Hysteria as a real disease: is hysteria a genuine disorder of mental synthesis rather than malingering or mere suggestion?

Pierre Janet, answered from the texts and cited to the page.

The position in brief

Hysteria is not the pretense of the malingerer nor the mere product of the physician's suggestion, though suggestion plays its part. It is a real malady, and its essence is a malady of the personal synthesis: a narrowing of the field of consciousness, in which the mind, lacking force to hold all its functions together, contracts — abandoning a portion of its sensations, memories, and members, which then fall out of awareness and out of voluntary control.¹²

The anesthesia is a real not-perceiving, the paralysis a real not- willing; the patient does not feel the pricked limb, does not command the still arm — not because she feigns, but because that sensation, that movement, has been dropped from the contracted field of the personal consciousness. Hysteria is the disease of a mind that cannot keep itself whole.

To call it imaginary is to misunderstand it; the splitting is real, the loss is real, and it follows laws that can be studied and treated.³⁴

Sources

1. This individual, although he may already have the field of consciousness contracted, is not an anaesthetic, but one absent-minded, and this study tries to represent what is called normal absent-mindedness. Let us go a little farther, and we shall have the theoretical representation of anaesthesia.

   The Mental State of Hystericals, pp. 39–40

2. If it is wanting, it is because the mind is too narrow to contain several ideas opposing one another. The second characteristic, exaggerated absent-mindedness, that abstraction bringing on all the blanks of consciousness, is but another aspect of the same phenomenon. Our schema gives us the formula perfectly. Let us suppose (Figure 22) an individual who cannot see, at r a! A" A' A'^ H- Fig. 22.

   The Major Symptoms of Hysteria, pp. 308–310

3. I think it results from a general disposition of the hysterical mind, which urges it to move in its entirety to one side, while neglecting the rest of the body and mind, then to move in its ensemble in another direction, while forgetting the first. This is connected with the preceding phenomenon of suggestion, and constitutes the last of the stigmata peculiar to hysteria that I wished to point out to you.

   The Major Symptoms of Hysteria, pp. 303–304

4. The exaltation of the automatic phenomena springs generally from a diminution in the power of the voluntary activity which at every instant of our life reunites the present phenomena.

   The Mental State of Hystericals, pp. 506–507

Where the argument is made

• The Mental State of Hystericals (1901)
• The Major Symptoms of Hysteria (1907 — hysteria as a narrowing of the field of consciousness and a disease of personal synthesis)

How the argument was received

Janet's account of hysteria as a genuine disorder of mental synthesis (a narrowing of the field of consciousness), not malingering, was a major clinical advance and is broadly vindicated in its core. The diagnostic category "hysteria" has since dissolved and been dispersed into modern categories — conversion / functional neurological disorder, the dissociative disorders, and post-traumatic conditions — but these are recognized as real disorders with real (functional, dissociative) mechanisms, which is Janet's central contention. The historical qualification is that the florid grande hystérie of the Salpêtrière was partly shaped by Charcot's clinic and by suggestion (a point Janet himself helped establish), so specific period presentations are read as clinically constructed; but the underlying claim — that these are real disorders of synthesis and dissociation, not fakery — is exactly the modern view.