Julio Torres, Intern
Carol S. North and Sean H. Yutzy edited the sixth edition of Goodwin and Guze’s Psychiatric Diagnosis, which provides an overview of major psychiatric disorders, covering the definition, historical background, epidemiology, clinical picture, natural
history, complications, family studies, differential diagnosis, and clinical management of each disorder.The excerpts bellow recount the place in history of panic disorders and phobias, and hysteria —what’s fascinating about both histories is the cultural emphasis in women as bearers of these disorders. In both cases, earliest observations (even in their most primitive, often inaccurate form) dealt almost exclusively with women and were constantly paired with superstitions of the time. The trend articulates the phenomenon of sexism in early psychological research.
Panic Disorder and Phobias
My cheek is cold and white, alas!
O lift me from the grass!
I die! I faint! I fall!
…
My check is cold and white, alas!
My heart beats loud and fast.
Percy Bysshe Shelley,
The Indian Serenade
It has been suggested that Shelly was having a panic attack when he wrote these lines. If so, he probably would have called it something else. In the nineteenth century, “anxiety reactions’ referring to fainting—which was fashionable among women in the era—were called “vapors.” Modern patients with panic disorder also sometimes faint—probably from hyperventilating. In Victorian times the prototype of a refined young woman was a “sooner, pale and trembling, who responded to unpleasant or unusual situations by taking to the floor in a graceful and delirious maneuver, in no way resembling the crash of an epileptic”… A Jane Austen heroine found one social situation “too pathetic for the feelings of Sophie and myself. We fainted alternately on a sofa.” Overly tight corsets may have been responsible for some of the fainting. A nineteenth-century physician, Dr. John Brown, cured fainting by “cutting the stay laces, which ran before the knife and cracked like a bow string”…
One of the first medical terms to describe anxiety disorders was “neurasthenia,” defined by an American physician, G.M. Beard, in 1869… Neurasthenia broadly included patients with hysteria, obsessional illness, and anxiety disorders, as well as hypochondriacs and swooners… The term “anxiety neurosis” was first used by Freud in 1895. It was not until 1980 that the concept of neurosis was dropped form American Psychiatric Association general nomenclature, and the term “panic disorder” replaced the older term “anxiety neurosis” as the disorder’s official name… Panic disorder was later subdivided into two types, with and without agoraphobia…, a distinction that still holds today.
The term phobia originates from the name of a Greek god, Phobos, whose likeness was painted on masks and shields for the purposes of frightening the enemy… The word phobia first appeared in medical terminology in Rome 2,000 years ago, when hydrophobia was used to describe a symptom of rabies. Hippocrates also described cases of phobic fears.