The term“hysteria” has been used for centuries to belittle, subjugate, and control women. The word stems from the Greek hysteria, which means uterus. During the Victorian era, the term was often used to refer to a host of symptoms that were generally observed, or at least acknowledged, only in women. This conjures up a picture of the woman swooning in public on receiving some bad news. It became a somewhat socially expected behaviour in that era.
For hundreds of years,the pathology of hysteria was linked to the absurd belief that its cause was a “wandering uterus.” The word was then used pejoratively to describe a female response that was seen as disproportionately emotional for the situation – a determination that was made primarily by men.
An analogous category is seen in the description of “attention-seeking behaviour” which from time to time is associated with the old picture of hysterical personality. I find the term demeaning to the patient. Regardless, as a patient, it is a right to expect appropriate attention. This term may have been used to be able to include symptoms, similar to those of hysteria, that appeared in people without a uterus; in other words, men.
The concept of hysterical neurosis was deleted in the 1980 DSM-3. It was finally evident that the word carried with it so much ignorance and gender bias that it should be discarded. The word hysteria was replaced by the word dissociation. Unfortunately, dissociation is a term borrowed from chemistry. As a result, the word has its own constraints and awkwardness when used to describe psychological processes.
The fact that hysteria is no longer used in the DSM reflects how concepts can emerge, change, and be replaced as we gain a greater understanding, a greater appreciation, of how human beings think and behave following the stress of early childhood trauma.
Dissociation is often a feature of some conditions that involve people experiencing physical symptoms that have a psychological cause. Dissociative Identity Disorder is now conceptualized as a psychological response to a trauma suffered in the specific time frame of early childhood. It is a dissociative disorder that may be generated as part of a complex post-traumatic stress syndrome.
Dissociative disorders also include other functional disabilities, potentially affecting the motor function of a limb, sensory function such as numbness (sense of touch), or memory. In other words, dissociation can affect many spheres of a person’s ability to function. This is the result of a disconnection, or discontinuity, of the subjective integration of behaviour, memory, consciousness, emotion, perception, body representation, and motor control that together is seen as a conventional unitary identity.
Dissociation is no longer considered to be a gender specific condition, as hysteria once was. While the larger percentage of DID diagnoses involves females. I presume this is the result of some specific social conventions. For example, males with DID are more likely to end up in the criminal justice system when alters act out with violence, because that is society’s most common response to male violence. Females with DID are more likely to end up in the social service system; a carryover perhaps of the original bias about women and hysteria to see their difficulties as warranting social intervention rather than judicial/criminal. Again, I believe this is due to the mistaken view that DID is uncommon. Therefore, DID is not on the index of suspicion, the radar if you will, of most psychiatrists whether they are providing psychiatric services for males in prison or females in the social services network.
Because of the myriad presentations of DID, it is hard for mental health professionals to fit differently appearing symptoms into any pigeon-hole like diagnostic category. Eventually, one has to resort to awkwardly adding other specified and unspecified conditions to embrace the whole spectrum of dissociative disorders, as in DSM 5. This is quietly acknowledged by including, “Other Specified Dissociative Disorder DSM5 code 300.16 (ICD-10 F44.89) and Unspecified Dissociative Disorder DSM5 code 300.15 (ICD-10 F44.9).
Definitions have power, for good and for ill. Inappropriate or unclear definitions are not helpful. Please remember that Multiple Personality Disorder is not a personality disorder. The term should be written and read as Multiple-Personality Disorder. I have come across this misunderstanding among mental health and medical professionals. For me, this to me is another reason why it may be preferable to adopt the revised terminology of Dissociative Identity Disorder.
