I’ve recently become aware that the current incidence of the hysteria diagnosis is even more common than I had once thought. When I was writing Guises of Desire my thinking was along the lines of the ideas discussed in Eliot Slater’s classic paper of 1965 which dismissed the hysteria label as a ‘disguise for ignorance’. Now, while researching the case of another patient from the early history of psychoanalysis, I’ve discovered a slew of articles in medical journals which indicate that about a third (figures vary) of patients referred to neurological clinics with suspected epilepsy suffer from what is now called psychogenic nonepileptic seizures (PNES) or sometimes nonepileptic attack disorder (NEAD).
To be more specific, PNES represent a sub-category of conversion disorder, the name which replaced hysteria. The striking thing about PNES is that for most people, even doctors, the symptoms are virtually indistinguishable from epilepsy and patients can often be treated with epilepsy medication for years before it becomes evident that their condition is not epileptic. The main differentiating characteristic is that epilepsy is associated with abnormal electrical discharges in the brain; in the case of PNES there are no such discharges and it is generally believed to be caused by some kind of psychological stress, although this is by no means certain – or at least not in all cases.
This doesn’t in any way undermine Guises of Desire as a novel as such diagnostic issues don’t enter into it. The narrative merely dramatises Bertha Pappenheim’s symptoms and those symptoms would remain the same, whether she suffered from a form of epilepsy or from PNES.
One of the difficulties for people affected by psychogenic disorder is the often implicitly critical nature of the discourse around the subject. A recent book on PNES, written by a neurologist, is subtitled Real Stories of Imaginary Illness, a description which homes right in on the problem. Apart from the offence it gives to patients, it suggests that there is nothing medically or physically wrong.
Such thinking reinforces the kind of dualistic approach which is so unhelpful in these cases – the idea that mental phenomena and physical phenomena are quite distinct. This can further lead to the idea that you are somehow the willing agent of your own mental phenomena, in contrast to physical phenomena which happen to you whether you like it or not.
All experience – motor activity, emotional and physical sensations, and cognitive processes – is associated with neurophysiological substrates and if we could identify all the neural mechanisms involved in PNES we might at last be heading towards a solution to the mind-body problem – an exciting prospect.
To be more specific, PNES represent a sub-category of conversion disorder, the name which replaced hysteria. The striking thing about PNES is that for most people, even doctors, the symptoms are virtually indistinguishable from epilepsy and patients can often be treated with epilepsy medication for years before it becomes evident that their condition is not epileptic. The main differentiating characteristic is that epilepsy is associated with abnormal electrical discharges in the brain; in the case of PNES there are no such discharges and it is generally believed to be caused by some kind of psychological stress, although this is by no means certain – or at least not in all cases.
This doesn’t in any way undermine Guises of Desire as a novel as such diagnostic issues don’t enter into it. The narrative merely dramatises Bertha Pappenheim’s symptoms and those symptoms would remain the same, whether she suffered from a form of epilepsy or from PNES.
One of the difficulties for people affected by psychogenic disorder is the often implicitly critical nature of the discourse around the subject. A recent book on PNES, written by a neurologist, is subtitled Real Stories of Imaginary Illness, a description which homes right in on the problem. Apart from the offence it gives to patients, it suggests that there is nothing medically or physically wrong.
Such thinking reinforces the kind of dualistic approach which is so unhelpful in these cases – the idea that mental phenomena and physical phenomena are quite distinct. This can further lead to the idea that you are somehow the willing agent of your own mental phenomena, in contrast to physical phenomena which happen to you whether you like it or not.
All experience – motor activity, emotional and physical sensations, and cognitive processes – is associated with neurophysiological substrates and if we could identify all the neural mechanisms involved in PNES we might at last be heading towards a solution to the mind-body problem – an exciting prospect.
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