Hysteria is a kind of strange disease which nobody could explain till the beginning of 20th century when Freud throw considerable light on its causative factors by approaching it from the psychological standpoint instead of the physical stand- point which has so long been the line of approach and which always led to a dead wall.
As a result of this physical line of approach, practically no symptom of hysteria could be satisfactorily explained and in order to force some sort of explanation, always keeping a firm hold on this physical line of approach, two terms were discovered by the medical men of the past centuries which could explain away all the manifestations of the disease. One of these terms is “functional” and the other is “malingering.” Both of these terms are frequently used even now.
The mental mechanism of the formation of the first term (functional) is very interesting. When a relative of my patient or the patient himself wants to know from me the explanation of a particular symptom, fever, for instance, which I myself, as his medical attendant, do not know, I try to bluff him with a few technical medical terms and he appears to be satisfied. This process is like gagging a person with something which he can neither swallow nor eject. Only it is strange that he mistakes the gag as knowledge and takes pleasure in exhibiting it to others. There is, however, some sense in my conduct in applying this gag, because after all you have to apply a gag when chloro- forming a fellow.
But frequently there comes the necessity to bluff yourself, which appears strange, when your own scientific curiosity to know the causes of certain diseased manifestations of the body begins to trouble you. If you can properly gag yourself by hunting out a certain term which you think superficially explains everything, but which in reality explains nothing, you at least remain at peace with yourself and, like the patient previously mentioned, you regard this term as a new acquisition of knowledge. In the present instance, we have clawed at the term “functional” like a drowning man catching at a straw. From time to time other such terms have been invented like neurotic, allergic etc.
“Functional” really means that we do not know the cause of the abnormality and consequently it does not explain anything. Yet we believe that it explains everything. I have a notion that a fellow who invents such terms puts back the progress of scientific medicine for decades if not for centuries.
The other term which we have had recourse to for explaining hysterical manifestations is “malingering.” That “functional” affair was a medical invention. This “malingering” business is a common belief among most men. This also explains everything. Only the cardinal question remains to be answered “why should the patient malinger ?” Obviously for some gain. What gain ? What does a patient gain by remaining bed-ridden with hysterical paralysis for 6 years. I would not remain in bed for 6 days for any gain unless I am forced to do by medical advice or incapacity. Who has advised the hysterical patient to stay in bed for 6 years and why ? The patient is unable to get up. The relatives say “He will not.” The patient says “I cannot.” The experienced physician says “The patient cannot will.”.
So much about the malingering and the gain of the patient who is cut off from his work and his pleasures and may lead the life of a semi-invalid for years and comes to us to cure his condition. It is hard on him to call his condition malingering. In this article I am not going to enumerate in detail the different symptoms which a hysterical patient may show and their differential diagnosis. This paper is not meant to repeat the symptoms of a medical text book. You will find a much better and exhaustive description of symptoms if you open up a text book of medicine. My purpose is to attempt to direct your attention to an entirely new angle, the angle which refuses to be bluffed by coined words like “functional” “neurotic” or “malingering.”.
The very first thing that should strike any medical man is that hysteria can take any form. I mean that its symptoms may resemble any disease. It may look like meningitis, appendicitis, gastritis, like heart or lung disease. There may be blindness, deafness and various forms of paralysis. There are diarrhoeas, dysenteries and constipations, leaving aside a host of sexual diseases included under terms like vaginismus, impotency, spermatorrhoea etc. That is why hysteria is frequently called “The Protean disease.” Proteus being a Greek sea-god who could take many forms.
Now, if you attempt at an explanation of the symptoms of a disease which can take any form on the physical basis, you are likely to find yourself resting on air with nothing underneath you and your scientific mind will refuse to accept this ridiculous position.
Formerly it was believed that hysteria is a disease peculiar to women and connected with some disturbance of the uterus (Gk. Hysteria == Womb). We now know that considerable number of males also suffer from it.
You have known Hysterical diarrhoeas. You can probably relieve the symptom temporarily by drugs, but you can hardly cure it completely, unless somehow or other it cures itself, just as many symptoms do. Light diet, even a liquid semi-digested milk diet does not help. It does not appear to be a digestive trouble. No adequate physical explanation of this kind of hurried peristalsis can be given until you suddenly remember that fright may cause rapid peristalsis leading to diarrhoea or even involuntary urination in children. You may even remember some of your friends going repeatedly to the lavatory before an important examination. There was a reputable surgeon who used to do the same thing before a specially risky operation. Has that kind of fright-diarrhoea anything to do with the present case ? You may argue that the symptom in those cases was temporary and it disappeared when the cause of the fright was removed. Besides, where is the cause of fright in the present case ? Have you enquired ? Anyway, such on idea opens up a new line of investigation and it is worth following it up and you may chance to find after a prolonged investigation that your patient might be harbouring some fright in the deeper layers of his mind, which is more or less of a permanent nature and which is not present for the time in his conscious mind because the cause of the fright might have been forgotten and the effect of it being manifested in the form of diarrhoea.
You cannot cure such patients of their symptoms by calling them functional or neurotic. The patients come to us for relief and not for any name by which we may choose to designate their symptoms. In this connection I remember the case of a well-known medical man of Calcutta. He had been suffering from a chronic gastric pain since many years. He went to one of his colleagues, a reputed surgeon of Calcutta, for examination and treatment. The surgeon, after examining him thoroughly said “The pain is due to nothing. It is neurotic.” The patient, himself a well-known medical man said, “Doctor, I know that. But can you care it ? I cant.”.
I should like to emphasise here and now that all diarrhoeas are not hysterical. It would be dangerous to suppose that. Most of them are not. But some undoubtedly are. Whenever a patient comes with a physical symptom–not only diarrhoeas, but any physical symptom which we suspect to be of hysterical origin, it is very necessary to exclude all physical factors by a very systematic and thorough physical examination and a complete elucidation of the history of the disease. Some serious mistakes have actually occurred in this connection. A symptom with a really organic basis has been diagnosed as hysterical and proper treatment neglected. If one has the least suspicion of any organic factor underlying the symptom, it should be thoroughly investigated and treated in the first instance, entirely disregarding the mental element behind it, because it is always the cardinal rule to treat the body first and then the mind For Homoeopathic treatment, priority cannot be given to one or the other. The physician must take the whole patient, the totality of his symptoms-mental and physical; and in the majority of cases the mental takes the lead. The speciality of its detailed investigation is the peculiarity of Homoeopathy. [Ed.] I shall have occasion later to give examples of the advantages of this procedure. The mental factors should be investigated by all means, but the body should never be neglected.
