How Psychogenic is Dystonia? Views from Past to Present

Alexander G. Munts; Peter J. Koehler


Brain. 2010;133(5):1552-1564. 

In This Article


We started our search on dystonia history using two standard books on the history of medicine (McHenry, 1969; Norman, 1991). Furthermore, we used the PubMed database by entering the term 'dystonia' with limitation to 'history of medicine'. We also used medical and neurological textbooks from the 19th and 20th century written in English, French, German or Dutch (Trousseau, 1882; Gowers, 1888; Oppenheim, 1894; Lewandowsky, 1914; Bouman and Brouwer, 1930; Bumke and Foerster, 1935, 1936; Kinnier Wilson, 1940; Biemond, 1946; Vinken and Bruyn, 1968, 1970). In the tables of contents and subject indexes, we searched for dystonia, spasm(s), spasmodic contortion or contraction, torticollis, wryneck, (writer's) cramp, scrivener's palsy, occupational neurosis (English); dystonie, torticolis (mental), spasme clonique (du sterno-mastoïdien), spasme fonctionel (du sterno-mastoïdien), crampe fonctionelle, crampes des écrivains (French); Dystonie, Torticollis, Schreib(e)krampf, Funktionskrämpfe, Beschäftigungsneurose (German); dystonie, torticollis, (ver)kramp(ing) and schrijverskramp (Dutch). In addition, we searched for relevant literature in the reference lists of consulted books and papers. As many 19th and early 20th century primary textbooks refer to the work of Duchenne and Bell, we chose to discuss their descriptions in more detail. When dealing with the question whether a particular author considered a disorder psychogenic or organic, we assumed a spectrum from organic to psychogenic between which ideas of the individual authors could be placed, as far as could be derived from the text.

Definition of Dystonia

The word dystonia was introduced in 1911 (Oppenheim, 1911). Later its meaning was changed several times. For example, Derek Denny-Brown (1901–1981) considered dystonia to be a disorder with a fixed posture or oscillation between two or more fixed postures (Denny-Brown, 1965, 1966). The modern definition is 'a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements, or abnormal postures' (Fahn, 1988). In this paper, we use the latter definition.

Definitions of Neurosis and Hysteria

In the late 18th and early 19th century, neurosis was defined as the category of clinically well-characterized nervous diseases without known pathological substrates (López Piñero, 1983; Goetz, 2006). Throughout the 19th century, this category became smaller when neuropathological substrates of several of these diseases were established (Bynum, 1985). Hysteria was a subcategory within the neuroses, in which neurological signs were similar to those in patients who suffered from nervous diseases with known anatomic lesions, although somewhat different and usually more extensive. In the late 19th century, Charcot assumed that hysteria arose from a lesion of an undetermined structural or functional nature and he expected that the pathological basis would be found in due course. The neurological defect was believed to result from a combination of hereditary predisposition and an environmental, provocative factor, which usually was a physical or emotional shock (Micale, 1995). Therefore, throughout history the term psychogenic cannot always be considered equal to non-organic, in particular in the pre-Freudian period. After this period, non-organic mostly did mean psychogenic. The meanings of neurosis and hysteria changed and finally the terms were used solely in descriptions of psychiatric diseases. At present, the terms are used less often, and are no longer listed in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000). In this paper, where needed, we clarify the context of these words.


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