British Journal of Psychiatry (1992), 160, 87—91
Is Hysteria on the Wane? A Community Survey in West Bengal, India D. N. NANDI, GAURANGA BANERJEE, SABYASACHI NANDI and PARTHASARATHINANDI A field survey was conducted in two villages - Gambhirgachi and Paharpur—¿ in 1972. The survey
was repeated
after 10 years in the former village and after 15 years in the latter one.
The second survey showed very little change in the rate of total mental morbidity. The rate of prevalence of hysteria declined significantly in both villages. In Gambhirgachi the rate of hysteria dropped from 16.9 to 4.6 per 1000 in 10 years, and in Paharpur it dropped from 32.3 to 2.05 per 1000 in 15 years. One of the concerns of social psychiatrists is to determine whether a mental disorder is on the wane oris agrowing health problem. Apart from its clinical significance, this concern has a practical import for
the study. The co-operation of the villagers assured, a pilot study was made to train the workers in the use of the tools of the study. All the families of two villages, Gambhirgachi and Paharpur, situated in two different districts of West Bengal, comprised the sample. Both the districts lay in the agricultural belt of the state. Almost all the villagers are either tillers of soil or subsist mainly on their income from agriculture.The village of Gambhirgachiis situated in the districtof North 24-Parganas at a distance of 50 km from Calcutta. Over 90% of the villagers are Muslim by religion and the rest are Hindu. The total population of the village was 1060in 1972and 1539in 1982.The villageof Paharpur is situated in the districtof Bankuraat a distance of 32 km from its nearest town and 130km from Calcutta. The total population of the village, divided almost equally between the Hindu and Muslim communities, was 1114in 1972and
those framing community mental health programmes. A growing health problem will need more elaborate plans for prevention, curative facilities, training of personnel and research projects. It is generally believed by psychiatrists that general paralysis of the insane (GPI), pellagra psychosis and hysteria are on the wane (Gruenberg & Turns, 1976).
The belief that hysteria has become less common is based entirely on the consensus of expert opinion and there are no statistical data to support it. In this paper we put forward some statistical data
on the declining trend of hysteria in two rural
1464 in 1987. Care had been taken to establish rapport with each family
communities in West Bengal. These data have been singled out from our longitudinal field survey of
before the actual work on the collection of data began. It
mental disorders in two villages, which began in
was a door-to-door
1972. The data on hysteria and depression presented
as a unit and of each individual member separately. The data were collected by psychiatrists who were trained in the use of the tools of the survey. The following four schedules were used to collect and tabulate the data. (a) The Household Schedulerecordedthe data connected with the family structure, the size of the family, the age, sex, education and occupation of each member, and the housing and identification of the family. (b) The Case-Detection Schedule, put in Bengali (the language spoken by the team of workers and the villagers under survey), contained 78 questions which led to the identification of all possible mental illnesses. The schedule was prepared in consultation with six other psychiatrists who examined it independently and made additions and alterations as they deemed fit. After incorporating their views, the final version was prepared.
here pertain to the prevalencefigures of(a) 1972 and 1982 for one of the villages (i.e. an interval of 10 years) and (b) 1972 and 1987 of the other village (i.e.
an interval of 15 years). The 1972—82 data formed part of one of our previous communications (Nandi et a!, 1986). The 1972—87 data have not yet been published elsewhere. The rationale behind the presentation of data on depression is to highlight the significance of the decline of hysteria in the context of another disorder with a rising trend observed in the same area.
Method The studywas conductedby a teamof psychiatristswho
Detection Schedule and recorded the fmdings of examination
of the leadersof the communitywereobtained.Smallgroup were
arranged
to dispel
the
doubts
and
(c) The Case Record Schedule gave all relevant in
formation regarding the case detected through the Case
visited the villages several times to get themselves acquainted with the people. In this task the co-operation and assistance meetings
survey by direct interview of each family
prejudice
ofthevillagers by explaining thenature and purposeof
87
and final diagnosis. ‘¿Case' status was decided according to the operational definition of a case (see Appendix). The operational definition was based on the model given
NANDI ET AL
88
in Technical Report 185of the World Health Organization
same. In Paharpur in 1972, 49.2% of the total population
(1960). The diagnosis of each case was made according
were women; 15 years later the percentage was 48.6%. In
to
diagnostic criteria developed before the beginning of the survey (see Appendix). Only illnesses diagnosed at the time of examination were accepted as cases, except where the diagnosis was hysteria or epilepsy. In these two instances, manifestation of symptoms at any time during the previous year was sufficient for inclusion as a case. (d) The Socioeconomic Status (SES) Scheduleof Pareek & Trivedi (1966), which is standardised for use in the rural
area of India, was used in the survey to determine the socioeconomic
status of each family.
The survey was conducted every year in the same season from 1972onwards. The actual study was completed in eight weeks. Usuallythe workbeganin the earlymorningand con tinued till late in the evening, with a short break at midday, so
that the persons interviewed were available in their home in a relaxed frame of mind. The same team conducted the survey every year. The data obtained by the surveys conducted according to this
method
have
been
compiled,
computed
and
statistically evaluated. Some of the findings have already been published (Nandi et al, 1975, 1976, 1978, 1986).
Gambhirgachi, women constituted 51.1% of the population in 1972 and 51.8% in 1982. The changes in total morbidity in the two villages during the survey periods are shown in Table 1. The changes are not statistically significant. The changes in the rates of mental morbidity of males and females are also shown in Table 1. These changes too are not significant. In Table 2 the decline of the prevalence of hysteria is shown against the rise of the prevalence of depression. In the course of 15 years, the prevalenceof hysteria fell from 32.3 per 1000 to 2.05 per 1000 in Paharpur. Hysteria is common in women; the fall in its prevalence is also marked in women (from54.7per 1000to 4.2per 1000).In Gambhirgachi a similar remarkable fall is evident. From
16.9per 1000,prevalenceto 4.6 per 1000in the courseof 10 years. In women, the rate fell from 25.9 per 1000 to 7.5 per 1000. The age distribution
of hysteria in both the
villages shows that almost all the cases in 1972 occurred
in middle-agedor youngerpersons;in 1987therewereno cases over the age of 47 nor any under the age of 12 (see
Table 3). Results Although the total population has increased remarkably in both the villages, the sex ratio has remained almost the Table 1 Distributionof total morbidity Paharpur 1972
1987
The rates of depression showed a remarkable rise. In Paharpur, the prevalence rose from 61.9 per 1000 to 77.2 per 1000. In Gambhirgachi, it rose from 37.7 per 1000 to 53.3 per 1000. Like hysteria, depression is more common in women than in men; the trend of increasing prevalence of depression
is shown by women also.
Gambhirgachi 1972
1982
Affected16518190126(per
1000)(148.1)(123.6)(84.9)(81.9)male59653558(per 1000)(104.2)(86.4)(67.4)(78.3)female1061165568(per 1000)(193.4)(162.9)(101.6)(85.2)Not affected94912839701413Total1114146410601539
Discussion
The growth of population in both the villages shows the usual pattern and rate. In Paharpur there were 1114 persons in 1972 and 1464 in 1987 (rise 31.4% in 15 years). This growth rate is slightly lower than India's national rate. In Gambhirgachi, a population of 1060 grew to 1539 in 10 years: the growth rate (45.2°lo in 10 years) is higher than the national rate. India's national rate of population growth was 24.75%
Decreasesin prevalencerates from 1972 are not statistically significant (P> 0.05).
e
over
1971—81. The sex distributions
of the
populations of both the villages are similar to the national pattern and they have not changed during
Table 2 Distribution of hysteria and depression by sex PaharpurGambhirgachi1972198719721982MaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalHysteria
(per 1000) Depression (per 1000)6 Change in hysteria
(4.2) (2.05) (10.6) (54.7) (32.3) (0) 21 48 69 32 81 113 (37.1)30(87.6)36(61.9)0 (42.5)3 (113.8)3 (77.2)4 ,t2=35.08, @21472
d.f.=1, d.f.=1.
P
Is Hysteria on the Wane? A Community Survey in West Bengal, India D. N. NANDI, GAURANGA BANERJEE, SABYASACHI NANDI and PARTHASARATHINANDI A field survey was conducted in two villages - Gambhirgachi and Paharpur—¿ in 1972. The survey
was repeated
after 10 years in the former village and after 15 years in the latter one.
The second survey showed very little change in the rate of total mental morbidity. The rate of prevalence of hysteria declined significantly in both villages. In Gambhirgachi the rate of hysteria dropped from 16.9 to 4.6 per 1000 in 10 years, and in Paharpur it dropped from 32.3 to 2.05 per 1000 in 15 years. One of the concerns of social psychiatrists is to determine whether a mental disorder is on the wane oris agrowing health problem. Apart from its clinical significance, this concern has a practical import for
the study. The co-operation of the villagers assured, a pilot study was made to train the workers in the use of the tools of the study. All the families of two villages, Gambhirgachi and Paharpur, situated in two different districts of West Bengal, comprised the sample. Both the districts lay in the agricultural belt of the state. Almost all the villagers are either tillers of soil or subsist mainly on their income from agriculture.The village of Gambhirgachiis situated in the districtof North 24-Parganas at a distance of 50 km from Calcutta. Over 90% of the villagers are Muslim by religion and the rest are Hindu. The total population of the village was 1060in 1972and 1539in 1982.The villageof Paharpur is situated in the districtof Bankuraat a distance of 32 km from its nearest town and 130km from Calcutta. The total population of the village, divided almost equally between the Hindu and Muslim communities, was 1114in 1972and
those framing community mental health programmes. A growing health problem will need more elaborate plans for prevention, curative facilities, training of personnel and research projects. It is generally believed by psychiatrists that general paralysis of the insane (GPI), pellagra psychosis and hysteria are on the wane (Gruenberg & Turns, 1976).
The belief that hysteria has become less common is based entirely on the consensus of expert opinion and there are no statistical data to support it. In this paper we put forward some statistical data
on the declining trend of hysteria in two rural
1464 in 1987. Care had been taken to establish rapport with each family
communities in West Bengal. These data have been singled out from our longitudinal field survey of
before the actual work on the collection of data began. It
mental disorders in two villages, which began in
was a door-to-door
1972. The data on hysteria and depression presented
as a unit and of each individual member separately. The data were collected by psychiatrists who were trained in the use of the tools of the survey. The following four schedules were used to collect and tabulate the data. (a) The Household Schedulerecordedthe data connected with the family structure, the size of the family, the age, sex, education and occupation of each member, and the housing and identification of the family. (b) The Case-Detection Schedule, put in Bengali (the language spoken by the team of workers and the villagers under survey), contained 78 questions which led to the identification of all possible mental illnesses. The schedule was prepared in consultation with six other psychiatrists who examined it independently and made additions and alterations as they deemed fit. After incorporating their views, the final version was prepared.
here pertain to the prevalencefigures of(a) 1972 and 1982 for one of the villages (i.e. an interval of 10 years) and (b) 1972 and 1987 of the other village (i.e.
an interval of 15 years). The 1972—82 data formed part of one of our previous communications (Nandi et a!, 1986). The 1972—87 data have not yet been published elsewhere. The rationale behind the presentation of data on depression is to highlight the significance of the decline of hysteria in the context of another disorder with a rising trend observed in the same area.
Method The studywas conductedby a teamof psychiatristswho
Detection Schedule and recorded the fmdings of examination
of the leadersof the communitywereobtained.Smallgroup were
arranged
to dispel
the
doubts
and
(c) The Case Record Schedule gave all relevant in
formation regarding the case detected through the Case
visited the villages several times to get themselves acquainted with the people. In this task the co-operation and assistance meetings
survey by direct interview of each family
prejudice
ofthevillagers by explaining thenature and purposeof
87
and final diagnosis. ‘¿Case' status was decided according to the operational definition of a case (see Appendix). The operational definition was based on the model given
NANDI ET AL
88
in Technical Report 185of the World Health Organization
same. In Paharpur in 1972, 49.2% of the total population
(1960). The diagnosis of each case was made according
were women; 15 years later the percentage was 48.6%. In
to
diagnostic criteria developed before the beginning of the survey (see Appendix). Only illnesses diagnosed at the time of examination were accepted as cases, except where the diagnosis was hysteria or epilepsy. In these two instances, manifestation of symptoms at any time during the previous year was sufficient for inclusion as a case. (d) The Socioeconomic Status (SES) Scheduleof Pareek & Trivedi (1966), which is standardised for use in the rural
area of India, was used in the survey to determine the socioeconomic
status of each family.
The survey was conducted every year in the same season from 1972onwards. The actual study was completed in eight weeks. Usuallythe workbeganin the earlymorningand con tinued till late in the evening, with a short break at midday, so
that the persons interviewed were available in their home in a relaxed frame of mind. The same team conducted the survey every year. The data obtained by the surveys conducted according to this
method
have
been
compiled,
computed
and
statistically evaluated. Some of the findings have already been published (Nandi et al, 1975, 1976, 1978, 1986).
Gambhirgachi, women constituted 51.1% of the population in 1972 and 51.8% in 1982. The changes in total morbidity in the two villages during the survey periods are shown in Table 1. The changes are not statistically significant. The changes in the rates of mental morbidity of males and females are also shown in Table 1. These changes too are not significant. In Table 2 the decline of the prevalence of hysteria is shown against the rise of the prevalence of depression. In the course of 15 years, the prevalenceof hysteria fell from 32.3 per 1000 to 2.05 per 1000 in Paharpur. Hysteria is common in women; the fall in its prevalence is also marked in women (from54.7per 1000to 4.2per 1000).In Gambhirgachi a similar remarkable fall is evident. From
16.9per 1000,prevalenceto 4.6 per 1000in the courseof 10 years. In women, the rate fell from 25.9 per 1000 to 7.5 per 1000. The age distribution
of hysteria in both the
villages shows that almost all the cases in 1972 occurred
in middle-agedor youngerpersons;in 1987therewereno cases over the age of 47 nor any under the age of 12 (see
Table 3). Results Although the total population has increased remarkably in both the villages, the sex ratio has remained almost the Table 1 Distributionof total morbidity Paharpur 1972
1987
The rates of depression showed a remarkable rise. In Paharpur, the prevalence rose from 61.9 per 1000 to 77.2 per 1000. In Gambhirgachi, it rose from 37.7 per 1000 to 53.3 per 1000. Like hysteria, depression is more common in women than in men; the trend of increasing prevalence of depression
is shown by women also.
Gambhirgachi 1972
1982
Affected16518190126(per
1000)(148.1)(123.6)(84.9)(81.9)male59653558(per 1000)(104.2)(86.4)(67.4)(78.3)female1061165568(per 1000)(193.4)(162.9)(101.6)(85.2)Not affected94912839701413Total1114146410601539
Discussion
The growth of population in both the villages shows the usual pattern and rate. In Paharpur there were 1114 persons in 1972 and 1464 in 1987 (rise 31.4% in 15 years). This growth rate is slightly lower than India's national rate. In Gambhirgachi, a population of 1060 grew to 1539 in 10 years: the growth rate (45.2°lo in 10 years) is higher than the national rate. India's national rate of population growth was 24.75%
Decreasesin prevalencerates from 1972 are not statistically significant (P> 0.05).
e
over
1971—81. The sex distributions
of the
populations of both the villages are similar to the national pattern and they have not changed during
Table 2 Distribution of hysteria and depression by sex PaharpurGambhirgachi1972198719721982MaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalHysteria
(per 1000) Depression (per 1000)6 Change in hysteria
(4.2) (2.05) (10.6) (54.7) (32.3) (0) 21 48 69 32 81 113 (37.1)30(87.6)36(61.9)0 (42.5)3 (113.8)3 (77.2)4 ,t2=35.08, @21472
d.f.=1, d.f.=1.
P
