In view of current understanding that clinical aspects of hysteriaii1 ve changed along ´ with the socio-cultural transition, Korea, now in rapid process of modernization and acculturation, was considered to provide a sensitive indicator of such possibility. Nevertheless, study of hysteria has been very scarce; only 2 papers were reported in Korea 10 years ago. The authors tried to understand the clinical aspects of current hysteria by vertical and horizontal comparisons and by producing it´s cross-sectional picture.
The records of -199 ?n pati.?rrts of hysterical neur osis, discharged from hvung flee University Hospital, Department of Neuropsychiatry during the period from Oct. 11. 1971 to Sep. 8. 1974 were studied. One hundred and eighty three nonhysterical neuropsychiatric cases were contrasted to the index group to compare educational and socio-economic status. Some of the results were compared to the data obtained 10 years ago in Korea, as well as those of Western world.
Admission rate was 11.09% of all admissions, and excluding 7 male subjects, 23.44% of all female admissions. Forty subjects were of conversion type, and 9 were dissociative type. Mean age was 26.98±9.45 years (range; 10-59). and subjects aged 16 or less occupied 10. 20%.
An analysis of distribution of the symptoms revealed that a definite transition from typical to atypical symptom manifestations occurred during last 10 or more years. Total number of typical symptoms including, sensory symptoms excluding pain, motor and dissociative symptoms and la belle indifference, was 142, whereas the number of atypical symptoms including pain, other neurotic symptoms of psychological expression, psychophysiological and other symptoms, was 230. Thirteen patients out of 50 had manifested hysterical convulsive symptoms 10 years before this report, but the number was dropped to 5 out of 49 in the present study. Ten years before, pain had been the primary complaints of 2 hysterical patients out of 50, but it was increased to 5 of 49. Moreover, pain was the most frequent symptom unit among others and was complained of by three quarters of those who complained of all sensory symptoms; nonhysterical, neurotic complaints of psychological character, such as anxiety, depression and phobia were noticed in 57% of all patients, while la belle indifference was apparent in only 20. 4 psychophysiological symptoms were found in 59% of patients; typical motor symptoms such as convulsive symptoms, aphonia, astasia-abasia and typical ammesia were seen only in a few cases. Moreover, sensory symptoms, especially pain, a verbal mode of appeal, were noticed more frequently and comphtely in hii~lter class :uul the non verbally appealing motor and dissuciatke symptoms in lower class. A sharp contrast was seen in the distribution of the other neurotic symptoms belle indifference; other neurotic symptoms were apparent significantly more in the higher class, whereas the la bellle indifference, far more in lower class at the level of 0.01 A very interesting finding was that excitement and/or devastating emotional lability were found in more than half of the subjects. This seemed to be unusual at first glance, but it was not too hard to understand with a little speculation, in so far as this phenomenon could be quite a natural accompaniment of so prevalent anxiety, phobia and panic in the subjects, and the inherent personality characteristics of excitability, over-reactivity and emotional lability could easily be elicited in so painful situations, especially in the general social atmosphere of indifferent individualism. Considering all these factors. still there must be some other reasons stemming possibly from cultural factors, i. e. the speed of acculturation. Traditional social inhibition of emotional expression has been abruptly relaxed, hence even in situations that necessitates expression of tensely charged emotion, remnants of strong inhibition should have reacted to result in felt anxiety and excitation. Futhermore, traditional social inhibition and consequent placement of ve on perseverence on the part of married females should have resulted in extreme repression. When this repression is demolished, the result should be either excitement or uncontrollable emotional lability.
Another remarkable finding was that there was no sexual and it´s allied symptoms apparent in spite of the fact that the vast majority of them complained of marital discord with husbands. This was attributed to the well nigh established manners of patients and doctors alike to avoid such topics, representing still forceful sexual repression. But in authors´ in pression, this might be partly due to their relatively frequent expression of such conflicts in other symbolic, physical symptoms, as was seen ingp many phallic symbolizations.
This apparently changing picture of the sympto matology was attributed to elevated level of medical knowledge on the part of general population due to improved educational levels and dissemination of mass media, together with prevalence of social individualism, resulting in cold and indifferent attitude to one another, forcing in effect, those with inner conflicts and outer stresses to choose some definite new ways of appeal ensuring definite secondary gains which had been very difficult to obtain by typical and primitive symptoms only. Another relevent factor maybe socially permissive attitude towards verbal expression of emotion, resulting from increasing individualism and decreasing authoritarianism, hence the increase of verbal modes of symptom manifestation, as seen in the increase of pains. However, we seem to be somewhere in between, wandering between traditional social inhibition and permission, between sexual inhibition and it´s liberalism, and between the extremes of social authoritarianism and individualism. This was manifested by the abundance of felt anxiety, depression, phobia, excitement and emotional lability.
Contrast of the educational and social status with those of control group revealed statisticallly significant results; college leveled persons were less and the illiterate were more in percentage, and higher class was much less and lower class much more frequent in proportions.
The mean number of sibling was 5.02±2.15. There was no significant difference in the occurrences of each different sibling order compared to the expected occurrences in general population. No significant difference was noticed between the occurrence of the "eldest daughter" who had one or more younger sister, and the expected occurrence, nor between the "last born" counting both sexes and it´s expected occurrence. The presence and absence of male elder and younger brothers did not affect the occurrence ratio of hysteria.
Frustration and oversatisf action experienced early from their parents accounted for 56. 1% of all subjects, while no definite pathology was apparent in only 16. 3%. Frustration outnumbered oversatisfac - tion by 35.7° vs. 19. 1%, and frustration came from father and mother alike, that from father being rather more in number. The authors speculated from this finding that paternal influence might play some independent role, at least in traditional cultural matrix of Korea where mothers have almost invariably been dependent on fathers and totally powerless by themselves.
Another interesting finding was that 48 of 49 subjects were in the groups of married females and single females and males, and only one was married male. According to strongly patriarchal tradition of Korean society, married man has been forced to be independent and responsible with his given authority and power, while married woman and children of both sexes just belonged to the father, being totally dependent and imposed by codes of silent acquiesence and perseverence in distresses; in short, they have been the oppressed, the dependent. Counting the fact that one married male in this group was also psychologically and financially dependent on his elder brother, no one in this group was in independent, responsible social position. This finding was in concordance with that of Hollingshead et al who reported that hysteria, different from other neuroses, was more prevalent in classes 4 and 5, and with Kim´s report that he could not find any officer
subject among 40 of male soldier hysterics. The analysis of persons related to the precipitating factor and secondary gain also adds to this line of conclusion. They were, in short, ´male elders´, those who got direct hold of the patients and whom the patients had to obey and dependent upon.
The foregoing data of incidence by subgroups divided by marital status, of the characteristics of symptoms, and the targets of precipitating factor and secondary gain, all converged on married females in the number and intensity of them. Why? Aside from the most probable and important reasons attributable to hysteria per se, some cultural influence may play it´s role here again. Married females have been counted as the extrafamilial from her original family soon after marriage, in the new homes, they should obey silently to husbands and other families-in-law, in so restricted a circle in social life that their only object of intimate personal relationship has been limited to husbands only. When persons who had experienced those frustrations or oversatisfactions in early life, arc encountered by this situation, what will be more ready way out than through hysterical resolution ?
|