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loop-hole of escape for those who maintained a sexual causation he
asserted that there are no varieties of hysteria, that the disease is one
and indivisible. Charcot recognized no primordial cause of hysteria beyond
heredity, which here plays a more important part than in any other
neuropathic condition. Such heredity is either direct or more occasionally
by transformation, any deviation of nutrition found in the ancestors
(gout, diabetes, arthritis) being a possible cause of hysteria in the
descendants. "We do not know anything about the nature of hysteria,"
Charcot wrote in 1892; "we must make it objective in order to recognize
it. The dominant idea for us in the etiology of hysteria is, in the widest
sense, its hereditary predisposition. The greater number of those
suffering from this affection are simply born _hystrisables_, and on them
the occasional causes act directly, either through autosuggestion or by
causing derangement of general nutrition, and more particularly of the
nutrition of the nervous system."[262] These views were ably and
decisively stated in Gilles de la Tourette's _Trait de l'Hystrie_,
written under the inspiration of Charcot.
While Charcot's doctrine was thus being affirmed and generally accepted,
there were at the same time workers in these fields who, though they by no
means ignored this doctrine of hysteria or even rejected it, were inclined
to think that it was too absolutely stated. Writing in the _Dictionary of
Psychological Medicine_ at the same time as Charcot, Donkin, while
deprecating any exclusive emphasis on the sexual causation, pointed out
the enormous part played by the emotions in the production of hysteria,
and the great influence of puberty in women due to the greater extent of
the sexual organs, and the consequently large area of central innervation
involved, and thus rendered liable to fall into a state of unstable
equilibrium. Enforced abstinence from the gratification of any of the
inherent and primitive desires, he pointed out, may be an adequate
exciting cause. Such a view as this indicated that to set aside the
ancient doctrine of a physical sexual cause of hysteria was by no means to
exclude a psychic sexual cause. Ten years earlier Axenfeld and Huchard had
pointed out that the reaction against the sexual origin of hysteria was
becoming excessive, and they referred to the evidence brought forward by
veterinary surgeons showing that unsatisfied sexual desire in animals may
produce nervous symptoms very similar to hysteria.[263] The present
writer, when in 1894 briefly discussing hysteria as an element in
secondary sexual characterization, ventured to reflect the view, confirmed
by his own observation, that there was a tendency to unduly minimize the
sexual factor in hysteria, and further pointed out that the old error of a
special connection between hysteria and the female sexual organs, probably
arose from the fact that in woman the organic sexual sphere is larger than
in man.[264]
When, indeed, we analyze the foundation of the once predominant opinions
of Charcot and his school regarding the sexual relationships of hysteria,
it becomes clear that many fallacies and misunderstandings were involved.
Briquet, Charcot's chief predecessor, acknowledged that his own view was
that a sexual origin of hysteria would be "degrading to women"; that is to
say, he admitted that he was influenced by a foolish and improper
prejudice, for the belief that the unconscious and involuntary morbid
reaction of the nervous system to any disturbance of a great primary
instinct can have "_quelque chose de dgradant_" is itself an immoral
belief; such disturbance of the nervous system might or might not be
caused, but in any case the alleged "degradation" could only be the
fiction of a distorted imagination. Again, confusion had been caused by
the ancient error of making the physical sexual organs responsible for
hysteria, first the womb, more recently the ovaries; the outcome of this
belief was the extirpation of the sexual organs for the cure of hysteria.
Charcot condemned absolutely all such operations as unscientific and
dangerous, declaring that there is no such thing as hysteria of menstrual
origin.[265] Subsequently, Angelucci and Pierracini carried out an
international inquiry into the results of the surgical treatment of
hysteria, and condemned it in the most unqualified manner.[266] It is
clearly demonstrated that the physical sexual organs are not the seat of
hysteria. It does not, however, follow that even physical sexual desire,
when repressed, is not a cause of hysteria. The opinion that it was so
formed an essential part of the early doctrine of hysteria, and was
embodied in the ancient maxim: "_Nubat illa et morbus effugiet_." The
womb, it seemed to the ancients, was crying out for satisfaction, and when
that was received the disease vanished.[267] But when it became clear that
sexual desire, though ultimately founded on the sexual apparatus, is a
nervous and psychic fact, to put the sexual organs out of count was not
sufficient; for the sexual emotions may exist before puberty, and persist
after complete removal of the sexual organs. Thus it has been the object
of many writers to repel the idea that unsatisfied sexual desire can be a
cause of hysteria. Briquet pointed out that hysteria is rare among nuns
and frequent among prostitutes. Krafft-Ebing believed that most
hysterical women are not anxious for sexual satisfaction, and declared
that "hysteria caused through the non-satisfaction of the coarse sensual
sexual impulse I have never seen,"[268] while Pitres and others refer to
the frequently painful nature of sexual hallucinations in the hysterical.
But it soon becomes obvious that the psychic sexual sphere is not confined
to the gratification of conscious physical sexual desire. It is not true
that hysteria is rare among nuns, some of the most tremendous epidemics of
hysteria, and the most carefully studied, having occurred in
convents,[269] while the hysterical phenomena sometimes associated with
revivals are well known. The supposed prevalence among prostitutes would
not be evidence against the sexual relationships of hysteria; it has,
however, been denied, even by so great an authority as Parent-Duchtelet
who found it very rare, even in prostitutes in hospitals, when it was
often associated with masturbation; in prostitutes, however, who returned
to a respectable life, giving up their old habits, he found hysteria
common and severe.[270] The frequent absence of physical sexual feeling,
again, may quite reasonably be taken as evidence of a disorder of the
sexual emotions, while the undoubted fact that sexual intercourse usually
has little beneficial effect on pronounced hysteria, and that sexual
excitement during sleep and sexual hallucinations are often painful in
the same condition, is far from showing that injury or repression of the
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