Brain, Vol. 124, No. 6, 1065-1066,
June 2001
© 2001 Oxford University Press
Editorial |
Explaining the unexplained: understanding hysteria
Institute of Neurology,University College Hospital,London, UK
The concept of hysteria or conversion disorder, firmly anchored in psychoanalytic theory, postulates the emergence of physical symptoms as an unconscious attempt to resolve a painful psychic conflict. The advantages accruing from the adoption of the sick role contribute to perpetuate the disability. Two major problems with this concept have detracted from its clinical value. The first is the difficulty in establishing the occurrence, relevance and timing of a `sufficient' psychological stressor. The second is to distinguish `unconscious' motivation from feigning. Faced with these difficulties and threatened by the fear of missing treatable neurological conditions, clinicians have opted for a diagnosis by exclusion, invoking conversion disorder only after detailed
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