Whose hysteria: Briquet's, Janet's or Freud's?

Are psychogenic non-epileptic seizures just another symptom of conversion disorder?

BACKGROUND

Psychogenic non-epileptic seizures (PNES) are classified with other functional neurological symptoms as 'Conversion Disorder', but there are reasons to wonder whether this symptomatology constitutes a distinct entity.

METHODS

We reviewed the literature comparing PNES with other functional neurological symptoms.

RESULTS

We find eight studies that directly examined this question. Though all but one found significant differences-notably in presenting age, trauma history, and dissociation-they were divided on whether these differences represented an important distinction.

CONCLUSION

We argue that the aetiological and mechanistic distinctions they support, particularly when bolstered by additional data, give reason to sustain a separation between these conditions.

A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena

OBJECTIVE

The aim of this paper is to develop an aetiological model for borderline personality disorder.

METHOD

The postulates of Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. As a necessary background to this discussion, the findings concerning abuse in the early history of borderline personality disorder (BPD) and other conditions, notably somatisation disorder and dissociative states, are briefly reviewed. Other data, including family studies, which might have significance in the aetiology of BPD are also reviewed.

RESULTS

The hypothesis is put forward that the symptoms of BPD are due to the failure of 'experience-dependent' maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of central nervous system function. These networks subserve higher psychological functions, including attentional focus and affect regulation. They also underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 years.

CONCLUSION

Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances that are amenable to investigation with psychometric and brain imaging techniques. Since these disturbances are seen as 'experience-dependent', they are considered reversible, at least in part.

Janet and Freud: revealing the roots of dynamic psychiatry

OBJECTIVES

Interest in the work of Pierre Janet is presently undergoing a scholarly revival and, in the process, his contribution to dynamic psychiatry is increasingly being recognised. This article compares and contrasts Pierre Janet's early studies on hysteria and the neuroses with those of Freud.

METHOD

The study surveys original works by Janet and Freud and contemporary scholarly exegeses. It particularly focuses on ideation and memory, consciousness and dissociation, psychological trauma, the self, therapeutic influence, and treatment by integration versus abreaction.

RESULTS

Grounds are presented for either preferring Janet's notions to Freud's or for integrating them.

CONCLUSIONS

It is concluded that a number of Janet's contributions to psychopathology and psychotherapy, particularly in the field of dissociative disorders, deserve further exploration and application.

A tormented mind: clinical and theoretical implications of overwhelming life events

A case study illustrates the aim of this paper, which is to discuss the clinical and theoretical implications of adult patients who have experienced extreme or catastrophic stress in their distant past which may not be immediately "recognisable". A close relationship between Post-Traumatic Stress Disorder and Borderline Personality Disorder (as defined in DSM-III-R) is suggested.