Vaughan Bell is a clinical and research psychologist based at the Institute of Psychiatry, King’s College London. He’s also working on a book about hallucinations due to be out in 2013.
Cheerleaders from a small town in New York state have been making headlines because several of them began to display tics and involuntary movements that have been diagnosed as conversion disorder—a situation which has often described in the media as being due to “mass hysteria” or a “mystery illness.” I can’t say for sure whether the diagnosis of conversion disorder is accurate or not because I’ve not been clinically involved with the affected people, and if I had, I couldn’t talk about it due to patient confidentiality, but what I can say is that some of the media reporting of conversion disorder, “hysteria” and its related concepts has been highly confused.
Hysteria is used in everyday language to mean “panic” but it has a long history as a medical condition, originating from Hippocrates who thought that a whole range of symptoms could be caused by the womb “wandering” around the body. As you might expect, it was traditionally thought of as a female disease until the French neurologist Jean-Martin Charcot shocked the medical world by reporting the first male cases. Although the connection with a wandering womb was comprehensively disproved, doctors were still puzzled by patients who seemed to have neurological disorders without damage to the brain and nervous system. The core definition of hysteria as neurological symptoms without neurological damage remains with us today.
A student of Charcot’s, Sigmund Freud, became curious about the condition and added another element to the definition, which both made his career and became the basis of psychoanalysis itself. As a neurologist, Freud came to believe that mental energy was equivalent to neural energy and, therefore, our mind obeys something akin to the laws of thermodynamics. The first such law says that energy cannot be created or destroyed, only converted into another form. This is why Freudian psychology is full of mechanical concepts such as “repression” and “conversion” and the idea that all emotional disturbance must be “processed” or “dealt with” (think: a release valve) or else it will express itself in another form (think: a burst or bulging pipe). Many of the theory’s predictions have been disproved but the theory lives on and, to a great extent, it has become what we unfortunately think of as common sense. Nevertheless, Freud applied the same thinking to hysteria, saying that these seemingly neurological symptoms can appear without neurological damage because the unconscious mind is shutting down the body to prevent us from encountering a deep emotional disturbance. A bit like locking the basement in a rushed attempt to deal with a burst pipe—the problem is easier to ignore but not any less serious.