A History of Hysteria: The Search to Understand Medically Unexplainable Symptoms

The Agony of Not Knowing: Why Mysterious Pain Bothers Everyone

Confusing symptoms have baffled patients and clinicians alike for millennia. When symptoms don’t fit a tidy diagnosis and patients expect answers, clinicians feel pressure to diagnose, investigate, and act. This tension—between the compulsion to explain and the limits of knowledge—has shaped centuries of medicine.

Blame, Bewilderment, and Everything In Between

From the ancient Greeks, who imagined the uterus as a wandering, animal-like creature responsive to scents, to medieval Europe’s fixation on demons and witchcraft, history shows an endless parade of wild guesses with limited diagnostic tools, explanations veered into myth and moral judgment.

Treatments reflected the beliefs and knowledge of the time: burnt herbs to “lure the uterus,” exorcisms for the possessed, and, later, pseudo-scientific rituals—hypnotism, animal magnetism, even “magnetized” group water therapy.

Doctors, Patients, and the Cycle of Frustration

When answers elude doctors, frustration and guilt often ripple into the clinical relationship. As the “reaction formation” and cognitive dissonance kicks in, a doctor’s initial sympathy can sour to skepticism. Patients, feeling dismissed, may in turn lose trust and interpret further explanations as blame or avoidance. Across history, this dynamic laid the foundation for stigma (“It must be in your head because I can’t otherwise explain it”) and a sense of isolation on both sides.

Institutionalized Uncertainty: Hysteria to DSM-5

In the 19th century, thinkers like Briquet and Charcot tried to classify “hysteria”—noting the clustering of vague symptoms, their prevalence in women, hereditary factors, and social stressors. Their frameworks, though sometimes biased, at least opened doors to recognize trauma, anxiety, and multifactorial causes. Yet, institutional labeling (from somatoform disorders to “conversion” and on to “somatic symptom disorder” in DSM-5) often perpetuated the same basic pattern: unexplained pain = psychological problem = your fault.

The Honest Doctor’s Plan: A Framework for Healing

The most empowering shift came with humility. When “I don’t know” is uttered sincerely—paired with statements like “I believe you,” “This won’t kill you,” and “We’ll make a plan together”—the cycle of blame can give way to genuine partnership.

The key insight: diagnostic labels are shaped by culture, knowledge, and resources. Respect for uncertainty, a clear plan, and empathy have always been the best medicine, no matter the era. As technology and knowledge improves, so do our explanations for things that had previously been explained in less than ideal ways.

For more insight and practical advice, tune in to episode 10 of It’s Not in Your Head Podcast.