Australian and New Zealand Journal of Psychiatry (1979) 13:3
Review HYSTERIA OR THE WANDERING WOMB F. E. KENYON
This review will concentrate on two aspectspsychodynamic formulations and recent attempts to refine the concept of hysteria. It is very difficult to find a definitive statement on hysteria by Classical psychoanalysis was founded on the study of hysterical patients such as Anna O8s9eventhough such a diagnosis would hardly be applied to her today. She presented with blatant neurological signs and, as we now know, made a complete recovery to become a pioneer social worker in Germany. Psychodynamic theories rest on motivation, with subtle differences between conscious and unconscious (e.g. secondary and primary gain), but ultimately on the use or failure of various defence mechanisms such as denial, repression and dissociation. The fixation point is presumed to be during the Oedipal phase. In view of the oft-quoted statements that psychoanalytical theories are untestable, there has been a remarkable amount of work done on the subject.6-22 Repression, in the sense of denial of entry into consciousness, has been supported by experimental evidence.22The early work of Jung2’ on the word association test was a first crude attempt in this direction. However, repression can also be used to support learning theory2*or cognitive theory3’, and surely, nowadays, it is not always of sexual matters. A clinical attempt to measure repression, and so operationally define hysteria, used two psychological tests. It was found that only half the cases, almost exclusively female, had been clinically diagnosed as hysteria mainly because of bodily complaints, overt aggression and absence of depression and anxiety.’ Others have looked for psycho-
physiological correlates, on the basis that repression and denial were anxiety-reducing; but in patients presenting with la belle indifference this was not supported.34 Janet first postulated dissociation of consciousness as a split into two or more independent currents. But he was a descendant of the associationists and took the spatial metaphor too literally, with bits of ‘mind stuff stuck together and then getting separated.” Just how and why the ‘split’came about, whether it was a fragmented or a massive one, or whether the split was between the affect and an idea, remain unresolved problems. This is exemplified by the fact that patients with dissociative states have few other common features*’, while delineation of the borderline syndrome”, hysterical and Ganser states4’remain unclear. Dissociation and conversion have in common the exclusion of competing and contradictory tendencies, with the latter leaving the personality more intact. Freud coined the term conversion for an unconscious mechanism whereby intrapsychic conflicts or the affect associated with them became ‘converted’ into a symbolically significant somatic symptom.’, Just how the ‘mysterious leap from mind to body’ mentioned by Deutsch was accomplished has never been explained. But again, experimental studies do not support its anxietyreducing function.23 Older psychoanalytical ideas that conversion symptoms are restricted to the sensori-motor system with psychosomatic symptoms restricted to the autonomic nervous system, are no longer tenable.3,32 Patients with conversion symptoms are
Downloaded from anp.sagepub.com at FLORIDA ATLANTIC UNIV on May 25, 2015
4
-
HYSTERIA OR
THE
a heterogeneous group with follow-up studies showing many changes in diagnosis, often to an organic 0ne.~~3 31. 38, Also many traditional conversion symptoms are now no longer considered to be hysterical, for instance, globus hystericus2’, torticollis’, fits36, psychogenic painM.7, 38, 39 and others.30 A confusing thread which runs through the history of hysteria is the failure to distinguish between hysterical personality or character traits, and hysterical symptoms.16That no close relationship is found between the two is not surprising in view of the disagreements over which traits to include, how to measure them’. z4, and the sexist biases.z8.26 Suggested division into the good hysteric with genital fixation and a good prognosis and the bad hysteric with pregenital fixation and a poor prognosisz4is little more than a value judgement. The most recent attempt to re-define hysteria has been made by the group at St Louis, U.S.A., under the unfortunate name of Briquet’s Syndrome. ‘ I . 12* 3 3 , 4 3 , 4 4 Paul Briquet (1796-1881) published in 1859 an influential book on hysteria in which he reviewed past theories but based his own views on the careful examination of 430 cases. He concluded that hysteria was a physical disease due to a physiological disturbance of that part of the brain concerned with affective impressions and the sensations. l 5 Three basic criteria are given for establishing the diagnosis of Briquet’s Syndrome: ‘First, the patient must demonstrate a dramatic or complicated medical history beginning before age 35. Second, the patient must admit to 25 symptoms in nine of ten special review of symptoms areas. Third, no other diagnosis can be made to explain the ~yrnptoms’.~~ Initially conversion was used as a vague descriptive term for unexplained physical symptom^'^ but later was restricted to embracing ‘pseudoneurologic’ symptoms which excluded headaches and other painful symptoms.” These conversion symptoms may or may not occur in Briquet’s Syndrome but were not essential to the diagnosis. The syndrome, as defined, is a serious polysymptomatic, chronic, disabling disease, which is also very rare and artificially excludes males.14’ So we are back not only to the wandering womb (many of the obligatory symptoms being sexual and menstrual) but to the wandering woman herself, visiting many different hospital departments. It represents a misuse of the medical model and could be a dangerous label to acquire especially when diagnosed by computer.45Symptoms are arbitrarily collected, have no relationship to each other and by definition do not denote disease (at least at the time
WANDERING WOMB
of diagnosis). It is essentially a syndrome of complainers and could equally well be regarded as defining the hypochondriac.” Criteria of selection, ensure that those with a poor prognosis are included. Predictably, this is confirmed at follow-up. Any relationship to hysterical personality is unclear.20 The proposed multifactorial genetic model to explain the increased incidence of hysteria in female relatives and sociopathy and alcoholism in the husbands and male relatives4can be criticized on stati~tical’~ and on other grounds.I8.20. The whole concept seems to be a throwback to the outdated theory of heredo-degenerative disease. Little contribution is made towards understanding aetiology or helping in management. The definition virtually excludes children and adolescents and there have been no studies on adopted children to examine any genetic influence. Also lacking are independent validation studies on foreign patients. While some studies offer indirect support, such as the more useful distinction between acute and chronic hysteriaz9 or the category of hysterical psychopath’, these cannot be regarded as replication studies. It is time hysteria was dropped in favour of a general descriptive term like hysterical reaction. This would then imply a disturbance of physiological or psychological function, which could be associated with some physical pathology but not entirely explained by it. It could only be fully understood by taking into account the patient’s emotional conflicts, personality and cultural background. References
ALMGREN, P. E., NORDGREN, L. and SKANTZE, H. (1978) A retrospective study of operationally defined hysterics. British Journal of Psychiatry, 132,67-73. CHODOFF, P. (1974) The diagnosis of hysteria: an overview. American Journal of Psychiatry, 131, 1073-1078. CLEGHORN, R. A. (1969) Hysterical personality and conversion: theoretical aspects. Canadian Psychiatric Association Journal, 14, 553-567. CLONINGER, C. R., REICH, T. and GUZE, S. B. (1975) The multifactorial model of disease transmission 111 Familial relationship between sociopathy and hysteria (Briquet’s Syndrome). British Journal of Psychiatry, 127, 23-32. COCKBURN, J. J. (1971) Spasmodic torticollis: a psychogenic condition? Journal of Psychosomatic Research, 15,471477. FISHER, S. and GREENBERG, R. P. (1977) The Scientific Credibility of Freud’s Theories and Therapy. Harvester Press, Sussex. ’ FORREST, A. D. (1967) The differentiation of hysterical personality from hysterical psychopathy. British Journal of Medical Psychology, 40,65-78. FREUD, S. (1893-5) Studies on Hysteria: Collected Works, Vol. 11. Hogarth Press, 1955, London.
Downloaded from anp.sagepub.com at FLORIDA ATLANTIC UNIV on May 25, 2015
F. E. KENYON
FREUD, S. (1910) Five Lectures on Psychoanalysis: Collected Works, Vol. XI. Hogarth Press, 1957, London. ‘“GRINKER, R. R., WERBLE, B. and DRYE, R. C. (1968) The Borderline Syndrome. Basic Books, New York. I ’ GUZE, S. B. (1967) The diagnosis of hysteria: what are we trying to do? American Journal of Psychiatry, 124, 491498. GUZE, S. B. (1975) The validity and significance of the clinical diagnosis of hysteria (Briquet’s Syndrome). American Journal oj’Psychiatry, 132, 138-141. l 3 GUZE, S. B. and PERLEY, M. J . (1963) Observations on the natural history of hysteria. American Journal of Psychiatry, 119, 960-965.
’’
l4
l6
”
GUZE, S. B., WOODRUFF, R. A. and CLAYTON, P. J . (1972) Sex, age and the diagnosis of hysteria (Briquet’s Syndrome). American Journal of Psychiatry, 129, 745-748. HART, B. (1939) Psychopathology: Its Development and Its Place in Medicine. Cambridge University Press. HOROWITZ, M. J. (Ed.) (1977) Hysterical Personality. J. Aronson Inc., New York. HUTCHINSON, T. P. and SATTERTHWAITE, S. P. (1977) Mathematical models for describing the clustering of sociopathy and hysteria in families: a comment on the recent paper by Cloninger et al. British Journal of Psychiatry, 130, 294-297.
’* KAMINSKY, M. J. and SLAVNEY, P. R. (1976) Methodology and personality in Briquet’s Syndrome: a reappraisal. American Journal of Psychiatry, 133, 85-88.
l9
KENYON, F. E. (1978) The hypochondriacal patient. The Practitioner, 220, 245-250.
2o
KIMBLE, R., WILLIAMS, J . G. and AGRAS, S. (1975) A comparison of two models of diagnosing hysteria. American Journal of Psychiatry. 132, 1197-1 199.
21
KIRSHNER, L. A. (1973) Dissociative reactions: an historical review and clinical study. Acta Psychiatrica Scandinavica, 49, 698491. KLINE, P. (1972) Fact and Fantasy in Freudian Theory. Methuen & Co. Ltd.. London.
’’
LADER, M. (1973) The psychophysiology of hysterics. Journal of Psvchosomatic Research. 17. 265-269. 24 LAZARE, A. (1971) The hysterical character in psychoanalytic theoryywolution and confusion. Archives of General Psvchiatry, 25, 131-137. 2s LEHTINEN, V. and PUHAKKA, H. (1976) A psychosomatic approach to the globus hystericus problem. Acta Psychiatrica Scandinavica. 53. 2 1-28. 26 LERNER, H. E. (1974) The hysterical personality: a ‘woman’s disease’. Comprehensive Psychiatry, 15, 157-164. ” LEWIS, A. (1967) JungS Early Work: Chpt 6 in the State of Psychiatry: Essays di Addresses. Routledge & Kegdn Paul, London. ”
5
’’ LUISADA, P. V., PEELE, R. and PITTARD, E. A. (1974)
The hysterical personality in men. American Journal of’ Psychiatry, 131. 518-522. 29 MEARES, R. and HORVATH, T. (1972) ‘Acute’ and ‘chronic’hysteria. British Journalof Psychiatry, 121,653-657. 30 MERSKEY, H. (1978) Disorders of conscious awareness: hysterical phenomena. British Journal of Hospital Medicine, 19, 305-309. ” MERSKEY, H. and BUHRICH, N. A. (1975) Hysteria and organic brain disease. British Journal of Medical Psychology, 48, 359-366. 32 MILLER, N. E. and DWORKIN, B. R. (1977) Effects of learning on visceral functions: biofeedback. New England Journal of Medicine, 296, 1274-1278. 33 PURTELL, J. J., ROBINS, E. and COHEN, M. E. (1951) Observations on clinical aspects of hysteria: a quantitative study of 50 hysteria patients and 156 controls. Journal of’the American Medical Association, 146, 902-909. 34 RICE, D. G. and GREENFIELD, N. S. (1969) Psychophysiological correlates of la Belle Indifference. Archives of General Psychiatry, 20, 239-245. 3s RICHMAN, J. and WHITE, H. (1970) A family view of hysterical psychosis. American Journal of Psychiatry, 127, 280-285. 36 SCOTT, D. F. (1978) Psychiatric aspects of epilepsy. British Journal of’ Psychiatry, 132, 417430. 37 SHAPIRO, D. (1965) Neurotic Styles. Basic Books, New York. 38 STEFANSSON, J. G., MESSINA, J. A. and MEYEROWITZ, S. (1976) Hysterical neurosis, conversion type: clinical and epidemiological considerations. Acta Psychiatrica Scandinavica. 53, 1 19-1 38. 39 WALTERS, A. (1961) Psychogenic regional pain alias hysterical pain. Brain, 84, 1-18. WHITLOCK, F. A. (1967) The aetiology of hysteria. Acta Psychiatrica Scandinavica, 43, 144-147. 41 WHITLOCK, F. A. (1967) The Ganser Syndrome. British Journal of’ Psychiatry, 113, 19-29. 42 WISDOM, J. 0. (1961) A methodological approach to the problem of hysteria. International Journal of’ Psychoanalysis, 42, 224-237. 43 WOODRUFF, R. A. (1968) Hysteria: an evaluation of objective diagnostic criteria by the study of women with chronic medical illnesses. British Journal of Psychiatry, 114, 1115-1 119. 44 WOODRUFF, R. A,, CLAYTON, P. J. and GUZE, S. B. (1971) Hysteria: studies of diagnosis, outcome and prevalence. Journal of the American Medical Association, 215, 425428. 45 WOODRUFF, R. A,, ROBINS, L. N., TAIBLESON, M., REICH, T. and SCHWIN, R. (1973) A computer assisted derivation of a screening interview for hysteria. Archives of General Psychiatry, 29, 450-454.
F. E. KENYON,M A , M D . F R C P (Ed ). F R C Psych, Consultant Psychiatrist, Warneford Hospital, Headington, Oxford. OX3 7JX U.K.
Downloaded from anp.sagepub.com at FLORIDA ATLANTIC UNIV on May 25, 2015
Review HYSTERIA OR THE WANDERING WOMB F. E. KENYON
This review will concentrate on two aspectspsychodynamic formulations and recent attempts to refine the concept of hysteria. It is very difficult to find a definitive statement on hysteria by Classical psychoanalysis was founded on the study of hysterical patients such as Anna O8s9eventhough such a diagnosis would hardly be applied to her today. She presented with blatant neurological signs and, as we now know, made a complete recovery to become a pioneer social worker in Germany. Psychodynamic theories rest on motivation, with subtle differences between conscious and unconscious (e.g. secondary and primary gain), but ultimately on the use or failure of various defence mechanisms such as denial, repression and dissociation. The fixation point is presumed to be during the Oedipal phase. In view of the oft-quoted statements that psychoanalytical theories are untestable, there has been a remarkable amount of work done on the subject.6-22 Repression, in the sense of denial of entry into consciousness, has been supported by experimental evidence.22The early work of Jung2’ on the word association test was a first crude attempt in this direction. However, repression can also be used to support learning theory2*or cognitive theory3’, and surely, nowadays, it is not always of sexual matters. A clinical attempt to measure repression, and so operationally define hysteria, used two psychological tests. It was found that only half the cases, almost exclusively female, had been clinically diagnosed as hysteria mainly because of bodily complaints, overt aggression and absence of depression and anxiety.’ Others have looked for psycho-
physiological correlates, on the basis that repression and denial were anxiety-reducing; but in patients presenting with la belle indifference this was not supported.34 Janet first postulated dissociation of consciousness as a split into two or more independent currents. But he was a descendant of the associationists and took the spatial metaphor too literally, with bits of ‘mind stuff stuck together and then getting separated.” Just how and why the ‘split’came about, whether it was a fragmented or a massive one, or whether the split was between the affect and an idea, remain unresolved problems. This is exemplified by the fact that patients with dissociative states have few other common features*’, while delineation of the borderline syndrome”, hysterical and Ganser states4’remain unclear. Dissociation and conversion have in common the exclusion of competing and contradictory tendencies, with the latter leaving the personality more intact. Freud coined the term conversion for an unconscious mechanism whereby intrapsychic conflicts or the affect associated with them became ‘converted’ into a symbolically significant somatic symptom.’, Just how the ‘mysterious leap from mind to body’ mentioned by Deutsch was accomplished has never been explained. But again, experimental studies do not support its anxietyreducing function.23 Older psychoanalytical ideas that conversion symptoms are restricted to the sensori-motor system with psychosomatic symptoms restricted to the autonomic nervous system, are no longer tenable.3,32 Patients with conversion symptoms are
Downloaded from anp.sagepub.com at FLORIDA ATLANTIC UNIV on May 25, 2015
4
-
HYSTERIA OR
THE
a heterogeneous group with follow-up studies showing many changes in diagnosis, often to an organic 0ne.~~3 31. 38, Also many traditional conversion symptoms are now no longer considered to be hysterical, for instance, globus hystericus2’, torticollis’, fits36, psychogenic painM.7, 38, 39 and others.30 A confusing thread which runs through the history of hysteria is the failure to distinguish between hysterical personality or character traits, and hysterical symptoms.16That no close relationship is found between the two is not surprising in view of the disagreements over which traits to include, how to measure them’. z4, and the sexist biases.z8.26 Suggested division into the good hysteric with genital fixation and a good prognosis and the bad hysteric with pregenital fixation and a poor prognosisz4is little more than a value judgement. The most recent attempt to re-define hysteria has been made by the group at St Louis, U.S.A., under the unfortunate name of Briquet’s Syndrome. ‘ I . 12* 3 3 , 4 3 , 4 4 Paul Briquet (1796-1881) published in 1859 an influential book on hysteria in which he reviewed past theories but based his own views on the careful examination of 430 cases. He concluded that hysteria was a physical disease due to a physiological disturbance of that part of the brain concerned with affective impressions and the sensations. l 5 Three basic criteria are given for establishing the diagnosis of Briquet’s Syndrome: ‘First, the patient must demonstrate a dramatic or complicated medical history beginning before age 35. Second, the patient must admit to 25 symptoms in nine of ten special review of symptoms areas. Third, no other diagnosis can be made to explain the ~yrnptoms’.~~ Initially conversion was used as a vague descriptive term for unexplained physical symptom^'^ but later was restricted to embracing ‘pseudoneurologic’ symptoms which excluded headaches and other painful symptoms.” These conversion symptoms may or may not occur in Briquet’s Syndrome but were not essential to the diagnosis. The syndrome, as defined, is a serious polysymptomatic, chronic, disabling disease, which is also very rare and artificially excludes males.14’ So we are back not only to the wandering womb (many of the obligatory symptoms being sexual and menstrual) but to the wandering woman herself, visiting many different hospital departments. It represents a misuse of the medical model and could be a dangerous label to acquire especially when diagnosed by computer.45Symptoms are arbitrarily collected, have no relationship to each other and by definition do not denote disease (at least at the time
WANDERING WOMB
of diagnosis). It is essentially a syndrome of complainers and could equally well be regarded as defining the hypochondriac.” Criteria of selection, ensure that those with a poor prognosis are included. Predictably, this is confirmed at follow-up. Any relationship to hysterical personality is unclear.20 The proposed multifactorial genetic model to explain the increased incidence of hysteria in female relatives and sociopathy and alcoholism in the husbands and male relatives4can be criticized on stati~tical’~ and on other grounds.I8.20. The whole concept seems to be a throwback to the outdated theory of heredo-degenerative disease. Little contribution is made towards understanding aetiology or helping in management. The definition virtually excludes children and adolescents and there have been no studies on adopted children to examine any genetic influence. Also lacking are independent validation studies on foreign patients. While some studies offer indirect support, such as the more useful distinction between acute and chronic hysteriaz9 or the category of hysterical psychopath’, these cannot be regarded as replication studies. It is time hysteria was dropped in favour of a general descriptive term like hysterical reaction. This would then imply a disturbance of physiological or psychological function, which could be associated with some physical pathology but not entirely explained by it. It could only be fully understood by taking into account the patient’s emotional conflicts, personality and cultural background. References
ALMGREN, P. E., NORDGREN, L. and SKANTZE, H. (1978) A retrospective study of operationally defined hysterics. British Journal of Psychiatry, 132,67-73. CHODOFF, P. (1974) The diagnosis of hysteria: an overview. American Journal of Psychiatry, 131, 1073-1078. CLEGHORN, R. A. (1969) Hysterical personality and conversion: theoretical aspects. Canadian Psychiatric Association Journal, 14, 553-567. CLONINGER, C. R., REICH, T. and GUZE, S. B. (1975) The multifactorial model of disease transmission 111 Familial relationship between sociopathy and hysteria (Briquet’s Syndrome). British Journal of Psychiatry, 127, 23-32. COCKBURN, J. J. (1971) Spasmodic torticollis: a psychogenic condition? Journal of Psychosomatic Research, 15,471477. FISHER, S. and GREENBERG, R. P. (1977) The Scientific Credibility of Freud’s Theories and Therapy. Harvester Press, Sussex. ’ FORREST, A. D. (1967) The differentiation of hysterical personality from hysterical psychopathy. British Journal of Medical Psychology, 40,65-78. FREUD, S. (1893-5) Studies on Hysteria: Collected Works, Vol. 11. Hogarth Press, 1955, London.
Downloaded from anp.sagepub.com at FLORIDA ATLANTIC UNIV on May 25, 2015
F. E. KENYON
FREUD, S. (1910) Five Lectures on Psychoanalysis: Collected Works, Vol. XI. Hogarth Press, 1957, London. ‘“GRINKER, R. R., WERBLE, B. and DRYE, R. C. (1968) The Borderline Syndrome. Basic Books, New York. I ’ GUZE, S. B. (1967) The diagnosis of hysteria: what are we trying to do? American Journal of Psychiatry, 124, 491498. GUZE, S. B. (1975) The validity and significance of the clinical diagnosis of hysteria (Briquet’s Syndrome). American Journal oj’Psychiatry, 132, 138-141. l 3 GUZE, S. B. and PERLEY, M. J . (1963) Observations on the natural history of hysteria. American Journal of Psychiatry, 119, 960-965.
’’
l4
l6
”
GUZE, S. B., WOODRUFF, R. A. and CLAYTON, P. J . (1972) Sex, age and the diagnosis of hysteria (Briquet’s Syndrome). American Journal of Psychiatry, 129, 745-748. HART, B. (1939) Psychopathology: Its Development and Its Place in Medicine. Cambridge University Press. HOROWITZ, M. J. (Ed.) (1977) Hysterical Personality. J. Aronson Inc., New York. HUTCHINSON, T. P. and SATTERTHWAITE, S. P. (1977) Mathematical models for describing the clustering of sociopathy and hysteria in families: a comment on the recent paper by Cloninger et al. British Journal of Psychiatry, 130, 294-297.
’* KAMINSKY, M. J. and SLAVNEY, P. R. (1976) Methodology and personality in Briquet’s Syndrome: a reappraisal. American Journal of Psychiatry, 133, 85-88.
l9
KENYON, F. E. (1978) The hypochondriacal patient. The Practitioner, 220, 245-250.
2o
KIMBLE, R., WILLIAMS, J . G. and AGRAS, S. (1975) A comparison of two models of diagnosing hysteria. American Journal of Psychiatry. 132, 1197-1 199.
21
KIRSHNER, L. A. (1973) Dissociative reactions: an historical review and clinical study. Acta Psychiatrica Scandinavica, 49, 698491. KLINE, P. (1972) Fact and Fantasy in Freudian Theory. Methuen & Co. Ltd.. London.
’’
LADER, M. (1973) The psychophysiology of hysterics. Journal of Psvchosomatic Research. 17. 265-269. 24 LAZARE, A. (1971) The hysterical character in psychoanalytic theoryywolution and confusion. Archives of General Psvchiatry, 25, 131-137. 2s LEHTINEN, V. and PUHAKKA, H. (1976) A psychosomatic approach to the globus hystericus problem. Acta Psychiatrica Scandinavica. 53. 2 1-28. 26 LERNER, H. E. (1974) The hysterical personality: a ‘woman’s disease’. Comprehensive Psychiatry, 15, 157-164. ” LEWIS, A. (1967) JungS Early Work: Chpt 6 in the State of Psychiatry: Essays di Addresses. Routledge & Kegdn Paul, London. ”
5
’’ LUISADA, P. V., PEELE, R. and PITTARD, E. A. (1974)
The hysterical personality in men. American Journal of’ Psychiatry, 131. 518-522. 29 MEARES, R. and HORVATH, T. (1972) ‘Acute’ and ‘chronic’hysteria. British Journalof Psychiatry, 121,653-657. 30 MERSKEY, H. (1978) Disorders of conscious awareness: hysterical phenomena. British Journal of Hospital Medicine, 19, 305-309. ” MERSKEY, H. and BUHRICH, N. A. (1975) Hysteria and organic brain disease. British Journal of Medical Psychology, 48, 359-366. 32 MILLER, N. E. and DWORKIN, B. R. (1977) Effects of learning on visceral functions: biofeedback. New England Journal of Medicine, 296, 1274-1278. 33 PURTELL, J. J., ROBINS, E. and COHEN, M. E. (1951) Observations on clinical aspects of hysteria: a quantitative study of 50 hysteria patients and 156 controls. Journal of’the American Medical Association, 146, 902-909. 34 RICE, D. G. and GREENFIELD, N. S. (1969) Psychophysiological correlates of la Belle Indifference. Archives of General Psychiatry, 20, 239-245. 3s RICHMAN, J. and WHITE, H. (1970) A family view of hysterical psychosis. American Journal of Psychiatry, 127, 280-285. 36 SCOTT, D. F. (1978) Psychiatric aspects of epilepsy. British Journal of’ Psychiatry, 132, 417430. 37 SHAPIRO, D. (1965) Neurotic Styles. Basic Books, New York. 38 STEFANSSON, J. G., MESSINA, J. A. and MEYEROWITZ, S. (1976) Hysterical neurosis, conversion type: clinical and epidemiological considerations. Acta Psychiatrica Scandinavica. 53, 1 19-1 38. 39 WALTERS, A. (1961) Psychogenic regional pain alias hysterical pain. Brain, 84, 1-18. WHITLOCK, F. A. (1967) The aetiology of hysteria. Acta Psychiatrica Scandinavica, 43, 144-147. 41 WHITLOCK, F. A. (1967) The Ganser Syndrome. British Journal of’ Psychiatry, 113, 19-29. 42 WISDOM, J. 0. (1961) A methodological approach to the problem of hysteria. International Journal of’ Psychoanalysis, 42, 224-237. 43 WOODRUFF, R. A. (1968) Hysteria: an evaluation of objective diagnostic criteria by the study of women with chronic medical illnesses. British Journal of Psychiatry, 114, 1115-1 119. 44 WOODRUFF, R. A,, CLAYTON, P. J. and GUZE, S. B. (1971) Hysteria: studies of diagnosis, outcome and prevalence. Journal of the American Medical Association, 215, 425428. 45 WOODRUFF, R. A,, ROBINS, L. N., TAIBLESON, M., REICH, T. and SCHWIN, R. (1973) A computer assisted derivation of a screening interview for hysteria. Archives of General Psychiatry, 29, 450-454.
F. E. KENYON,M A , M D . F R C P (Ed ). F R C Psych, Consultant Psychiatrist, Warneford Hospital, Headington, Oxford. OX3 7JX U.K.
Downloaded from anp.sagepub.com at FLORIDA ATLANTIC UNIV on May 25, 2015
