A Unitary Syndrome?

However, some workers take the opposite point of view. Observational support for the existence of "hysteria " as a unitary syndrome has been claimed by Purtell, Robins, and Cohen (1951). The patients were diagnosed by the authors, and were compared with a control series. There were significant differences between the, two groups of patients, hysterics and non-hysterics, in the frequencies of a number of clinical findings - for example, the number of past hospitalizations, the variety of symptoms, the degree of social adjustment, etc. The authors think, as Head did, that the clinical picture is sufficiently characteristic for practical use; but no evidence is offered that the case material is homogeneous.

    Guze and Perley (1963) define "hysteria" as a syndrome which starts early in life, which occurs mainly in the female, and which is shown by recurrent symptoms in many different organ systems. Conversion symptoms are included, but there are many others: pains of all kinds, menstrual disorders, anxiety symptoms, etc. An excess of hospitalizations and of operations form part of the picture, as also do attention-getting and manipulative behaviour. So defined, this syndrome shows a certain amount of stability (Perley and Guze, 1962), and in twothirds of the patients so diagnosed (11 out of 17) the diagnosis was confirmed on follow-up. The authors think that a valid and distinct clinical syndrome is defined ; but that its chief usefulness is to permit one to refuse to make the diagnosis let us say, when faced by a case in which conversion symptoms are prominent but which lacks the required characteristics.

    "Hysteria " in this sense is a serious illness which runs a chronic course, lasting many years without remission; and it is a very rare one. It reminds one of that mythical disease "paranoia," which was defined by Kraepelin in much the same way. All the stability in the syndrome is supplied by the criteria of selection. If one accepts only patients who have been ill for a long time, one learns little from finding them still ill some years later. From this consistency alone no guarantee is provided that the group, small as it is, is homogeneous.