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This article throws light upon the three main categories of conversion hysteria in humans. The types are: 1. Sensory Conversion 2. Motor Symptoms 3. Visceral Disorder
Type # 1. Sensory Conversion:
This refers to the inability to receive sensory stimuli. Anyone of the senses like visual, or tactual may be involved.
The most common forms of Sensory Conversion described by Coleman are:
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Anaesthesia — loss of sensitivity
Hyposthenia — partial loss of sensitivity
Hyperesthesia — excessive sensitivity
Analgesic — loss of pain sensitivity
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Paraesthesia — exceptional sensation such as tinglings.
Anaesthesia is one of the most primary diagnostic signs of hysterical reactions. Though during second world war tactual anaesthesia was found in many hysteric soldiers now it is rarely found. In this type of anaesthesia touch sensation is lost in a particular part of the body which is otherwise physically alright.
There is one type of glove anaesthesia where there is loss of feeling in their hands up to the wrist. Besides, loss of touch, deafness, blindness and pain sensitivity in various parts of the body are also experiences.
There is actually no organic pathology behind loss of senses, the loss of sensitivity is psychologically real. In other words, the patient is really unable to get the sensation. But nevertheless, it is quite selective. Ironside and Batchelor’s (1945) have given some illustrations of hysterical visual symptoms of airmen.
A significant aspect of the findings of the above study is that the symptoms of each patient were closely reliable to his performance duties. For instance, night blindness was more found among night fliers and day fliers usually developed defect in day vision.
Type # 2. Motor Symptoms:
Motor conversions include paralysis of the different parts of the body which is usually confined to a single limb. Under motor conversions fits and muscular contractions of termers occur without any physical basis. The extent of paralysis is determined by popular conception of organs rather than the anatomical distribution of nerves.
For example, arms may be paralysed up to the soldiers and the legs may be paralysed from the knee down. There also may be various degrees of paralyses. By and large, the loss of function is selective in case of a conversion hysteric. For instance, a patient cannot write but he can use the same muscles for knitting or playing musical instrument. This is popularly known as writer’s cramp.
Hysterical fits:
1. Epileptic fit is one of the most common motor symptom of a conversion hysteria. But the hysterical fit is different from the genuine organic fits. Rhythmic movement found in real seizures is not found in the hysterical fit.
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2. The hysterical patients do not bite their tongues during fits as is found in case of genuine fits.
3. While the person having genuine organic fits falls at any place, the hysteric person during fits falls in a safe and comfortable place.
4. The hysterical symptoms can be removed by drug or hypnosis, while the genuine fits require medical treatment for their cure.
Astasia-abasia:
This refers to the inability to stand or walk. The individual suffering from astasia-abasia may be bed ridden because of the difficulties in walking. The special feature of this disease is that the patient in-spite of the inability to stand and walk is able to move his legs freely when lying on bed or sitting.
Physical examination however reveals that there is no defect in the muscles. According to Duke and Nowicki “In astasia-abasia, there is usually absence of the muscle atrophy or impairment of blood flow found in true neurological disorders marked by loss of muscle use.”
Termers and tics are other common motor symptoms including paralysis of other parts of the body. Occasionally there is flexion of fingers and toes or rigidity of the larger joints like the knees and the elbows.
Disturbance of speech:
Hysterical aphonic is a most common hysterical speech disturbance in which the patient is able to limit his speech to whisper i.e. he cannot talk above a whisper. The following incident can explain the fact. A forty-five year old married woman felt badly treated and neglected by her husband.
This had been particularly aggravated following the separation of two grown up children from the home. After a number of quarrels and angry scenes with her husband, she suddenly developed aphonic.
After examining the patient, the physician spoke to another person in a whispered tone but quite loud so that the patient is sure to over hear him. “That lady is awful really. There is nothing wrong with her. She could talk very well, if she wanted to.” Immediately the patient became extremely angry and retorted back in an indignant vocal denial. Thus the patient was cured.
An aphonic patient cannot talk but he can cough perfectly. However, hysterical mutism is rarely found in comparison to other motor conversions. It is very interesting to note that hysterical fits and convulsions almost always take place in the presence of other people.
Hysterical fainting attacks similarly occur occasionally but rarely. Motor ticks involve a group of muscles ranging from occasional jerking of a limb to choreiform movements.
Type # 3. Visceral Disorder:
Hysterical visceral symptoms include headache, lump in the throat, chocking sensations, cold, nausea, vomiting, pain in abdomen etc. Thus, these are conversions which include the autonomic nervous system, commonly called autonomic conversions. As a result a number of respiratory and autonomic disorders may be found.
Pseudo Cyesis or phantom pregnancy is a common example of autonomic conversion where there is not only cease of periods, but also morning sickness, enlarged breasts and abdomen. It is as though a woman wants a child so much, that she behaves psychologically pregnant. Similarly vomiting signifies repressed disgust.
Similarly in a pseudo attack of acute appendicitis, the patient not only suffers from severe pain in the lower abdomen, there is also rise in temperature above the normal level. Such cases lead to a number of confusions and unnecessary operations.
Anrexia nervosa is another autonomic conversions where the dysfunction occurs in eating behaviour. The patient eats less and less. At last a time comes when he does not take anything at all.
Bliss and Branch (1960) on the basis of a survey report view that usually women between 18-25 years become victims to this and those weighing 122 pounds before illness weigh 78 pounds at the height of disorder. Even there are reports of women to weigh 37-38 pounds after suffering from this disease. But thankfully, anorexia nervosa is quite uncommon.
Tropic symptoms:
The vaso motor disturbances of hysterically paralyzed limbs are otherwise known as tropic symptoms where the limbs become blue and cold.
Dejerine’s explanation:
According to Dejerine, hysteria resulted from emotional disturbance, but only in subjects with a peculiar emotional constitution. By emotional constitution he meant the tendency to reach more intensely than the normal to an emotional stimulus and to react in a particular organ or group of organs. This type of personality make up leads to a distinct tendency to become dissociated from consciousness.
They are in-fact highly excitable and show dramatic response to normal circumstances. Dejerine has thus emphasized on the role of emotion in the causation of hysteria. But never the less, his explanation of hysterical reactions lacked the precision and details which were to be supplied by Freud.
Janet’s explanation:
Janet held that hysteria is a malady of the synthesis of personality. It is a form of mental depression characterized by restriction of the field of personal consciousness and a tendency to dissociation and emancipation of the symptoms of ideas and functions that constitute personality.
According to Janet, when the nervous tension or psychological force is lowered by disease, fatigue or emotion, there is a general lowering of the level of psychological function. In hysteria, Janet viewed the lowering of function which disappears in consequence from the conscious state, it is dissociated from the rest of conscious personality.
However, Janet’s hypothesis does not explain of what brings about the dissociation except the hysterical dissociation is said to occur at moments of emotion.