Hustvedt’s ignorance over “CFS”
Acting up: is hysteria all in the mind? | Life and style | The Guardian
Asti Hustvedt has written a large book on the “celebrity” hysterics of 19th-century Paris, whose doctor, Jean-Martin Charcot, paraded them before packed lecture theatre audiences who watched them throw fits, and hypnotised “to exhibit the various stages of hysteria”. It is noted that Charcot was discredited shortly after his death and his patients were moved onto more general psychiatric wards, but the author, as the article by Laura Barnett notes, “controversially argues that certain aspects of hysteria are still with us today”. (There is another article on Hustvedt’s book at NPR).
Hustvedt argues:
But some of the facets of what was once termed hysteria, do … still exist: in the many neurological complaints that still go undiagnosed; in eating disorders (some of Charcot’s hysterics refused food); in the increasingly widespread diagnosis of depression (Augustine, Blanche and Geneviève all led extremely troubled and traumatic lives: towards the end of his life, Charcot was approaching a psychosomatic explanation for their symptoms); in self-mutilation, multiple personality disorder and chronic fatigue syndrome; and even in the sudden outbreak of rashes reported by schoolgirls across America in the wake of 9/11.
Some of this could be down to the fact that Charcot put any unexplained, possibly neurological but possibly partly psychological, disorder in a woman down to his pet diagnosis of hysteria. In the early part of the 20th century, a large proportion of the population of the UK, and presumably France, were infected with syphilis; the availability of antibiotics, particularly penicillin, cut this rate drastically in the last century, but if allowed to progress, it can lead to dementia and paralysis.
I’ve read the bit of Hustvedt’s book related to “chronic fatigue syndrome” and clearly she inclines to the view that the condition is indeed a form of hysteria. She alleges that patients insist on calling it myalgic encephalomyelitis as a way of legitimising their condition, and puts the term in the index in quote marks, and notes that when Elaine Showalter named the condition along with Gulf War Syndrome as latter-day hysteria in her book Hystories, she received death threats. Of course, when you offend a huge number of people (intentionally or otherwise), you are likely to get a proportion of hate mail; it does not reflect on the patient community as a whole. She notes in the book that the illness was briefly linked to the Epstein-Barr virus in the 1980s but that this theory was discredited, and that antibodies to the virus are present in the sick and in the “energetically spry”. The virus does cause glandular fever (or infectious mononucleosis as it is known in the USA), but also causes several varieties of cancer. Of course, not everyone who is infected with EBV gets cancer, but this does not prove that it does not cause ME either, although the consensus is that it does not. Many other types of virus, notably enterovirus, have been associated with it over the years, particularly given its tendency to occur in epidemic form at the same times as polio outbreaks.
Some conditions were labelled hysteria before their neurological bases were demonstrated — multiple sclerosis and Parkinson’s disease are two examples, and Hilary Johnson notes that when MRI scanning became available, some female patients who had been previously diagnosed with schizophrenia were released when the new scans indicated a diagnosis of MS. In the case of ME, it is not a fancy medical name for chronic fatigue but a term well-established and accepted before the mid-1980s. There had been one paper suggesting that an outbreak of ME at Royal Free Hospital in London was in fact mass hysteria, but this was written by two psychiatrists who had not met any of the patients and was an isolated opinion.
The label of hysteria has been thrown at many ME patients who were clearly physically ill and who, unlike the three French women Hustvedt mentions, had no reason to become hysterical; like the MS and Parkinson’s patients, clear evidence of physical illness was found in many of them, including, in one case, hypothalmic dysfunction and a shrivelled pituitary gland, and in others, dorsal root ganglionitis, and abnormal brain scans. The casual inclusion of “chronic fatigue syndrome” among conditions which show facets of hysteria will cause a great deal of hurt to people who have already suffered a great deal, but that is not the main reason for not doing it; it is just factually wrong, and ignorant.
