An essay on the Charcot and Richer hysteria: from charcoal drawings to cell phones

Hysteria, previously also known as the disease of the womb, has moved from being a woman's illness through the medieval times' stigma of demonic possession, to the modern concept of a functional neurological disorder. Interestingly to the present assay, Charcot (1825–1893) and Richer (1849–1933) described, in their 1887 work Les Démoniaques dans l'art, by means of iconography, semiological aspects of the so-called Grande Attaque Hystérique, which resembles features of psychogenic nonepileptic seizures emulating grand mal epileptic seizures. The aim of the present assay is to describe how those charcoal iconographic representations evolved through history and are nowadays portrayed in videos recorded at epilepsy monitoring units and patients' cell phones.

Keywords
Hysteria; Conversion Disorder; Dissociative Disorders; Epilepsy; Epilepsy, Tonic-Clonic

Authorship

Marlon Wycliff Caeira

conceptualization

data curation

video editing

writing – original manuscript

Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Epilepsia, Curitiba PR, Brazil.Universidade Federal do ParanáBrazilCuritiba, PR, BrazilUniversidade Federal do Paraná, Hospital de Clínicas, Serviço de Epilepsia, Curitiba PR, Brazil.

https://orcid.org/0000-0001-9094-4141

Leo Coutinho

conceptualization

data curation

writing – critique and review of original manuscript

Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Distúrbios do Movimento, Curitiba PR, Brazil.Universidade Federal do ParanáBrazilCuritiba, PR, BrazilUniversidade Federal do Paraná, Hospital de Clínicas, Serviço de Distúrbios do Movimento, Curitiba PR, Brazil.

https://orcid.org/0000-0003-4921-2939

Igor Abrahim Nascimento

video editing and review of original draft

https://orcid.org/0009-0009-9381-1286

Luciano de Paola

conceptualization

resources

video editing

writing – review of final manuscript

https://orcid.org/0000-0002-0512-610X

Hélio Afonso Ghizoni Teive Address for correspondence Hélio Afonso Ghizoni Teive (email: hagteive@mps.com.br)

conceptualization

resources

writing – critique and review of final manuscript

Universidade Federal do Paraná, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna, Curitiba PR, Brazil.Universidade Federal do ParanáBrazilCuritiba, PR, BrazilUniversidade Federal do Paraná, Departamento de Medicina Interna, Programa de Pós-Graduação em Medicina Interna, Curitiba PR, Brazil.

https://orcid.org/0000-0003-2305-1073

Address for correspondence
Hélio Afonso Ghizoni Teive (email: hagteive@mps.com.br)

Conflict of Interest

The authors have no conflict of interest to declare.

Editor-in-Chief

Ayrton Massaro.

Associate Editor

Ylmar Correa-Neto.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (2)

Thumbnail

Figure 1
(A) Période épileptoide of the hysterical attack from Les Démoniaques dans l'art.⁸8 Charcot JM, Richer P Les démoniaques dans l'art: Hachette Livre-BNF; 2018 (B) Similar semiological features are present in a patient in our practice diagnosed with psychogenic non-epileptic seizure (PNES), who shows both upper limbs in extension, crossed legs, tilted head, and closed eyes and fists, along with unresponsiveness during the functional seizure. (C) Période de clownisme and grands mouvements in a male patient in the Richer drawing depicted with opisthotonus − the arc de cercle (D) and in a patient of ours diagnosed with PNES. (E) L'attitude passionnelle, the contemplative attitude found in Les Extatiques (F) and the same facial expression in a patient of ours with the diagnosis of PNES after vEEG. (G) Période épileptoide, phase de résolution − after the seizure-like phenomena of the Période épileptoide, follows the resolution phase of the hysteric attack as depicted by Richer. (H) A similar asthenic expression was also observed in one of our patients following a functional seizure. The patients' eyes were blacked out to preserve their identities for ethical purposes.

Thumbnail

Figure 2
(A) Grands mouvements. Pelvic thrusting movements and sustained elevation of the legs present in the clownism phase of the grande attaque hystérique as depicted in Les Démoniaques dans l'arts.⁸8 Charcot JM, Richer P Les démoniaques dans l'art: Hachette Livre-BNF; 2018 On the frames of the upper panel, a young male patient presents alternating movements of the lower limbs and trunk over the hips, both arms were crossed in a posture unfit for an epileptic seizure. The movements could be stopped and be induced by the touch of the technician. (B) In the lower panel, one can see the generalized contractures in the période terminale of the attack as depicted by Charcot and Richer, and examples of generalized contractures and bizarre postures at the end of a functional seizure. Both patients tend to opisthotonus, with the patient on the left lying down with both eyes open and a similar dystonic posture of the hand as shown in the drawing, while the patient at the botton right of the figure presents with hand drop, eyes closed and an asymmetrical contracture of head and neck muscles with jaw deviation to the left. The patients' eyes were blacked out to preserve their identities for ethical purposes.

Figure 1 (A) Période épileptoide of the hysterical attack from Les Démoniaques dans l'art.⁸8 Charcot JM, Richer P Les démoniaques dans l'art: Hachette Livre-BNF; 2018 (B) Similar semiological features are present in a patient in our practice diagnosed with psychogenic non-epileptic seizure (PNES), who shows both upper limbs in extension, crossed legs, tilted head, and closed eyes and fists, along with unresponsiveness during the functional seizure. (C) Période de clownisme and grands mouvements in a male patient in the Richer drawing depicted with opisthotonus − the arc de cercle (D) and in a patient of ours diagnosed with PNES. (E) L'attitude passionnelle, the contemplative attitude found in Les Extatiques (F) and the same facial expression in a patient of ours with the diagnosis of PNES after vEEG. (G) Période épileptoide, phase de résolution − after the seizure-like phenomena of the Période épileptoide, follows the resolution phase of the hysteric attack as depicted by Richer. (H) A similar asthenic expression was also observed in one of our patients following a functional seizure. The patients' eyes were blacked out to preserve their identities for ethical purposes.

Figure 2 (A) Grands mouvements. Pelvic thrusting movements and sustained elevation of the legs present in the clownism phase of the grande attaque hystérique as depicted in Les Démoniaques dans l'arts.⁸8 Charcot JM, Richer P Les démoniaques dans l'art: Hachette Livre-BNF; 2018 On the frames of the upper panel, a young male patient presents alternating movements of the lower limbs and trunk over the hips, both arms were crossed in a posture unfit for an epileptic seizure. The movements could be stopped and be induced by the touch of the technician. (B) In the lower panel, one can see the generalized contractures in the période terminale of the attack as depicted by Charcot and Richer, and examples of generalized contractures and bizarre postures at the end of a functional seizure. Both patients tend to opisthotonus, with the patient on the left lying down with both eyes open and a similar dystonic posture of the hand as shown in the drawing, while the patient at the botton right of the figure presents with hand drop, eyes closed and an asymmetrical contracture of head and neck muscles with jaw deviation to the left. The patients' eyes were blacked out to preserve their identities for ethical purposes.

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An essay on the Charcot and Richer hysteria: from charcoal drawings to cell phones

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[1] Address for correspondence
Hélio Afonso Ghizoni Teive (email: hagteive@mps.com.br)