3 After freud – the history of hysteria, conversion and functional disorders in neurology in the 20th century

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Jon has had a research interest in functional disorders in neurology since 1999 starting with his PhD thesis – a case control study of patients with functional limb weakness.He has published widely in the area including systematic reviews, large cohort studies, imaging studies, exploration of new phenotypes and treatment studies. He has contributed to new diagnostic criteria for DSM-5 and ICD-11 and been involved in promoting functional disorders in training and research.He has made a website for patients at http://www.neurosymptoms.org which has been translated by other neurologists in to 12 other languages and receives 60 000 hits a month. He runs a weekly functional disorders clinic and as of August 2012 is a National Research Strategy (NHS Scotland) Clinical Fellow.In 2016, he edited a 51-chapter book “Functional Neurologic Disorders” with longstanding colleague Alan Carson and Mark Hallett of NIH as part of the “Handbook of Clinical Neurology” series.In September 2017, he is co-organising an international meeting on functional neurological disorders in Edinburgh – www.fnd2017.org or sign up at http://www.fnforum.org. Jon also co-leads the ABN special interest group on this topic (http://abnsigfd.moonfruit.com/) The idea of hysteria has been around, overtly anyway, since Hippocrates. Historians of psychiatry and medicine have obsessed over Charcot and Freud and their contributions to hysteria although arguably there were many others in the 19th century such as Briquet and Janet who had even more to offer.This talk however will examine the history of functional neurological disorders in the 20th century after Freud. This flurry of interest between 1880s and early 1920s gave way to disinterest, scepticism and concern about misdiagnosis. This was mirrored by increasing professional and geographical divisions between neurology and psychiatry after the First World War. I will explore the reason why these doldrums may have lasted such a long time.In the 1990s the advent of more detailed imaging and videotelemetry may have brought attention to functional disorders although ultimately the diagnosis has always been a positive one based on clinical signs, not normal tests. These disorders are now once again the subject of academic and clinical interest, although arguably still too much on the fringes of neurology and psychiatry. It remains commonplace for historians of Freud and psychoanalysis for example, to assume, incorrectly, that “hysteria” is a historical entity.Revisiting older material provides a rich source of ideas and data for today’s clinical researcher but also offers cautionary tales of theories and treatments that led to stagnation rather than advancement of the field. Patterns of treatment do have a habit of repeating themselves, for example, the current enthusiasm for transcranial magnetic stimulation mirrors the excitement about electrotherapy in the 19th century. For these reasons, an understanding of the history of functional disorders in neurology is arguably more important than it is for other areas of other neurological practice.

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