Abstracts
The main objective of this paper is to present the importance of hysteria on Babinski's oeuvre, and the conceptions of pithiatism from Babinski until the one of conversion disorder. Babinski gave a mental basis for hysteria in the place of Charcot's encephalopatic one, and several important semiotic tools to differentiate organic from hysterical manifestations based on studies from 1893-1917/8. His teachings were spread worldwide, and in Brazil they were also appreciated in the work on hysteria by Antonio Austregesilo, the first Brazilian neurology chairman. The neurobiological basis of hysteria conceived by Charcot is nowadays reappraised, and Babinski's neurosemiological contribution is everlasting. The patients believed to be hysterical, and the two outstanding neurologists, Charcot and Babinski, gave support for the development of the modern neurology.
hysteria; Babinski; Charcot; somatoform disorder; conversion disorder; history of Neurology
O objetivo principal deste trabalho é apresentar a importância da histeria na obra de Babinski e a concepção de pitiatismo de Babinski até a de transtorno de conversão. Babinski deu uma base mental para histeria no lugar da encefalopática de Charcot, e várias ferramentas semiológicas importantes para diferenciar manifestações orgânicas de histéricas, com base em estudos de 1893-1917/8. Seus ensinamentos foram disseminados em todo o mundo, e no Brasil eles também foram apreciados no trabalho sobre a histeria por Antonio Austregésilo, o primeiro catedrático da neurologia brasileira. A base neurobiológica da histeria concebida por Charcot é reavaliada hoje em dia, e a contribuição neurosemiológica de Babinski é perene. Os pacientes considerados histéricos e os dois grandes neurologistas, Charcot e Babinski, deram suporte para o desenvolvimento da neurologia moderna.
histeria; Babinski; Charcot; transtorno somatoforme; transtorno de conversão; história da Neurologia
Joseph Jules François Félix Babinski (1857-1932) had at the beginning of his career the
influence of Jean-Martin Charcot (1825-1893) on hysteria conception. Nevertheless, from
1901 on, he presented his own theory about the issue, as well as several approaches to
differentiate organic from hysterical symptomatology what he expressed in several
publications (1893-1917/8)11 Allilaire JF. Babinski and hysteria. Bull Acad Natl Med
2007;191:1329-1339.
2 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
-33 National Institute of Neurological diseases and blindness,
National Institutes of Health, Bethesda, Maryland. Great names in neurology.
Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles
Sherrington and Arthur Van Gehuchten. Prepared for the International Congress of
Neurological Sciences, Brussels, Belgium, July 21-20,1957..
Babinski's work on hysteria is the subject of this paper. Additionally, the thoughts
about hysteria stated by Antônio Austregésilo Rodrigues de Lima (1876-1960)44 Austregésilo A. Novas concepções sobre a hysteria. Arch Bras
Psychiatr, Neurol Med Legal (Rio de Janeiro) 1908;4:52-66.,55 Austregésilo A. Hysteria e syndromo hysteroide. Comunicação à
Sociedade de psiquiatria e neurologia. Arch Bras Psychiat Neurol Med Legal (Rio
de Janeiro) 1909;5:59-77., the first Brazilian professor of Neurology, are
pointed out. Furthermore, the nowadays neurobiological conception and classification of
what was once called hysteria, mainly that with pseudo-physical-neurological symptoms,
are also considered, as well as an appraisal of Charcot's and Babinski's contribution on
hysteria vs. neurology.
Babinski's aim to understand hysteria and differentiate it from organic disorders
Babinski graduated in Medicine at the University of Paris (1884) with a thesis on
multiple sclerosis. He was chosen to become Charcot's chefe de
clinique at La Salpêtrière (1885-1887), a starting point in his
interest on hysteria22 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
,33 National Institute of Neurological diseases and blindness,
National Institutes of Health, Bethesda, Maryland. Great names in neurology.
Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles
Sherrington and Arthur Van Gehuchten. Prepared for the International Congress of
Neurological Sciences, Brussels, Belgium, July 21-20,1957.. He later became a great diagnostician, relying
considerably on clinical findings, and head of the neurological clinic at the
Hospice de la Pitié.
Babinski's academic trajectory may be examined through Oeuvre
scientifique, published by his pupils, two years after his death
(1934), that recollected 288 publications22 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
,33 National Institute of Neurological diseases and blindness,
National Institutes of Health, Bethesda, Maryland. Great names in neurology.
Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles
Sherrington and Arthur Van Gehuchten. Prepared for the International Congress of
Neurological Sciences, Brussels, Belgium, July 21-20,1957.. Babinski's first work on hysteria was about
L'atrophie musculaire dans Ies paralysies hysteriques (1886).
However, over a period of 25 years, he had a long lasting preoccupation to develop
criteria for differentiating hysterical symptoms from signs produced by organic
lesions of the nervous system. This series commences in 1893 with
Contractions organique until 1917-8 (with his book on
Hystérie-pithiatisme et troubles nerveux d'ordre réflexe en neurologie
de guerre)33 National Institute of Neurological diseases and blindness,
National Institutes of Health, Bethesda, Maryland. Great names in neurology.
Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles
Sherrington and Arthur Van Gehuchten. Prepared for the International Congress of
Neurological Sciences, Brussels, Belgium, July 21-20,1957.. In 1896,
three years after Charcot's death, he published the toe phenomenon description,
later known as the Babinski reflex or Babinski sign, in a communication of merely 28
lines22 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
. He made also several
contributions to neurological semiology. In 1901, he launched his Définition
de hysterie, unfolding later his concepts on hysteria. This approach
guided him to advocate that hysteria was a psychical state in which the patient had
a predisposition to self-suggestion, and consequently he recommended the term
“pithiatism” (from the Greek: created by suggestion and curable by persuasion)11 Allilaire JF. Babinski and hysteria. Bull Acad Natl Med
2007;191:1329-1339.,66 Babinski JFF, Froment J. Hystérie-pithiatisme et troubles nerveux
d'ordre réflexe en neurologie de guerre. Paris: Masson et Cie,
1917.. This theory of the preeminence of suggestion, in
spite of being subsequently rejected by many neurologists such as Dejerine and
Raymond, reached large acceptance worldwide11 Allilaire JF. Babinski and hysteria. Bull Acad Natl Med
2007;191:1329-1339.,44 Austregésilo A. Novas concepções sobre a hysteria. Arch Bras
Psychiatr, Neurol Med Legal (Rio de Janeiro) 1908;4:52-66.. Additionally, during World War I, there was a new
neurological charge on “traumatic hysteria”, as first proposed by Charcot.
Furthermore, several Charcot's students became actively involved in medical military
care, including Babinski, who worked with Jules Froment (1878-1946), from the
University of Lyon22 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
. They had to
distinguish patients with nervous organic lesions from those with “pithiatism” and
malingering. In 1917, they published an important book on hysteria (Box 1, Figure)22 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
. Clovis
Vincent incentivized by Babinski to be a neurosurgeon, developed a treatment called
torpillage (literally, torpedoing) for war hysteria, associating painful galvanic
current discharges with “persuasion”, put into practice also to distinguish between
the recalcitrant simulator and the pithiatic11 Allilaire JF. Babinski and hysteria. Bull Acad Natl Med
2007;191:1329-1339.. The last work of Babinski's career was about hysteria:
Reponse à Radovici. Sur l'Hysterie (1930)22 Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph
Babinski (1857-1932), IBRO History of Neuroscience 2008.
[http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
http://www.ibro.info/Pub/Pub_Main_Displa...
,33 National Institute of Neurological diseases and blindness,
National Institutes of Health, Bethesda, Maryland. Great names in neurology.
Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles
Sherrington and Arthur Van Gehuchten. Prepared for the International Congress of
Neurological Sciences, Brussels, Belgium, July 21-20,1957.. From the 1920s on arose not only a growing criticism
on the theories of Charcot, but also a change in the conceptualization of hysteria,
henceforth understood by the neurologists according primarily to Babinski's
theories.
. Babinski facilitated the distinction between functional and organic neurological symptoms. Babinski's description of the cutaneous-plantar response (1896) - now called Babinki's sign, figure B (and its association with pyramidal tract lesions). He described also other differential signs besides that presented in the figure, several others, such as: Sign of contracture of the hand (1893), the first one described by Babinski, where in hysterical hemiplegia, unlike organic, spasticity is such that the examiner cannot introduce his/her fingers between the patient's fingers whose hand is tightly flexed against the palm (figures reproduced from the book by Babinski and Froment66 Babinski JFF, Froment J. Hystérie-pithiatisme et troubles nerveux d'ordre réflexe en neurologie de guerre. Paris: Masson et Cie, 1917.).
Hysteria in Brazil
In Brazil, Antônio Austregesilo at the time physician at the National Hospice for the Insane (1904-1910), considered hysteria as the major diagnosis in women admitted over there77 Gomes MM, Cavalcanti MT. National hospice for the insane and the Brazilian Neurology in the beginning of the 20th century. Arq Neuropsiquiatr 2012;70:823-825.. He viewed it as a “diagnosis of the facility, above all when dealing with females”44 Austregésilo A. Novas concepções sobre a hysteria. Arch Bras Psychiatr, Neurol Med Legal (Rio de Janeiro) 1908;4:52-66.. He believed that “difficult and unusual cases of nervous affections, particularly in women, received a label of hysteria”44 Austregésilo A. Novas concepções sobre a hysteria. Arch Bras Psychiatr, Neurol Med Legal (Rio de Janeiro) 1908;4:52-66.. He defended a division of true hysteria (hysterical syndrome or pithiatism) and a pseudo-hysteria (histeroid syndrome or false hysteria due to other physical or mental disorders)55 Austregésilo A. Hysteria e syndromo hysteroide. Comunicação à Sociedade de psiquiatria e neurologia. Arch Bras Psychiat Neurol Med Legal (Rio de Janeiro) 1909;5:59-77.. In his “New concepts on hysteria”, his first work on the subject (1908), he stated that the phenomenon was produced by suggestion, following the already Babinski's respected ideas11 Allilaire JF. Babinski and hysteria. Bull Acad Natl Med 2007;191:1329-1339.. Austregesilo was also aligned to the currents that placed hysteria in the field of Psychiatry, and in the same way he admitted that hysteria was a psychoneurosis that developed from a large diathesis: “nervousness”, in harmony with Charcot's thoughts44 Austregésilo A. Novas concepções sobre a hysteria. Arch Bras Psychiatr, Neurol Med Legal (Rio de Janeiro) 1908;4:52-66..
Renewing old paradigms with new terminology, but still confusing
The complex construct of “hysteria”, from 1980 until the present time, was split in several diagnostic categories. The term was no longer included in the DSM-III and following editions, and it was mainly replaced by a disorder group under “Somatoform Disorders” and “Dissociative Disorders”, this last one with psychological manifestations. One of the aspects of the hysteria spectrum was called “somatization disorder” and Briquet's syndrome, but this eponymous, in this only edition88 Mai F. Somatization disorder: a practical review. Can J Psychiatry 2004;49:652-662.. The term somatization comes from an English translation (1925) of Organsprache by a Viennese psychoanalyst Wilhelm Stekel, former Freud's pupil88 Mai F. Somatization disorder: a practical review. Can J Psychiatry 2004;49:652-662.. In short, the old Freud's concept of conversion neurosis (unconscious conflicts become converted to bodily manifestations) is today mainly called somatoform (such as conversion and somatization). This somatization concept became characterized by an ample assortment of somatic symptoms affecting different organ systems, and it was enrolled among the five somatoform disorders, the others being conversion, pain, hypochondria, and dysmorphophobic disorders88 Mai F. Somatization disorder: a practical review. Can J Psychiatry 2004;49:652-662.. Regarding conversion disorder (DSM-IV), it involves one or more symptoms affecting voluntary motor or sensory function related to psychological factors, unintentional and unfeigned, resembling neurological or medical ailments99 Owens C, Dein S. Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment 2006;12:152-157.. However, its nomenclature suffered changes over the time: in 1952 (DSM-I), the used term was conversion reaction; in 1968 (DSM-II), hysterical neurosis (conversion type); in 1980 (DSM-III), conversion disorder99 Owens C, Dein S. Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment 2006;12:152-157.. From this time forth, the label ‘dissociation' and ‘conversion' disorders began to be used99 Owens C, Dein S. Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment 2006;12:152-157.. Concerning the ICD-10 (1992), contradictorily, it includes conversion disorder under the category of dissociative (conversion) disorders, together with dissociative amnesia and fugue states99 Owens C, Dein S. Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment 2006;12:152-157..
In conclusion, “Hysteria” was the main leitmotif of Charcot's and Babinski's work. This favored studies on brain-mind link, brain functioning conceptions, nervous (dys)functions, neurological examination and differentiation of several disorders (Box 2).
References
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1Allilaire JF. Babinski and hysteria. Bull Acad Natl Med 2007;191:1329-1339.
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2Clarac M, Massion J, Smith AM. History of Neuroscience: Joseph Babinski (1857-1932), IBRO History of Neuroscience 2008. [http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990]
» http://www.ibro.info/Pub/Pub_Main_Display.asp?LC_Docs_ID=2990 -
3National Institute of Neurological diseases and blindness, National Institutes of Health, Bethesda, Maryland. Great names in neurology. Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles Sherrington and Arthur Van Gehuchten. Prepared for the International Congress of Neurological Sciences, Brussels, Belgium, July 21-20,1957.
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4Austregésilo A. Novas concepções sobre a hysteria. Arch Bras Psychiatr, Neurol Med Legal (Rio de Janeiro) 1908;4:52-66.
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5Austregésilo A. Hysteria e syndromo hysteroide. Comunicação à Sociedade de psiquiatria e neurologia. Arch Bras Psychiat Neurol Med Legal (Rio de Janeiro) 1909;5:59-77.
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6Babinski JFF, Froment J. Hystérie-pithiatisme et troubles nerveux d'ordre réflexe en neurologie de guerre. Paris: Masson et Cie, 1917.
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7Gomes MM, Cavalcanti MT. National hospice for the insane and the Brazilian Neurology in the beginning of the 20th century. Arq Neuropsiquiatr 2012;70:823-825.
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8Mai F. Somatization disorder: a practical review. Can J Psychiatry 2004;49:652-662.
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9Owens C, Dein S. Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment 2006;12:152-157.
Publication Dates
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Publication in this collection
Apr 2014
History
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Received
18 Aug 2013 -
Accepted
26 Aug 2013