Descriptive Psychopathology: The Signs and Symptoms of ...

26 Section 1: Present, past, and futuretraumatic events. The neurosis emerged from the inability to integrate unconsciousand conscious processes. 23 He considered hypnosis and dream analysis asmethods for identifying the neurotic unconscious’ fixed ideas, and that theexposure of these ideas with associated catharsis as curative. 24 These notionsinfluenced Bleuler’s formulations of schizophrenia (see below).Janet described dissociation as a hysterical condition in which intolerablethoughts and feelings become independent from other mental functions andare then expressed as dissociative states. This notion prevails in present classifications.He also associated hysteria and other neuroses with a hereditary or constitutionalweakness in personality. He detailed the characteristics of hystericalpersonality as the predisposing factor to neurosis. 25Janet was not alone in understanding unconscious mechanisms as underlyingneurosis and its cures, although Freud received the major credit. Auguste AntoineLiébeault and Hippolyte Bernheim in Nancy, J. Milne Bramwell in England, andJosef Breuer in Vienna, each treated neurotics with hypnosis as a form of psychotherapybefore Freud’s work became well-known. 26 “Psychic” treatments werewidely prescribed throughout Europe’s private psychiatric clinics before Freuddominated the field. 27Theories merge in the notions of neurosis and hysteriaUnderstandings of neurosis and hysteria included all the early theories explaininghuman behavior. The theories were eventually blended with the fledgling understandingof the nervous system, foreshadowing modern efforts to reconcilepsychoanalytic and biological views of behavior into the “biopsychosocial” modelof psychiatric illness.Hippocrates began the theoretical journey by attributing hysteria to awandering uterus and thus a condition exclusively seen in women. 28 Galenrejected that notion, but accepted an “engorged” uterus as the cause. 29 In theEuropean Early Modern period, hysteria was considered of supernatural origin,but still exclusively seen in women. 30 Reports were common of large groups ofpeople (also exclusively female) suddenly succumbing to supernatural forces.Dramatic cases of chorea, St Vitus’ Dance, Tarantism (a dance-like movementdisorder that in its cultural form is the dance, the Tarantella), and convulsive-likesyndromes were described. The true nature of these events is obscure.One clue, however, comes from a presentation of 135 patients with chronicencephalitis from the 1918 influenza pandemic who were admitted for psychiatricdisturbances to Manhattan State Hospital in New York City between 1920 and1930. 31 Reasons for psychiatric hospitalization included “impudence and disobedience”,various odd motor disturbances, “excessive love of excitement”,“constant complaining”, “meddlesomeness”, “maliciousness”, emotional lability,