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126hystericalyears-thecontributionofHisteria126anosacontribuiçãodeCharcotHélioAfonsoGhizoniTeive,FranciscoM.B.Germiniani,RenatoPuppiMunhoz,LucianodePaolaABSTRACTTheauthorssummarisetheconceptsofhysteria,emphasizingtheseminalcontributionofCharcottoitsstudy.Keywords:hysteria,conversion,functionaldisorders.RESUMO UnidadedeDesordensdoMovimento,ServiçodeNeurologia,DepartamentodeClínicaMédica,HospitaldeClínicas,UniversidadeFederaldoParaná,CuPR,Brazil;MovementDisordersCentre,TorontoWesternHospital,UniversityofToronto,TorontoON,Canada; 10.1590/0004-282X20140068 HISTORICALNOTES Inthe1770sFerriar,anEnglishdoctor,introducedthetermhystericalconversion.Duringtheeighteenthandnine-teenthcenturieshysteriaandepilepsywereconsideredcor-relatediseasesandtherelationshipbetweenhysteriaandsexuality,namelysexualfrustration,werelinked.Hysteriacouldalsobeaddressedbyothernames,suchashysterialibi-dinosafuroruterinus.In1859Briquet,aFrenchphysi-cian,publishedhisbookonthesubjectentitledonhysteria.Duringaperiodof10yearsBriquetstudied430casesofhystericalpatientswithdifferentconversionsymptoms,suchasspasms,anesthesias,hyperesthesias,paralysis,andconvulsions.AfterBriquetsseminalstudy,thegalenic-hippocraticuterinetheorywaschanged,emphasizingtheroleofthebrain,andhysteriawasnamedsdisease.AnotherimportantcontributiontothestudiesofhysteriacamefromCharlesLasègue,whopub-lishedseveralstudiesabouthystericalcough,hystericalanesthesia,catalepsyandhystericalataxiaCHARCOTSCONTRIBUTIONTOHYSTERIAProfessorCharcotstartedhisactivitiesattheSalpêtrièrehospitalin1862andin1882anewdiscipline,thestudyofDiseasesoftheNervousSystemwascreatedforhim.Fromthattimeonwards,untilhisdeathin1893,CharcotreignedasthemostcelebratedneurologistoftheXIXcentury.HewasunanimouslyregardedasthefounderofNeurologyandtheParisianSalpêtrièreHospitalwasaptlyconsideredastheMeccaofWorldNeurology.Duringhistime,scontributionstoNeurologywereenormous,includingthedescriptionofseveralneurologicaldiseases,suchasamyotrophiclateralsclerosis(laterknownassdisease),multiplesclerosis(scléroseenplaquesCharcot-Marie-Toothsdisease(hereditarysensoryandmotorneuropathy),theclinicaldescriptionofParkinsondisease,Tourettessyndrome(Maladiedestics),tabeticarthropathy(Charcotsjoints),thepathogenesisofintra-cerebralhemorrhage(themicroaneurysmsofCharcot-Bouchard),andstudiesofcerebrallocalization,amongmyriadothersBytheendofhisacademiccareer,Charcotwasalsointerestedinhysteria(hysteroepilepsia)andhypnosis.Inthelate1870sCharcotandtheSalpêtrièresSchoolofNeurologydefinedhysteriaasaneurologicaldisease,withanon-visibledynamicorfunctionallesion3,6Theveryfamousanatomo-clinicalmethodhadfailedindemonstratinganyneuropathologicallesion.CharcotandhisdisciplePaulRicherdefinedthatahysteriaattack(grandehystérie)wascomposedoffourstages:(1)Epileptoid;(2)Contortionsandacrobaticpostures(Clownism);(3)Emotionalgestures(attitudespassionnelles);and(4)finaldelirium.MostofthepatientsstudiedwerewomenandCharcotalsoassociatedhysteriato Table.Historicalsummaryofresearchersanddifferentconceptsregardingtheoriginsofhysteria,fromancienttimesuntilthepost-Charcotperiod.TimeperiodResearcher(s)Concept/contributionRationaleAncient/classicaltimes(Egypt,GreeceandRome)HippocratesFrustrateduterusLackofsexualintercourseToxiceffectsoftheWomband19centuries,priortoCharcotFerriarHystericalconversionSexualfrustrationBriquetTreatiseonhysteriaDifferentclinicalpresentationsofhystericalsymptoms,ruledoutthegynecologicaloriginLaségueHystericalanesthesia,ataxia,cataplexy,CharcotsSalpêtrièresyearsCharcotHysteriaasaneurologicaldiseaseDynamic,functionallesionCharcotandFourstagesofthehystericalattackgrandehystérie):(1)Epileptoid;(2)Clownism;(3)emotionalgestures(attitudespassionnelles(4)finaldelirium.esttoujourslachosesexuelleLackofsexualintercourseCharcotMalehysteriaTraumaticshockCharcotHypnotismPost-CharcotperiodBabinskiPithiatismPsychicstatepronetosuggestionJanetSubconsciousSubconsciousfixedideasFreudConversionhysteriaFreudTherapeuticalcatharsisYellandShellshockTraumatic(war)shockHélioAfonsoGhizoniTeiveetal.Histeria126yearsscontribution sexualintercourse,orlackthereof,evencoiningaveryfamousstatementabouthysteria:esttoujourslachose.Afterthatstatement,hysteriawentontobecomearemarkableandeventrendy,fashionabledisease,andspatients,includingseveralwomen,someofwhich,suchasJustineEtchevery,RosalieLeroux,Augustine,and,particularly,BlancheWittman(Figure),wouldbecomeknownworldwideCharcotusedhypnotismasanexperimentaltechniquetotreathystericalpatientsandthisapproachbecameverypopularwiththegeneralpublic.However,inacademiccir-cleshypnosiswasconsideredanon-scientifictreatmentandCharcotbecamethetargetofheavycriticism.AnothercontributionofCharcotwasthedefinitionoftraumaticmalehysteria.Finally,in1893CharcotstatedthattheSalpêtrièreconceptofhysteriahadbecomeobsoleteandthatitneededtoundergoaprofoundrevision,butafewmonthslaterhediedsuddenlyHYSTERIAAFTERCHARCOTAfterCharcotsdeathin1893,thecontinuinginvestiga-tionofhysteriahadotherprotagonists.InthegroupofProfessorCharcotsdisciples,GeorgesGillesdelaTourette,PaulRicher,PaulSollierandCharlesFerèpublishedstudiesinaccordancetotheSalpêtrièresmaster;however,anotherbranchofCharcotsdisciples,suchasPierreJanet,SigmundFreudandJosephBabinski,developedotherhypo-thesesthatwouldclashwiththeirmentorsvision.Babinskidefinedhysteriaasapsychicstatethatwouldgivethepatienttheabilityofauto-suggestion,sothatthepatientwouldbeabletobepersuadedandthereforewaspronebysuggestion.BabinskicreatedthetermPithiatismandalsopublishedastudyabouthypnotismandhysteria.Janetcreatedtheconceptoffixedideasasanunderlyingmechanismforhysteria,whilescontributionsincludeddiscussingtheconceptofconversionhysteriaanddescribingthefirsthistoricalcaseoftherapeuticcatharsisinafamouspatient,aJewishwomannamedBerthaPappenheim,a.k.a.AnaO.Duringthefirstworldwar,acrossthepond,malepatientswouldalsobediagnosedwithhysteria:inFrance,ClovisVincenthadapivotalrolewithhisstudiesandthedevelopmentofthetorpillagemethodoftreatment,whereasintheUK,LewisYeallandcontributedbystudying196soldierswithfunctionalmotorandsensorysymptoms,functionalseizuresandsomatoformdisordersresultingfromwitnessingexplo-sions(shellshockHYSTERIAINTHEXXCENTURYDuringmostoftheXXcenturytheinterestinthestudyofhysteriasufferedaprogressivedecline,butbytheendoftheXXcenturyandthebeginningofXXIcenturyanewinterestreklinded.Psychogenicmovementdisordersandnonepilepticseizures,nowdefinedasfunctionaldisorders,representanimportantgroupofdiseasesevaluatedinneurologicalservicesworldwide,withexpress-iveprevalence4,5,7Inconclusion,thestudyofhysteriawasoneofthegreatcontributionsofProfessorCharcottoNeurology,andalthoughhisconceptsconcerningitwereopenlycriticizedatthetime,nowadaysanewinterestinthestudyofthisstillsomewhatunknownconditionanditsintersectionwithneuropsychiatryhasresurfaced.1.StoneJ,LafranceJrWC,LevensonJL,SharpeM.IssuesforDSM-5:conversiondisorder.AmJPsychiatry2010;167:626-627.2.MaiFM.Hysteriainclinicalneurology.CanJNeurolSci1995;22:101-110.3.GoetzCG,BonduelleM,GelfandT.Hysteria.In:GoetzCG,BonduelleM,GelfandT(Eds).Charcot:ConstructingNeurology.OxfordUniversityPress,NewYork,USA,1995:172-216.4.GoetzCG.Charcotandpsychogenicmovementdisorders.In:HalletM,FahnS,JankovicJ,LangAE,CloningerCR,YudofskySC(Eds).Psychogenicmovementdisorders.LippincottWilliams&Wilkins,Philadelphia,USA,2006:3-13.5.BogousslavskyJ.HysteriaafterCharcot:backtothefuture.FrontNeurolNeurosci2013;29:137-161.6.TeiveHAG,AlmeidaSM,ArrudaWO,SáDS,WerneckLC.CharcotandBrazil.ArqNeuropsiquiatr2001;59:295-299.7.MunhozRP,ZavalaJA,BeckerN,TeiveHA.Cross-culturalinfluencesonpsychogenicmovementdisordersacomparative AclinicallessonattheSalpêtrière,theoriginalpaintingexhibitedattheMuséedelHistoiredelaMédicine.PicturetakenbyoneoftheauthorsFranciscoM.B.attheMuseum,on18May2012.ArqNeuropsiquiatr2014;72(8):636-639 reviewwithaBrazilianseriesof83cases.ClinNeurolNeurosurg2011;113:115-1188.PhilipponJ,PoirierJ.Pithiatismversushysteria.In:PhilipponJ,PoirierJ(Eds).JosephBabinski,OxfordUniversityPress,Oxford,UK,2009:297-319.9.LindenSC,JonesE,LeesAJ.ShellshockatQuennSquare:LewisYealland100yearson.Brain2013;136:1976-1988.10.CritchleyEMR,CantorHE.Charcotshysteriarenaissant.BrMedJ1984;289:1785-1788.HélioAfonsoGhizoniTeiveetal.Histeria126yearsscontribution