyperventilating, fainting, and/or convulsing as if suffering from seizures, and many will later invent a host of physical complaints (Colligan & Murphy, 1979; McGrath, 1982; Sirois, 1982; Small et al. 1991). Typically, in these instances of mass hysteria, a single female may become "ill" for no apparent reason, and just as suddenly a second female, who may be close friends with, or standing next to, and/or attending the first female, may also become "ill." Soon, more and more women or girls become "ill" and may hyperventillate, faint, fall to the ground and display tremors and convulsions, and/or become incapacitated to varying degrees for varying time periods.

Hence, "mass female hysteria" may be initially triggered by the reaction of a single woman who then literally emotionally infects her female coworkers and friends as the "disorder" spreads. Among some (but certainly not all) girls and women, hysteria can be contagious.

For example, in April of 1989 there was an outbreak of mass illness among student performers who were to participate in a recital in a high school in Santa Monica California (Small et al. 1991). It was noted earlier in the day during rehearsal, that two girls complained of faintness, nausea, and dizziness. However, once the recital began the performance was interrupted by a mystery illness involving headache, abdominal pain, nausea, and dizziness which spread swiftly among the female students with 16 females initially fainting followed by over 247 students, mostly female, becoming ill and severely upset. Ambulances were called, students were rushed to the hospital, and no physical reason for their ailments could be found.

These hysteria epidemics have occurred in factories, hospitals, and schools, and in rural as well as suburban areas. Nor is mass female hysteria limited to certain cultural or age groups. Rather, it effects women regardless of age (though younger females tend to be effected), culture, religion, or nation of origin (Markush, 1973; Sirois, 1982). Even nuns have been effected (e.g. the mewing nuns; see Markush, 1973; Sirois, 1982). However, it has been reported that those of lower occupations are far more likely to be effected (Colligan & Murphy, 1979; McGrath, 1982), whereas among girls and young women, those who failed to complete high school or who have a history of recent grief or personal loss (death, divorce) tend to be at the most risk (see Small et al. 1991). In addition, risk of subsequent contamination has been shown to be positively correlated with friendship and the social hierarchy (Moss & McEvedy, 1966; Small et al. 1991). That is, close friends are more likely to "contaminate" each other (usually by simple observation), whereas younger girls are likely to imitate older girls and thus become similarly ill.

A variety of explanations have been proposed for mass female hysteria, including stress, anxiety, boredom, and the fact that some of the work settings where these outbreaks occur are noisy and prevent the women from socializing and talking to one another (see Colligan et al. 1982); which females tend to find stressful. Moreover, given the routine and the repetitive qualities of some work situations, it has been argued that the aflicted women have little or no opportunity to express their attachment needs or to attract attention. That is, they utilize hysteria as a means of attracting attention, to solicit nurturance, and to express their feelings.

Moreover, many of the femals effected tend to have high rates of absentism for health problems prior to the outbreak, suggesting that in part these women are manifesting a hypochondriacle and hysterical coping pattern independent of these outbeaks. On the other hand, it is possible that the absentism and the hysteria in these women are manifestations of an increased susceptibility to internal or external stress. Hence, they become "ill" more frequently, and are therefore predisposed to developing "hysterical" disorders.

However, it has also been noted that women or girls who have been recently subject to stress, such as due to a divorce or death, are also at risk (e.g. Small et al. 1991). Hence, certain forms of stress, including, perhaps the stress associated with the excitement of a high school recital, can increase the risk of developing a hysterical reaction among women, if other females are also observed to mysteriously become ill.

Of course, those afflicted (and their attorneys) will vigorously deny that their illness is imaginary. In fact, given the role of the limbic system in controlling emotional and autonomic nervous system functioning, if sufficiently stressed, such as by watching their friends and coworkers become ill, it is likely that these women will subsequently become excessively emotionally aroused and will feel ill, and may even suffer convulsions and gastrointestinal and related limbic and autonomic abnormalities -in which case it may become almost impossible to determine if the disorder is "hysterical."

Consider, for example, the widely reported incident of possible mass hysteria which took place in the emergency room of General Hospital in Riverside California (reviewed by Stone, 1995). Specifically, on the evening of February 19, 1994, a 31 year old women, Gloria R. was in the process of being resuscitated when a female nurse, S. K. noticed a chemical smell, similar to ammonia that she thought was coming from Gloria's blood.

In addition, a female resident, J. G. noticed manila colored particles floating in the blood. Suddenly the nurse, S.K. felt that her face was burning and she fell to the floor. She was placed on a gurney and taken to away. Suddenly the female resident, J. G. began feeling queasy and light headed. She then slumped to the floor, shook and convulsed intermittently, and displayed apnea. And then, a female respiratory therapist M. W. also began displaying symptoms and "couldn't control the movement of" her "limbs." And then, a vocational nurse, S. B., felt a burning sensation and began retching. Eventually 23 of the 37 emergency room staff were afflicted and an intensive investigation was launched to determine the cause.

According to the California Dept. of Heath and Human Services, and two of its scientists, Drs. A. Osorio and K. Waller, those afflicted experienced "an outbreak of mass sociogenic illness, perhaps triggered by an odor," i.e. mass hysteria. It was noted that the two male paramedics who brought in the patient and who touched G.R.'s skin and blood did not become ill, and that women were predominantly and the most severely effected. It was also noted that those who had skipped dinner and were working on an empty stomach (which would induce limbic arousal) were also more likely to be effected.

Nevertheless, the diagnosis of "mass hysteria" was not acceptable to those who became ill, or to their attorneys. Scientists at Livermore Laboratories were called onto the case. As often occurs when lawsuits are involved, completely different conclusions were reached and a completely different scenario involving a rather harmless substance, DMSO, was hypothesized as the main factor involved (see Stone 1995 for details). That is, these female nurses and female doctors became "ill" because of a sequence of chemical transformations involving the deceased patient's presumed excessive use of DMSO as a treatment for pain. The family of the patient (Gloria R.), however, denied that she ever used DMSO or had access to it.

SEX DIFFERENCES IN HYSTERIA

As noted, some males were also effected to varying degrees in the above mentioned cases. Hence, males are not immune from developing hysterical disorders. However, in contast to women who may develop such symptoms in isolation or in groups, often via the power of suggestion or through mild fear and social contagion, for heterosexual men the conditions must be generally quite horrendous and involve not imagined fears but death, destuction, and the killing of close friends and comrades such as in war (Grinker & Spiegel, 1945; see chapter 30).

That is, in contrast to some women who may develop any number of hysterical symptoms while working or studying in large female dominated groups in otherwise safe environments where threats to their lives and health are for the most part imaginary, men are more likely to develop hysterical disorders when placed in horrible conditions where the threat to their life is not only real but is experienced daily, weekly, and monthly, and under conditions where they may see friends blown apart by gun fire or their air planes blown to bits (Grinker & Spiegel, 1945). During World War II, in the "overseas Air Force it was a mathematical certainty that only a few men out of each sqaudron would finish a tour of duty" (Grinker & Spiegel, 1945, p. 33). In this regard, in contrast to those females who may experience a single episode of terrible fear or tremendous excitement and then develop hysterical symptoms, when men develop hysteria involving physical symptoms, often the fear must be repeatedly experienced -as is common during war time.

"Fear itself is the most potent source of emotional stress in combat. Fear is cumulative, because the longer the individual stays in the battle, the more remote appears his chance of coming outalive or uninjured" (Grinker & Spiegel, 1945, p. 33). Hence, under these repetitive traumatic conditions, some male's may eventually convert their fears and feelings of stress which are then manifested as physical symptoms (see chapter 16). Presumably, it is the physical symptom which enables them to escape the horror and their terrible fears, without suffering overwhelming feelings of cowardice.

However, as detailed in chapter 30, fear and emotional trauma can in fact damage the brain, which in turn can influence physical and perceptual functioning and induce psychotic and dissociative states as well as post traumatic stress disorder (Joseph, 1998b, 1999d). For example, it has been demonstrated that the hippocampus is damaged by repetitive stress (Lupien & McEwen, 1997; Sapolsky, 1996; Uno et al. 1989), and that patients with combat-related post traumatic stress disorder display a statistically significant, 8% reduction in the right hippocampus (Bremner et al. 1995). Similarly, abnormal early environmental influences not only effect the hippocampus and a variety of cerebral structures, but results in reductions in the size of the right amygdala (Diamond 1986). As detailed in chapter 30, limbic and amygdala hyperactivation and hippocampal dysfunction are directly associated with dissociative and psychotic states as well as the development of post-traumatic stress disorder.

SEX DIFFERENCES, HYSTERIA & THE LIMBIC SYSTEM

As detailed in chapter 13, the amygdala and hypothalamus are the primary source for feelings of fear and both nuclei are sexually differentiated. Hence, men and women respond differently to similar stimuli, and differentially develop hysterical and related mood disorders which in turn reflects not only sex differences in the limbic system, but sex differences in self-concept, and in reactions to stress and even the possibility of illness. As also noted in chapter 13, the female limbic system may predispose women to becoming more easily stressed and emotionally upset which in turn can disrupt the functioning of the HPA axis. Since females are more emotionally sensitive and expressive, they are also more likely to respond fearfully and thus develop emotional, physical and/or "hysterical" disorders.

Indeed, as is well known, females are also far more likely to seek medical attention than males (see chapter 13), and this includes female "soldiers." For example, female armed forces personnel generally have a much higher rate of "illness" that requires some sort of medical attention and thus relief from their duties (see Farrell 1993) e.g. almost a third of female enlisted personnel became "pregnant" or ill just prior to the 1993 Gulf War and thus could not ship out with their male counterparts (reviewed in Farrell 1993).

By contrast, male soldiers and Air Force personnel (as well as men and boys in general) often try to downplay or hide their injuries or potentially disabling conditions. Moreover, in war time, many obviously injured male soldiers earnestly desire to rejoin their comrades and fighting units; in part due to a sense of loyalty and feeling of brotherhood, and, in some cases a fear of appearing cowardly or weak, whereas in others, due to a desire to be part of the continuing action. Indeed, as noted in chapter 5, even male chimpanzees enjoy and seek out aggressive encounters, which in turn is a manifestation of their enjoyment of aggression as well as their concern for and desire for status (Goodall 1971, 1990) -functions which are clearly linked to sex differences in the functional integrity of the limbic system.

As is also detailed in chapter 13, sex differences in the limbic system are reflected in those behaviors and activities which men and women are most likely to find pleasurable, aversive, or threatening to their self-concept as men or women. For example, an injured soldier may seek to rejoin his comrades not because he enjoys fighting, but because he fears being perceived as weak. Being viewed as weak or fragile is not something most women fear, whereas seeking nurturance and revealing, discussing, and sharing one's problems and troubles is often a source of considerable female pleasure (Glass 1993; Tannen 1991). Moreover, whereas males may be teased or tormented by other men, regarding their perceived fears, illness, or disabilities, women respond with concern, nurturance and sympathy.

Hence, it is more socially acceptable for women to become ill, to seek help, and to become upset, which (when coupled with limbic system sex differences) increases the likelihood they may develop "imaginary" illness, especially if their close friends or associates also become "ill." By contrast, whereas a single instance of intense fear may induce hysteria and the development of physical disturbances in females, males tend to be intensely fearful of and reluctant to reveal similar problems which in turn reduces the likelihood that they may develop imaginary illnesses. Of course, this male predisposition to "tough it out" probably also contributes to the development of real illnesses leading to death.



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