Sarah Constantin

Freud learned about hysteria from Charcot, the French neurologist after whom Charcot-Marie-Tooth disease is named. Charcot's case studies of hysteria included many men, and he argued strongly that it was a disease that affected both men and women. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1036207/pdf/medhist00053-0005.pdf …

In fact, Charcot's case studies of "hysteria" look more like what we would call "movement disorders"; paralyses, twitches, numbness, spasms, and the back-arching spasticity that is now called opisthotonos. https://en.wikipedia.org/wiki/Opisthotonus …

Charcot observed that these "hysterical" disorders often followed physical injury (often head trauma in workplace accidents), alcoholism, infectious disease, or exposure to toxic fumes.

Charcot thought these disorders were psychological rather than physical, however, because he thought they were out of proportion with the severity of the injuries. I am suspicious.

Modern case studies of "hysteria" similar to Charcot's are interpreted as "functional" (i.e. psychological) disorders but they do seem to follow traumatic injury and epilepsy as well! https://www.bmj.com/content/bmj/289/6460/1785.full.pdf …

http://sci-hub.tw/10.1159/000278594 … Modern cases of "hysterical" fits exactly like those described by Charcot have been induced by the anticonvulsant drug phenytoin, which can indeed cause seizures and ataxias at high doses.

What is now called "psychogenic noneptileptic seizure" (PNES) is very much like Charcot's "hysterical fits". But there isn't a crisp distinction between PNES and neurological disorders; many PNES sufferers are also epileptic, and some epilepsy looks like PNES.

Modern neurologists, like Charcot, observe that people with PNES often have a history of head injury and/or epilepsy, as well as history of trauma and diagnosis of PTSD. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1011.9802&rep=rep1&type=pdf …

So: "hysteria" as described in the late 19th century was *not* a fake illness. It was either something PTSD-like or a neurological disorder (or a grab bag of both.)

Freud's famous "hysterical" patient Anna O (Bertha Pappenheim) suffered from limb and facial, paralysis, disturbances in vision, hearing, and speech, severe headaches, brief lapses in consciousness, and convulsions. http://sci-hub.tw/http://dx.doi.org/10.1037/1093-4510.6.3.239 …

Freud & Breuer's "Studies on Hysteria" painted her case as psychological in origin, but this was written 13 years after the treatment ended. Breuer's initial report diagnosed Pappenheim with trigeminal neuralgia, an extremely severe pain condition.

Freud & Breuer lied in their "Studies on Hysteria", falsely claiming that "Anna O" had been cured of her symptoms by psychoanalysis when she had not, and falsely denying that they had prescribed her morphine to treat her pain. In fact, she was addicted.

There's still debate about what Pappenheim's "real" diagnosis was, but she was clearly physically ill, and Freud and Breuer were clearly lying. Also, if you read the study, Freud is notably cruel and berates her for her symptoms as though she were malingering.