defect of will and a strong stimulus is required to lead to
action.
Among civilized women, the author proceeds, this condition does
not appear to subserve any useful purpose. "Let us, however, go
back to aboriginal woman--to woman of the woods and the fields.
Let us picture ourselves a young aboriginal Venus in one of her
earliest hysterical paroxysms. In doing so, let us not forget
some of the twelve characteristics previously mentioned. She will
not be 'acting her part' alone, or, if alone, it will be in a
place where someone else is likely soon to discover her. Let this
Venus be now discovered by a youthful Apollo of the woods, a man
with fully developed animal instincts. He and she, like any other
animals, are in the free field of Nature. He cannot but observe
to himself: 'This woman is not dead; she breathes and is warm;
she does not look ill; she is plump and rosy.' He speaks to her;
she neither hears (apparently) nor responds. Her eyes are closed.
He touches, moves, and handles her at his pleasure.
She makes no
resistance. What will this primitive Apollo do next?
He will cure
the fit, and bring the woman back to consciousness, satisfy her
emotions, and restore her volition--not by delicate touches that
might be 'agonizing' to her hyperesthetic skin, but by vigorous
massage, passive motions, and succussion that would be painless.
The emotional process on the part of the woman would end,
perhaps, with mingled laughter, tears, and shame; and when
accused afterward of the part which the ancestrally acquired
properties of her nervous system had compelled her to act, as a
preliminary to the event, what woman would not deny it and be
angry? But the course of Nature having been followed, the natural
purpose of the hysterical paroxysm accomplished, there would
remain as a result of the treatment--instead of one discontented
woman--two happy people, and the possible beginning of a third."
"Natural, primary sexual hysteria in woman," King concludes, "is
a temporary modification of the nervous government of the body
and the distribution of nerve-force (occurring for the most part,
as we see it to-day, in prudish women of strong moral principle,
whose volition has disposed them to resist every sort of liberty
or approach from the other sex), consisting in a transient
abdication of the general, volitional, and self-preservational
ego, while the reins of government are temporarily assigned to
the usurping power of the reproductive ego, so that the
reproductive government overrules the government by volition, and
thus, as it were, forcibly compels the woman's organism to so
dispose itself, at a suitable time and place, as to allow,
invite, and secure the approach of the other sex, whether she
will or not, to the end that Nature's imperious demand for
reproduction shall be obeyed."
This perhaps rather fantastic description is not a presentation of
hysteria in the technical sense, but we may admit that it presents a state
which, if not the real physiological counterpart of the hysterical
convulsion, is yet distinctly analogous to the latter.
The sexual orgasm
has this correspondence with the hysterical fit, that they both serve to
discharge the nervous centres and relieve emotional tension. It may even
happen, especially in the less severe forms of hysteria, that the sexual
orgasm takes place during the hysterical fit; this was found by Rosenthal,
of Vienna, to be always the case in the semiconscious paroxysms of a young
girl whose condition was easily cured;[286] no doubt such cases would be
more frequently found if they were sought for. In severe forms of
hysteria, however, it frequently happens, as so many observers have noted,
that normal sexual excitement has ceased to give satisfaction, has become
painful, perverted, paradoxical. Freud has enabled us to see how a shock
to the sexual emotions, injuring the emotional life at its source, can
scarcely fail sometimes to produce such a result. But the necessity for
nervous explosion still persists.[287] It may, indeed, persist, even in an
abnormally strong degree, in consequence of the inhibition of normal
activities generally. The convulsive fit is the only form of relief open
to the tension. "A lady whom I long attended," remarks Ashwell, "always
rejoiced when the fit was over, since it relieved her system generally,
and especially her brain, from painful irritation which had existed for
several previous days." That the fit mostly fails to give real
satisfaction, and that it fails to cure the disease, is due to the fact
that it is a morbid form of relief. The same character of hysteria is
seen, with more satisfactory results for the most part, in the influence
of external nervous shock. It was the misunderstood influence of such
shocks in removing hysteria which in former times led to the refusal to
regard hysteria as a serious disease. During the Rebellion of 1745-46 in
Scotland, Cullen remarks that there was little hysteria.
The same was true
of the French Revolution and of the Irish Rebellion, while Rush (in a
study _On the Influence of the American Revolution on the Human Body_)
observed that many hysterical women were "restored to perfect health by
the events of the time." In such cases the emotional tension is given an
opportunity of explosion in new and impersonal channels, and the chain of
morbid personal emotions is broken.
It has been urged by some that the fact that the sexual orgasm usually
fails to remove the disorder in true hysteria excludes a sexual factor of
hysteria. It is really, one may point out, an argument in favor of such an
element as one of the factors of hysteria. If there were no initial lesion
of the sexual emotions, if the natural healthy sexual channel still
remained free for the passage of the emotional overflow, then we should
expect that it would much oftener come into play in the removal of
hysteria. In the more healthy, merely hysteroid condition, the psychic
sexual organism is not injured, and still responds normally, removing the
abnormal symptoms when allowed to do so. It is the confusion between this
almost natural condition and the truly morbid condition, alone properly
called hysteria, which led to the ancient opinion, inaugurated by Plato
and Hippocrates, that hysteria may be cured by marriage.[288] The
difference may be illustrated by the difference between a distended
bladder which is still able to contract normally on its contents when at
last an opportunity of doing so is afforded and the bladder in which
distension has been so prolonged that nervous control had been lost and
spontaneous expulsion has become impossible. The first condition
corresponds to the constitution, which, while simulating the hysterical
condition, is healthy enough to react normally in spite of psychic
lesions; the second corresponds to a state in which, owing to the
prolonged stress of psychic traumatism,--sexual or not,-
-a definite
condition of hysteria has arisen. The one state is healthy, though
abnormal; the other is one of pronounced morbidity.
The condition of true hysteria is thus linked on to almost healthy states,
and especially to a condition which may be described as one of sex-hunger.
Such a suggestion may help us to see these puzzling phenomena in their
true nature and perspective.
At this point I may refer to the interesting parallel, and
probable real relationship, between hysteria and chlorosis. As
Luzet has said, hysteria and chlorosis are sisters.
We have seen
that there is some ground for regarding hysteria as an
exaggerated form of a normal process which is really an
auto-erotic phenomenon. There is some ground, also, for regarding
chlorosis as the exaggeration of a physiological state connected
with sexual conditions, more specifically with the preparation
for maternity. Hysteria is so frequently associated with anæmic
conditions that Biernacki has argued that such conditions really
constitute the primary and fundamental cause of hysteria
(_Neurologisches Centralblatt_, March, 1898). And, centuries
before Biernacki, Sydenham had stated his belief that poverty of
the blood is the chief cause of hysteria.
It would be some confirmation of this position if we could
believe that chlorosis, like hysteria, is in some degree a
congenital condition. This was the view of Virchow, who regarded
chlorosis as essentially dependent on a congenital hyoplasia of
the arterial system. Stieda, on the basis of an elaborate study
of twenty-three cases, has endeavored to prove that chlorosis is
due to a congenital defect of development (_Zeitschrift für
Geburtshülfe und Gynäkologie_, vol. xxxii, Part I, 1895). His
facts tend to prove that in chlorosis there are signs of general
ill-development, and that, in particular, there is imperfect
development of the breasts and sexual organs, with a tendency to
contracted pelvis. Charrin, again, regards utero-ovarian
inadequacy as at least one of the factors of chlorosis.
Chlorosis, in its extreme form, may thus be regarded as a
disorder of development, a sign of physical degeneracy. Even if
not strictly a cause, a congenital condition may, as Stockman
believes (_British Medical Journal_, December 14, 1895), be a
predisposing influence.
However it may be in extreme cases, there is very considerable
evidence to indicate that the ordinary anæmia of young women may
be due to a storing up of iron in the system, and is so far
normal, being a preparation for the function of reproduction.
Some observations of Bunge's seem to throw much light on the real
cause of what may be termed physiological chlorosis.
He found by
a series of experiments on animals of different ages that young
animals contain a much greater amount of iron in their tissues
than adult animals; that, for instance, the body of a rabbit an
hour after birth contains more than four times as much iron as
that of a rabbit two and a half months old. It thus appears
probable that at the period of puberty, and later, there is a
storage of iron in the system preparatory to the exercise of the
maternal functions. It is precisely between the ages of fifteen
and twenty-three, as Stockman found by an analysis of his own
cases (_British Medical Journal_, December 14, 1895), that the
majority of cases occur; there was, indeed, he found, no case in
which the first onset was later than the age of twenty-three. A
similar result is revealed by the charts of Lloyd Jones, which
cover a vastly greater number of cases.
We owe to Lloyd Jones an important contribution to the knowledge
of chlorosis in its physiological or normal relationships. He has
shown that chlorosis is but the exaggeration of a condition that
is normal at puberty (and, in many women, at each menstrual
period), and which, there is good reason to believe, even has a
favorable influence on fertility. He found that light-complexioned persons are more fertile than the dark-complexioned, and that at the same time the blood of the
latter is of less specific gravity, containing less hæmoglobin.
Lloyd Jones also reached the generalization that girls who have
had chlorosis are often remarkably pretty, so that the tendency
to chlorosis is associated with all the sexual and reproductive
aptitudes that make a woman attractive to a man. His conclusion
is that the normal condition of which chlorosis is the extreme
and pathological condition, is a preparation for motherhood (E.
Lloyd Jones, "Chlorosis: The Special Anæmia of Young Women,"
1897; also numerous reports to the British Medical Association,
published in the _British Medical Journal_. There was an
interesting discussion of the theories of chlorosis at the Moscow
International Medical Congress, in 1898; see proceedings of the
congress, volume in, section v, pp. 224 et seq.).
We may thus, perhaps, understand why it is that hysteria and
anæmia are often combined, and why they are both most frequently
found in adolescent young women who have yet had no sexual
experiences. Chlorosis is a physical phenomenon; hysteria,
largely a psychic phenomenon; yet, both alike may, to some extent
at least, be regarded as sexual aptitude showing itself in
extreme and pathological forms.
FOOTNOTES:
[251] _Genèse et Nature de l'Hystérie_, 1898; and, for Sollier's latest
statement, see "Hystérie et Sommeil," _Archives de Neurologie_, May and
June, 1907. Lombroso (_L'Uomo Delinquente_, 1889, vol.
ii, p. 329),
referring to the diminished metabolism of the hysterical, had already
compared them to hibernating animals, while Babinsky states that the
hysterical are in a state of subconsciousness, a state, as Metchnikoff
remarks (_Essais optimistes_, p. 270), reminiscent of our prehistoric
past.
[252] Professor Freud, while welcoming the introduction of the term
"auto-erotism," remarks that it should not be made to include the whole of
hysteria. This I fully admit, and have never questioned.
Hysteria is far
too large and complex a phenomenon to be classed as entirely a
manifestation of auto-erotism, but certain aspects of it are admirable
illustrations of auto-erotic transformation.
[253] The hysterical phenomenon of _globus hystericus_
was long afterward
attributed to obstruction of respiration by the womb.
The interesting case
has been recorded by E. Bloch (_Wiener Klinische Wochenschrift_, 1907, p.
1649) of a lady who had the feeling of a ball rising from her stomach to
her throat, and then sinking. This feeling was associated with thoughts of
her husband's rising and falling penis, and was always most liable to
occur when she wished for coitus.
[254] As Gilles de la Tourette points out, it is not difficult to show
that epilepsy, the _morbus sacer_ of the ancients, owed much of its sacred
character to this confusion with hysteria. Those priestesses who, struck
by the _morbus sacer_, gave forth their oracles amid convulsions, were
certainly not the victims of epilepsy, but of hysteria (_Traité de
l'Hystérie_, vol. i, p. 3).
[255] Aretæus, _On the Causes and Symptoms of Acute Diseases_, Book ii,
Chapter II.
[256] It may be noted that this treatment furnishes another instance of
the continuity of therapeutic methods, through all changes of theory, from
the earliest to the latest times. Drugs of unpleasant odor, like
asafoetida, have always been used in hysteria, and scientific medicine
to-day still finds that asafoetida is a powerful sedative to the uterus,
controlling nervous conditions during pregnancy and arresting uterine
irritation when abortion is threatened (see, e.g., Warman, _Der
Frauenarzt_, August, 1895). Again, the rubbing of fragrant ointments into
the sexual regions is but a form of that massage which is one of the
modern methods of treating the sexual disorders of women.
[257] _Les Démoniaques dans l'Art_, 1887; _Les Malades et les Difformes
dans l'Art_, 1889.
[258] Glafira Abricosoff, of Moscow, in her Paris thesis, _L'Hystérie aux
xvii et xviii siécles_, 1897, presents a summary of the various views held
at this time; as also Gilles de la Tourette, _Traité de l'Hystérie_, vol.
i, Chapter I.
[259] _Edinburgh Medical Journal_, June, 1883, p. 1123, and _Mental
Diseases_, 1887, p. 488.
[260] Hegar, _Zusammenhang der Geschlechtskrankheiten mit nervösen
Leiden_, Stuttgart, 1885. (Hegar, however, went much further than this,
and was largely responsible for the surgical treatment of hysteria now
generally recognized as worse than futile.) Balls-Headley, "Etiology of
Nervous Diseases of the Female Genital Organs," Allbutt and Playfair,
_System of Gynecology_, 1896, p. 141.
[261] Lombroso and Ferrero, _La Donna Delinquente_, 1893, pp. 613-14.
[262] Charcot and Marie, article on "Hysteria," Tuke's _Dictionary of
Psychological Medicine_.
[263] Axenfeld and Huchard, _Traité des Névroses_, 1883, pp. 1092-94.
Icard (_La Femme pendant la Période Menstruelle_, pp.
120-21) has also
referred to recorded cases of hysteria in animals (Coste's and Peter's
cases), as has Gilles de la Tourette (op. cit., vol. i, p. 123). See also,
for references, Féré, _L'Instinct Sexuel_, p. 59.
[264] _Man and Woman_, 4th ed., p. 326. A distinguished gynæcologist,
Matthews Duncan, had remarked some years earlier (_Lancet_, May 18, 1889)
that hysteria, though not a womb disease, "especially attaches itself to
the generative system, because the genital system, more than any other,
exerts emotional power over the individual, power also in morals, power in
social questions."
[265] Gilles de la Tourette, _Archives de Tocologie et de Gynécologie_,
June, 1895.
[266] _Rivista Sperimentale di Freniatria_, 1897, p.
290; summarized in
the _Journal of Mental Science_, January, 1898.
[267] From the earliest times it was held that menstruation favors
hysteria; more recently, Landouzy recorded a number of observations
showing that hysterical attacks coincide with perfectly healthy
menstruation; while Ball has maintained that it is only during
menstruation that hysteria appears in its true color.
See the opinions
collected by Icard, _La Femme pendant la Période Menstruelle_, pp. 75-81.
[268] Krafft-Ebing, "Ueber Neurosen und Psychosen durch Sexuelle
Abstinenz," _Jahrbücher für Psychiatrie_, vol. iii, 1888. It must,
however, be added that the relief of hysteria by sexual satisfaction is
not rare, and that Rosenthal finds that the convulsions are thus
diminished. (_Allgemeine Wiener Medizinal-Zeitung_, Nos.
46 and 47, 1887.)
So they are also, in simple and uncomplicated cases, according to Mongeri,
by pregnancy.
[269] "All doctors who have patients in convents,"
remarks Marro (_La
Pubertà_, p. 338), "know how hysteria dominates among them;" he adds that
his own experience confirms that of Raciborski, who found that nuns
devoted to the contemplative life are more liable to hysteria than those
who are occupied in teaching or in nursing. It must be added, however,
that there is not unanimity as to the prevalence of hysteria in convents.
Brachet was of the same opinion as Briquet, and so considered it rare.
Imbert-Goubeyre, also (_La Stigmatisation_, p. 436) states that during
more than forty years of medical life, though he has been connected with a
number of religious communities, he has not found in them a single
hysterical subject, the reason being, he remarks, that the unbalanced and
extravagant are refused admission to the cloister.
[270] Parent-Duchâtelet, _De la Prostitution_, vol. i, p. 242.
[271] It may not be unnecessary to point out that here and throughout, in
speaking of the psychic mechanism of hysteria, I do not admit that any
process can be _purely_ psychic. As Féré puts it in an admirable study of
hysteria (_Twentieth Century Practice of Medicine_, 1897, vol. x, p. 556):
"In the genesis of hysterical troubles everything takes place as if the
psychical and the somatic phenomena were two aspects of the same
biological fact."
[272] Pierre Janet, _L'Automatisme Psychologique_, 1889; _L'Etat mental
des Hystériques_, 1894; _Névroses et Idées fixes_, 1898; Breuer und Freud,
_Studien über Hysterie_, Vienna, 1895; the best introduction to Freud's
work is, however, to be found in the two series of his _Sammlung Kleiner
Schriften zur Neurosenlehre_, published in a collected form in 1906 and
1909. It may be added that a useful selection of Freud's papers has lately
(1909) been published in English.
[273] We might, perhaps, even say that in hysteria the so-called higher
centres have an abnormally strong inhibitory influence over the lower
centres. Gioffredi (_Gazzetta degli Ospedali_, October 1, 1895) has shown
that some hysterical symptoms, such as mutism, can be cured by
etherization, thus loosening the control of the higher centres.
[274] Charcot's school could not fail to recognize the erotic tone which
often dominates hysterical hallucinations. Gilles de la Tourette seeks to
minimize it by the remark that "it is more mental than real." He means to
say that it is more psychic than physical, but he implies that the
physical element in sex is alone "real," a strange assumption in any case,
as well as destructive of Gilles de la Tourette's own fundamental
assertion that hysteria is a real disease and yet purely psychic.
[275] See, e.g., his substantial volume, _Die Traumdeutung_, 1900, 2d ed.