tag:theconversation.com,2011:/africa/topics/hysteria-29373/articlesHysteria – The Conversation2024-03-12T17:51:11Ztag:theconversation.com,2011:article/2220162024-03-12T17:51:11Z2024-03-12T17:51:11ZMenstrual health literacy is alarmingly low – what you don’t know can harm you<figure><img src="https://images.theconversation.com/files/580119/original/file-20240306-27-eeqobz.jpg?ixlib=rb-1.1.0&rect=8%2C17%2C5982%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stone-sculpture-female-genitals-covered-hands-1024757548">Len-art/Shutterstock</a></span></figcaption></figure><p>Given that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541669/#:%7E:text=In%20fact%2C%20approximately%2098%25%20of,the%20elephant%20shrew%20%5B6%5D.">98% of mammals</a> do not have periods, do you know why humans do?</p>
<p>When I ask my menstrual health workshop participants – including doctors – there’s usually a lot of shrugging and shaking of heads. If given multiple choice options, most think that periods either “clean the womb” or somehow “help prepare for pregnancy”. </p>
<p>Not only are these beliefs inaccurate, but they also reproduce damaging myths about the inherent impurity and <a href="https://www.perlego.com/knowledge/study-guides/what-is-abjection/">abject status</a> (responses of repulsion and horror to aspects of women’s bodies such as menstruation and childbirth) of the female body. Wombs are not dirty, or toxic. They do not need to be cleaned. <a href="https://www.menstrual-matters.com/top-10-period-myths/">Menstrual fluid</a> is not an excretory product like urine or faeces. </p>
<p>Yes, the blood part can stain clothing, but there is nothing pathological, contaminating, or dangerous about periods. The idea that the womb and vagina are dirty or toxic directly contributes to <a href="https://www.ncbi.nlm.nih.gov/books/NBK565611/">menstrual stigma</a> and associated discrimination, such as the exclusion of menstruating people from certain <a href="https://www.ncbi.nlm.nih.gov/books/NBK565592/">religious</a> places or practices, or the reports of intentional humiliation of <a href="https://www.ncbi.nlm.nih.gov/books/NBK565595/">female prisoners</a> on their periods.</p>
<p>As part of <a href="https://www.menstrual-matters.com/black-box/">my research</a>, <a href="https://global.oup.com/academic/product/experiences-of-menstruation-from-the-global-south-and-north-9780197267578?cc=gb&lang=en&">I reviewed</a> the menstrual cycle content of 16 of the most used biology and physiology textbooks in UK secondary schools, university level natural sciences, medicine, and specialist gynaecology education – and what I found was pretty alarming.</p>
<p>Nobody, it seems, is taught about the function of periods.</p>
<h2>So, why do we have periods?</h2>
<p>The most <a href="https://www.menstrual-matters.com/why-humans-menstruate/">robust evidence based theory</a> we have is described by evolutionary biologist <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528014/">Deena Emera and colleagues</a>. Periods likely evolved as a kind of preemptive abortion, to protect women from unviable or dangerous pregnancies. </p>
<p>Humans have exceptionally high rates of genetically abnormal eggs, sperm and fertilised eggs, highly invasive placental attachments, and pregnancy and childbirth are risky – even potentially fatal – experiences for human females. As a result, we have <a href="https://academic.oup.com/humrep/article/32/2/346/2713082">low rates of conception</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/11023804/">high rates of miscarriage</a>, and extremely high rates of maternal mortality in comparison to other mammals. In fact, despite advances in modern medicine, nearly <a href="https://www.who.int/news-room/fact-sheets/detail/maternal-mortality">300,000 expectant mothers</a> still die every year, globally.</p>
<p>If there is no pregnancy, as in the case for most menstrual cycles, or an unviable fertilised egg is detected, a period is triggered. </p>
<p>Periods cannot possibly help a pregnancy. Just think about it for a minute. How can the removal of the contents of the womb – including any eggs that may be present – possibly help conception or maintain a pregnancy? My research suggests that this assumption is influenced by sexist beliefs that position the female body, and all women, as <em>for</em> having babies – rather than eligible for equal opportunities in education, paid employment, and leadership. </p>
<p>Take a look at this quote from one of the <a href="https://global.oup.com/academic/product/oxford-textbook-of-obstetrics-and-gynaecology-9780198766360?cc=gb&lang=en&">medical textbooks</a> reviewed for <a href="https://global.oup.com/academic/product/experiences-of-menstruation-from-the-global-south-and-north-9780197267578?cc=gb&lang=en&">the study</a>. It explicitly positions the entire menstrual cycle (not just ovulation) as critical for having babies, and childbearing as the sole purpose of the female reproductive body. The fact that humans evolved a means to terminate potentially dangerous unviable pregnancies is not so much omitted, as denied. </p>
<blockquote>
<p>The principal functions of this (female reproductive) system are to produce an ovum, enable its fertilisation and implantation, and allow growth and safe expulsion of the foetus into the external world. The menstrual cycle is critical for facilitation of the initial steps of this raison d’être of the female reproductive system.</p>
</blockquote>
<h2>What else don’t we know?</h2>
<p>Well, where do I begin? Perhaps with the fact that the second phase of the cycle from ovulation to menstruation is a series of <a href="https://pubmed.ncbi.nlm.nih.gov/36304016/">highly inflammatory processes</a>. This was only very briefly mentioned in three out of 16 textbooks. </p>
<p>Given that common premenstrual changes reflect the <a href="https://www.verywellhealth.com/signs-of-inflammation-4580526">“cardinal signs”</a> of inflammation – temperature increase, swelling, pain, and blood flow changes – and anti-inflammatory <a href="https://www.menstrual-matters.com/tips-and-tricks/all-changes/">interventions</a>, including diet, lifestyle and medications, <a href="https://www.cochrane.org/CD001751/MENSTR_nonsteroidal-anti-inflammatory-drugs-dysmenorrhoea">alleviate cyclical changes</a>, this is quite the omission. We really ought to be taught from puberty how to reduce period pain and blood loss – this is not difficult science.</p>
<p>In fact, only around half of the textbooks even mentioned blood loss, and only four went on to explain how regular periods typically result in iron deficiency – leading to anaemia in some cases. </p>
<p>Fewer than half of the textbooks mentioned any associated health issues, such as endometriosis, heavy menstrual bleeding, fibroids, polycystic ovarian syndrome, <a href="https://pubmed.ncbi.nlm.nih.gov/33347177/">premenstrual syndrome</a>, premenstrual dysphoric disorder, or the cyclical exacerbation of asthma, migraine, epilepsy, irritable bowel syndrome, auto-immune disorders, or anxiety and depression. So, even doctors are <a href="https://metro.co.uk/2022/07/22/why-wasnt-it-mandatory-for-doctors-to-be-taught-about-womens-issues-before-now-17052718/">not taught enough</a> about female-prevalent illnesses, which must surely have a negative impact on the health outcomes of their patients.</p>
<h2>Why aren’t we taught this stuff?</h2>
<p>In <a href="https://www.menstrual-matters.com/black-box/">my review</a>, no textbooks mentioned the purpose or embodied – typically painful – experiences of periods, and all effectively reduced the entire menstrual cycle to fluctuating sex hormones. </p>
<p>There is no scientific reason for this. My research shows that the exclusive focus on the female sex hormones in menstrual education is informed by societal influences, such as the myth of the hysterical or hormonal female. </p>
<p>For hundreds of years, women’s experiences of emotional and physical distress were <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">blamed on the womb</a> – as the essence of femininity – rather than distressing life experiences, pain, or underlying health conditions. There is a <a href="https://wellcomecollection.org/articles/ZN-ELxEAACMABO5a">familiar western</a> stereotype of the pathologically emotional <a href="https://www.medicalnewstoday.com/articles/the-controversy-of-female-hysteria#Female-hysteria-in-the-18th-century">“hysterical woman”</a>, who is biologically prone to invent, exaggerate, and imagine things, especially pain or distress. This gender myth is still alive and well, although now we tend to <a href="https://sciencebasedmedicine.org/the-hormone-myth/">blame the (female sex) hormones</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=755&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=755&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=755&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=949&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=949&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=949&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The doctor’s visit by Frans van Mieris, 1657.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:A_physician_taking_the_pulse_of_a_female_patient_who_is_touc_Wellcome_V0016033.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>As soon as the female sex hormones were <a href="https://academic.oup.com/endo/article/160/3/605/5250672">first identified</a> in the late 1920s, textbooks containing information about menstrual physiology <a href="https://www.taylorfrancis.com/books/mono/10.4324/9780203421529/beyond-natural-body-nelly-oudshoorn">switched</a> from being about its inflammatory processes to hormonal models and explanations. Again, there was no scientific reason for this change in focus, although it reflected <a href="https://www.tandfonline.com/doi/pdf/10.1080/09612020000200260">existing societal beliefs</a> about the inherently <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">irrational behaviour of women</a>. </p>
<p>Unfortunately, menstrual health literacy has not yet recovered from this shift in physiological models.</p>
<h2>So what?</h2>
<p>Once the purpose and inflammatory nature of the menstrual cycle are understood, premenstrual changes are no longer mysterious or difficult to treat. It also becomes much easier to differentiate premenstrual changes from underlying health conditions, since the latter will not be substantially alleviated by anti-inflammatory interventions alone.</p>
<p>Teaching the reductive hormonal model of the menstrual cycle unintentionally provides pseudo-scientific evidence for the damaging hormonal or hysterical female gender myth. This myth contributes <a href="https://theconversation.com/womens-pain-is-often-not-believed-heres-how-to-make-your-voice-heard-when-seeking-help-207866">to disbelief</a> in women’s accounts of painful or distressing symptoms, and even reports of <a href="https://www.tandfonline.com/doi/full/10.1080/1369118X.2020.1770832">abuse and discrimination</a>.</p>
<p>It is time we taught more comprehensive menstrual health literacy to all.</p><img src="https://counter.theconversation.com/content/222016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally King is the founder of Menstrual Matters- the world's first evidence-based info hub on menstrual health and rights <a href="http://www.menstrual-matters.com">www.menstrual-matters.com</a>. Her doctoral research and current research fellowship were funded by the ESRC (Economic and Social Research Council). </span></em></p>No one seems to be taught about the function of periods. It’s time to take menstrual literacy seriously.Sally King, Menstrual Matters Founder & Research Associate in Menstrual Physiology, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1471152020-10-01T12:02:22Z2020-10-01T12:02:22ZSpider home invasion season: why the media may be to blame for your arachnophobia<figure><img src="https://images.theconversation.com/files/361037/original/file-20201001-16-dyxmzs.jpg?ixlib=rb-1.1.0&rect=0%2C219%2C2816%2C1648&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/house-spider-tegenaria-atrica-backlight-205481692">LukasPich/Shutterstock</a></span></figcaption></figure><p>Spiders have an unfortunate media presence. No number of studies emphasising their ecological value or the potential of their silks to inspire wonder materials can overcome the negative press. The more emotive and sensational the coverage, the more likely it is to travel.</p>
<p>Although the proportion of spider species capable of giving humans a bad bite is very small, and no known deaths have occurred in recent decades, we retain a fear. We tend to exaggerate the risk from spider bites, even in countries with no indigenous dangerous spiders, such as the UK. There is always the apocryphal arachnid lurking <a href="https://www.telegraph.co.uk/news/2016/04/27/venomous-spider-bite-sends-man-sitting-on-the-toilet-to-hospital/">under the toilet seat</a>, or panic over <a href="https://www.mirror.co.uk/news/uk-news/britain-facing-invasion-false-widow-6432907">false widow spiders</a> whose infestations have <a href="https://www.thesun.co.uk/news/7534016/false-widow-spider-infestation-fears-force-eleventh-london-school-closing/">closed schools</a>.</p>
<p>With the arrival of autumn comes lurid news stories of <a href="https://www.theboltonnews.co.uk/news/18682685.giant-house-spiders-invade-bolton-homes-looking-love/">amorous</a> house spiders “<a href="https://www.mirror.co.uk/news/uk-news/sex-crazed-giant-house-spiders-22577203">the size of your hand</a>” invading homes to find somewhere warm and dry to mate and die. It happens every year, but the media’s insistence on turning this small arachnid’s breeding season into an annual spectacle could be doing more than selling papers. <a href="https://besjournals.onlinelibrary.wiley.com/doi/full/10.1002/pan3.10143">A new study</a> from Italy suggests it could be stoking arachnophobia where it may otherwise not have existed.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1301892975182721024"}"></div></p>
<h2>A web of lies</h2>
<p>The researchers scoured the digital archives of Italian newspapers, looking for the use of “bite”, “spider” and “sting” (not that spiders do sting, but don’t let that spoil a good story) in stories published during the last ten years about four spider species thought of as dangerous: the yellow sac spider, the Mediterranean black widow, the Mediterranean recluse and the false wolf spider.</p>
<p>They found 314 media reports of spider encounters in Italy between 2010 and 2020 – the majority being Mediterranean black widows or recluses. The reach of each article was measured by the number of shares on social media, along with any errors such as species misidentification or incorrect medical advice. The team counted the use of certain words, such as “devil, "terror” or “panic”, to rate how each story sensationalised the encounter.</p>
<p>They found that media reports of spider attacks have increased in recent years, especially for the Mediterranean recluse. The rise coincided with a single report of <a href="https://www.hindawi.com/journals/criem/2016/7640789/">loxoscelism</a> – the deep ulcerations and necrosis of skin resulting from a spider bite – in Europe, and an Italian murder mystery novel in which the venom of the Mediterranean recluse is the murder weapon.</p>
<figure class="align-center ">
<img alt="A large, pink-bodied spider with long legs on a black background." src="https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361045/original/file-20201001-13-fce268.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mediterranean recluse spiders have a (perhaps unwarranted) bad reputation in Italy.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Mediterranean_recluse_spider#/media/File:Loxosceles_rufescens2.jpg">Antonio Serrano/Wikipedia</a></span>
</figcaption>
</figure>
<p>The spider species in the loxoscelism case was never definitively identified, but newspaper coverage of the Mediterranean recluse spiked nonetheless after the case was reported. Both the mysterious bite and the murder novel featured often in the increasing number of newspaper reports about these spiders. The press had found a compelling narrative to weave between a rare medical event and a well-timed work of fiction. Suddenly, recluse spiders weren’t so reclusive.</p>
<p>Stories that shared more recent and startling encounters travelled further. This isn’t surprising, the viral spread of content is greater if it provokes intense <a href="https://journals.sagepub.com/doi/10.1509/jmr.10.0353">delight, fear or anxiety</a>. But the emotional contagion, as the team put it, helps drive up the perceived risk from spider attack, creating unreasonable hostility towards arachnids.</p>
<h2>Jumping spiders to the rescue</h2>
<p>Spiders are often overlooked in conservation, despite controlling <a href="https://doi.org/10.1111/geb.12927">insect pests on farms</a> and having important roles in food webs as both <a href="https://doi.org/10.1371/journal.pone.0043446">predators and prey</a>. It won’t help if their media profile is largely driven by overhyped stories about “devilish” attacks and life-threatening venom. The researchers go so far as to accuse some journalists of sensationalising their stories at the expense of blameless wildlife.</p>
<p>Spiders are easy targets for scaremongering, but there are ways to improve their reputation. After all, some lovable spiders are cherished in popular culture. I defy anyone to watch Charlotte’s Web without sobbing. </p>
<p>Natural history documentaries seem to have seized on a candidate for improving the public image of spiders. If you see a cute spider feature on TV, it’s almost always a jumping spider. Furry, not so long-legged and with a large pair of eyes, it’s as if they’re designed to dispel the idea that all spiders are sinister. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/PQbScg3r1oQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Incidentally, I’m a jumping spider, according to a BBC children’s service quiz that reveals <a href="https://www.bbc.co.uk/cbbc/quizzes/which-spider-are-you-quiz?collection=cbbc-cute">what kind of spider you are</a>. </p>
<p>On the whole, spiders in films terrorise small American towns, but seldom trouble Italy. Nonetheless, Italian spiders suffering at the hands of hype enjoy some revenge in 2014’s <a href="https://www.imdb.com/title/tt4030898/">Arachnicide</a>. A “truly joyous” spectacle of “bad Italian cinema”, <a href="http://www.nerdly.co.uk/2017/02/07/spiders-dvd-review/">reads one review</a>.</p><img src="https://counter.theconversation.com/content/147115/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mike Jeffries does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An Italian study revealed how a murder mystery novel and a medical rarity were used to whip up media hysteria about spiders.Mike Jeffries, Associate Professor, Ecology, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1340322020-03-20T02:46:30Z2020-03-20T02:46:30ZPsychology can explain why coronavirus drives us to panic buy. It also provides tips on how to stop<figure><img src="https://images.theconversation.com/files/321841/original/file-20200320-22602-1v7youi.jpg?ixlib=rb-1.1.0&rect=101%2C119%2C3892%2C2538&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>In an address on Wednesday, Prime Minister Scott Morrison <a href="https://www.theguardian.com/australia-news/2020/mar/18/pm-tells-australians-to-stop-hoarding-as-he-announces-sweeping-measures-to-slow-spread-of-coronavirus">expressed his dismay at the hordes of “panic buyers”</a> sweeping supermarket shelves clean across the country:</p>
<blockquote>
<p>Stop hoarding. I can’t be more blunt about it. Stop it. It is not sensible, it is not helpful and it has been one of the most disappointing things I have seen in Australian behaviour in response to this crisis. </p>
</blockquote>
<p>It started with toilet paper, and now many <a href="https://www.smh.com.au/lifestyle/health-and-wellness/i-do-feel-a-bit-crazy-australians-stockpiling-food-to-prepare-for-coronavirus-20200229-p545kh.html">non-perishable foods</a> are difficult to source, as shoppers stockpile in preparation for the worst.</p>
<p>But is there a rationale for such behaviour? And how can we move beyond our psychological impulses to shop smarter, and consider the needs of others? </p>
<h2>COVID-19 - an unwitting stress test</h2>
<p>The coronavirus outbreak is not only a time of uncertainty, but also a period in which many of us are <a href="https://www.health.gov.au/resources/publications/coronavirus-covid-19-isolation-guidance">experiencing social isolation</a>. Both of these factors can psychologically motivate people to buy things they don’t need. </p>
<p>Feeling <a href="https://www.sciencedirect.com/science/article/abs/pii/S0010440X16303844">unable to tolerate uncertainty</a> is associated with more extreme hoarding behaviour. Hoarding entails the collection of more items than can be feasibly used, to the point of impeding the functionality of a home. Even though the behaviours we’re seeing may not be “hoarding” in this sense, they’re likely driven by the same psychological mechanisms. </p>
<p>One of the strongest predictors of hoarding behaviour is an individual’s <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165178117317754">perceived inability to tolerate distress</a>. If it’s in a person’s general nature to avoid distress, they may be at risk of buying more products than they can feasibly use during the pandemic. </p>
<p>For such people, it may be difficult to believe authorities when they announce supermarkets will not close. Or, if they do believe them, they may decide it’s best to “prep”, just in case things change. </p>
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Read more:
<a href="https://theconversation.com/when-possessions-are-poor-substitutes-for-people-hoarding-disorder-and-loneliness-97784">When possessions are poor substitutes for people: hoarding disorder and loneliness</a>
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<p>The coronavirus also reminds many people of their own mortality, and this can lead to an <a href="https://www.sciencedirect.com/science/article/abs/pii/S1057740804701485">increase in spending to offset fear</a>.</p>
<p>Even if a person typically feels able to handle distress, they may still end up buying more than they need. Seeing empty shelves can trigger an urge to snatch what is left. Research on the “<a href="https://www.amazon.com/Influence-Practice-Robert-B-Cialdini/dp/0321011473">scarcity heuristic</a>” suggests we assume items are more valuable if they are in low supply.</p>
<p>Also, consumer goods are more than functional. Products and brands <a href="http://www.pascallegovers.nl/uploads/1/2/3/9/12391484/govers_and_mugge_de2004.pdf">also serve psychological purposes</a> and can <a href="https://onlinelibrary.wiley.com/doi/10.1016/j.jcps.2016.05.003">change how we feel</a>. For example, some people <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22886">turn to alcohol</a>to alleviate anxiety or distress.</p>
<h2>How to overcome psychological forces</h2>
<p>So how can we make rational decisions, when multiple psychological forces make this difficult? </p>
<p>While no perfect remedy exists, cognitive behavioural therapy (CBT) techniques can help people avoid making decisions based on unhelpful urges and emotions. <a href="https://www.sciencedirect.com/science/article/pii/S0887618516300615?via%3Dihub">CBT</a> has been shown to improve intolerance of uncertainty, and reduce anxiety and fear. </p>
<p>CBT involves problem-solving and engaging in avoided behaviour to test the validity of one’s beliefs. The idea is to challenge unhelpful thoughts, and make decisions based on evidence. </p>
<p>To apply this approach when shopping during the coronavirus pandemic, you should start by taking stock of the items you already have at home, and how long they will last. </p>
<p>When stocking up, it’s important to limit waste and be considerate. It’s not helpful to buy food that spoils, or buy so many products <a href="https://www.abc.net.au/news/2020-03-17/supermarkets-elderly-disabilities-special-hours-bare-shelves/12063454">that others, including the elderly</a>, experience hardship. Buying 100 rolls of toilet paper is useless if it takes a year to use them.</p>
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Read more:
<a href="https://theconversation.com/scott-morrison-has-said-well-face-at-least-6-months-of-disruption-where-does-that-number-come-from-134025">Scott Morrison has said we'll face at least 6 months of disruption. Where does that number come from?</a>
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<p>Food waste can be limited by developing meal plans for the next two to three weeks, keeping in mind when certain products expire. By focusing your attention on what you will realistically use during this time, you can make more informed decisions about what to buy. </p>
<h2>It’s OK to feel anxious</h2>
<p>When shopping, take a list with you to guide your purchases, and try your best to stick to it. This way, you’ll be less likely to succumb to anxiety-driven purchases triggered by the sight of empty shelves, or thoughts of supermarkets closing. That said, be willing to buy substitutes if certain items are sold out. You can plan for this in advance.</p>
<p>You may start to feel anxious when only buying items for use in the immediate future. That’s OK. <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-clinpsy-021815-093533?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed">Numerous research trials</a> have shown people can tolerate anxiety, and that changing unhelpful behaviour reduces anxiety in the long run. </p>
<p>Research has also shown people who chronically hoard can <a href="https://www.sciencedirect.com/science/article/pii/S0005789419300656?via%3Dihub">tolerate distress</a> better than they think. So, while anxiety may be inevitable for some on their next shopping trip, they will likely be able to tolerate it. And it may be reduced if the above strategies are adopted. </p>
<p>Even before the COVID-19 pandemic, Australians had a problem of buying things they didn’t need. We’re the <a href="https://www.oecd-ilibrary.org/environment/municipal-waste/indicator/english_89d5679a-en">ninth-largest contributor of household waste</a> per person in the world, spending more than <a href="https://www.tai.org.au/node/940">A$10.5 billion each year</a> on goods and services we rarely use. Over half of that expenditure is for food that gets wasted.</p>
<p>Perhaps understanding the psychological mechanisms underpinning our shopping behaviour can help us make more rational purchases during this time of uncertainty.</p><img src="https://counter.theconversation.com/content/134032/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Norberg has received funding from the International OCD Foundation to study the mechanisms underlying hoarding disorder.</span></em></p><p class="fine-print"><em><span>Derek Rucker is affiliated with the annual Kellogg Advertising Superbowl Review. He has served as a consultant for brand strategy and advertising.</span></em></p>Apart from their functional purpose, products can also impact how we feel, both about ourselves and our situation.Melissa Norberg, Associate Professor in Psychology, Macquarie UniversityDerek Rucker, Professor of Marketing, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1331152020-03-06T12:56:02Z2020-03-06T12:56:02ZCoronavirus: why people are panic buying loo roll and how to stop it<figure><img src="https://images.theconversation.com/files/319070/original/file-20200306-118960-1ffqk36.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C4019%2C3005&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shelves of ready noodles in Singapore were left empty after fear led people to panic buy</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/singapore-february-8-2020-panicbuying-supermarkets-1659421018">kandl/Shutterstock</a></span></figcaption></figure><p>The UK has found itself in a panic buying frenzy in response to the <a href="https://theconversation.com/what-the-coronavirus-emergency-declaration-means-for-canada-130950">novel coronavirus outbreak</a>. A very flustered health secretary Matt Hancock urged restraint and attempted to calm fears of shortages <a href="https://www.mirror.co.uk/news/politics/question-time-health-secretary-pleads-21642304">on BBC television’s Question Time</a> after being asked about a lack of paracetamol, dry pasta and toilet paper. </p>
<p>The UK is not alone. Social media has been flooded with images from across the world of shopping carts lined up at check outs, empty shelves and crazed shoppers carrying six-months’ worth of toilet paper. Just seeing this footage has fed the panic, escalating the problem far beyond anything that was noted during the SARS epidemic when digital connections were far less prevalent.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1235021742470389760"}"></div></p>
<p><a href="https://www.straitstimes.com/singapore/coronavirus-rumour-about-death-of-foreign-domestic-worker-due-to-virus-is-fake-news">These kind of posts are spreading hysteria</a> and false news to the extent that <a href="https://theconversation.com/coronavirus-is-a-breeding-ground-for-conspiracy-theories-heres-why-thats-a-serious-problem-132489">coronavirus hoaxes</a> have, arguably, <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters">become dangerous in their own right</a>. If they want panic buying to stop, governments need to demonstrate that they are in control through decisive action and sustained and transparent communication.</p>
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Read more:
<a href="https://theconversation.com/coronavirus-and-the-black-death-spread-of-misinformation-and-xenophobia-shows-we-havent-learned-from-our-past-132802">Coronavirus and the Black Death: spread of misinformation and xenophobia shows we haven't learned from our past</a>
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<h2>Regaining control</h2>
<p>In research I conducted with marketing professors Charlene Chen and Leonard Lee, we found that consumers <a href="https://academic.oup.com/jcr/article-abstract/43/6/1031/2687775?redirectedFrom=fulltext">compensate for a perceived loss of control</a> by buying products designed to fill a basic need, solve a problem or accomplish a task. This is what we’re seeing as people rush to buy rice, cleaning products and paper goods in illogically large proportions. </p>
<p>This has led to <a href="https://www.nielsen.com/us/en/insights/article/2020/nielsen-investigation-pandemic-pantries-pressure-supply-chain-amidst-covid-19-fears/">price gouging and shortages of vital health equipment</a> where it is needed most. </p>
<p>In times of crisis, people don’t want a huge debate, they want action. To assuage people’s anxiety and help them regain a feeling of control, it is <a href="https://www.scmp.com/lifestyle/health-wellness/article/3052101/why-hong-kong-panic-buying-happened-herd-mentality-media">up to governments to signal</a> that they have a game plan in mind and are taking timely steps to address the problem. </p>
<p>Singapore – which has had no virus-related deaths, despite <a href="https://www.straitstimes.com/singapore/health/2-new-covid-19-cases-in-singapore-including-non-teaching-staff-at-pre-school-at">112 cases</a> and a rate of infection that’s been <a href="https://www.bloomberg.com/news/articles/2020-02-27/singapore-emerges-as-litmus-test-for-coronavirus-containment">outpaced by recoveries</a> – has emerged as an example of how to contain both the infection and maintain citizen’s trust. </p>
<p>A day after signs that people were panic buying rice and instant noodles, Prime Minister Lee Hsien Loong was on television calling for calm, and assured Singaporeans: <a href="https://www.scmp.com/week-asia/health-environment/article/3049668/singapore-pm-says-coronavirus-spread-could-worsen">“We have ample supplies, there’s no need to stock up.”</a></p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319071/original/file-20200306-118910-1sqhnmk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People queue outside a Watsons pharmacy in Hong Kong.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hong-kong-30-january-2020-people-1630888825">Lewis Tse Pui Lung/Shutterstock</a></span>
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</figure>
<p>Singapore was one of the first countries to impose <a href="https://www.todayonline.com/singapore/all-new-visitors-who-have-been-china-last-14-days-barred-entering-transiting-through">entry restrictions</a> on anyone with recent travel history to China and parts of South Korea. The country has also introduced temperature screening, systems to identify people who have been in contact with carriers, and strict hospital and home quarantine regimes for potentially infected patients. Firm action, in the form of fines and jail time, is being taken towards those who breach these <a href="https://www.wsj.com/articles/asian-countries-wield-fines-jail-terms-to-stop-coronavirus-quarantine-violations-11582824849">new rules</a>.</p>
<p>The government has made regular public statements and been very frank with its people about the dangers posed by the coronavirus. <a href="https://www.channelnewsasia.com/news/singapore/coronavirus-covid-19-panic-buying-singapore-dorscon-orange-12439480">A week after the panic buying frenzy</a>, things have calmed down and shoppers have gone back to purchasing items in normal quantities.</p>
<h2>Getting it wrong</h2>
<p>This contrasts with what is happening in <a href="https://www.bloomberg.com/news/articles/2020-02-17/support-for-japan-s-abe-slides-amid-doubts-over-virus-handling">Japan</a> and <a href="https://www.dw.com/en/coronavirus-iranians-lose-trust-in-government-as-virus-spreads/a-52651804">Iran</a>, where governments are under fire for their lack of transparency. This distrust stems from concerns that governments may be deliberately concealing or may not have access to <a href="https://www.channelnewsasia.com/news/asia/indonesia-government-intensify-efforts-covid-19-coronavirus-12500572">accurate information</a>. </p>
<p>This has led to people stockpiling goods, which in Japan has resulted in <a href="https://asia.nikkei.com/Spotlight/Coronavirus/Coronavirus-rumors-fuel-panic-buying-of-toilet-paper-in-Japan2">shortages of toilet paper</a>. Longs lines and price surges have followed. Theft is now so common that some establishments have taken to <a href="https://www.ft.com/content/397bd2a4-5d35-11ea-b0ab-339c2307bcd4">chaining rolls to their dispensers</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1235624136602509314"}"></div></p>
<p>While the UK government has published an official coronvirus <a href="https://www.gov.uk/government/publications/coronavirus-action-plan">action plan</a>, setting out advice for how the public should respond during each stage of the outbreak and what to expect if it becomes a pandemic, there have been hiccups in communication that have stoked rather than tempered fears.</p>
<p>The most recent problem was the decision to withhold daily updates about the geographical spread of the virus. The government has since <a href="https://www.theguardian.com/world/2020/mar/05/coronavirus-minister-hints-u-turn-decision-stop-daily-uk-updates">made a u-turn</a> on this, calling it a “a communication fumble” and acknowledging that such lack of transparency would only lead to feelings of government secrecy and aid the potential spread of fake news. </p>
<p>How action is communicated, including when and how often, is critical to diffusing panic. The situation of any pandemic is so volatile that government policies may need to evolve rapidly in response. As seen in Singapore, strong communication can be the difference between seeming to understand the dynamic nature of the situation and not knowing how to address it at all.</p><img src="https://counter.theconversation.com/content/133115/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andy J. Yap does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When it comes to stemming the frenzy of stockpiling in the face of Covid-19, governments have to act decisively and communicate clearly.Andy J. Yap, Assistant Professor of Organisational Behaviour, INSEADLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1186782019-07-03T21:16:02Z2019-07-03T21:16:02Z‘Havana syndrome’ symptoms of diplomats in Cuba are not mass hysteria<figure><img src="https://images.theconversation.com/files/281686/original/file-20190627-76697-9lm0ir.jpg?ixlib=rb-1.1.0&rect=113%2C63%2C4103%2C2738&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A neuro-otologist at the University of Miami reported “central vestibular" (inner ear) findings in 36 per cent of American diplomats and their families affected by Havana syndrome. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>It is a disservice to the men and women of the United States and Canadian diplomatic services to <a href="https://www.theglobeandmail.com/canada/article-mad-gassers-toxic-buses-and-the-havana-syndrome-what-society-still/">suggest they are suffering from a “mass psychogenic illness”</a> arising from their <a href="https://www.vanityfair.com/news/2019/01/the-real-story-behind-the-havana-embassy-mystery">tenure in Havana</a>. </p>
<p>In the autumn of 2016, many members of the U.S. mission in Cuba began to <a href="https://ottawacitizen.com/news/national/our-men-women-and-children-in-havana-how-a-dream-posting-became-a-nightmare">develop “symptoms of dizziness, ear pain and tinnitus”</a> — as physicians who investigated them reported — after perceiving high frequency noise and cerebral pressure. In the late winter of 2017, 14 members of the Canadian legation began developing similar symptoms.</p>
<p>The <a href="https://www.newyorker.com/magazine/2018/11/19/the-mystery-of-the-havana-syndrome">mysterious “Havana syndrome”</a> has since been a subject of intense speculation. The question is whether the victims are <a href="https://www.theglobeandmail.com/canada/article-mad-gassers-toxic-buses-and-the-havana-syndrome-what-society-still/">suffering from a psychogenic disorder</a> arising in the mind or a somatogenic disorder arising from a physical disorder of brain tissue itself. Mass psychogenic illness is simply a new term for <a href="https://www.goodreads.com/book/show/2605367-from-paralysis-to-fatigue">what used to be called “epidemic hysteria.”</a></p>
<p>Do these diplomats have hysteria, now being called “Havana Syndrome?” Or do they have a lesion, <a href="https://doi.org/10.1136/bmj.k3848">caused by some kind of a device intended to inflict injury</a>?</p>
<h2>Victims suffered traumatic brain injuries</h2>
<p>A number of things are wrong with the “psychogenesis” (hysteria) argument. Most notably, symptoms of hysteria are caused by the action of the mind. </p>
<p>A <a href="https://doi.org/10.1002/lio2.231">study led by Dr. Michael E Hoffer</a>, a neuro-otologist at the University of Miami, however, reported problems with the central vestibular system (inner ear) in 36 per cent of American diplomats and their families affected by Havana syndrome.</p>
<p>Lesions in this part of the auditory apparatus would be organic. Inner ear damage is not psychogenic and means that the tissues of the inner ear itself have sustained some kind of assault.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1093547111411531781"}"></div></p>
<p>The affected Canadians who were evacuated to the University of Miami, and who then subsequently went to the University of Pennsylvania for similar examinations, were <a href="https://www.newyorker.com/magazine/2018/11/19/the-mystery-of-the-havana-syndrome">reportedly diagnosed with “traumatic brain injuries akin to concussions.”</a></p>
<p>It is wrong to see these diplomats and their families as fitting any kind of psychogenic profile. In 1974 psychiatrist François Sirois at Laval University analyzed <a href="https://books.google.ca/books/about/Epidemic_Hysteria.html?id=gNJSNQAACAAJ&redir_esc=y">70 outbreaks of “epidemic hysteria,” both historical and present-day</a>. Of the 70, 69 occurred in girls and young women. Only one of the 70 — the koro epidemic in Singapore in the 1960s — affected males only. (Koro is the delusional belief that your sex organs are retracting inside your body.)</p>
<p>Historically, “hysteria” — meaning physical symptoms “of unexplained origin” —was <a href="https://books.google.ca/books/about/From_the_mind_into_the_body.html?id=vrXuAAAAMAAJ&redir_esc=y">associated more with women than men</a>. This is because it has been women who, traditionally, have borne the brunt of loss and suffering, and often dealt with these wrenching emotions by developing bodily symptoms. </p>
<p>Thinking that these middle-aged men and women in the U.S. and Canadian embassies in Havana could have been suffering from “mass psychogenic illness” simply defies belief.</p>
<h2>Endometriosis once diagnosed as hysteria</h2>
<p>It is wrong to imagine that their symptoms could have some kind of psychological mechanism. The mechanism of psychogenesis/hysteria is suggestion. For example, all the <a href="https://www.tandfonline.com/doi/abs/10.1080/0305569960220301">schoolgirls fall to the ground vomiting at recess</a> because they have been suggested into their symptoms. </p>
<p>The loss of balance, sensations of pressure inside their brains and so forth that these diplomats report are no more psychological than mumps.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281685/original/file-20190627-76717-l0za8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A classic American convertible car passes beside the United States embassy as Cuban flags fly at the Anti-Imperialist Tribune, on the Malecon seaside promenade in Havana, Cuba.</span>
<span class="attribution"><span class="source">(AP Photo/Desmond Boylan, File)</span></span>
</figcaption>
</figure>
<p>“Stress” has been invoked as the psychological motor. Indeed these diplomats and their families are under stress. But so is everyone else. Stress is a constant in modern life. Schoolteachers in inner city schools around the globe are also under stress, but they don’t develop this illness of the diplomats.</p>
<p>What caused these lesions? It is anybody’s guess. But medicine has a long history of assuming psychogenesis when occult organic disease is at play. Multiple sclerosis in women, for example <a href="https://www.ncbi.nlm.nih.gov/pubmed/16085995">was once considered to be a form of hysteria</a>. </p>
<p>Similarly, before the discovery of endometriosis, <a href="https://www.goodreads.com/book/show/8885027-a-history-of-women-s-bodies">deep pelvic pain in women was diagnosed as hysteria</a>. Let’s not make this mistake again.</p><img src="https://counter.theconversation.com/content/118678/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edward Shorter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Multiple sclerosis and endometriosis in women both used to be diagnosed as hysteria. The same could be happening with ‘Havana syndrome.’Edward Shorter, Jason A Hannah Professor of the History of Medicine, Professor of Psychiatry, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1009172018-08-08T09:12:57Z2018-08-08T09:12:57ZSix ‘psychological’ terms that psychologists never use<figure><img src="https://images.theconversation.com/files/230563/original/file-20180803-41338-3og0od.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C2882%2C1825&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">French neurologist Jean-Martin Charcot demonstrating hypnosis on a 'hysterical' patient. </span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=3820726">André Brouillet/Wikimedia Commons</a></span></figcaption></figure><p>Psychology is the scientific study of human thought and behaviour, and hence of everyday life, which means that many people consider themselves experts on the topic, even if they’ve never cracked the spine of a psychology textbook. </p>
<p>Armchair psychologists will bandy terms about, such as “neurotic” or “split personality”, with little understanding of where these terms came from or even whether they’re still in use. Here is a small selection of some of the psychological terms that are most frequently abused.</p>
<h2>1. Personality type</h2>
<p>The idea that people come in types – like flavours of ice cream – has a long history, dating back to the <a href="https://ryanfb.github.io/loebolus-data/L225N.pdf">ancient Greeks</a>. We talk about introverts and extroverts, narcissists and type A personality. But the closest that these ideas come to the truth is the identification of very broad traits – like <a href="https://www.psychologytoday.com/us/basics/conscientiousness">conscientiousness</a> – that we all share to a greater or lesser extent. </p>
<p>We don’t fall into categories at all and our personalities are far from fixed. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144810/">best research</a> we have tells us that we’re all full of inconsistencies, and our characteristic personalities change a lot over our lives as we learn and adapt to the events and relationships we encounter.</p>
<h2>2. Psychotic</h2>
<p>The psychotic killer is one of the common tropes of cinema, and even respectable dictionaries will give synonyms such as “unhinged” or “frantic”. But for psychologists and psychiatrists, psychotic isn’t synonymous with dangerous or angry. It certainly doesn’t have anything to do with serial killers – as in the horror trope of the psychotic killer on the prowl. </p>
<p>The term psychosis is used rather differently. It refers to a cluster of sometimes distressing experiences, such as hearing voices, unusual beliefs and confused speech, which are <a href="https://www.time-to-change.org.uk/media-centre/responsible-reporting/violence-mental-health-problems">not</a> usually, despite some lurid headlines, associated with murderous impulses.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/230435/original/file-20180802-136667-h1kbbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psycho killer: a common movie trope.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/542652949?src=BPeHwGlg1If0GF7z_0EobQ-1-72&size=huge_jpg">Nomad_Soul/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>3. Hysteria</h2>
<p>The ancient Greeks believed that the womb (the hystera) detached itself and roamed around the body, putting pressure on other organs, causing “hysteria”. During the Victorian era, the French neurologist Jean-Martin Charcot further developed the concept of hysteria, saying that it was a mental phenomenon that could be cured with hypnosis.</p>
<p>In polite and scientific circles, we avoid using the term hysterical because the association of femininity with psychological vulnerability is as insulting as it is incorrect. Many societies are remarkably unequal in the opportunities extended to the genders, but the idea that women, by virtue of their gender, are prone to hysterical emotions is a degrading myth, started by the ancient Greeks and perpetuated by the Victorians. </p>
<h2>4. Split personality</h2>
<p>Screenwriters love the concept of “split personality”, the idea that a person might have Jekyll and Hyde personalities, operating independently, unaware of each other. It’s certainly true that we all have shifting and changing moods. Even our “personalities” are much less fixed than we’d assume, and perhaps more inconsistent than we’d like to believe. </p>
<p>Some people find that their emotions and self-esteem fluctuate greatly, and occasionally this causes problems. A handful of people find that their sense of who they are fluctuates so much that they describe themselves as having two or more personalities, but this is very rare indeed and, because of that, somewhat controversial.</p>
<p>This kind of experience is usually a consequence of traumatic childhood experiences, leaving the person with problems in making sense of their own emotions and relationships. It’s important to recognise that childhood trauma can have lifelong consequences, but the Jekyll and Hyde character is pure fiction.</p>
<h2>5. Neurotic</h2>
<p>Neurosis (or neurotic) is another one of those technical words from psychiatry which, over time, has seen its meaning change, been incorporated into everyday language, and has then been used as a insult. </p>
<p>Originally, the “neuroses” were mental health problems characterised by distressing emotions, such as anxiety and depression, and distinguished from the “psychoses”, characterised by experiences such as hearing voices or holding unusual beliefs. Over time, that meaning extended to refer to a personality trait of “neuroticism”, characterised by anxiety, moodiness, worry, envy and jealousy.</p>
<p>But, as we’ve established, it’s scientifically inappropriate, and insulting, to refer to someone as “neurotic”, when the science of personality traits simply doesn’t support such a description. Some of us are more prone to anxiety and depression, and that’s probably both an accurate and a respectful way to phrase it.</p>
<h2>6. Brainwashed</h2>
<p>Can people be brainwashed? Well, maybe, but not quite like the lurid headlines. We’ve seen tragedies like <a href="https://en.wikipedia.org/wiki/Jonestown">Jonestown</a>, where hundreds of followers of the cult leader, Jim Jones, took their own lives under his direction. And, of course, we are currently concerned about “radicalisation”, as young, and often troubled, people are attracted to terrorist groups. </p>
<p>So it’s clearly possible for people to be persuaded and coerced to commit terrible crimes. But when we talk about “brainwashing”, we seem to assume that there are cunning psychological tricks that can manipulate the mind in ways known only to cults and intelligence agencies. </p>
<p>People, unfortunately, can be tricked, persuaded and coerced. But there’s no secret brainwashing technique. We’re vulnerable to propaganda, bribery, the influence of charismatic leaders and to peer pressure. If that’s brainwashing, it’s happening every day, and it’s happening to us all.</p><img src="https://counter.theconversation.com/content/100917/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Kinderman is Professor of Clinical Psychology at the University of Liverpool and an honorary Clinical Psychologist with Mersey Care NHS Foundation Trust. He has twice been Chair of the British Psychological Society's Division of Clinical Psychology, and is a former President of the Society. He is also a member of the Council for Evidence-Based Psychiatry. He has received research grant funding from a number of sources, but none which represent a conflict of interest in respect to this subject. He is a life-long member of the UK Labour Party and describes himself as a socialist. </span></em></p>Split personality, neurotic, hysterical … these terms aren’t used by mainstream psychologists.Peter Kinderman, Professor of Clinical Psychology, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/923022018-02-27T09:30:13Z2018-02-27T09:30:13ZThe Yellow Wallpaper: a 19th-century short story of nervous exhaustion and the perils of women’s ‘rest cures’<figure><img src="https://images.theconversation.com/files/207484/original/file-20180222-152348-9itcl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/patkashtock/5395617059/in/photolist-edZwre-eKuLnq-eE3bmy-eFkhdf-edZyFk-eXDPxN-9dMXip-eSMfGm-eipKEj-ehJJkT-eDYS77-egVxeF-ehQWWG-9dR2au-8a8CJB-9dMXGT-9dR2d9-9dR2fq-ehK4ZK-eeHgB4-egVBFz-ehQxA5-ehQEmd-9dMXfD-ehK9MF-ehQSaq-egVDtp-ekznNM-eij4Vp-ehK3CP-eeDXom-9dR1Cq-9dMWNe-eNvT62-9dR22f-9dMWYk-eNHv53-ehj5LT-ehQYCu-ehKbEZ-ehj9LR-f3jdUS-ehpMQy-eeycDZ-9dMWRP-eRghji-YuUsf5-RFSd4q-effZDm-9dMX3Z">Patricia Hammell Kashtock/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>“These nervous troubles are dreadfully depressing”, wrote Charlotte Perkins Gilman in her short story, The Yellow Wallpaper. Though later gaining recognition as a journalist and social critic rather than an author of fiction, Gilman is best known for this brief and extraordinary piece of writing published in 1892. </p>
<p><a href="http://bit.ly/2crbPMx">The Yellow Wallpaper</a> enlightens the reader on women’s health, motherhood, mental breakdown and its treatment, as well as feminism and gender relations in late 19th-century America. Though many details are changed, the story is semi-autobiographical, drawing on Gilman’s own health crisis and particularly her fraught relationship with <a href="http://exhibits.hsl.virginia.edu/nerves/rest/">Dr Silas Weir Mitchell</a> – who carved a reputation for <a href="http://medhum.med.nyu.edu/view/1445">treating nervous exhaustion</a> following his experiences as a Civil War doctor – and who was brought in to treat her in 1886. In Gilman’s own words, he drove her to “mental agony” before she rejected his treatment and began once again to write. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=729&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=729&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=729&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=916&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=916&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207534/original/file-20180222-152348-1jb7eiv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=916&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rest, take tonics, air and exercise.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ergsap/16831996686/in/photolist-rDoocq-7dW1bR-ctpv11-8T1NZb-aS6eP-rJ3WP-6STTbC-92xitP-9DNosy-qJTW2p-at4EQg-9dRLrp-rDwTh3-212iS63-pkPB24-rFXGhb-oAehvc-21xvgo8-cX4Jm5-rpbZaG-rG1k79-8Kd8b1-4V6rZN-849EUH-rDou8U-rFQAkt-7X8zwz-8bLmrM-5784VS-rnEhqF-9e69Pc-B4w4j-7XdgZd-ux3KX-7WrdmW-5LPStm-qK5bjU-83KTMe-9daPrW-bXyvYm-7LDewT-7Xa2M2-TjpQnS-cEjEFN-WJF6Ba-8Nzfac-9SQrcB-8bbMjM-6dKzMm-6zFRzn">Art Gallery ErgsArt – by ErgSap</a></span>
</figcaption>
</figure>
<p>Gilman’s short story is a straightforward one. The narrator is brought by her physician husband to a summer retreat in the countryside to recover from her “temporary nervous depression – a slight hysterical tendency”. There she is to rest, take tonics, air and exercise – and absolutely forbidden to engage in intellectual work until well again. The house is “queer”, long abandoned and isolated. The room her husband selects as their bedroom, though large, airy and bright, is barred at the window and furnished with a bed that is bolted to the floor. The wallpaper is torn, the floor scratched and gouged. Perhaps, the narrator muses, it had once been a nursery or playroom. </p>
<p>It is the room’s wallpaper, a “repellant” and “smouldering unclean yellow”, with “sprawling flamboyant patterns committing every artistic sin” that forms the centrepiece of the story. The narrator spends much of her days being cared for – and often left alone – in this room, reading, attempting to write (though the subterfuge this involved leaves her weary, she noted) and, increasingly, watching the wallpaper, as it starts to take on a life of its own.</p>
<h2>Nervous exhaustion</h2>
<p>The story highlights the plight of many women during the 19th century. All women were seen by physicians as susceptible to ill health and mental breakdown by reason of their biological weakness and reproductive cycles. And those who were creative and ambitious were deemed even more at risk. </p>
<p>The protagonist of the story might have been suffering from <a href="https://www.ncbi.nlm.nih.gov/pubmed/14621687">puerperal insanity</a>, a severe form of mental illness labelled in the early 19th century and claimed by doctors to be triggered by the mental and physical strain of giving birth. The condition captured the interest of both psychiatrists and obstetricians, and its treatment involved quietening the nervous system and restoring the strength of the patient. In her autobiography, published in 1935, Gilman wrote of the “dragging weariness … absolute incapacity. Absolute misery” following the birth of her daughter that led her to consult Dr Mitchell. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=827&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=827&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=827&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1040&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1040&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207480/original/file-20180222-152369-1c2hd12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1040&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Charlotte Perkins Gilman.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Charlotte_Perkins_Gilman#/media/File:Charlotte_Perkins_Gilman_by_Frances_Benjamin_Johnston.jpg">United States Library of Congress's Prints and Photographs division / Wikipedia</a></span>
</figcaption>
</figure>
<p>The story can also be seen as a rich account of neurasthenia or nervous exhaustion, a disorder first defined by Mitchell in his book <a href="http://www.gutenberg.org/ebooks/13197">Wear and Tear, or Hints for the Overworked</a> in 1871. Neurasthenia took hold in modernising America in the closing decades of the 19th century, as incessant work was said to ruin the mental health of its citizens. Women were reported to be putting themselves at risk of nervous collapse with their eagerness to take on roles unsuited to their gender, including higher education or political activities. “City-bred” women, Mitchell concluded, might be poorly equipped to fulfil the natural functions of motherhood. </p>
<p>Gilman was treated with the “rest cure”, <a href="http://medhum.med.nyu.edu/view/1445">devised by Mitchell</a>, as is the protagonist of the story; like an infant, she was dosed, fed at regular intervals and above all ordered to rest. Mitchell instructed Gilman to live as domestic a life as possible “and never touch pen, brush or pencil as long as you live”.</p>
<h2>Escape from the wallpaper</h2>
<p>It is the wallpaper that dwells increasingly on the narrator’s mind with its “vicious influence”. Behind it, dim shapes get clearer by the day, sometimes of many women, sometimes one, stooping down and creeping about behind the pattern. At the end of the story the narrator takes the opportunity of her husband’s absence to lock the door and tear away the wallpaper, the women now creeping outside in the garden. “I wonder if they all come out of that wallpaper as I did?” she asks. Her husband, on opening the door, collapses as the narrator declares:</p>
<blockquote>
<p>I’ve got out at last … and you can’t put me back. Now why should that man have fainted? But he did, and right across my path by the wall, so that I had to creep over him every time!</p>
</blockquote>
<p>Was her “escape” her salvation or had she finally lost her mind? Readers are left to reach their own conclusions. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207478/original/file-20180222-152366-13emdvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Silas Weir Mitchell.</span>
</figcaption>
</figure>
<p>The Yellow Wallpaper illuminates the challenges of being a woman of ambition in the late 19th century. While all women were seen vulnerable, those who expressed political ambition (suffrage reformers), or who took on male roles and challenged female dress codes (<a href="https://en.wikipedia.org/wiki/New_Woman">New Women</a>), or who sought higher education or creative lives – or even read too much fiction – could be accused of flouting female conventions and placing themselves at risk of mental illness. Mitchell, largely through his treatment of Gilman and her later description of this, gained a notorious reputation, and he may well have misdiagnosed her or believed that her intellectual pursuits were too introspective.</p>
<p>Yet historical scholarship <a href="https://www.jstor.org/stable/3174743?seq=1#page_scan_tab_contents">has also suggested</a> that some well-to-do and educated women <a href="https://www.palgrave.com/gp/book/9781403920386">might also have helped shape</a> their own diagnoses or used their illness to avoid domestic duties that they found unpleasant or taxing. Not all doctors condemned women for their ambition – many advocated more rounded lives embracing intellectual and physical pursuits alongside domestic roles. <a href="https://www.palgrave.com/gp/book/9781403920386">Other patients</a> treated by Mitchell, including the critic and historian Amelia Gere Mason and writer Sarah Butler Wister, tailored their treatments to suit their lifestyles, with Mitchell encouraging their intellectual and creative pursuits. </p>
<p>For Gilman, her divorce proceedings, rare enough at the time to be announced as a “scandal” in various American newspapers, began in the same year as The Yellow Wallpaper was published, and she became increasingly active in the women’s movement. Writing years later about the short story, Gilman described how it was written to celebrate her narrow escape from utter mental ruin. A copy was sent to Mitchell but did not receive a response.</p><img src="https://counter.theconversation.com/content/92302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hilary Marland does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Treatment for nervous exhaustion in the Victorian era could literally drive you mad.Hilary Marland, Professor of History, University of WarwickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/864972017-11-16T09:56:07Z2017-11-16T09:56:07ZWhy Freud was right about hysteria<figure><img src="https://images.theconversation.com/files/194238/original/file-20171112-29345-14j52jy.jpg?ixlib=rb-1.1.0&rect=1%2C39%2C1059%2C625&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sigmund Freud.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=5234443">Max Halberstadt/Wikimedia Commons</a></span></figcaption></figure><p>A 35-year-old woman loses the use of her legs, suddenly becoming paralysed from the waist down. In another case, a woman feels an overwhelming compulsion to close her eyes, until eventually she cannot open them at all. After numerous tests, nothing physically wrong was found with these patients, so what caused their symptoms? </p>
<p>Conditions like these used to be diagnosed as hysteria. In fact, they would fit neatly into the pages of Sigmund Freud and Josef Breuer’s <a href="https://en.wikipedia.org/wiki/Studies_on_Hysteria">Studies On Hysteria</a>, written over a century ago. </p>
<p>You might think our understanding has advanced since Freud, or, rather more fashionably, that Freud was just wrong. But this isn’t the case. </p>
<p>The term hysteria was dropped when the influence of a psychodynamic theory of mental ill health, with its concepts of unconscious mental forces affecting behaviour, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695775/">fell out of favour</a> in psychiatry. But while they turned to more measurable features and symptoms, the condition remains in what is now called “conversions disorder”.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194355/original/file-20171113-27573-7g2lp2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Josef Breuer, co-author of Studies On Hysteria.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=2547712">Albrecht Hirschmüller/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>It was Freud who proposed that the memory of trauma which the patient fails to confront, because it will cause them too much mental anguish, can be <a href="https://www.penguin.co.uk/books/1034856/complete-psychological-works-of-sigmund-freud-the-vol-1/">“converted” into physical symptoms</a>. What is more surprising is that cases like this are typical of those routinely seen by neurologists today. </p>
<p>For example, the case of the 35-year-old woman (Ely), noted above, is given in Gordon Turnbull’s <a href="https://www.penguin.co.uk/books/1082467/trauma/">Trauma</a>, a book on the history and treatment of post-traumatic stress disorder. After X-rays for a bleed in Ely’s spinal cord came back negative, Turnbull tried a lumber puncture to extract fluid. Ely didn’t even wince as the needle went in. She seemed indifferent to her sudden paralysis. The nurses thought she was putting it on. </p>
<p>Perplexed, Turnbull’s mind “suddenly jumped to Freud”, who he recalls said that mental conflict could become physical disability. </p>
<p>On interviewing Ely, he eventually discovered that she had been raped by someone she knew. This caused the unbearable mental conflict that was “converted” into her physical symptoms. She evidently knew this, but had pushed its significance out of her conscious awareness to protect herself. She found that talking her experiences through repeatedly was cathartic – her pent up feelings were released. Two days later, she was able to leave the hospital, unaided.</p>
<p>The woman (Mary) who felt compelled to shut her eyes is one of many cases described by the neurologist Suzanne O’Sullivan in <a href="https://penguinrandomhouse.ca/search?search=suzanne%20o%27sullivan%20it%27s%20all%20in%20your%20head">It’s All In Your Head</a>. Her husband was on remand for child abuse, but she refused to think this might be an important factor in her illness. Treated with muscle relaxant drugs, she soon recovered. But a month later, she was readmitted, suffering from amnesia. Brain scans and an EEG were normal, but a neighbour told O’Sullivan that her husband had been released from prison. O’Sullivan is left wondering what this patient “could not bear to look upon” or “tolerate to remember”. </p>
<p>Despite the many new technical means of investigation, researchers have very little to offer beyond Freud to account for how psychological and emotional experiences manifest in physical symptoms. O’Sullivan writes that:</p>
<blockquote>
<p>… for all the shortcomings in the concepts proposed by Freud and Breuer in Studies, the 21st century has brought no great advances to a better understanding of the mechanisms for this disorder. </p>
</blockquote>
<h2>Publicly acknowledged, at last</h2>
<p>This is acknowledged more publicly now. For example, the neurologist Richard Kanaan in BBC Radio 4’s All In The Mind <a href="http://www.bbc.co.uk/programmes/b01681ky">states</a> that Freud still “looms quite large in our repertoire of explanations”. In fact, it would be a very small repertoire if you excluded Freud. </p>
<p>Since we can use sophisticated medical testing, we now know that it is not the neurological “hardware” that is damaged, so it must be the “software”, our psychological response to the meaning of trauma, that leads to conversion disorder. </p>
<p>Freud originally studied anatomy and neurology and wrote notable papers, some of which are still considered classics today, such as On Aphasia. But it was the limitations inherent in the brain sciences of his day that led him to develop a more psychological map of the mind. </p>
<p>In a radical departure from the practice of the day, which either paraded hysterical patients around at public demonstrations – as the French neurologist, Jean-Martin Charcot did – or treated them as malingerers, Freud sat his patients down and listened attentively to them. After ten years of this practice, Freud came to believe that behind every hysterical symptom, such as convulsions, paralysis, blindness, epilepsy, amnesia or pain, lay a hidden trauma or series of traumas. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194359/original/file-20171113-27607-1443dp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Charcot demonstrating hypnosis on a hysterical patient.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=3820726">André Brouillet/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>In his many case examples, Freud carefully traces these initially hidden traumas. His accounts in Studies On Hysteria would still make exemplary reading for those working with conversion disorder patients today who also deserve to be listened to. </p>
<p>While conversion disorder has attracted suspiciously little academic attention, what research has been done tends to confirm Freud. </p>
<p>In 2016, researchers <a href="https://www.kcl.ac.uk/ioppn/news/records/2016/July/New-study-examines-Freuds-theory-of-Hysteria.aspx">discovered</a> that patients with conversion disorder had experienced a greater number of stressful life events than other people, and a dramatic increase in these events near to the time when their symptoms began. </p>
<p>This profile fits many of the cases described by Freud in Studies On Hysteria. For example, Katherina’s breathing difficulties and visions of a frightening face staring at her, came on after witnessing her father sexually abuse her cousin. The research also found that in some patients no stressors were identified, but one wonders if this is only because few researchers can replicate Freud’s skillful picking up of clues in his patients’ “free associations”? </p>
<p>Freud’s brilliance was in recognising that disturbing memories don’t just go away. His compassion lives to this day in the method he established for bringing them to light and reducing their negative and sometimes debilitating effects: psychoanalysis.</p><img src="https://counter.theconversation.com/content/86497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Nicholson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sigmund Freud understood that mental conflict could become physical disability.Chris Nicholson, Deputy Head of Department of Psychosocial and Psychoanalytic Studies, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/849982017-10-09T19:09:59Z2017-10-09T19:09:59ZDo trauma victims really repress memories and can therapy induce false memories?<figure><img src="https://images.theconversation.com/files/189320/original/file-20171009-25749-3h6ijf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Repression is a defensive process where the mind forgets or places events, thoughts and memories we cannot acknowledge or bear elsewhere.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/66327170@N07/7166340752/in/photolist-bVgnrb-jP6hD9-65RdQs-C2qCUT-dyrM7e-YqeDx-7K8aWN-k9pL7q-8Hcn5N-jP4Nwt-65LWi2-qkjQs-dk8vs8-gq5prd-95rmCv-b6HzR2-5Y87R4-8U7qRJ-7c9ohX-Dg96x2-dyxftu-9yqar9-k9qdNn-k9mXiv-cpKpo1-6UMNQ6-3UqamK-e6ATu5-4mVtQW-4HUhiF-gCxKqo-k9nshn-83ybEp-9fKufz-gHTXE-eAfx2-k9r4he-6vboWU-k9nPqc-5vuA1D-775dFr-5UPXai-CMc8eu-k9sGr3-6zbbSm-7wX7yT-88T7Ef-4Nv2Pr-bBACU9-gCyf1t">Roxanne Milward/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The <a href="http://www.theaustralian.com.au/life/weekend-australian-magazine/the-disputed-memories-of-child-abuse-activist-cathy-kezelman/news-story/fb0b24837c3955ad1ff441029e88f7c3">Australian newspaper recently reported</a> the royal commission investigating institutional child sex abuse was advocating psychologists use “potentially dangerous” therapy techniques to recover repressed memories in clients with history of trauma. The reports suggest researchers and doctors are speaking out against such practices, which risk implanting false memories in the minds of victims. </p>
<p>The debate about the nature of early trauma memories and their recovery isn’t new. Since <a href="https://manhattanpsychoanalysis.com/wp-content/uploads/readings/Subramanian_Freud_II_upload/Freud_New_Introductory_Lectures_On_Psycho_Analysis.pdf">Sigmund Freud</a> developed the idea of “repression” – where people store away memories of stressful childhood events so they don’t interfere with daily life – psychologists and law practitioners have been arguing about the nature of memory and whether it’s possible to create false memories of past situations. </p>
<p>Recovery from trauma for some people involves recalling and understanding past events. But repressed memories, where the victim remembers nothing of the abuse, are relatively uncommon and there is little reliable evidence about their frequency in trauma survivors. According to reports from clinical practice and experimental studies of recall, most patients can <a href="https://link.springer.com/article/10.1023/A:1022344128649">partially recall events</a>, even if elements of these have been suppressed. </p>
<h2>What are repressed memories?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=791&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=791&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=791&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=994&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=994&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189322/original/file-20171009-973-122z19u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=994&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sigmund Freud introduced the concept of child abuse underlying disorders such as hysteria.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/0/0e/Sigmund_Freud.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Freud <a href="https://manhattanpsychoanalysis.com/wp-content/uploads/readings/Subramanian_Freud_II_upload/Freud_New_Introductory_Lectures_On_Psycho_Analysis.pdf">introduced the concept that child abuse</a> is a major cause of mental disorders such as hysteria, also known as <a href="http://apt.rcpsych.org/content/12/2/152">conversion disorder</a>. People with these disorders could lose bodily functions, such as the ability to move one of their limbs, following a stressful event. </p>
<p>The concept of repressing traumatic memories was part of this model. Repression, as Freud saw it, is a fundamental defensive process where the mind forgets or places events, thoughts and memories we cannot acknowledge or bear elsewhere.</p>
<p>Freud also suggested that if these memories weren’t recalled, it could result in physical or mental symptoms. He argued symptoms of a mental disorder can be a return of the repressed memories, or a symbolic way of communicating a traumatic event. An example would be suddenly losing speech ability when someone has a terrible memory of trauma they feel unable to disclose. </p>
<p>This idea of hidden traumas and their ability to influence psychological functioning despite not being recalled or available to consciousness has shaped much of our current thinking about symptoms and the need to understand what lies behind them. </p>
<p>Those who accept the <a href="https://www.goodreads.com/book/show/499636.Unchained_Memories">repression interpretation</a> argue children may repress memories of early abuse for many years and that these can be recalled when it’s safe to do so. This is variously referred to as traumatic amnesia or dissociative amnesia. Proponents accept repressed traumatic memories can be accurate and <a href="http://europepmc.org/abstract/med/7960294">used in therapy</a> to recover memories and build up an account of early experiences. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">Dissociative identity disorder exists and is the result of childhood trauma</a>
</strong>
</em>
</p>
<hr>
<h2>False memory and the memory wars</h2>
<p>Freud later withdrew his initial ideas around abuse underlying mental health disorders. He instead drew on his belief of the child’s commonly held sexual fantasies about their parents, which he said could influence formation of memories that did not did not mean actual sexual behaviour had taken place. This may have been Freud caving in to the social pressures of his time.</p>
<p>This interpretation lent itself to the <a href="http://journals.sagepub.com/doi/abs/10.1111/j.1745-6924.2009.01112.x">false memory hypothesis</a>. Here the argument is that <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.660.1144&rep=rep1&type=pdf">memory can be distorted</a>, sometimes even by therapists. This can influence the experience of recalling memories, resulting in false memories. </p>
<p>Those who hold this view oppose therapy approaches based on uncovering memories and believe it’s better to focus on recovery from current symptoms related to trauma. This group point out that emotionally traumatic memory can be more vividly remembered than non-traumatic memories, so it wouldn’t hold these events would be repressed. They remain sceptical about reclaimed memories and even more so about <a href="http://batstar.net/drama/bias.pdf">therapies based on recall</a> – such as recovered memory therapy and hypnosis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189321/original/file-20171009-32184-1hc81k5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The false memory hypothesis holds memories can be distorted.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/23119666@N03/4291112560/in/photolist-7xc5gj-eFmkzD-7PDAK9-4iZ58h-WeDWYg-fwESNN-7S6ZxD-4hFJJx-9seYr7-e7pM8a-qbGfKj-9R8c9K-CiVaq1-5qz8PR-69Tr96-pTQXdc-9gG4A9-9dQiY7-naeS5G-dubjT-jP3Wh2-7jAMyg-72H8TY-f31VL1-pHmL2Z-9this6-35NRZD-5p5xTx-9xvP3-7iBcrx-dydLT-LF8Ab-58SHnW-V6FrUX-cXhQBw-dVnxCw-9pCxt-5exCzm-fGFt3-5R33Sh-4WWy9L-M8kEB-7aQAB-4JjsJc-3dz3WG-4XNQh3-3BLL1-U2WD8J-LLFyc-dZmhxg">Mark Bonica/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The 1990s saw the height of these <a href="https://books.google.com.au/books/about/The_Memory_Wars.html?id=saMAAAAACAAJ&redir_esc=y">memory wars</a>, as they came to be known, between proponents of repressed memory and those of the false memory hypothesis. The debate was <a href="https://books.google.com.au/books/about/The_Recovered_Memory_false_Memory_Debate.html?id=GJ5HAAAAMAAJ&redir_esc=y">influenced by increasing awareness</a> and research on memory systems in academic psychology and an attitude of scepticism about therapeutic approaches focused on encouraging recall of past trauma. </p>
<p>In 1992, the parents of Jennifer Freyd, who had accused her father of sexual assault, founded the <a href="http://www.fmsfonline.org/">False Memory Syndrome Foundation</a>. The parents maintained Jennifer’s accusations were false and encouraged by recovered memory therapy. While the foundation has claimed false memories of abuse are easily created by therapies of dubious validity, there is <a href="http://www.tandfonline.com/doi/abs/10.1300/J070v09n03_02">no good evidence</a> of a “false memory syndrome” that can be reliably defined, or any evidence of how widespread the use of these types of therapies might be.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-capable-of-infinite-memory-but-where-in-the-brain-is-it-stored-and-what-parts-help-retrieve-it-63386">We're capable of infinite memory, but where in the brain is it stored, and what parts help retrieve it?</a>
</strong>
</em>
</p>
<hr>
<h2>An unhelpful debate</h2>
<p>Both sides do agree that abuse and trauma during critical developmental periods are related to both biological and psychological vulnerability. Early trauma <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966730/">creates physical changes in the brain</a> that predispose the individual to mental disorders in later life. Early trauma has a negative impact on self-esteem and the ability to form trusting relationships. The consequences can be lifelong.</p>
<p>A therapist’s role is to help abuse survivors deal with these long-term consequences and gain better control of their emotional life and interpersonal functioning. Some survivors will want to have relief from ongoing symptoms of anxiety, memories of abuse and experiences such as nightmares. </p>
<p>Others may express the need for a greater understanding of their experiences and to be free from feelings of self-blame and guilt they may have carried from childhood. Some individuals will benefit from <a href="https://search.informit.com.au/documentSummary;dn=547238400686231;res=IELHEA">longer psychotherapies</a> dealing with the impact of child abuse on their lives.</p>
<p>Most therapists use techniques such as <a href="https://www.amazon.com.au/Treating-Trauma-Traumatic-Children-Adolescents-ebook/dp/B01N6AORKP">trauma-focused cognitive behavioural therapy</a>, which aren’t aimed exclusively at recovering memories of abuse. The royal commission has heard evidence of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/16221661">serious impact of being dismissed</a> or not believed when making disclosures of abuse and seeking protection. The therapist should be respectful and guided by the needs of the survivor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-it-take-victims-of-child-sex-abuse-so-long-to-speak-up-46412">Why does it take victims of child sex abuse so long to speak up?</a>
</strong>
</em>
</p>
<hr>
<p>Right now, we need to acknowledge child abuse on a large scale and develop approaches for intervention. It may be time to move beyond these memory wars and focus on the impacts of abuse on victims; impacts greater than the direct symptoms of trauma.</p>
<p>It’s vital psychotherapy acknowledges the variation in responses to trauma and the profound impact of betrayal in abusive families. Repetition of invalidation and denial should be avoided in academic debate and clinical approaches.</p><img src="https://counter.theconversation.com/content/84998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Newman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The debate about the nature of early trauma memories and their recovery isn’t new.Louise Newman, Director of the Centre for Women’s Mental Health at the Royal Women’s Hospital and Professor of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/749112017-04-04T00:44:28Z2017-04-04T00:44:28ZFrom shell-shock to PTSD, a century of invisible war trauma<figure><img src="https://images.theconversation.com/files/163561/original/image-20170403-27251-14zcqdy.jpg?ixlib=rb-1.1.0&rect=0%2C311%2C2389%2C1544&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some soldiers' wounds in WWI were more mental than physical.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/taybot/14565207240">George Metcalf Archival Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>In the wake of World War I, some veterans returned wounded, but not with obvious physical injuries. Instead, their symptoms were similar to those that had previously been <a href="https://www.valas.fr/IMG/pdf/Freud-Oeuvre-traduction-anglaise.pdf">associated with hysterical women</a> – most commonly amnesia, or some kind of paralysis or inability to communicate with no clear physical cause.</p>
<p>English physician Charles Myers, who wrote the first paper on “shell-shock” in 1915, theorized that these symptoms actually did stem from a physical injury. He posited that repetitive exposure to concussive blasts caused brain trauma that resulted in this strange grouping of symptoms. But once put to the test, his hypothesis didn’t hold up. There were plenty of veterans who had not been exposed to the concussive blasts of trench warfare, for example, who were still experiencing the symptoms of shell-shock. (And certainly not all veterans who had seen this kind of battle returned with symptoms.)</p>
<p>We now know that what these combat veterans were facing was likely what today we call <a href="https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml">post-traumatic stress disorder, or PTSD</a>. We are now better able to recognize it, and treatments have certainly advanced, but we still don’t have a full understanding of just what PTSD is.</p>
<p>The medical community and society at large are accustomed to looking for the most simple cause and cure for any given ailment. This results in a system where symptoms are discovered and cataloged and then matched with therapies that will alleviate them. Though this method works in many cases, for the past 100 years, PTSD has been resisting.</p>
<p>We are three scholars in the humanities who have individually studied PTSD – the framework through which people conceptualize it, the ways researchers investigate it, the therapies the medical community devises for it. Through our research, each of us has seen how the medical model alone fails to adequately account for the ever-changing nature of PTSD. </p>
<p>What’s been missing is a cohesive explanation of trauma that allows us to explain the various ways its symptoms have manifested over time and can differ in different people.</p>
<h2>Nonphysical repercussions of the Great War</h2>
<p>Once it became clear that not everyone who suffered from shell-shock in the wake of WWI had experienced brain injuries, the British Medical Journal provided alternate nonphysical explanations for its prevalence. </p>
<blockquote>
<p>A poor morale and a defective training are one of the most important, if not the most important etiological factors: also that shell-shock was a “catching” complaint. – (<a href="http://www.jstor.org/stable/20420866">The British Medical Journal, 1922</a>)</p>
</blockquote>
<p>Shell-shock went from being considered a legitimate physical injury to being a sign of weakness, of both the battalion and the soldiers within it. <a href="https://doi.org/10.1017/CHO9780511675669">One historian estimates</a> <a href="http://www.telegraph.co.uk/history/world-war-one/10577200/WW1-dead-and-shell-shock-figures-significantly-underestimated.html">at least 20 percent</a> of men developed shell-shock, though the figures are murky due to physician reluctance at the time to brand veterans with a psychological diagnosis that could affect disability compensation.</p>
<p>Soldiers were archetypically heroic and strong. When they came home unable to speak, walk or remember, with no physical reason for those shortcomings, the only possible explanation was personal weakness. Treatment methods were based on the idea that the soldier who had entered into war as a hero was now behaving as a coward and needed to be snapped out of it.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163558/original/image-20170402-27259-1c361ss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Electric treatments were prescribed in psychoneurotic cases post-WWI.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/27337026@N03/2653489628">Otis Historical Archives National Museum of Health and Medicine</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Lewis Yealland, a British clinician, described in his 1918 “<a href="https://archive.org/details/hystericaldisord00yealuoft">Hysterical Disorders of Warfare</a>” the kind of brutal treatment that follows from thinking about shell-shock as a personal failure. After nine months of unsuccessfully treating patient A1, including electric shocks to the neck, cigarettes put out on his tongue and hot plates placed at the back of his throat, Yealland boasted of telling the patient, “You will not leave this room until you are talking as well as you ever did; no, not before… you must behave as the hero I expect you to be.”</p>
<p>Yealland then applied an electric shock to the throat so strong that it sent the patient reeling backwards, unhooking the battery from the machine. Undeterred, Yealland strapped the patient down to avoid the battery problem and continued to apply shock for an hour, at which point patient A1 finally whispered “Ah.” After another hour, the patient began to cry and whispered, “I want a drink of water.”</p>
<p>Yealland reported this encounter triumphantly – the breakthrough meant his theory was correct and his method worked. Shell-shock was a disease of manhood rather than an illness that came from witnessing, being subjected to and partaking in incredible violence.</p>
<h2>Evolution away from shell-shock</h2>
<p>The next wave of the study of trauma came when the Second World War saw another influx of soldiers dealing with similar symptoms.</p>
<p>It was Abram Kardiner, a clinician working in the psychiatric clinic of the United States Veterans’ Bureau, who rethought combat trauma in a much more empathetic light. In his influential book, “<a href="https://books.google.com/books/about/The_Traumatic_Neuroses_of_War.html?id=B2tmMQEACAAJ">The Traumatic Neuroses of War</a>,” Kardiner speculated that these symptoms stemmed from psychological injury, rather than a soldier’s flawed character.</p>
<p>Work from other clinicians after WWII and the Korean War suggested that post-war symptoms could be lasting. Longitudinal studies showed that <a href="https://doi.org/10.1001/archpsyc.1965.01720350043006">symptoms could persist anywhere from six to 20 years</a>, if they disappeared at all. These studies returned some legitimacy to the concept of combat trauma that had been stripped away after the First World War. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=479&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=479&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=479&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=602&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=602&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163582/original/image-20170403-19462-27tbqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=602&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As veterans returned home from the war in Vietnam, combat trauma became less stigmatized.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/13476480@N07/24594442566">manhhai</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Vietnam was another watershed moment for combat-related PTSD because veterans began to advocate for themselves in an unprecedented way. Beginning with a small march in New York in the summer of 1967, veterans themselves began to become <a href="https://doi.org/10.2307/800744">activists for their own mental health care</a>. They worked to redefine “post-Vietnam syndrome” not as a sign of weakness, but rather a normal response to the experience of atrocity. Public understanding of war itself had begun to shift, too, as the widely televised accounts of the My Lai massacre brought the <a href="http://www.ucpress.edu/book.php?isbn=9780520065437">horror of war into American living rooms</a> for the first time. The veterans’ campaign helped get PTSD included in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III), <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm">the major American diagnostic resource</a> for psychiatrists and other mental health clinicians.</p>
<p>The authors of the DSM-III deliberately avoided talking about the causes of mental disorders. Their aim was to develop a manual that could simultaneously be used by psychiatrists adhering to radically different theories, including Freudian approaches and what is now known as “biological psychiatry.” These groups of psychiatrists would not agree on how to explain disorders, but they could – and did – come to agree on which patients had similar symptoms. So the DSM-III defined disorders, including PTSD, solely on the basis of clusters of symptoms, an approach that has been retained ever since.</p>
<p>This tendency to agnosticism about the physiology of PTSD is also reflected in contemporary evidence-based approaches to medicine. Modern medicine focuses on using clinical trials to demonstrate that a therapy works, but is skeptical about attempts to link treatment effectiveness to the biology underlying a disease.</p>
<h2>Today’s medicalized PTSD</h2>
<p>People can develop PTSD for a number of different reasons, not just in combat. Sexual assault, a traumatic loss, a terrible accident – each might lead to PTSD. The U.S. Department of Veterans Affairs estimates about <a href="https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp">13.8 percent of the veterans</a> returning from the wars in Iraq and Afghanistan currently have PTSD. For comparison, a male veteran of those wars is four times more likely to develop PTSD than a man in the civilian population is. PTSD is probably at least partially at the root of an <a href="https://www.mentalhealth.va.gov/docs/Suicide_Data_Report_Update_January_2014.pdf">even more alarming statistic</a>: Upwards of <a href="https://www.va.gov/opa/docs/Suicide-Data-Report-2012-final.pdf">22 veterans commit suicide</a> every day.</p>
<p>Therapies for PTSD today tend to be a mixed bag. Practically speaking, when veterans seek PTSD treatment in the VA system, policy requires they be <a href="https://www.healthquality.va.gov/guidelines/MH/ptsd/cpg_PTSD-full-201011612.PDF">offered either exposure or cognitive therapy</a>. Exposure therapies are based on the idea that the fear response that gives rise to many of the traumatic symptoms can be dampened through <a href="https://www.ptsd.va.gov/public/treatment/therapy-med/prolonged-exposure-therapy.asp">repeated exposures to the traumatic event</a>. Cognitive therapies work on developing personal coping methods and <a href="https://www.ptsd.va.gov/public/treatment/therapy-med/cognitive_processing_therapy.asp">slowly changing unhelpful or destructive thought patterns</a> that are contributing to symptoms (for example, the shame one might feel at not successfully completing a mission or saving a comrade). The most common treatment a veteran will likely receive will include psychopharmaceuticals – especially the class of drugs called SSRIs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163578/original/image-20170403-19423-b8aw4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The military is working on incorporating virtual reality with exposure therapy for PTSD sufferers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/lancecheungmedia/3553753011">Lance Cheung</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>Mindfulness therapies, based on becoming aware of mental states, thoughts and feelings and accepting them rather than trying to fight them or push them away, are <a href="https://www.ptsd.va.gov/professional/treatment/overview/mindful-ptsd.asp">another option</a>. There are also more <a href="https://books.google.com/books?hl=en&lr=&id=MFyEg007YEIC&oi=fnd&pg=PR1&dq=hypnosis+and+creative+therapy+for+PTSD&ots=ctUJrwZsSw&sig=NeEiWA7JXZROLxCClei_FB8U-f0#v=onepage&q=hypnosis%20and%20creative%20therapy%20for%20PTSD&f=false">alternative methods being studied</a> such as eye movement desensitization and reprocessing or EMDR therapy, therapies using controlled doses of MDMA (Ecstasy), <a href="http://dx.doi.org/10.1037/ccp0000134">virtual reality-graded exposure therapy</a>, hypnosis and creative therapies. The military funds a wealth of research on new technologies to address PTSD; these include <a href="http://www.darpa.mil/program/our-research/darpa-and-the-brain-initiative">neurotechnological innovations like transcranial stimulation and neural chips</a> as well as <a href="https://doi.org/10.1038/npp.2013.317">novel drugs</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Zoellner%20LA%5BAuthor%5D&cauthor=true&cauthor_uid=19577224">Several studies</a> have shown that patients improve most when they’ve chosen their own therapy. But even if they narrow their choices to the ones backed by the weight of the National Center for PTSD by using the center’s online <a href="https://www.ptsd.va.gov/apps/decisionaid/">Treatment Decision Aid</a>, patients would still find themselves weighing five options, each of which is evidence-based but entails a different psychomedical model of trauma and healing.</p>
<p>This buffet of treatment options lets us set aside our lack of understanding of why people experience trauma and respond to interventions so differently. It also relieves the pressure for psychomedicine to develop a complete model of PTSD. We reframe the problem as a consumer issue instead of a scientific one.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=873&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=873&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=873&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1097&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1097&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163580/original/image-20170403-19459-2ufn6w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1097&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Whereas shell-shock was a weakness, PTSD is understood more sympathetically.</span>
<span class="attribution"><a class="source" href="http://www.loc.gov/pictures/item/2017674898/">Library of Congress, Prints & Photographs Division, American National Red Cross Collection, LC-A6196- 6839-Bx</a></span>
</figcaption>
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<p>Thus, while WWI was about soldiers and punishing them for their weakness, in the contemporary era, the ideal veteran PTSD patient is a health care consumer who has an obligation to play an active role in figuring out and optimizing his own therapy. </p>
<p>As we stand here with the strange benefit of the hindsight that comes with over 100 years of studying combat-related trauma, we must be careful in celebrating our progress. What is still missing is an explanation of why people have different responses to trauma, and why different responses occur in different historical periods. For instance, the paraylsis and amnesia that epitomized WWI shell-shock cases are now so rare that they don’t even appear as symptoms in the DSM entry for PTSD. We still don’t know enough about how soldiers’ own experiences and understandings of PTSD are shaped by the broader social and cultural views of trauma, war and gender. Though we have made incredible strides in the century since World War I, PTSD remains a chameleon, and demands our continued study.</p><img src="https://counter.theconversation.com/content/74911/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mental health trauma has always been a part of war. Treatments have come a long way over the last century, but we still don’t understand why the responses change for different people and times.MaryCatherine McDonald, Assistant Professor of Philosophy and Religious Studies, Old Dominion UniversityMarisa Brandt, Assistant Professor of Practice, Michigan State UniversityRobyn Bluhm, Associate Professor of Philosophy, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/726802017-03-06T12:23:52Z2017-03-06T12:23:52ZThe Victorians are to blame for assumptions that self-harm is just attention-seeking<figure><img src="https://images.theconversation.com/files/158541/original/image-20170227-26326-9jb1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A photo by Albert Londe of a 'hysterical' woman taken around 1890.</span> <span class="attribution"><a class="source" href="https://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=1&_IXSR_=qQF0FfV5DVB&_IXSS_=_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26create_creator_name_name%253atext%3d%2522Albert%2bLonde%2522%26%252asform%3dwellcome%252dimages%26_IXACTION_%3dquery%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26%2524%2bwith%2bimage_sort%3d%26_IXMAXHITS_%3d15%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft&s=yWtCT6Wewjb">Wellcome Library, London </a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>As I know from bitter experience, self-harm is often linked to a desire to seek attention. “What’s the point in referring you?” a GP once said to me, with obvious irritation, when I asked him for referral to a free, charity service that helped camouflage self-harm scars. “You’ll only go and do it again.”</p>
<p>Today, the term self-harm usually refers to superficial injuries to the surface of the skin, especially those made by cutting. In 2013, it was listed as a category for the first time in the fifth edition of the influential <a href="https://psychiatry.org/psychiatrists/practice/dsm">Diagnostic and Statistical Manual of the American Psychiatric Association</a>. </p>
<p>Meanwhile, the notion that self-harm is a demanding or <a href="https://www.selfharm.co.uk/get/myths/attention_please">attention-seeking behaviour</a> has become so ingrained in modern, Western life that today it’s seen as an obvious way of viewing self-inflicted injury – even among some doctors. </p>
<p>Yet the attitude that self-harm is attention-seeking has only been common since the late 19th century, as my <a href="http://www.reaktionbooks.co.uk/display.asp?K=e2016081116212375">new research</a> has tracked.</p>
<h2>Malingerers, with and without a motive</h2>
<p>Victorian psychiatrists were the first to consider a desire to manipulate others as a widespread motivation for self-mutilation. Before this time, each individual case was usually considered on its own terms. Yet attention-seeking was by no means the most significant <a href="https://archive.org/details/dictionaryofpsyc02tuke">of the reasons</a> that doctors in the 19th century suggested for self-harm. These included religious conviction, demonstrations of endurance, attempted suicide, response to hallucinations and delusions and, most prominently at this time, <a href="https://www.ncbi.nlm.nih.gov/pubmed/21837447">sexual perversion</a>. </p>
<p>Manipulation of others, however, was a new explanation that began to appear in the 1870s. Most of the cases these psychiatrists described had very practical benefits. Men were often accused of self-mutilation to gain financially <a href="https://books.google.co.uk/books?hl=en&lr=&id=b5U5DAAAQBAJ&oi=fnd&pg=PR5&dq=eghigian+security&ots=deOVjQr9l6&sig=yoIqgwI1G8jkKM-D6DIlShtiLQc#v=onepage&q=eghigian%20security&f=false">through bogus insurance claims or the avoidance of work or duty</a>. This made these working men <a href="http://www.jstor.org/stable/j.ctt1b3h9bj.19.">malingerers in the classic sense</a>, defined by the outcome of their act.</p>
<p>Women, unlike men, were categorised as <a href="http://www.bmj.com/content/1/470/14">“motiveless malingerers”</a> for there seemed to be no obvious reason for their attempts to harm themselves. Their acts, <a href="http://www.sciencedirect.com/science/article/pii/S0140673602650792">doctors explained</a>, were symptoms of hysteria, for “hysterical patients are extremely fond of attracting attention and sympathy”.</p>
<p>Most frequently diagnosed in women, <a href="http://journals.sagepub.com/doi/abs/10.1177/007327538902700401">hysteria</a> was considered either a product of <a href="https://muse.jhu.edu/article/2437/summary">woman’s reproductive instability</a> or her <a href="http://www.jstor.org/stable/3827084?seq=1#page_scan_tab_contents">irrational, emotional mind</a> – or both. </p>
<p>It is impossible to detach the diagnosis and treatment of hysteria from prevailing attitudes to gender, and this can be seen clearly in the case of self-harm. An act of self-injury might be the only symptom observed by a Victorian doctor, but nonetheless led to a diagnosis of hysteria. As an anonymous writer in the British Medical Journal <a href="http://www.bmj.com/content/1/470/14">put it in 1870</a>, motiveless malingerers: </p>
<blockquote>
<p>Are almost invariably of the class of those known as ‘hysterical’. In other words, they are of the female sex, arrived at the age of puberty and unmarried. Hysterical in any more definite sense they seldom are. </p>
</blockquote>
<p>For a single woman to self-harm, then, was all the evidence that was needed to make a diagnosis of hysteria. After all, “we know that hysterical women cheat in all manner of ways”. Blunt statements like this implying a desire to manipulate, <a href="http://www.sciencedirect.com/science/article/pii/S0140673602738774">made</a> by surgeon Benjamin Collins Brodie in 1843, were later used to explain self-injury in women. </p>
<p>By the early 20th century, this view was often reversed. Rather than diagnosing women as hysterical as a result of self-inflicted injuries, self-harm was instead used as proof that all women (whether or not they self-harmed) were attention-seeking. Applying an evolutionary perspective to psychology seemed, to some doctors, to support this. As the doctor <a href="http://www.sciencedirect.com/science/article/pii/S0140673600404101">Frederick Parkes Weber</a> put it in 1911, women were physically weaker than men. Therefore, they had evolved mentally to use “simulation or deception of various kinds” in order to protect themselves from men. Self-harm was, to Weber, a piece of evidence that the female brain had evolved in such a way.</p>
<p>This led him to the damning conclusion that: “At the present time the facility (instinct) for deception is probably greater in the average female than in the average male.”</p>
<h2>Attention-seeking and gender stereotypes</h2>
<p>This view of the manipulative, deceitful female self-harmer has <a href="http://journals.sagepub.com/doi/pdf/10.1177/1357034X04047857">lingered in the popular imagination</a>, often attached to subsequent concerns about the changing role of women. In Elizabeth Ferrars’s 1942 detective novel, <a href="https://books.google.co.uk/books/about/Don_t_Monkey_with_Murder.html?id=aYuiHwAACAAJ&source=kp_cover&redir_esc=y">Don’t Monkey With Murder</a>, female self-harm became sexualised, with the plot hinging around the self-mutilation of the beautiful, promiscuous and murderously manipulative Katharine Peach. By the 1980s, the female professional became the new trope, as in the film <a href="http://www.imdb.com/title/tt0093010/">Fatal Attraction</a>, in which Glenn Close plays a successful businesswoman who cuts her wrists and leg in a manipulative act of obsessive jealousy.</p>
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<p>There is actually <a href="https://www.ncbi.nlm.nih.gov/pubmed/25795294">little reliable scientific evidence</a> on whether more women or men self-harm today: statistics, after all, rely on who happens to come into contact with health services or otherwise and then reports injuring themselves. Describing self-harm as attention-seeking or <a href="http://journals.sagepub.com/doi/abs/10.1177/0952695112473619">assuming that only women self-harm</a> tells us very little about an act of self-injury and what has caused it. It tells us much more about cultural assumptions: what is considered normal or appropriate male and female behaviour, and what stereotypes remain prevalent about the supposed emotional needs of women.</p><img src="https://counter.theconversation.com/content/72680/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Chaney received funding from the Wellcome Trust for an earlier stage of this research.</span></em></p>Psychiatrists in the 19th century began attributing self-harm to a desire to manipulate others.Sarah Chaney, Research Project Manager, School of History, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/626042016-07-18T02:26:15Z2016-07-18T02:26:15ZMemo Steve Price: how ‘hysteria’ has been used to degrade and control women<figure><img src="https://images.theconversation.com/files/130816/original/image-20160718-2153-1rx3m17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Is there a difference between calling a woman or a man “hysterical”? The word’s origin as the term for a psychological disorder grounded in female physiology suggests the answer is yes.</p>
<p>Last week’s <a href="http://www.smh.com.au/entertainment/tv-and-radio/qa-recap-steve-prices-hysterical-insult-prompts-a-mic-drop-from-van-badham-20160711-gq3jco">verbal tussle</a> on the ABC’s Q&A contributes the latest chapter to our ongoing national conversations about <a href="http://www.abc.net.au/news/2016-04-06/fact-file-domestic-violence-statistics/7147938">domestic violence</a>, <a href="http://theaimn.com/the-war-on-feminism-and-the-normalisation-of-misogyny-in-australia/">misogyny</a>, and <a href="http://theconversation.com/many-small-microaggressions-add-up-to-something-big-50694">microaggressions</a>.</p>
<p>Amid a discussion about the culture of violence towards women, journalist Steve Price repeatedly interrupted and talked over Guardian columnist Van Badham. Their kerfuffle peaked when, to audible audience gasps, Price accused Badham of being “hysterical”. Her rejoinder, that “it’s probably my ovaries making me do it,” <a href="https://twitter.com/hashtag/MyOvariesMadeMe?src=hash&lang=en">exploded on Twitter</a>. </p>
<p>On <a href="http://thevine.com.au/news/watch-steve-price-defends-hysterical-comment-carrie-waleed-let/">The Project</a>, Price later asserted that Badham’s status as a woman was irrelevant to the meaning and impact of his characterisation of her as hysterical. Gender and history, he said, had nothing to do with it.</p>
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<p>Yet hysteria’s long, dark past as a medical diagnosis casts a shadow over our modern colloquial use. With a genealogy that can be traced back 4000 years to ancient Egypt, hysteria can arguably be understood as Western civilisation’s <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480686/">first conceptualisation of mental illness</a>. </p>
<p>Ancient physicians attributed erratic female behaviour to spontaneous movement of the womb, with which the disorder shares its Latin root.</p>
<p>By its very definition, hysteria could not afflict men. The hallmark behavior of a hysteric – overly emotional, out-of-control, irrational – was uniquely characteristic of women and linked directly to their anatomy.</p>
<p>Over millennia, Western medicine and culture reinforced the connection between the understanding and interpretation of women’s behaviour and their reproductive capacity. In more modern times, this knot tightened as the emerging field of psychology tied the diagnoses of so-called nervous disorders to women’s reproductive organs.</p>
<p>Nineteenth-century physicians widely attributed mental disturbance in women to a malfunction of their sex organs, a phenomenon that had no parallel in the diagnosis of male patients. </p>
<p>Treating hysteria with hypnosis, French neurologist JM Charcot emphasised that it afflicted both men and women, but nonetheless the wider medical community continued to link female psychology to female physiology. Advocating a rest cure, British physician WS Playfair attributed nervous disorders to “<a href="http://www.ncbi.nlm.nih.gov/pubmed/11763705">uterine mischief</a>”. </p>
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<a href="https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/130817/original/image-20160718-2127-18v9x0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Rogue uteri.</span>
<span class="attribution"><span class="source">Denis Bocquet</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>At the other end of the spectrum, the “<a href="http://www.bmj.com/content/346/bmj.f3756">grim apotheosis</a>” of this mind-body link took the form of hysterectomies, oophorectomies (removal of the ovaries) and clitoridectomies. Beginning in the late-1800s and continuing into the mid-20th century, doctors treated women’s mental disorders by removing the uterus, ovaries or clitoris that were believed to be the problem.</p>
<p>Sigmund Freud, whose ideas dominated Western psychology for much of the 20th century, also promoted a theory of hysteria that was ultimately grounded in physiology. <a href="https://books.google.com.au/books/about/In_Dora_s_Case.html?id=vPklkpYPwrMC">He believed</a> hysteria to be an expression of stunted, immature sexual development. The uncontrolled behaviour of the hysteric served as an outlet for frustrated sexual impulses that had failed to develop beyond infantile desires for parental affection.</p>
<p>Despite arguing, like Charcot, that hysteria could afflict both women and men, Freud was far from egalitarian in his thinking. Women’s intrinsic inadequacy, experienced psychologically as “penis envy”, left them vulnerable to hysteria. For men, a diagnosis of hysteria bore a clear medico-cultural stamp of feminisation and emasculation.</p>
<p>Hysteria today is no longer an accepted medical diagnosis, but the word lives on as a colloquial way to deem someone out-of-control and irrational. It can, as Price notes, be levelled again women and men, but it beggars belief that he did not acknowledge the word’s lingering gendered overtones.</p>
<p>The fact is, describing someone as “hysterical” associates them with a trait deemed feminine – if levelled against a man, the charge would impugn his manliness.</p>
<p>Price’s refusal to acknowledge the power of this word, so freighted with gendered meaning, is evidence of his male privilege. He asserts his right to determine the very terms of debate and <a href="http://www.refinery29.com/2014/09/75146/stop-women-crazy-emotions-gender">denies the reality of others</a>.</p>
<p>Calling out offensive language is not, as those on the Right would have it, <a href="https://overland.org.au/2016/06/political-correctness-gone-right-wing/">political correctness gone wild</a>. It is a strategy for resistance. </p>
<p>Only by shining a light on how we use language to degrade and diminish others – in this instance, women – can we challenge injustices that run the gamut from <a href="https://theconversation.com/mansplaining-the-word-of-the-year-and-why-it-matters-37091">mansplaining</a> to murder.</p>
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<p><em>Paula will be online for an Author Q&A between 4 and 5pm AEST on Monday, 18 July, 2016. Post any questions you have in the comments below.</em></p><img src="https://counter.theconversation.com/content/62604/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paula Michaels does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Describing someone as ‘hysterical’ associates them with traits long deemed feminine – being overly emotional, out-of-control and irrational. If levelled against a male, the charge would impugn his manliness.Paula Michaels, Senior lecturer, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.