Monday, January 10, 2011
Hysteria As Misdiagnosis - Then and Now
Over 45 years ago Dr. Slater documented the frequent misdiagnosis of neurological diseases as “hysteria”. He published his findings in the British Medical Journal in 1965.
Following 85 patients admitted to a mental hospital, nine years later 50% were dead or disabled; 50% were living independently; 22% were symptom free.
The dead or disabled were found to have had vascular disease, epilepsy, vestibular lesions, angioma of the brain stem or neoplasms such as brain tumors.
At least 50% of those patients admitted to a mental hospital had physical diseases yet were diagnosed as “hysterical”, the old way of saying “It's all in the head.”
The idea that physical illnesses were manifestations of feelings and thoughts started with Charcot in the 1880's. His pupil, Freud, advanced that idea with a series of writings that have since been found to be largely fabricated.
For instance, a man knocked unconscious for 5 days by a carriage was unable to speak, walk or remember the accident when he regained consciousness. Charcot diagnosed him as being hysterical because of the psychological trauma of the event.
As Richard Webster says “Le Log - the classic example of a patient who supposedly suffered from traumatic hysteria, did not forget because he was frightened. He forgot because he was concussed. His various symptoms were not produced by an unconscious idea. They were the result of brain damage”
When a 14-year old patient of Freud's died of abdominal cancer two months after he diagnosed her with “unmistakeable hysteria” he claimed her hysteria had caused the tumor.
Webster explains how hysteria, renamed conversion disorder or somatoform disorder, became so popular:
“What made the resulting labyrinth of medical error all but inescapable was that practically every other physician had become lost within it. Over and over again, highly trained medical practitioners, confronted by some of the more subtle symptoms of epilepsy, head injury, cerebral tumours, multiple sclerosis, Parkinson’s disease, Tourette’s syndrome, autism, syphilis, encephalitis, torsion dystonia, viral hepatitis, reflux oesophagitis, hiatus hernia and hundreds of other common or uncommon conditions, would resolve their diagnostic uncertainty by enlarging the category of hysteria yet further. As a result medical misconceptions which sprang from one misdiagnosis would almost inevitably receive support, and apparent confirmation, from misdiagnoses made by other physicians.”
After brain scans of patients sufferering from chronic fatigue syndrome were shown to an expert scan reader in 1984, he said the punctate lesions he saw looked like the scans of AIDS patients. Months later the CDC issued its verdict. The town of Incline Village NV was suffering from mass hysteria.
Misdiagnosis of neurological disease in 1890 or even in 1965 is understandable.
It remains a mystery why the Centers For Disease Control (CDC) continues to place research on CFS in the Chronic Viral Diseases Branch of the National Center for Emerging and Zoonotic Infectious Diseases, yet has refused to research the viral associations with this illness and, instead, pursues mental illness as a diagnosis 27 years after those brain scans showed it to be a neurological disease.
"Somatoform disorder" is characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by tests used by the attending physician. It is newspeak for "hysteria". In the tradition of Charcot and Freud, some doctors who cannot find the reasons for a patient's illness resort to the default diagnosis of somatoform disorder. That they stubbornly stick to this diagnosis even when physical signs and symptoms should alert them to change their diagnoses is a testament to the egos, culture and political considerations that get in the way of pure science.
To quote Slater:"The malady of the wandering womb began as a myth, and a
myth it yet survives. But, like all unwarranted beliefs which still attract credence, it is dangerous. The diagnosis of " hysteria " is a disguise for ignorance and a fertile source of clinical error. It is in fact not only a delusion but also a snare."
Cartoons by T. McCracken