COMMENTARY

Morgellons: Real Disease or Imaginary Malady?

Andrew Scull, PhD

Disclosures

June 18, 2015

In This Article

Hypnosis and Hysteria

Most French physicians were loath to admit hysteria to the status of a legitimate disease. It was a wastebasket category. Its alleged victims, as most medical men saw it, were parading their deceit and acting out a shameful falsehood while demanding to be recognized as genuinely ill. It was a status Charcot marshaled his prestige to grant them. Hysteria, he insisted, was an organic disease, just like the other neurologic ailments he had discovered. His primary therapy for his patients was to mesmerize them—or rather, to hypnotize them, as the treatment had been relabeled. (Mesmer had long been dismissed by his medical brethren as a charlatan and a fraud.)

At first blush this was odd, because the hypnotic trance was surely a form of psychological intervention or manipulation. Not so, Charcot countered. Hypnotism only worked with the susceptible, and that susceptibility in its turn reflected their biological defects.

As for the audience—male and female, demi-mondaine and ultra-respectable haute bourgeoisie alike—it was these hypnotized patients that they had come to see. The hysterics created and recreated the spectacle and circus: Scantily clad young women disported themselves on the lecture platform in unmistakably erotic and sensual poses, responding obediently to the commands of the somber, gray-coated master of ceremonies, the great Charcot himself. Masculine dominance and female foolishness were equally on display.

Charcot's insistence on the neurologic reality of hysteria did not long survive his death. Even his own disciples swiftly turned on the now safely silenced bully who had cowed any dissent. Shame-faced (or not), they dismissed the whole exercise as a sham and an exercise in delusion and folly.

Hysteria lingered, however, now passing into the hands of a Viennese doctor who had journeyed to Paris to study at Charcot's feet, and who now began to advance a thoroughly psychological theory—not just of the origins of hysteria, but of other neuroses as well. Indeed, in the end, he ended up offering a theory of human psychology tout court, one that saw madness and sanity as a continuum, not as discrete entities. As he did so, Sigmund Freud abandoned hypnosis for a more elaborate "talking cure," embarking upon his famous embrace of free association on the psychoanalytic couch as the road to exploring and rearranging the unconscious. Remarkably, and unusually, patients did not desert him.

Three quarters of a century later, psychiatry deserted hysteria. Or rather, the new official Bible of psychiatric diagnoses, the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), could find no place for hysteria in its elephantine array of disorders. Relentlessly shifting back to a biological model of mental disorder, the bulk of the profession shuffled this embarrassing relic of what it saw as an embarrassing embrace of psychodynamic accounts of madness off the stage. However, ultimately, the state previously termed "hysteria" was renamed "conversion disorder" in the DSM as it is now recognized that symptoms previously written off as "hysterical" are often real despite there being no identifiable neurologic cause.

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