HYSTERICAL

MARC

PSYCHOSIS
AND

H.

HOLLENDER, was a popular

M.D.,

STEVEN

J. HIRSCH,
with case

M.D.1

term the term never became part of the standard nomenclature, many psychiatrists assume that it suffered the fate of other terms once in vogue and now all but forgotten. Yet, it is still very much with us. There is even reason to believe that its popularity today is no less than it was half a century ago. Letters addressed to 6 teachers of psychiatry2 in scattered parts of the country disclosed

Hysterical

psychosis

connection

reports,

it

received

in this country and in Europe during early part of the century. Since the

only

passing

or incidental

notice.

term is so widely known and appropriate to set down how doing so, we hope to provide a point of reference for support or criticism, something that is impossible as long as the term is handed down mainly by word of mouthmuch as various versions of a folk song are handed down-from one generation of psychiatrists to the next.

Since the used, it seems it is used. By

that

all

but

one

use

the

term.

No

attempt

has been made to conduct a broad survey because our interest was only in establishing the fact that the term is still alive. Since no system of classification includes
the term hysterical psychosis, it has lived on without official sanction. Standard textbooks do not mention it by name, and only by inference can we surmise that it is subsumed under hysteria (as a neurosis). Its existence was recognized in one psychiatric dictionary in which it was defined but with the implication that it is a historical relic.

Freuds Formulations. Freud( 17), in his first article on the neuro-psychoses (1894), extended his early formulation of hysteria. He regarded psychotic behavior as a defense against an unbearable idea and the anxiety or guilt associated with it. The flight from a disturbing life situation could take the form of wish-fulfilling delusions and hallucinations. Brody(8) commented that this formulation might fit a hysterical psychosis.
Freud( 18), in neuro-psychoses failure in repression, rent stress, may havior in that it, his second article on the (1896), suggested that a in response to a curbe basic to psychotic be1. Permits the eruption of

Hinsie

and

Campbell(24)

said:

At present this term is synonymous with hysteria, which is more commonly looked upon as a psychoneurosis rather than a psychosis. However, at times a hysteroid condition seems closely allied to a psychosis (e.g., certain stuperous and hallucinatory states) and then it is called a hysterical psychosis or a hysteriform condition. Our article search of the literature revealed in which hysterical psychosis as no an

material,

wholly

or partially,

out

of aware-

ness, and, 2. Modifies the ego function concerned with evaluating reality. This statement is consistent with the thesis for hysterical psychosis which will be developed in this article.

Descriptive

Features.

From

a descriptive

entity

was

considered.

When

mentioned

in

1 Respectively, Professor, Department of Psychiatry, State University of New York, Upstate Medical Center and Director, Syracuse Psychiatric Hospital, and Assistant Instructor, Department of

standpoint, the hysterical psychosis begins suddenly and dramatically. The onset is temporally related to an event or circumstance which has been profoundly upsetting. In this sense, it is reactive, much as some depressions are referred to as reactive. The manifestations may take the form of hallucinations, delusions, depersonalization or grossly unusual behavior. Affectivity is not usually altered. If it is, it is in the direction of volatility and not flatness.

Psychiatry, State University of state Medical Center in Syracuse. 2Dr. Franz Alexander (Mount

New

York,

Up-

Sinai-Cedars of Lebanon), Dr. Douglas Bond (Western Reserve), Dr. Norman Q. Brill (UCLA), Dr. Lawrence C. Kolb (Columbia) and Dr. Milton Rosenbaum (Albert Einstein). Dr. Eugene Brody (University of Maryland) used the term in an article, to be quoted later, but he does not use it in practice.

Thought disorders, when they are generally circumscribed and sient. We agree with Brill(7)
thought disorders (in hysterical

do occur, very tranthat the

psychosis),

1066

1964] even though lusions and characterized hallucinations,

MARC

H.

HOLLENDER.

AND

STEVEN

j.

HIRSCH

1067 Fisher( 15), on the basis

like the simple distortions of reality seen in the very angry or fearful child, which disappear when emotional control is achieved, than like the more complex, autistic and even
chronic thought disorders of the schizophrenic patient. The acute episode in hysterical psychosis seldom lasts longer than one to 3 weeks. The process recedes as suddenly and dramatically as it began, leaving practically no residue. Generally, the outlook for the future and the possibility of

at times are more

by

de-

phenomena

of Rorschach test records obtained

protocols, stated that the from patients with conuniquely distincfrom many other

version symptoms are not tive and might be obtained

groups perience

of patients). we would

From our clinical exconclude that a conwith and

tinuum of behavior exists beginning the hysterical (or histrionic)3 character ending with hysterical psychosis.

Correspondents

Comments.

In

addition

treatability

in psychotherapy

is favorable.

Second or even third episodes may, and do, occur. Persons most vulnerable to this type of ego disorganization usually are referred to as hysterical characters or having hysterical

to asking our correspondents hysterical psychosis was used, quired how it might be used. responses were consistent with viewpoint we have expressed. tive sample statements will be

if the term we also inMost of the the general Representacited.

Brill(7)
Some

stated:

personalities.

These

patients-mostly

women

-are very dramatic and even histrionic in their behavior. They turn from one interest to another with the intensity and short lasting quality of a brush fire. Life is lived on a day to day basis. Responses to problems in interpersonal relationships often find expression in pantomime (body language) or in action (suicidal gesture or attempt) rather than in more direct form (verbal

patients who have a basic hysterical structure at times become so frustrated, so angry, so fearful, that they lose control and behave in a psychotic fashion without ever manifesting the kind of thought disorder or real inappropriateness of the schizophrenic.
character

Much in the commented:

same

vein,

Rosenbaum

(30)

confrontation).
are seen sexuality

Frequently
mainly as may serve

other

persons

sources of supply and as a form of barter.

These women are characteristically tish and seductive. Chodoff and Lyons( 11), in this subject, stated:

coquetdiscussing

a finding of a basic thought disorder is not present, but rather there is a simple or primitive type of wish-fulfillment fantasy which may take vivid and hallucinatory form. Also, in these cases, the onset of the reaction is dramatic and sudden.... Brody(9) psychosis stated seemed that the occasionally term hysterical appropriate

cable who

the hysterical personality is a term applito persons who are vain and egocentric, display labile and excitable but shallow
whose dramatic, attention seeking

when
fulfilling

the the or

psychological condition, while criteria for a failure in reality

to have a clear problem-

testing,

appeared

affectivity,

and histrionic behavior may go to the extremes of lying and even pseudologia phantastica, who are very conscious of sex, sexually provocative yet frigid, and who are dependently demanding in interpersonal situations. The fact that hysterical psychosis seems to occur mainly in persons who would be described as hysterical characters stands in sharp contrast to the relationship of conversion hysteria and hysterical character.

solving added:

wish-fulfilling

function.

He

The tendency to think of hysterical psychosis rather than schizophrenia would be greater when the secondary, interpersonal or adaptive gain from the psychotic behavior is most obvious. Thus, the psychosis of some prisoners disappears with freedom, and that of soldiers may vanish with their removal from danger.

(Chodoff
no single

and

Lyons

found:

there

is

found

pattern in individuals

of personality presenting

traits to be conversion

3 Several authors(32) is a more descriptively because of the striking persons for dramatization.

maintained fitting term

propensity

that histrionic than hysterical of this group of

1068

HYSTERICAL

PSYCHOSIS

[May

In Alexanders( 1) opinion, the term hysterical psychosis is really a telegram-style reference to hysterical states which from the

point of view of descriptive symptomatology strongly resemble psychotic states. Bond(4) commented:
I have chosis) of it (hysterical psysame way as Freuds ubervaltingungspsychose, which he mentioned in the second (paper on the) defense neuropsychoses. . To me the differences (which distinguish hysterical psychosis from schizophrenia) are mainly in the contact of the patient with the environment, the easily understandable dynamics and the shortness of duration.
much in
.

so diagnosed by others differed in no ways from other schizophrenics. When a supposed hysteric becomes psychotic or deteriorates, he is, in my experience, not a hysteric at all, but a schizophrenic. Fenichels( 14) stand was similar to

always

thought the

Bleulers.

He stated:

Sometimes an ego, otherwise intact, is capable of temporarily turning away from an unpleasant reality in schizophrenic episodes of short duration, which were called hysterical psychosis or amentia in older psychiatric terminology. In discussing reactions to war which he classed as schizophrenia would call hysterical psychosis,
If

Review discussing psychosis

stated:

Of The Literature. a case diagnosed (in statu nascendi),

In an article as hysterical Reich(29)

experiences, and we he stated:

psychoanalytical literature contains no special study on this subject, except for the cases dealt with by Breuer and Freud in particular those of Anna 0., and Emmy v. N, and a few brief remarks in other analytic works.

reality becomes unbearable, the patient breaks with reality. But enough preconscious attention remains to re-establish the contact with reality as soon as it becomes bearable again.

A similar type Fenichel, may combat stresses:

of also

reaction, according be a response to

to non-

Very few references to hysterical psychosis are to be found either in the psychoanalytic or psychiatric literature, and those found are mainly brief, sketchy or critical.
Breuer and Freud(6) mentioned hysteripsychosis several times in Studies on Hysteria, but seemed to assume that the manner in which they used the term needed little clarification or discussion. Freud( 19), in a letter to Fliess (January 24, 1895), cal

Acute hallucinatory states which frequently develop after definite traumata, such as operations or childbirth, are often easily recognizable as wish-fulfillments. A man whose leg has been amputated may develop an acute psychosis in which he denies the amputation and imagines that he still possesses a healthy leg. One final quotation from the term Fenichel is also

stated that in the hysterical psychosis both the affect and the content of the idea which have been fended off gain mastery over the ego. The hallucinations that occur are hostile to ego and defense, resulting in failure of the latter. In a paper sent to Fliess (January 1, 1896), Freud( 19) referred to the overwhelming of the patients ego in various forms of the neuroses of defence. One year later (letter of January 11, 1897(19)), he used the term uberwaltingungspsychose (a psychosis in which the ego is overwhelmed). Bleuler(3) took the following position:
I have never yet had any reason a diagnosis of hysterical psychosis.

relevant
sis although

to the subject
he used

of hysterical

psycho-

schizophrenia.

He commented:
Sometimes sudden schizophrenic episodes, which give an impression of severity because they entail a complete break with reality, orcur as a response to acute frustration or strain and pass entirely and relatively quickly. Probably this type of acute schizophrenic episode with good prognosis is the way in which certain disturbed persons react to excessive strain.

In
Gross, Another phrenic

more
Slater group

recent
and

publication,
stated: labelled reactions

Mayer-

Roth(27)

for making All cases

are

of cases often severe hysterical

schizoto an

19641

MARC

H.

HOLLENDER,

AND

STEVEN

J.

HIRSCH

1069 brief schizophrenias actually lie

emotional loss, an affective trauma or a deprivation of support and home. These hysterical psychoses may occur in children of an introverted and solitary disposition Marmor(26) cited a case that he did not classify as a psychosis but which clearly fits the designation of hysterical psychosis, as we use it. He stated: A hysterical patient, in the course of analysis, reacted with intense anxiety to a remark on the analysts part which she considered critical. On leaving the office, she felt confused and felt as though the high buildings on either side of the street were leaning over toward her, and were about to topple over and crush her. She wandered through the streets disoriented and frightened for several hours, after which the confusion subsided and she was able to return home. This patient did not develop a psychosis, but there is little doubt that greater stress at this time could have led to a psychotic breakdown. In a review of the Continental literature on the concept of reactive psychosis, Astrup, Fossum and Holmboe(2) suggested that these psychoses are distinguished by a non-schizophrenic course of illness, neurotic or psychopathic predisposition and precipitation by more or less easily recognized exogenous factors. They added, Our impression is that psychotherapy of such cases is described too often in the literature as successful therapy for schizophrenia. The term transient psychosi$ often refers

The
soldiers

so-called
in wartime

where

between

may dementia

praecox

of someand hys-

teria, as Duval and Hoffman( 12) suggested. Grinker and Spiegel(23), referring to these psychotic-like reactions in which the ego crumbles and ignores either reality or the great anxieties stimulated by it, in-

dicated

that

they
the to

were

variously
appellation diagnosis

misof of

labeled, from schizophrenia hysteria. drome paper disorder

malignant the benign

bears his name. In his second (1904), Ganser(21) considered the to be a hysterical twilight state with transitory clouding of consciousness, hallucinations and disorientation in addition to the cardinal symptom of approximate answers to familiar and simple questions. It is interesting in the context of the present discussion, that hysterical personality traits are prominent in nearly all the reported cases and that in most of them there is

Ganser(20), which

in 1898,

described

the

syn-

evidence for a transitory, self-limited, dramatic cognitive and perceptual distortion

of reality. Still there are significant differences which clearly differentiate them from hysterical psychosis.4

Case opinion

Reports.
seen

The
by

following
Rosenbau.m,

case

report instance

of a patient of hysterical

is, in his

as well

as ours,

a classical

psychosis.

to what

we call

hysterical

psychosis.
of course, in discussing

(Toxic
must
this

psychosis or acute delirium, be excluded). Bower(5), subject, remarked:

In transient psychosis the conflict is severe, usually environmental, escape routes are barred, and there exists an inability to manipulate or influence the factors contributing to the conflict situation. Neurotic mechanisms are inapplicable and non-goal-directed, and regressive behaviour results. Noble(28), manifestations gested the in a paper on hysterical in schizophrenic illness, sugexistence of a continuum of

The patient, a 45-year-old widow, had worked as a housemother in an orphanage so that she could raise and support her daughter. After 20 years, her daughter, who had finished college, left to establish a life of her own. Other housemothers pointed out to the patient that she was still relatively young and attractive and that she might get married now that she had fulfilled her responsibilities to her daughter. Reluctantly, she accepted their advice. Family members found a suitable suitor for her, a widower 10 years her senior. After going out with him twice, she developed an acute psychotic disorder which took the form of fears that men were breaking into her house and of hallucinations in which she was being called a prostitute or something similar. She was ad4 A case reported schizophreniform Gansers Syndrome drome.

disturbances

ranging

from

the frank

hysteri-

cal illness to the disorganizing process and including the ss.

schizophrenic hysterico-psycho-

by Fox( 18) under the title of hysteria might be classified as or, at least, a Ganser-like Syn-

1070

HYSTERICAL

PSYCHOSIS

[May

mitted to the psychiatric service of a general hospital. Her therapist suggested that the stress of marriage, after being a widow so many years, would be too much for her, and he recommended that she return to a position similar to her former one. The psychotic symptoms cleared up in less than a week and she was discharged from the hospital.

The following two case reports have been selected from patients seen recently at the Syracuse Psychiatric Hospital. More striking the instances past, but there have since is no come they to our attention were only given in

The patient married for the first time at the age of 18. Six days later her husband was sent overseas, and subsequently he requested an annulment, which she granted. Shortly thereafter, she became pregnant by an artist for whom she was posing and went to New York where the baby was delivered and given up for adoption. She then returned to Syracuse and became acquainted with a student whom she married when she was 21. She had confessed all her past indiscretions to him prior to the marriage. After a few months, her husband

a
to

refused berating

to sleep with her, accusing

her her

and

diagnosis
system, locate

to fit our the records.

standard
reasonably

classification
easy way

Three weeks prior to admission to the hospital, an attractive, shapely and smartly dressed 24-year-old divorced woman, became quite hysterical and went haywire at her parents twenty-fifth anniversary party when an aunt and uncle gave her parents the same gift which she had ordered for them. She reacted as though her aunt and uncle were out to get her and she accused them of deliberately giving the same gift to make her look small. She had been somewhat tense before the anniversary party. That evening the patient experienced guilt about things she had done long ago-things I
couldnt

hold

anyone

responsible

for

except

myself. She added, After awhile I got so I couldnt cope with holding all this guilt in myself. She was unable to sleep, and suddenly, while still very much awake, heard a mans voice-perhaps it was my former husbands -calling her a tramp, a slut, uneducated, no good. Her first reaction was one of fright mingled with curiosity. I was still rational enough to know that I shouldnt have been hearing the voice. I wondered if I was losing my mind. The following day, after uncontrollable sobbing and excessive drinking, she consulted a psychiatrist, who arranged for her hospitalization. The patient said that she always tried to say what she thought others wanted to hear and that she had consistently taken the easy way out of situations. I have always been willing to admit my mistakes but I would never sit down and do anything about them. I found out at an early age that if you admit your mistakes to people, they think youre intelligent. She added that she has often enjoyed being a martyr, and that her only goal was to make the most of the moment.

a prostitute, one of the good. Despite two years of almost constant abuse, the patient took no legal action. Finally, her husband sought and obtained a divorce. Shortly thereafter the patient went to work for a local professional man, to whom she related her problems. He soon began to make sexual advances which she repulsed, and she then lived in a state of fear that he would continue to make advances. For several months, however, she made no attempt to leave the job. Her next romantic adventure involved a 19-year-old college freshman who planned to marry her upon completing his 4 years of college. Three days before entering the hospital, she told him that she was no good, rotten, and otherwise unworthy of his attentions. Of her early years, the patient recalled that her parents constantly argued with one another. She believed that she could confide in her father, but he was often away from home when she needed him. Her mother was described as a cold to lukewarm type of person, very jealous and insincere. The patients brother, 10 years her junior, had somehow been responsible for bringing the parents closer together-something which the patient herself had never been able to do. She dated the onset of her problems to age 6, when her father impulsively left the mother following an argument. Before leaving, he told the little girl, JoAnn, I dont love your mother anymore, but I still love you. He returned 4 years later. The second patient, a 26-year-old married woman, was first admitted to the hospital in 1959, at the age of 22, 12 days after giving birth to a child by a man other than her husband. She was in the process of obtaining a divorce from her husband and planned to marry the father of her child. During the pregnancy she had been abandoned by her parents, who felt that she had disgraced them. She apparently did well until the time of delivery. Following her delivery, she began to

spent much time being a tramp, common masses, no of

19641

MARC

H.

HOLLENDER,

AND

STEVEN

J.

HIRSCH

1071

talk very rapidly and nearly continuously about many things. The patient was discharged from the hospital 6 days post-partum but remained bedridden because of cystitis. Remaining in bed caused her to feel extremely anxious. She did not know precisely how to care for her new baby, she received no support from her parents and her paramour was becoming upset because of the total situation, but especially by her continual talking, and he threatened to leave her. Her behavior became more hyperactive and disorganized. She began to spend much time reading the Bible. Feeling that she had no one to turn to, she decided to take her life two days prior to admission to the hospital. When she attempted to accomplish this with several pills, the result was only somnolence. On admission, the patient appeared dishevelled, motorically hyperactive and agitated. She was very concerned that the relationship with the interviewer would be only temporary, and she expressed her desire for a continuing
relationship. She was highly productive and

her back to life. On admission to the hospital, she appeared hyperactive, voluble and dishevelled. She stated that she had died and had been reborn that morning, that she was invulnerable to further pain and even death, that she was now a form of Cod and that while Jesus took care of men, she would take care of women. Once again the patient reconstituted from her acute psychosis within 10 days. The patients father, in his mid-fifties, had
always insisted on high moral standards from

brought

his

stated that he and the patient were never very close. Her mother, age 50, also had never had a close relationship with the patient. She had been permissive and had never discussed anything with her daugh-

children.

He

ter.
was

The
always

patients
friction

father

indicated
his

that
wife

there

spontaneous, but her stream of thought was difficult to follow since she would begin one subject and shift to another without completing the first. Despite its disorganization, her trend of thought seemed to deal with her effort to master the situation related to the birth of her child. She expressed the delusions that God was determining the course of events in her life and that she was able to transmit a kind of mystical energy from her eyes to the eyes of her sister. The patient was placed on chlorpromazine and was given intensive supportive psychotherapy. She rapidly became calmer and was able to organize her thoughts and to gain some understanding of the problems which led to her hospitalization. Within 10 days she had reconstituted and at the end of two weeks she was well enough to be discharged. Four months later, she married her former paramour. She described this marriage as turbulent. Four days prior to the patients second hospitalization in October 1962, the couple had an argument during which she accused her husband of infidelity and he, in turn, assaulted her and banged her head against the floor. Later that night, the patient left the house and remained with friends for 3 days. She went to her parents home one day prior to hospitalization. On the morning of admission, the patient

and daughter. The patient had married for the first time at age 20, and separated from her husband after 3 weeks because of incompatibility. She then worked for a time as a night club singer and travelled to New York with her agent. There she was picked up by a bookie who acted as her sugar daddy, and the two lived together. During his absences, the patient became acquainted with a musician. She invited him to her apartment and lived with him after the bookie threw her out. After returning to her home town, she became pregnant by the man who subsequently became her second husband.
DISCUSSION

between

was discovered by her mother lying limply in a partially filled bath tub, her eyes closed and her face dry. On being revived (with artificial respiration), the patient announced that she had died from drowning but that God had

In most instances, the clinical picture of hysterical psychosis is the end-point on a continuum beginning with hysterical character. By hysterical character we mean a personality configuration, life style or type of ego function which is the product of a particular constitutional make-up and set of life experiences. It also refers to a limited repertory of responses available to meet or to cope with situations and problems. In attempting to draw a picture of the patterns which characterize the behavior of persons we refer to as hysterical characters, we find ourselves somewhat in the position of the pictorial illustrator; if we are to present a clear picture, we must eliminate details and use sweeping brush strokes to convey an impression instead of striving for a photographic likeness. Also, we can present only a single picture, knowing full well that several pictures would be required to bring out significant, and perhaps strildng variations.

1072 The persons who hysterical character fit the

HYSTERICAL

PSYCHOSIS

[May
the circumstances which brought

designation

of

partly

by

have been taught to use antennae, so to speak, to deal with most situations. They develop an exquisite sensitivity to cues and an ability to accommodate readily to the expectations or requirements of others. Their life style is also characterized by fluidity, with rapid, pronounced and often unpredictable changes in mood, relationships and behavior. Volatility and expediency rather than stability and a wellcharted course are prominent features. The need to behave as others might expect is responsible for the frequent use of role-playing. The ability to act may be such that it can be said that a mask is wearing the person( 22). A flare for the dramatic or the histrionic is also often highly developed. The life style described, obviously, does not lend itself to consistency or stability. Neither does the proclivity to live for the pleasures of the moment, which is another common trait. Since most long-range aspirations and goals seem too far beyond reach, the stability derived from methodical planning and persistent striving is not achieved. Early experiences, too, foster an outlook oriented to affective truth (i.e., it feels or seems right, so it is right) instead of to facts, logic and validation. This outlook contrasts sharply with that of the person trained to share the scientists orientation. Here again, we find fluidity rather than stability. The ego structure of the hysterical character has certain strengths and weaknesses. Its weaknesses become most evident when a person reacts to a crisis by feeling distraught. As anxiety mounts, the person may become overwhelmed and be unable to bring forth a well-organized pattern of behavior or to improvise a response to handle the situation. At this point an altered ego state (or ego feeling) and phenomena such as hallucinations or delusions are experienced. These reactions cannot be classed as defensive; they are manifestations of the disruption of ego function. In Federns( 13) terms, for example, the hallucinations result from a breakdown of the ego boundary which in turn impairs the persons ability to distinguish what is outside from what is inside. The content of the hallucinations (or delusions) is shaped

on In

the

disruption most, but

of not
of

ego function. in all, instances

the

clinical picture the end-point with hysterical

hysterical psychosis is on a continuum beginning character. Notable excep-

tions

are

the

cases

which
and

occur

in wartime

combat situations civilian stresses gical operations).

is an

and stress, A contributory part may be played by the biological state (i.e., exhaustion or malnutrition) and/or the psychological set (i.e., outlook of the combat soldier). It is possible that the most distinctive feature of the egos function in these cases is not its sudden

in response to severe (i.e., auto accidents or surIn these instances there inverse relationship between the stress the predisposition: the greater the the less need be the predisposition.

disruption

but

its ability

to quickly

reinte-

grate. Fenichel, as cited previously, maintained that if a man whose leg has been amputated develops an acute psychosis in which he denies the amputation5 it is easily recognizable as a wish-fulfillment. This formulation is consistent with Freuds first formulation (1894) of the neuro-psychoses. While it cannot be denied that a wish-fulfillment is involved, it seems likely that its expression in this form is the result of ego modifications which impair or disrupt ego function. This latter viewpoint is consistent with Freuds second formulation of the neuropsychoses (1896). In our discussion we have not ruled out the possibility that hysterical psychosis is a variant or a type of schizophrenia. Insofar as diagnostic categories are determined by convention, this is an arbitrary matter. The crucial issue would seem to be: can we sharply delimit what we have described as hysterical psychosis from schizophrenia? It is our contention that we can do so in a general way but not with unfailing precision. At times the borderline between the two disorders is fuzzy. As a result, even psychiatrists who use the designation of hysterical psychosis may disagree about the diagnosis of a case presented at a clinical conference or cited in the literature. An example of such a case would be the third tom It is assumed that limb, a universal this does not refer phenomenon. to phan-

1964]

MARC

H. HOLLENDER,

AND

STEVEN

J.

HIRSCH

1073

one in the section entitled Case Reports. (The first two-Rosenbaums patient and the first one from the Syracuse Psychiatric
Hospital-clearly and completely fit the definition of hysterical psychosis.) In the third case, the thought disorder is so profound that it is difficult to be certain that we have not crossed the borderline. Cogent arguments could be adduced to support the contention that the patient experienced two brief schizophrenic episodes. Other forms of disruption of ego function may be closely related to hysterical psychosis; at least they share some features in common. In this group are syndromes such as amok, latah, imu and whitico psychosis.#{176} Related, too, is the disruption of ego function occurring in subjects during perceptual isolation and sensory deprivation experiments and in explorers or adventurers during prolonged periods of enforced isolation. It should be noted, also, that although toxic psychosis is an ego disruption resulting primarily from an alteration in the physical state, it shares some clinical features in common with hysterical psychosis resulting primarily from an alteration in the psychological state.
SUMMARY

psychoses insofar as we view the disturbance as a form of ego disruption. Descriptively, hysterical psychosis is marked by a sudden and dramatic onset temporally related to a profoundly upsetting event or circumstance. Its manifestations include hallucinations, delusions, depersonalization and grossly unusual behavior. Thought disorders, when they occur, are usually sharply circumscribed and very transient. Affectivity, if altered, is changed in the direction of volatility and not flatness. The acute episode seldom lasts longer than one to 3 weeks, and the eruption is sealed off so that there is practically no residue. Hysterical psychosis is encountered most commonly in persons referred to as hysterical characters or personalities when faced by trying life situations or problems. Statements received from correspondents were consistent generally with our viewpoint. Case notes have been presented to illustrate certain aspects of the clinical pictore.

BIBLIOGRAPHY F.: Personal Communication. 2. Astrup, C., et al.: Prognosis in Functional Psychoses. Springfield, Ill.: Charles C Thomas, 1962. 3. Bleuler, E. P.: Dementia Praecox or the Group of Schizophrenias. New York: Int. Univ. Press, 1950. 4. Bond, D.: Personal Communication. 5. Bower, H. M.: Transient Psychosis. in Proceedings of the Third World Congress of Psychiatry, 2. Montreal: Univ. Toronto Press and McGill Univ. Press, 1961. 6. Breuer, J., and Freud, S.: Studies in Hysteria. New York: Nervous and Mental Disease Publications, 1937. 7. Brill, N. Q.: Personal Communication. 8. Brody, E. B.: J. Nerv. Ment. Dis., 133:
36, 1961.

1. Alexander,

The term hysterical psychosis has been in common usage for longer than half a century, but it has never become part of the standard nomenclature. Indeed, there is no single article in the literature in which hysterical psychosis as an entity is described and the subject discussed. We have set down how the term is used to provide a fixed point of reference for support or criticism. Our conceptualization of the process is essentially in agreement with Freuds formulation in his second article on the neuro6Yap(31) regarded the Malayan fright psychosis known as latah as a highly specialized form of hysteria, and Lin(25) noted that attacks of hsieh-ping, marked by clouding of consciousness and often accompanied by visual or auditory hallucinations, are seen mostly in women with hysterical personalities. In his exhaustive survey of African psychiatric data, Carothers( 10) described
as common, an acute, transitory confusional state accompanied with or without hallucination, cal elements. type of twilight or by reality distortion, and having hysteri-

9.

_______

Personal

10. Carothers, J. C.: The Health and Disease. Geneva:

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