Abstract
In 1959 I suggested that the term ‘hysterical pain’ be replaced by the term ‘psychogenic regional pain’. Now, with this innovation having proved useful, I am suggesting that the term ‘psychogenic and regional' replace the term ‘hysterical' for the following sensory and motor symptoms and signs: pain, tenderness, sensory deficits, motor deficits of power, movement and posture, ataxias, involuntary movements and fits. These are the sensory and motor phenomena which have been called ‘hysterical’ or due to ‘conversion hysteria’ or due to ‘conversion reaction’.
‘Psychogenic' means being evoked by psychical factors. ‘Regional' indicates a bodily region of contiguous parts as a strip, area or volume with boundaries defined by psychical circumstances. This is a bodily region of psychological reference with all the parts in the contiguous locality co-operating together in regional behaviour that has psychical significance.
By dropping the term ‘hysteria' from all these symptoms and signs we avoid the confusing fact that the phenomena occur in all sorts of psychoses and neuroses and are not confined to any clinical condition which might be called ‘hysteria’. The phenomena also often occur in persons who do not have a personality which could be called ‘hysterical’. Furthermore, persons with ‘hyterical personalities' do not necessarily develop such symptoms and signs. Incidentally the term ‘psychogenic regional' releases these phenomena from any implication that they are necessarily ‘conversion' reactions. While a conversion process may be one way such sensory and motor features come about, the conversion mechanism may produce other symptoms and signs and the sensory and motor signs may be produced by other processes than conversion.
The term ‘psychogenic regional' has the advantage that it leaves these symptoms and signs as natural phenomena, defined and denoted descriptively, free of any concept of specific disease entity or psychodynamic process. By this means the natural history of these sensory and motor features can be elucidated independently of other considerations. By the same means such concepts as hysteria, conversion, dissociation, symbolization and regression can be varied from time to time without disturbing the identity of these signs. With the new clinical, neurophysiological and psychosomatic knowledge we can expect the usefulness of the term ‘hysteria' to decline and the meaning of the term ‘conversion' to be extended. We can also expect new knowledge of the representation at bodily sites by remote localization, by symbolization, by somatic hallucination or by somatic excitation or inhibition. We can expect new knowledge of the involuntary action of the voluntary nervous system and of the voluntary and behavioural action of the involuntary autonomic nervous system. The role of affective, schizophrenic, regressed, dissociated and disintegrated states is relevant to much of the psychopathology and calls for attention. The new neurophysiology of behaviour will be likely to provide models which will help us to understand how somatic analogues can be related to psychic experience as non-verbal body language.
In the past it has been a matter of historical accident that these sensory and motor symptoms and signs have been called ‘hysterical' and related to ‘hysteria’. It is now recommended that such terms be dropped and that these symptoms and signs be given the simple descriptive designation ‘psychogenic regional’. With this, we should speak of ‘psychogenic regional' pain, tenderness, anesthesia, paralysis, fixed posture, ataxia, involuntary movement or fit or convulsion. When such symptoms and signs occur with ‘la belle indifférence’ they can be denoted as ‘complacent re-actions’. This will make for accuracy in clinical descriptions and clarity in thinking of pathological processes.