Uncontrollable laughter causes. Unreasonable laughter may be a symptom of illness

At first glance, the connection between laughter and illness seems strange. After all, we usually laugh when we are happy or think something is funny. According to the science of happiness, intentional laughter can even lift our mood and make us happy. But it's another thing if you're standing in line at the bank or in the supermarket, and suddenly someone suddenly and wildly laughs for no apparent reason. Perhaps the laughing man will have nervous tic, he may twitch or appear slightly disoriented. A person can laugh and cry at the same time, while looking either childish or like a victim of violence.

If you start laughing involuntarily and often, this may indicate a symptom such as pathological laughter. It is a sign of an underlying disease or pathological condition that usually affects the nervous system. Researchers are still trying to learn more about this phenomenon (pathological laughter is usually not associated with humor, amusement, or any other expression of joy).

As you know, our brain is the control center of the nervous system. It sends signals that control involuntary actions such as breathing, heartbeat, and voluntary actions such as walking or laughing. If these signals go awry due to a chemical imbalance, abnormal brain growth, or birth defect, bouts of unaccountable laughter may occur.

Let's learn more about diseases and medical symptoms that may be accompanied by laughter, but not smiling.

Laughter due to illness

Patients or their family members are usually forced to seek help by any other signs of illness, but not by laughter. However, sometimes laughter medical symptom worthy of close attention.

Here's an example: in 2007, a 3-year-old girl from New York began to behave quite unusually: periodically laughing and wincing (as if in pain) at the same time. Doctors discovered she had a rare form of epilepsy that causes involuntary laughter. They then discovered a benign brain tumor in the girl and removed it. After the operation, the symptom of this tumor – involuntary laughter – also disappeared.

Surgeons and neurologists have repeatedly helped people with brain tumors or cysts get rid of involuntary and uncontrollable attacks of laughter. The fact is that removing these formations eliminates pressure on the areas of the brain that cause it. Acute stroke can also cause abnormal laughter.

Laughter is a symptom of Angelman syndrome, a rare chromosomal disease, affecting the nervous system. Patients often laugh due to increased stimulation of the parts of the brain that control joy. Tourette syndrome is a neurobiological disorder that causes tics and involuntary vocal outbursts. People with Tourette syndrome generally do not need treatment unless their symptoms interfere with daily activities, such as work or school. Medication and psychotherapy can help patients minimize their symptoms.

Laughter can also be a symptom of drug abuse or chemical dependency. In both cases, the damaged nervous system sends signals, including those that cause laughter. Dementia, anxiety, fear and restlessness can also cause involuntary laughter.

Hysterical attack

We use the expression “throw a tantrum” quite often, but few people think about the fact that this is not simple behavioral promiscuity, but a real disease, with its own symptoms, clinic and treatment.

What is a hysterical attack?

A hysterical attack is a type of neurosis manifested by indicative emotional states(tears, screams, laughter, arching, wringing of hands), convulsive hyperkinesis, periodic paralysis, etc. The disease has been known since ancient times; Hippocrates described this disease, calling it “rabies of the uterus,” which has a very clear explanation. Hysterical fits are more typical for women, they are less likely to bother children and occur only as an exception in men.

Professor Jean-Martin Charcot shows students a woman in a hysterical fit

At the moment, the disease is associated with a certain personality type. People subject to attacks of hysteria are suggestible and self-hypnosis, prone to fantasizing, unstable in behavior and mood, love to attract attention with extravagant actions, and strive to be theatrical in public. Such people need spectators who will babysit and care for them, then they receive the necessary psychological release.

Often, hysterical attacks are associated with other psychosomatic deviations: phobias, dislike of colors, numbers, pictures, conviction of a conspiracy against oneself. Hysteria affects approximately 7-9% of the world's population. Among these people there are those who suffer from severe hysteria - hysterical psychopathy. The seizures of such people are not a performance, but a real disease that you need to know, and also be able to provide assistance to such patients. Often, the first signs of hysteria appear already in childhood, so parents of children who react violently to everything, bend over backwards, and scream angrily should be shown to a pediatric neurologist.

In cases where the problem has been growing for years and an adult is already suffering from severe hysterical neuroses, only a psychiatrist can help. An examination is carried out individually for each patient, an anamnesis is collected, tests are taken and, as a result, specific treatment is prescribed that is suitable only for this patient. As a rule, these are several groups of drugs (hypnotics, tranquilizers, anxolytics) and psychotherapy.

Psychotherapy in this case is prescribed to reveal those life circumstances that influenced the development of the disease. With its help, they try to level out their significance in a person’s life.

Symptoms of hysteria

A hysterical attack is characterized by an extreme variety of symptoms

A hysterical attack is characterized by an extreme variety of symptoms. This is explained by the self-hypnosis of patients, “thanks to” which patients can depict the clinic of almost any disease. Seizures occur in most cases after an emotional experience.

Hysteria is characterized by signs of “rationality”, i.e. the patient experiences only the symptom that he “needs” or is “beneficial” at the moment.

Hysterical attacks begin with hysterical paroxysm, which follows an unpleasant experience, a quarrel, or indifference on the part of loved ones. A seizure begins with the corresponding symptoms:

• Crying, laughing, screaming
• Pain in the heart area
• Tachycardia (rapid heartbeat)
• Feeling short of air
• Hysterical ball (feeling of a lump rolling up to the throat)
• The patient falls, convulsions may occur
• Hyperemia of the skin of the face, neck, chest
• Eyes are closed (when trying to open, the patient closes them again)
• Sometimes patients tear their clothes, hair, and hit their heads

It is worth noting features that are not characteristic of a hysterical attack: the patient has no bruises, no bitten tongue, the attack never develops in a sleeping person, there is no involuntary urination, the person answers questions, there is no sleep.

Sensitivity disorders are very common. The patient temporarily ceases to feel parts of the body, sometimes cannot move them, and sometimes experiences severe pain in the body. The affected areas are always varied, these can be the limbs, the abdomen, sometimes there is a feeling of a “driven nail” in a localized area of ​​the head. The intensity of the sensitivity disorder varies, from mild discomfort to severe pain.

Sensory organ disorder:

• Visual and hearing impairment
• Narrowing of visual fields
• Hysterical blindness (can be in one or both eyes)
• Hysterical deafness

• Hysterical aphonia (lack of sonority of voice)
• Muteness (cannot make sounds or words)
• Chant (syllable by syllable)
• Stuttering

A characteristic feature of speech disorders is the patient’s willingness to enter into written contact.

• Paralysis (paresis)
• Inability to perform movements
• Unilateral paresis of the arm
• Paralysis of the muscles of the tongue, face, neck
• Trembling of the whole body or individual parts
• Nervous tics of facial muscles
• Arching the body

It should be noted that hysterical seizures do not mean real paralysis, but an elementary inability to make voluntary movements. Often, hysterical paralysis, paresis, and hyperkinesis disappear during sleep.

Disorder of internal organs:

• Lack of appetite
• Swallowing disorder
• Psychogenic vomiting
• Nausea, belching, yawning, cough, hiccups
• Pseudoappendicitis, flatulence
• Shortness of breath, imitation of an attack bronchial asthma

At the core mental disorders lies the desire to always be the center of attention, excessive emotionality, inhibition, psychotic stupor, tearfulness, a tendency to exaggerate and the desire to play a leading role among others. All the patient’s behavior is characterized by theatricality, demonstrativeness, and to some extent infantilism; one gets the impression that the person is “glad about his illness.”

Hysterical seizures in children

Symptomatic manifestations mental attacks in children depends on the character psychological trauma and from personal characteristics patient (susceptibility, anxiety, hysteria).

Typical for a child increased sensitivity, impressionability, suggestibility, selfishness, instability of mood, egocentrism. One of the main features is recognition among parents, peers, society, the so-called “family idol”.

For children younger age It is common to hold your breath when crying, provoked by the child’s dissatisfaction and anger when his requests are not satisfied. At older ages, the symptoms are more varied, sometimes similar to attacks of epilepsy, bronchial asthma, and suffocation. The seizure is characterized by theatricality and lasts until the child gets what he wants.

Less commonly observed are stuttering, neurotic tics, blinking tics, whining, and tongue-tiedness. All these symptoms arise (or intensify) in the presence of persons towards whom the hysterical reaction is directed.

A more common symptom is enuresis (bedwetting), which often occurs due to changes in the environment (a new kindergarten, school, home, the appearance of a second child in the family). Temporarily removing the baby from a traumatic environment can lead to a decrease in diuresis attacks.

Diagnosis of the disease

The diagnosis can be made by a neurologist or psychiatrist after necessary examination, during which there is an increase in tendon reflexes and tremor of the fingers. During the examination, patients often behave unbalanced, may groan, scream, demonstrate increased motor reflexes, spontaneously shudder, and cry.

One of the methods for diagnosing hysterical seizures is color diagnostics. The method represents the rejection of a certain color during the development of a particular condition.

For example, a person dislikes the color orange; this may indicate low self-esteem, problems with socialization and communication. Such people usually do not like to appear in crowded places; it is difficult for them to find a common language with others and make new acquaintances. Rejection of blue color and its shades indicate excessive concern, irritability, and agitation. Dislike for the color red indicates disturbances in the sexual sphere or psychological discomfort that arose against this background. Color diagnostics is currently not very common in medical institutions, but the technique is accurate and in demand.

First aid

It is often difficult to understand whether the person in front of you is sick or an actor. But despite this, it is worth knowing the mandatory first aid recommendations in this situation.

Do not persuade the person to calm down, do not feel sorry for him, do not be like the patient and do not fall into panic yourself, this will only encourage the hysteroid even more. Be indifferent, in some cases you can go to another room or room. If the symptoms are violent and the patient does not want to calm down, try to splash cold water on his face, bring him to inhale ammonia fumes, give a gentle slap in the face, press on pain point in the cubital fossa. Do not indulge the patient under any circumstances; if possible, remove strangers or take the patient to another room. After this, call your doctor before arriving medical worker don't leave the person alone. After an attack, give the patient a glass cold water.

During an attack, you should not hold the patient’s arms, head, neck or leave him unattended.

To prevent attacks, you can take courses of tinctures of valerian, motherwort, and use sleeping pills. The patient’s attention should not be focused on his illness and its symptoms.

Hysterical seizures first appear in childhood or adolescence. With age, clinical manifestations smooth out, but in the menopause they can again appear and worsen. But with systematic observation and treatment, exacerbations pass, patients begin to feel much better, without seeking help from a doctor for years. The prognosis of the disease is favorable if the disease is detected and treated in childhood or adolescence. We should not forget that hysterical fits may not always be a disease, but only a personality trait. Therefore, it is always worth consulting with a specialist.

Hysteria and hysterical neurosis

As a rule, hysterical neurosis is characterized by increased suggestibility of patients who strive by hook or by crook to attract the attention of others to their person. This form of neurosis is manifested by various disorders: motor, autonomic and sensitive.

Hysteria is manifested by such emotionally violent reactions as laughter, screaming and tears. It can also be expressed in convulsive hyperkinesis (violent movements), paralysis, deafness and blindness, loss of consciousness and hallucinations.

Causes

Mental experiences associated with disruption of the mechanisms of nervous activity are the main causes of the appearance of hysterical neurosis. Moreover, nervous tension can be associated with both external factors and intrapersonal conflict.

Hysteria in such people can arise literally out of the blue, thanks to a completely insignificant reason. Often the disease begins suddenly: due to severe mental trauma or due to a long-term traumatic situation. The causes of hysterical attacks lie in the quarrels that precede them, leading to emotional unrest.

Symptoms of hysteria and hysterical neurosis

A hysterical attack begins with a feeling of a lump in the throat, a sudden increase in heart rate and a feeling of lack of air. Often these symptoms are accompanied by unpleasant sensations in the heart area, which incredibly frighten the patient. The condition continues to rapidly deteriorate, the person falls to the ground, after which convulsions appear, during which the patient stands on the back of his head and heels - this body position is called a “hysterical arc.”

The attack is accompanied by redness and paleness of the face. Often patients begin to tear their clothes, shout out some words and bang their heads on the floor. In addition, such a convulsive attack may be preceded by crying or hysterical laughter.

A frequent manifestation of hysteria is anesthesia, in which there is a complete loss of sensitivity of one half of the body. Headaches reminiscent of the feeling of a “driven nail” are also possible.

Visual and hearing impairments also occur, but are temporary. In addition, speech disorders cannot be ruled out, consisting in loss of sonority of the voice, stuttering, pronunciation in syllables and silence.

Symptoms appear already in adolescence and are pronounced: the desire to always be in the center of attention, sudden changes moods, tearfulness and constant whims. At the same time, the impression often arises that the patient is quite satisfied with life, since his behavior is distinguished by some theatricality, demonstrativeness and pomposity.

Hysteria occurs chronically, with periodic exacerbations. With age, the symptoms disappear, only to return during menopause, which is known for the complete restructuring of the female body.

Varieties

In young children, hysterical states arise as an acute reaction to fear, which, as a rule, has no basis. Also, hysterical fits in children can be provoked by punishment from parents. Such disorders usually go away quickly if parents realize their mistake and reconsider their attitude towards punishing the child.

In adolescents, manifestations of hysteria are often observed among pampered girls and boys with a weak will, who, moreover, are not accustomed to work and do not accept words of refusal. Such children will happily flaunt their illness.

In women, hysteria has its origins in the peculiarities of hormonal metabolism, so it is closely related to the sex glands that produce steroids, which greatly influence mood swings during menstruation. It is fluctuations in hormone levels that lead to hysteria during puberty and at the end of the childbearing period.

Treatment of hysterical neurosis

For hysterical neurosis, treatment is aimed at eliminating the causes of its occurrence. And in such cases, there is no way to do without psychotherapy, the main assistants of which are training, hypnosis and all sorts of methods of suggestion, in a positive way influencing the elimination mental disorder, after all, it is necessary to explain to the patient that this disease is caused by “flight into illness” and that only a full awareness of the depth of the problem can change it.

This cannot be done without restorative and psychotropic drugs to improve the health and mental state of patients. In addition, massage, vitamin therapy and bromine preparations, as well as andexin, librium, and small doses of reserpine and aminazine are indicated.

An attack of hysteria in children can be successfully treated with simplified methods, the most effective of which are suggestion and false treatment. If the reason that caused the neurosis relates to a lack of attention, then for treatment you just need to spend more of your time with the child.

Hysteria can also be treated with folk remedies. ethnoscience is rich in various recipes to calm an overly excitable person. It is necessary to use teas and decoctions of herbs such as motherwort, mint, chamomile and valerian. All herbs have a calming effect, and taking them on an empty stomach and before bed helps cure hysterical attacks.

Prevention

The most important thing in the prevention of such an unpleasant disease is the lack of excessive care and sympathy among the patient’s relatives, since their reverent attitude can be misinterpreted: patients may well feign illness not only in order to deserve a large portion of attention to their person, but also for receiving any benefit. Ignoring the seriousness of the problem can lead to the fact that the hysteria will either disappear, or the very need for its spectacular demonstration will disappear.

After consultation with a specialist, you can use sedatives and psychotropic drugs, and also do not forget about teas and infusions of medicinal herbs.

An important point in prevention is the creation of conditions that reduce mental trauma at work and at home.

Laughing attacks in a teenager

Modern scientists attribute uncontrollable laughter to symptoms of multiple sclerosis, Parkinson's disease, Lou Gehrig's disease, Alzheimer's disease and other diseases. However, according to Professor Robert Provine from the University of Maryland, any manifestation of laughter does not depend on human consciousness. “You can’t choose when to laugh the same way you can choose when to talk,” writes psychology professor R. Provine in his work “Laughter: A Scientific Inquiry.”

In his book, the scientist cites as an example an incident that occurred in Tanzania in 1962. Several girls from the class suddenly started laughing. Looking at them, several more girls began to laugh, and soon the entire school began to suffer from uncontrollable laughter, which continued for 6 months. The educational institution then had to be temporarily closed.

Any neurologist will explain why a sick person, not feeling happy or particularly unhappy, suddenly begins to scream or laugh, but explain why this happens to healthy people, very difficult. However, Stanford University professor Joseph Parvizi, who studies the problems of seizures and pathological laughter and crying, agrees that outbursts of such emotions are beyond a person’s control. Laughter and crying are the result of interactions between different brain structures that occur without the participation of consciousness. The brain simply tells the heart a signal to beat faster, so situations where one falls down the stairs and the other starts laughing loudly do not mean that the second is an evil person.

During the experiment, scientists learned to induce laughter and crying artificially. Thus, stimulation of the subthalamic nucleus caused tears, and the anterior cingulate cortex caused laughter. However, the patients did not experience the emotions necessary for such manifestations of feelings.

Scientists compare the appearance of laughter with sudden appearance desire to eat ice cream. “The fact that I want ice cream at the moment is beyond my control. I can buy or not buy ice cream for myself. But I can’t force my brain not to want it,” says J. Parvizi.

Laughter for no reason: a symptom of bipolar disorder

Symptoms of Bipolar Disorder

One of the symptoms of bipolar disorder is the so-called periods of mania, when positive emotions are off the charts.

During the manic period, a person experiences:

• feeling of strength,
• the need for sleep decreases,
• excessive self-confidence appears.

At first glance, there is nothing wrong with this. However, during periods of mania, people with bipolar disorder spend money, get into debt, leave relationships, and engage in impulsive and often life-threatening behavior.

The uniqueness of bipolar disorder is that with this disease, positive emotions become dangerous and take on an unwanted character.

Inappropriate emotions in people with bipolar disorder

Yale University psychologist Dr. Gruber observed people with bipolar disorder during remission and found that even at such moments they experienced more positive emotions than people who had never suffered from this disease. Expressing positive emotions may not seem to be a problem, but in some cases their expression may be inappropriate.

In the study, people with bipolar disorder experienced more positive emotions both while watching comedies and when watching scary or sad films, such as the scene where a child cries over his father's grave. The survey found that patients can feel great even when a loved one says unpleasant or sad things to their face.

Too many positive emotions

Research can help identify impending relapse of the disease. Showing positive emotions in inappropriate situations is a warning sign.

In another study, Dr. Gruber interviewed college students who had never previously shown symptoms of bipolar disorder. The survey revealed that those who have positive emotions predominate in both positive and negative and neutral situations are at risk of developing bipolar disorder.

It should be noted that with bipolar disorder, patients experience a certain type of positive emotions. Such emotions are usually selfish and self-directed - pride, ambition, self-confidence, etc. These emotions do not promote social interactions and relationships in the way that love and empathy do, for example.

People with bipolar disorder set high goals for themselves, are very sensitive to praise and rewards, and during periods of mania, some even believe that they have superpowers.

Positive emotions should be appropriate

Positive emotions are not always helpful for people who do not suffer from bipolar disorder. Although positive emotions are generally good for the psychological state, when they take on excessively expressed forms or appear in an inappropriate situation, they positive effect leveled out. Thus, positive emotions are good and useful in right time and in the right place.

How to overcome an inappropriate and uncontrollable fit of laughter?

Hello, dear friends!

Laughter not only prolongs life, but also improves its quality. Thanks to it, a person is able to reduce anxiety, symptoms of stress and even depression. But what if laughter becomes a cause of discomfort?

Have you ever laughed under inappropriate circumstances? What to do if a fit of uncontrollable joy caught you while submitting a report or in the clinic? When meeting an important person or even at a funeral?

In today's article I would like to tell you how to properly cope with an avalanche of laughter that has fallen on your head? What should you do to quickly calm down and what are the reasons for this “strange” behavior?

Having a fit of laughter at an awkward moment is another challenge! The person is flooded so much that it is difficult for him to breathe! Tears are rolling down like hail, and people around are twirling their fingers at their temples, wondering if everything is okay?

Doctors of psychological sciences say that laughter, like any other human emotion, cannot go away immediately! It may take anywhere from 15 minutes to several hours to completely calm down!

Sometimes, a funny reaction occurs as a protective function of an individual to a difficult life situation. But the most important thing that needs to be done is to learn to control emotions so that they cannot take over the mind.

It is worth noting that sudden, voluntary laughter may indicate serious disorders in the mental state and be a symptom of diseases such as Tourette's syndrome, pre-stroke condition, brain tumor, etc.

Theoretically, it is very difficult to identify a connection between the disease and causeless laughter. Usually people burst into joy when they feel good. They are happy and carefree, what's the problem? And at the same time, doctors have still identified several reasons that can be provocateurs for outbreaks of an attack.

Causes

There are 4 main causes of an attack of uncontrollable laughter:

1. pathological effect of cognitive impairment in the body (Alzheimer's disease, tumor, head injury, damage to the nervous system);
2. emotional regulation disorder (dementia: neurosis, depression, psychosis, apathy, etc.);
3. defensive reaction of the psyche to a stimulus (complexes, emotional barriers, blocks and clamps);
4. chemicals (medicines, addiction to poisons - tobacco, drugs, alcohol).

A nervous disorder can cause episodic bursts of uncontrollable crying or laughter, repeated several times a day. Sometimes these reactions occur in response to bad news, the novelty of an event, or surprise.

The human brain is the control room for the entire nervous system. Its job is to send clear control signals over uncontrollable actions such as systematic breathing or heartbeat.

By the way, by developing awareness and practicing breathing exercises and meditation, it is possible to train and control them! In any case, yogis do it quite well! It is also involved in the tight control of voluntary obligations: walking, thinking, concentration, crying, laughing, etc.

When the quality of communication is disrupted, a functional imbalance is observed and the individual demonstrates a fit of hysterical laughter, which scares not only themselves, but also those around them. How to deal with the situation?

Fighting an attack

Autotraining

If you literally feel the urge to burst into laughter, then I recommend that you resort to auto-training. What it is? This correct installation, helping your brain get a grip on reality. These are powerful affirmations and suggestions that increase your sense of control over a situation, helping you avoid panic attack at the time of the attack.

Close your eyes and confidently repeat phrases to yourself, avoiding the “not” part: “I am holding back my laughter,” “My emotions are under complete control,” “I am safe.”

Try to abstract yourself from what is happening, focusing on your breathing and reducing its frequency, you can do deep breath and exhale slowly at least 5 times. Drink cold water or take a walk.

Don't look at people's faces

If an attack was noticed in a child at the most inopportune moment, then he should be switched from visual communication with an adult or peers as soon as possible. Laughter can be extremely contagious, especially in children!

This is similar to the condition when yawning, collective crying in babies, etc. Children have a stronger connection with the Force and energy information fields. And, as a result, they more easily accept the emotional background that surrounds them.

If you already hear chuckles nearby that support the situation, then beware of looking at faces, because then it will be even more difficult to stop, both for you and for people.

Muscle activity

In the fight against uncontrollable laughter, it is important to understand how to switch the brain? I recommend that you resort to muscular distraction.

For example, if you are frozen in anticipation of a seizure when called to the carpet to the boss, then try to find and cling to another idea, the opposite of the present one.

If nothing helps and attempts fail, this means that you are a person with increased emotionality. What to do in this case? No matter how strange it may be, pain is the strongest human feeling. In order to quickly relieve the symptoms of a seizure in the form of abdominal muscle tension, smiling and even tics, I advise you to hurt yourself.

Pinch your finger, bite the tip of your tongue, prick your leg with a paper clip, etc., the main thing is to hit the nerve endings, and they won’t keep you waiting quickly.

A couple of seconds and you are completely fine, cheerful and can calmly look at what is happening without a smile. At the same time, I am not encouraging you to get carried away with this point and use it only when absolutely necessary.

Subscribe to updates, and in the comments share your ways to overcome inappropriate laughter! Under what circumstances did you have to do this?

Hysterical neurosis (hysteria)

Hysteria (syn.: hysterical neurosis) is a form of general neurosis, manifested by a variety of functional motor, autonomic, sensitive and affective disorders, characterized by great suggestibility and self-hypnosis of patients, the desire to attract the attention of others in any way.

Hysteria as a disease has been known since ancient times. A lot of mythical and incomprehensible things were attributed to her, which reflected the development of medicine of that time, the prevailing ideas and beliefs in society. These data are now of a general educational nature only.

The term “hysteria” itself comes from the Greek. hystera - uterus, since ancient Greek doctors believed that this disease occurs only in women and is associated with dysfunction of the uterus. Wandering around the body in order to satisfy itself, it allegedly compresses itself, other organs or the vessels leading to them, which causes unusual symptoms of the disease.

The clinical manifestations of hysteria, according to the medical sources that have come down to us of that time, were also somewhat different and more pronounced. However, the leading symptom was and remains hysterical attacks with convulsions, insensitivity of certain areas of the skin and mucous membranes, a constricting headache (“hysterical helmet”) and pressure in the throat (“hysterical lump”).

Hysterical neurosis (hysteria) is manifested by demonstrative emotional reactions (tears, laughter, screaming). There may be convulsive hyperkinesis (violent movements), transient paralysis, loss of sensitivity, deafness, blindness, loss of consciousness, hallucinations, etc.

The main cause of hysterical neurosis is a mental experience that leads to a breakdown of the mechanisms of higher nervous activity. Nervous tension may be associated with some external moment or intrapersonal conflict. In such persons, hysteria can develop under the influence of an insignificant reason. The disease occurs either suddenly under the influence of severe mental trauma, or more often, under the influence of a long-term traumatic unfavorable situation.

Hysterical neurosis has the following symptoms.

More often, the disease begins with the appearance of hysterical symptoms. Usually a seizure is provoked by unpleasant experiences, a quarrel, or emotional disturbance. A seizure begins with unpleasant sensations in the heart area, a feeling of a “lump” in the throat, palpitations, and a feeling of lack of air. The patient falls, convulsions appear, often tonic. The convulsions are in the nature of complex chaotic movements, like opisthotonus or, in other words, a “hysterical arc” (the patient stands on the back of his head and heels). During a seizure, the face either turns red or turns pale, but is never purplish-red or bluish, as with epilepsy. The eyes are closed; when trying to open them, the patient closes his eyelids even more. The reaction of the pupils to light is preserved. Often patients tear their clothes, hit their heads on the floor without causing significant damage to themselves, moan or mutter some words. A seizure is often preceded by crying or laughter. Seizures never occur in a sleeping person. There are no bruises or tongue bites, no involuntary urination, and no sleep after a seizure. Consciousness is partially preserved. The patient remembers the seizure.

One of frequent phenomena Hysteria is a sensory disorder (anesthesia or hyperesthesia). This can be expressed as a complete loss of sensation in one half of the body, strictly along the midline, from the head to lower limbs also increased sensitivity and hysterical pain. Headaches are common and classic symptom with hysteria there is a feeling of a “driven nail”.

Disorders of the function of the sensory organs are observed, which manifest themselves in transient impairments of vision and hearing (transient deafness and blindness). There may be speech disorders: loss of voice sonority (aphonia), stuttering, pronunciation in syllables (chanted speech), silence (hysterical mutism).

Motor disorders are manifested by paralysis and paresis of muscles (mainly limbs), forced positioning of limbs, and the inability to perform complex movements.

Patients are characterized by character traits and behavioral characteristics: egocentrism, a constant desire to be in the center of attention, to take a leading role, mood swings, tearfulness, capriciousness, a tendency to exaggerate. The patient’s behavior is demonstrative, theatrical, and lacks simplicity and naturalness. It seems that the patient is happy with his illness.

Hysteria usually begins in adolescence and proceeds chronically from periodic exacerbations. With age, the symptoms smooth out, and during menopause they worsen. The prognosis is favorable once the situation that caused the aggravation is eliminated.

In the Middle Ages, hysteria was considered not a disease requiring treatment, but a form of obsession, transformation into animals. The patients were afraid of church rituals and objects of religious worship, under the influence of which they had convulsive seizures, they could bark like a dog, howl like a wolf, cackle, neigh, and croak. The presence of areas of skin insensitive to pain in patients, which is often found in hysteria, served as evidence of a person’s connection with the devil (“the seal of the devil”), and such patients were burned at the stake of the Inquisition. In Russia, such a state was considered as “hypocrisy.” Such patients could behave calmly at home, but it was believed that they were possessed by a demon, therefore, due to their great suggestibility, seizures with shouting - “calling out” – often occurred in the church.

In Western Europe in the 16th and 17th centuries. There were some kind of hysteria. The sick gathered in crowds, danced, wailed, and went to the chapel of St. Vitus in Zabern (France), where healing was considered possible. This disease was called “major chorea” (actually hysteria). This is where the term “St. Vitus’s Dance” came from.

In the 17th century French physician Charles Lepois observed hysteria in males, which refuted the role of the uterus in the occurrence of the disease. At the same time, the assumption arose that the reason lay not in the internal organs, but in the brain. But the nature of the brain damage, naturally, was unknown. At the beginning of the 19th century. Brickle considered hysteria a “cerebral neurosis” in the form of disturbances of “sensitive perceptions and passions.”

Deep scientific study hysteria was carried out by J. Charcot (1825-1893), the founder of the French school of neuropathologists. 3. Freud and the famous neuropathologist J. Babinsky worked with him on this problem. The role of suggestions in the origin of hysterical disorders, such manifestations of hysteria as convulsive seizures, paralysis, contractures, mutism (lack of verbal communication with others while the speech apparatus is intact), and blindness were studied in detail. It was noted that hysteria can copy (simulate) many organic diseases of the nervous system. Charcot called hysteria “a great simulator,” and even earlier, in 1680, the English physician Sydenham wrote that hysteria imitates all diseases and “is a chameleon that constantly changes its colors.”

Even today in neurology such terms as “Charcot minor hysteria” are used - hysteria with movement disorders in the form of a tic, tremor, twitching of individual muscles: “Charcot major hysteria” - hysteria with severe motor disorders (hysterical seizures, paralysis or paresis) and (or) dysfunction of the sensory organs, for example blindness, deafness; “Charcot hysterical arc” - an attack of generalized tonic convulsions in patients with hysteria, in which the body of the patient with hysteria arches with support on the back of the head and heels; “Charcot hysterogenic zones” are painful points on the body (for example, on the back of the head, arms, under the collarbone, under the mammary glands, on the lower abdomen, etc.), pressure on which can cause a hysterical attack in a patient with hysteria.

Causes and mechanisms of development of hysterical neurosis

According to modern views, an important role in the occurrence of hysterical neurosis belongs to the presence of hysterical personality traits and mental infantilism as a factor of internal conditions (V.V. Kovalev, 1979), in which heredity undoubtedly plays a significant role. From external factors V.V. Kovalev and other authors attached importance to family education of the “family idol” type and other types of psychotraumatic influence, which can be very different and to a certain extent depend on the age of the child. Thus, in younger children, hysterical disorders can arise in response to acute fear (more often this is a perceived threat to life and well-being). In preschool and primary school age, such conditions in some cases develop after physical punishment, when the parents express dissatisfaction with the child’s behavior or categorically refuse to fulfill his request. Such hysterical disorders are usually temporary; they may not recur in the future if the parents realize their mistake and treat the child more carefully. Consequently, we are not talking about the development of hysteria as a disease. This is just a basic hysterical reaction.

In children of middle and older (in fact, teenagers) school age, hysteria usually occurs as a result of long-term psychological trauma, which infringes on the child as an individual. It has long been noted that various clinical manifestations of hysteria are more often observed in pampered children with weak will and immunity to criticism, who are not accustomed to work, and who do not know the words “impossible” and “must”. They are dominated by the principle of “give” and “I want”; there is a contradiction between desire and reality, dissatisfaction with their position at home or in the children's group.

I. P. Pavlov explained the mechanism of occurrence of hysterical neurosis by the predominance of subcortical activity and the first signaling system over the second, which is clearly formulated in his works: “. the hysterical subject lives to a greater or lesser extent not rationally, but emotional life, is controlled not by cortical activity, but by subcortical activity. "

Clinical manifestations of hysterical neurosis

The clinic of hysteria is very diverse. As stated in the definition of this disease, it is manifested by motor autonomic, sensory and affective disorders. These violations in varying degrees severity can occur in the same patient, although sometimes only one of the above symptoms occurs.

Clinical signs of hysteria are most pronounced in adolescents and adults. In childhood, it is less demonstrative and often monosymptomatic.

A distant prototype of hysteria may be conditions often found in children of the first year of life; a child who does not yet consciously utter individual words, but can already sit up and down independently (at 6-7 months), stretches out his arms to his mother, thereby expressing the desire to be taken. If the mother for some reason does not fulfill this wordless request, the child begins to be capricious, cry, and often throws his head back and falls, screams, and trembles all over his body. Once you pick him up, he quickly calms down. This is nothing more than the most elementary manifestation of a hysterical attack. With age, the manifestation of hysteria becomes more and more complicated, but the goal remains the same - to achieve what I want. It can only be supplemented by the opposite desire, “I don’t want,” when the child is presented with demands or given instructions that he does not want to fulfill. And the more categorically these demands are presented, the more pronounced and diverse the protest reaction. The family, in the figurative expression of V. I. Garbuzov (1977), becomes a real “battlefield” for the child: the struggle for love, attention, care not shared with anyone, a central place in the family, reluctance to have a brother or sister, to let go of oneself parents.

With all the variety of hysterical manifestations in childhood, the most common are motor and autonomic disorders and relatively rare sensory disorders.

Motor disorders. It is possible to distinguish separate clinical forms of hysterical disorders, accompanied by motor disorders: seizures, including respiratory affective ones, paralysis, astasia-abasia, hyperkinesis. They are usually combined with affective manifestations, but can also be without them.

Hysterical seizures are the main, most striking manifestation of hysteria, which made it possible to distinguish this disease into a separate nosological form. It should be noted that at present, in both adults and children, hysterical attacks, which were described by J. Charcot and Z. Freud at the end of the 19th century, practically do not occur or are observed only rarely. This is the so-called pathomorphosis of hysteria (like many other diseases) - a persistent change clinical manifestations diseases under the influence of environmental factors: social, cultural (customs, morality, culture, education), medical advances, preventive measures etc. Pathomorphosis is not one of the hereditary changes, which does not exclude manifestations in its original form.

If we compare hysterical seizures, on the one hand, in adults and adolescents, and on the other, in childhood, then in children they are of a more elementary, simple, rudimentary (as if underdeveloped, remaining in an embryonic state) character. For illustration, several typical observations will be given.

The grandmother brought three-year-old Vova to the appointment, who, according to her, “suffers from a nervous disease.” The boy often throws himself on the floor, kicks his legs, and cries. This state occurs when his desires are not fulfilled. After an attack, the child is put to bed, his parents sit next to him for hours, then they buy a lot of toys and immediately fulfill all his requests. A few days ago, Vova was with his grandmother in the store, asking her to buy a chocolate bear. Knowing the child’s character, the grandmother wanted to fulfill his request, but there was not enough money. The boy began to cry loudly, scream, then fell to the floor, banging his head on the counter. There were similar attacks at home until his wish was fulfilled.

Vova is the only child in the family. Parents spend most of their time at work, and raising the child is completely entrusted to the grandmother. She loves her only grandson very much, and her “heart breaks” when he cries, so the boy’s every whim is fulfilled.

Vova is a lively, active child, but very stubborn, and gives standard answers to any instructions: “I won’t,” “I don’t want.” Parents regard this behavior as greater independence.

When examining the nervous system, no signs of organic damage were found. Parents are advised not to pay attention to such attacks, to ignore them. The parents followed the doctors' advice. When Vova fell to the floor, the grandmother went into another room, and the attacks stopped.

The second example is a hysterical attack in an adult. During my work as a neurologist in one of the regional hospitals in Belarus, I once came into our department chief physician and said that the next day we should go to the vegetable base and sort out the potatoes. We all silently, but with enthusiasm (previously it was impossible to do otherwise) greeted his order, and one of the nurses, a woman about 40 years old, fell to the floor, arched over and then began to convulse. We knew that she had similar seizures and provided the help necessary in such cases: we sprinkled her with cold water, patted her on the cheeks, and gave her ammonia to smell. After 8-10 minutes everything passed, but the woman experienced great weakness and could not move on her own. She was taken home in a hospital car and, of course, she did not go to work at the vegetable base.

From the patient’s story and the conversations of her friends (women always like to gossip), the following was revealed. She grew up in a village in a wealthy and hardworking family. I graduated from 7th grade and studied mediocrely. Her parents taught her early to do housework and raised her in harsh and demanding conditions. Many desires in adolescence were suppressed: it was forbidden to go to gatherings with peers, to be friends with the guys, to attend dances in village clubs. Any protests in this regard were met with a ban. The girl hated her parents, especially her father. At the age of 20, she married a divorced fellow villager, who was much older than her. This man was lazy and had a certain passion for drinking. They lived separately, there were no children, the household was neglected. A few years later they divorced. She often came into conflict with neighbors who tried to somehow infringe on the “lonely and defenseless woman.”

During conflicts, she experienced seizures. Her fellow villagers began to shun her, and she found a common language and mutual understanding with only a few friends. Soon she left to work as a nurse in a hospital.

She is very emotional in behavior, easily excitable, but tries to restrain and hide her emotions. Doesn't get into conflicts at work. She loves it very much when she is praised for good work, in such cases she works tirelessly. He likes to be fashionable in a “city manner”, flirt with male patients and talk about erotic topics.

As can be seen from the above data, there were more than enough reasons for neurosis: this and infringement sexual desires in childhood and adolescence, unsuccessful family relationships, and financial difficulties.

As far as I know, this woman has not had hysterical attacks for 5 years, at least at work. Her condition was quite satisfactory.

If you analyze the nature of hysterical attacks, you may get the impression that this is a simple simulation (pretense, i.e. imitation of an illness that does not exist) or aggravation (exaggeration of signs existing disease). In reality, this is a disease, but it proceeds, as A. M. Svyadoshch figuratively writes (1971), according to the mechanism of “conditional desirability, pleasantness for the patient, or “flight into illness” (according to Z. Freud).

Hysteria is a way to protect yourself from difficult life situations or achieve a desired goal. With a hysterical attack, the patient seeks to evoke sympathy from those around him; they do not occur if there are no strangers.

In a hysterical attack, a certain artistry is often visible. Patients fall without receiving bruises or injuries; there is no biting of the tongue or oral mucosa, urinary or fecal incontinence, which is often found during an epileptic seizure. Yet it is not so easy to distinguish them. Although in some cases there may be induced disorders, including due to the doctor’s behavior during a patient’s seizure. Thus, J. Charcot, while demonstrating hysterical seizures to students, discussed their difference from epileptic seizures in front of patients, paying special attention to the absence of involuntary urination. The next time he demonstrated the same patient, he urinated during a seizure.

Respiratory affective seizures. This form of seizures is also known as spasmodic crying, crying-sobs, breath-holding attacks, affective-respiratory seizures, spasms of rage, crying of anger. The main thing in the definition is respiratory, i.e. relating to breathing. The seizure begins with crying caused by negative emotions or pain.

The crying (or screaming) becomes louder and breathing quickens. Suddenly, during inhalation, breathing is delayed due to spasm of the muscles of the larynx. The head usually tilts back, the veins in the neck swell, and the skin becomes blue. If this lasts no more than 1 minute, then only pallor and slight cyanosis of the face appear, most often only in the nasolabial triangle, the child takes a deep breath and that’s where everything stops. However, in some cases, holding the breath may last for several minutes (sometimes up to 15-20), the child falls, partially or completely loses consciousness, and there may be convulsions.

This type of seizure is observed in 4-5% of children aged 7-12 months and accounts for 13% of all seizures in children under 4 years of age. Respiratory affective seizures are described in detail by us in the “Medical Book for Parents” (1996), where their connection with epilepsy is indicated (in 5-6% of cases).

In this section we only note the following. Respiratory affective seizures are more common in boys than in girls; they are psychogenic and are a common form of primitive hysterical reactions in children early age, usually disappear by 4-5 years. In their occurrence, a certain role is played by hereditary burden with such conditions, which, according to our data, occurred in 8-10% of those examined.

What to do in such cases? If the child cries and becomes upset, then you can splash him with cold water, spank him or shake him, i.e. apply another pronounced irritant. Often this is enough and the seizure does not develop further. If a child falls and convulsions occur, he should be placed on the bed, his head and limbs should be supported (but not forcibly held) to avoid bruises and injuries, and a doctor should be called.

Hysterical paresis (paralysis). In terms of neurological terminology, paresis is a limitation, paralysis is the absence of movements in one or more limbs. Hysterical paresis or paralysis are corresponding disorders without signs of organic damage to the nervous system. They can involve one or more limbs, are most often found in the legs, and sometimes are limited to only part of the leg or arm. If one limb is partially affected, weakness may be limited to only the foot or foot and lower leg; in the hand it will be the hand or hand and forearm, respectively.

Hysterical paresis or paralysis occurs much less frequently than the above hysterical motor disorders.

As an example, I will give one of my personal observations. Several years ago I was asked to consult a 5-year-old girl whose legs had become paralyzed a few days earlier. Some doctors even suggested polio. The consultation was urgent.

The girl was carried in her arms. Her legs did not move at all, she could not even move her toes.

From questioning the parents (historical history), it was possible to establish that 4 days ago the girl began to walk poorly for no apparent reason, and soon could not make the slightest movement with her feet. When lifting the child, the armpits of the legs dangled (dangled). When they put their feet to the floor, they buckled. She could not sit down, and when her parents sat her down, she immediately fell to the side and back. A neurological examination revealed no organic lesions of the nervous system. This, along with many assumptions that develop during the examination of the patient, suggested the possibility of hysterical paralysis. The rapid development of this condition made it necessary to clarify its connection with certain causes. However, their parents did not find them. He began to clarify what she was doing and what she had done several days before. Parents again noted that these were common days, they were working, the girl was at home with her grandmother, playing, running, and was cheerful. And as if by the way, my mother noted that she bought her skates and had been taking her to learn how to skate for several days. At the same time, the girl’s expression changed, she seemed to perk up and turn pale. When asked if she liked skating, she shrugged her shoulders vaguely, and when asked if she wanted to go to the skating rink and become a figure skating champion, at first she did not answer anything, and then quietly said: “I don’t want to.”

It turned out that the skates were a little too big for her, she couldn’t stand on them, skating didn’t work, she constantly fell, and after the skating rink her legs hurt. No traces of bruises were found on the legs; walking to the skating rink lasted several days with minimal movement. Next visit the skating rink was scheduled for the day the illness began. By this time, the girl had developed a fear of the next skating, she began to hate skates, and was afraid to skate.

The cause of the paralysis has become clear, but how can it be helped? It turned out that she loves sleep and knows how to draw, she likes fairy tales about good animals, and the conversation turned to these topics. Skating and skating were immediately put to rest, and the parents firmly promised to give the skates to their nephew and not visit the skating rink again. The girl perked up and willingly talked to me on topics she liked. During the conversation, I stroked her legs, lightly massaging her. I also realized that the girl was suggestible. This gives hope for success. The first thing I managed to do was get her to rest her legs a little on my hands while lying down. It worked. She was then able to sit up and sit up on her own. When this was possible, he asked her, sitting on the sofa and lowering her legs, to press them to the floor. So gradually, stage by stage, she began to stand on her own, at first staggering and bending her knees. Then, with rest breaks, she began to walk a little, and eventually she could jump almost well on one leg or the other. The parents sat silently all this time, without uttering a word. After completing the entire procedure, he told her with a hint of a question, “Are you healthy?” She shrugged her shoulders at first, then said yes. Her father wanted to take her in his arms, but she refused and walked from the fourth floor. I watched them unnoticed. The child's gait was normal. They didn't contact me anymore.

Is it always so easy to cure hysterical paralysis? Of course not. The child and I were lucky in the following: early treatment, identification of the cause of the disease, the child’s suggestibility, correct response to a traumatic situation.

In this case there was a clear interpersonal conflict without any sexual overtones. If her parents had stopped visiting the skating rink in time and bought her skates that were the right size, and not “for her growth,” perhaps there would not have been such a hysterical reaction. But, who knows, all's well that ends well.

Astasia-abasia literally means the inability to stand and walk independently (without support). At the same time, in a horizontal position in bed, active and passive movements in the limbs are not impaired, the strength in them is sufficient, and the coordination of movements is not changed. It occurs with hysteria mainly in females, more often in adolescence. We have observed similar cases in children, both boys and girls. A connection with acute fear is suspected, which may be accompanied by weakness in the legs. There may be other causes of this disorder.

Here are a few of our observations. A 12-year-old boy was admitted to the pediatric neurological department with complaints of the inability to stand and walk independently. Ill for a month.

According to his parents, he stopped going to school 2 days after he went with his father for a long walk in the forest, where he was frightened by a suddenly flying bird. My legs immediately gave way, I sat down and everything went away. His father at home made fun of him that he was cowardly and physically weak. The same thing happened at school. He reacted painfully to the ridicule of his peers, was worried, tried to “pump up” his muscle strength with dumbbells, but after a week he lost interest in these activities. Initially treated at children's department district hospital, where the diagnosis of astasia-abasia of psychogenic origin was correctly made. Upon admission to our clinic: calm, somewhat slow, reluctant to make contact, answers questions in monosyllables. He treats his condition indifferently. No pathology was detected from the nervous system or internal organs; he sits up and sits independently in bed. When trying to put him on the floor, he does not resist, but his legs immediately bend as soon as they touch the floor. The whole thing sags and falls towards the accompanying personnel.

At the beginning natural needs relieved himself in bed on the ship. However, soon after being ridiculed by his peers, he asked to be taken to the toilet. She was noted to be able to use her legs well on the way to the toilet, although bilateral support was required.

In the hospital, courses of psychotherapy were carried out, he took nootropic drugs (aminalon, then nootropil), Rudotel, and darsonvalization of the legs. He did not respond well to treatment. A month later he could walk around the department with one-sided assistance. Coordination problems decreased significantly, but severe weakness in the legs remained. Then he was treated several more times in the hospital of a psychoneurological dispensary. After 8 months from the onset of the disease, the gait was completely restored.

The second case is more peculiar and unusual. To our nursery neurological clinic A 13-year-old girl was admitted, who had previously been in the intensive care unit of one of the children's hospitals for 7 days, where she was taken by ambulance. And the background to this case was as follows.

The girl’s parents, residents of one of the union republics of the former USSR, often came to trade in Minsk. Recently they have been living here for about a year, running their business. Their only daughter (let's call her Galya - she really has Russian name) lived with her grandmother and aunts in her homeland, went to 7th grade. In the summer I came to my parents. Here she was met by a 28-year-old native of the same republic, and he really liked her.

It has long been a custom in their country to steal brides. This form of getting a wife has become more common nowadays. The young man met Galya and her parents, and soon, as Galina’s mother said, he stole her and took her to his apartment, where they stayed for three days. Then the parents were informed about what had happened and, according to the mother, allegedly according to the customs of Muslim countries, the girl stolen by the groom is considered his bride or even his wife. This custom was observed. The newlyweds (if you can call them that) began to live together in the groom's apartment. Exactly 12 days later, Galya felt bad in the morning: pain appeared in the lower left abdomen, she had a headache, could not get up, and soon stopped speaking. An ambulance was called and the patient was taken to one of the children's hospitals with suspected encephalitis (inflammation of the brain). Naturally, the ambulance doctor was not told a word about the previous events.

At the hospital, Galya was examined by many specialists. Data indicating acute surgical disease, not installed. The gynecologist found pain in the area of ​​the ovary on the left and assumed the presence inflammatory process. However, the girl did not make contact, could not stand or walk, and during a neurological examination she became tense all over, which did not allow us to judge the presence of organic changes in the nervous system.

A comprehensive clinical and instrumental examination of the internal organs and nervous system was carried out, including computer and magnetic resonance imaging of the brain, which did not reveal any organic disorders.

During the first days of the girl’s stay in the hospital, her “husband” managed to enter her room. Seeing him, she began to cry, shout something in her language (she knows Russian very poorly), shook all over and waved her hands. He was quickly taken out of the room. The girl calmed down, and the next morning she began to sit down on her own and talk with her mother. Soon she tolerated her “husband’s” visits calmly, but did not come into contact with him. The doctors suspected something was wrong, and the idea arose that the illness was mental. The mother had to tell some details of what happened, and a few days later the girl was transferred to us for treatment.

Upon examination, it was established that she was tall, slender, somewhat inclined to be overweight, with well-developed secondary sexual characteristics. He looks 17-18 years old. It is known that women in the East experience puberty earlier than in our climate zone. She is somewhat wary, neurotic, makes contact (through her mother as a translator), complains of compressive headaches, and periodic tingling in the heart area.

When walking, he drifts somewhat to the sides, staggers while standing with his arms outstretched forward (Romberg test). He eats well, especially spicy dishes. The possibility of pregnancy has not been proven. In the ward he behaves adequately with others. While visiting the groom, they retire and talk for a long time about something. He asks his mother why he doesn’t come every day. But in general, the condition is noticeably improving.

In this case, a hysterical reaction is clearly visible in the form of astasia-abasia and hysterical mutism - the absence of verbal communication while the speech apparatus and its innervation are intact.

The cause of the condition was early sex life child with an adult man. Perhaps there were some other circumstances in this regard, which the girl is unlikely to tell her mother, much less the doctor.

Hysterical hyperkinesis. Hyperkinesis - involuntary, excessive movements of various external manifestations. various parts bodies. With hysteria, they can be either simple - trembling, shuddering the whole body or twitching of various muscle groups, or very complex - peculiar pretentious, unusual movements and gestures. Hyperkinesis can be observed at the beginning or end of a hysterical attack, occur periodically and without an attack, especially in difficult life situations, or are observed constantly, especially in adults or adolescents.

As an example, I will give one personal observation, or my “first meeting” with hysterical hyperkinesis, which took place in the first year of my work as a district neurologist.

On the main street of our small urban village, in a small private house, lived with his mother one young man, 25-27 years old, who had an unusual and strange gait. He raised his leg, bending it at the hip and knee joints, moved it to the side, then forward, rotating his foot and lower leg, and then placed it on the ground with a stamping motion. The movements were the same on both the right and left sides. This man was often accompanied by a crowd of children, repeating his strange gait. The adults got used to it and didn’t pay any attention. This man was known throughout the area because of the strangeness of his walking. He was slender, tall and fit, always wore a military khaki jacket, riding breeches and boots that were polished to a shine. After observing him for several weeks, I approached him myself, introduced myself and asked him to come for an appointment. He was not particularly enthusiastic about this, but still showed up on time. All I learned from him was that this condition had been going on for several years and came on for no apparent reason.

A study of the nervous system did not reveal anything wrong. He answered each question briefly and thoughtfully, saying that he was very worried about his illness, which many tried to cure, but no one achieved even minimal improvement. I didn’t want to talk about my past life, not seeing anything special in it. However, it was clear from everything that he did not allow interference either in his illness or in his life; it was only noted that he artistically demonstrated to everyone his gait with some kind of pride and contempt for the opinions of others and the ridicule of children.

I learned from local residents that the patient’s parents have lived here for a long time; the father left the family when the child was 5 years old. They lived very poorly. The boy graduated from a construction college and worked at a construction site. He was self-centered, proud, could not stand other people's comments, and often entered into conflicts, especially in cases when it came to his personal qualities. He met a divorced woman of “easy” virtue and was older than him in age. They talked about marriage. However, suddenly everything became upset, allegedly on a sexual basis, his former acquaintance told one of her next gentlemen about this. After that, none of the girls and women wanted to deal with him, and the men laughed at the “weakling.”

He stopped going to work and didn’t leave the house for several weeks, and his mother didn’t let anyone into the house. Then he was seen in the yard with a strange and with an uncertain gait, which has been fixed for many years. He received the second group of disability, while his mother received a pension for her years of service. So they lived together, growing something in their small garden.

I, like many doctors who treated and advised the patient, was interested in the biological meaning of such an unusual walk with a kind of hyperkinesis in the legs. He told the attending physician that when walking, the genitals “stick” to the thigh, and he cannot take the right step until “unsticking” occurs. Perhaps this was so, but subsequently he avoided discussing this issue.

What happened here and what is the mechanism of hysterical neurosis? It is obvious that the disease arose in a person with hysterical personality traits (emphasis on the hysterical type), a subacutely acting role played a psychotraumatic role conflict situation in the form of problems at work and personal life. Man has been haunted everywhere by failures, creating a contradiction between what is desired and what is possible.

The patient was consulted by all the leading neurological luminaries of that time working in Belarus; he was repeatedly examined and treated, but there was no effect. Even the hypnosis sessions had no effect positive action, and no one was doing psychoanalysis at that time.

The psychological significance for a given person of his hysterical disorders is clear. In fact it was the only way obtaining disability and the possibility of living without work.

If he lost this opportunity, everything would go to waste. But he didn’t want to work, and, apparently, he couldn’t do it anymore. Hence the deep fixation of this syndrome and negative attitude towards treatment.

Autonomic disorders. Autonomic disorders in hysteria, they usually relate to disturbances in the activity of various internal organs, the innervation of which is carried out by the autonomic nervous system. This is most often pain in the heart, epigastric (epigastric) region, headaches, nausea and vomiting, a feeling of a lump in the throat with difficulty swallowing, difficulty urinating, bloating, constipation, etc. Children and adolescents especially often experience tingling in the heart, a burning sensation, lack of air and fear of death. At the slightest excitement and different situations, requiring mental and physical stress, patients clutch their hearts and swallow medicine. They describe their sensations as “excruciating, terrible, terrible, unbearable, terrible” pain. The main thing is to attract attention to yourself, evoke compassion from others, and avoid the need to carry out any errands. And, I repeat, this is not pretense or aggravation. This is a kind of illness for a certain type of personality.

Autonomic disorders can also occur in infants and preschool age. If, for example, they try to force-feed a child, he will cry and complain of pain in the abdomen, and sometimes while crying from displeasure or unwillingness to carry out some assignment, the child begins to hiccup frequently, then the urge to vomit occurs. In such cases, parents usually change their anger to mercy.

Due to increased suggestibility, vegetative disorders can occur in children who see the illness of their parents or other persons. Cases have been described where a child, having seen urinary retention in an adult, stopped urinating himself, and even had to urinate with a catheter, which led to even greater fixation of this syndrome.

It is a general property of hysteria to take the form of other organic diseases, imitating these diseases.

Autonomic disorders often accompany other manifestations of hysteria, for example, they may occur in the intervals between hysterical attacks, but sometimes hysteria manifests itself only in the form of various or persistent autonomic disorders of the same type.

Sensory disorders. Isolated sensory disturbances in hysteria in childhood are extremely rare. They are pronounced in adolescents. However, in children, changes in sensitivity are possible, usually in the form of its absence in a certain part of the body on one or both sides. A unilateral decrease in sensitivity to pain or its increase always extends strictly along the midline of the body, which distinguishes these changes from changes in sensitivity in organic diseases of the nervous system, which usually do not have clearly defined boundaries. Such patients may not feel parts of a limb (arm or leg) on ​​one or both sides. Hysterical blindness or deafness may occur, but is more common in adults than in children and adolescents.

Affective disorders. In terms of terminology, affect (from the Latin affectus - emotional excitement, passion) means a relatively short-term, pronounced and violently occurring emotional experience in the form of horror, despair, anxiety, rage and other external manifestations, which is accompanied by screaming, crying, unusual gestures or a depressed mood and decreased mental activity. The state of affect can be physiological in response to a sharply expressed and sudden feeling of anger or joy, which is usually adequate to the force of external influence. It is short-term, quickly passing, leaving no long-lasting experiences.

We all periodically rejoice in good things, and experience sorrows and adversities that often occur in life. For example, a child accidentally broke an expensive and beloved vase, plate, or spoiled some thing. Parents may yell at him, scold him, put him in a corner, or show an indifferent attitude for a while. This is a common phenomenon, a way of instilling in a child the prohibitions (“don’ts”) that are necessary in life.

Hysterical affects are of an inadequate nature, i.e. do not correspond to the content of the experience or the situation that has arisen. They are usually sharply expressed, outwardly brightly decorated, theatrical and can be accompanied by peculiar poses, sobs, wringing of hands, deep sighs, etc. Similar conditions may occur on the eve of a hysterical attack, accompany it, or occur between attacks. In most cases, they are accompanied by vegetative, sensitive and other disorders. Often, at a certain stage of development, hysteria can manifest itself exclusively as emotional-affective disorders, which in most cases are accompanied by other disorders.

Other disorders. Other hysterical disorders include aphonia and mutism. Aphonia is the absence of sonority of the voice while maintaining whispered speech. It is predominantly laryngeal or true in nature, occurs in organic, including inflammatory, diseases (laryngitis), with organic lesions nervous system with impaired innervation of the vocal cords, although it can be psychogenically caused (functional), which in some cases occurs during hysteria. Such children speak in a whisper, sometimes straining their faces to create the impression that normal verbal communication is impossible. In some cases, psychogenic aphonia occurs only in a certain situation, for example, in kindergarten when communicating with a teacher or during lessons at school, while when talking with peers, speech is louder, and at home it is not impaired. Consequently, a speech defect occurs only in response to a certain situation, something displeasing to the child, in the form of a unique form of protest.

A more pronounced form of speech pathology is mutism - complete absence speech while maintaining the speech apparatus. It can occur in organic diseases of the brain (usually in combination with paresis or paralysis of the limbs), severe mental illness(for example, in schizophrenia), as well as in hysteria (hysterical mutism). The latter can be total, i.e. is constantly noted in different conditions, or selective (elective) - occurs only in a certain situation, for example, when talking about certain topics or in relation to specific individuals. Total psychogenically caused mutism is often accompanied by expressive facial expressions and (or) accompanying movements of the head, torso, and limbs (pantomime).

Total hysterical mutism in childhood is extremely rare. Some casuistic cases of it in adults are described. The mechanism of occurrence of this syndrome is unknown. The previously generally accepted position that hysterical mutism is caused by inhibition of the speech-motor apparatus does not contain any specification. According to V.V. Kovalev (1979), selective mutism usually develops in children with speech and intellectual disabilities and traits of increased inhibition in character with increased demands on speech and intellectual activity while visiting kindergarten (less often) or school (more often). This can occur in children at the beginning of their stay in psychiatric hospital when they are silent in class but make verbal contact with other children. The mechanism of occurrence of this syndrome is explained by the “conditional desirability of silence,” which protects the individual from a traumatic situation, for example, coming into contact with a teacher you don’t like, responding in class, etc.

If a child has total mutism, careful evaluation should always be carried out. neurological examination for the purpose of exclusion organic disease nervous system.

Illustration / Photo: from open sources

Uncontrollable laughter may be a sign of a disease or condition that usually affects the nervous system

Uncontrollable, unreasonable, pathological laughter can be a medical symptom of serious health problems such as brain tumors, stroke, Angelman syndrome, Tourette syndrome, and nervous system disorders due to drug abuse.

At first glance, the connection between laughter and illness seems strange, because we usually laugh when we are happy or think something is funny. According to the science of happiness, intentional laughter can even lift our mood and make us happy. But it's another thing if you're standing in line at the bank or in the supermarket, and suddenly someone suddenly and wildly laughs for no apparent reason. The person laughing may have a nervous tic, twitch, or appear slightly disoriented. A person can laugh and cry at the same time, while looking either childish or like a victim of violence.

If you start laughing involuntarily and often, this may indicate a symptom such as pathological laughter. It is a sign of an underlying disease or pathological condition that usually affects the nervous system. Researchers are still trying to learn more about this phenomenon (pathological laughter is usually not associated with humor, amusement, or any other expression of joy).

As you know, our brain is the control center of the nervous system. It sends signals that control involuntary actions such as breathing, heartbeat, and voluntary actions such as walking or laughing. When these signals go awry due to a chemical imbalance, abnormal brain growth, or a birth defect, bouts of uncontrollable laughter may occur.

Let's learn more about diseases and medical symptoms that may be accompanied by laughter (but not smiling).

Laughter due to illness

Patients or their family members are usually forced to seek help by any other signs of illness, but not by laughter. However, sometimes laughter is a medical symptom that deserves close attention.

Here's an example: in 2007, a 3-year-old girl from New York began to behave quite unusually: periodically laughing and wincing (as if in pain) at the same time. Doctors discovered she had a rare form of epilepsy that causes involuntary laughter. They then discovered a benign brain tumor in the girl and removed it. After the operation, the symptom of this tumor, involuntary laughter, also disappeared.

Surgeons and neurologists have repeatedly helped people with brain tumors or cysts get rid of involuntary and uncontrollable attacks of laughter. The fact is that removing these formations eliminates pressure on the areas of the brain that cause it. Acute stroke can also cause abnormal laughter.

Laughter is a symptom of Angelman syndrome, a rare chromosomal disorder that affects the nervous system. Patients often laugh due to increased stimulation of the parts of the brain that control joy. Tourette syndrome is a neurobiological disorder that causes tics and involuntary vocal outbursts. People with Tourette syndrome generally do not need treatment unless their symptoms interfere with daily activities, such as work or school. Medication and psychotherapy can help patients minimize their symptoms.

Laughter can also be a symptom of drug abuse or chemical dependency. In both cases, the damaged nervous system sends signals, including those that cause laughter. Dementia, anxiety, fear and restlessness can also cause involuntary laughter.

Let's try to figure out what nervous laughter indicates.

Nervous laughter is one of the most interesting speech signals used by a person under stress. Firstly, it simultaneously relieves stress and masks the degree of anxiety experienced. Let me give you an example. Observe teenagers in the process of “courtship ritual” for a member of the opposite sex. Remember when you were a giggling teenager yourself? Nervous laughter performs almost the same function as whistling or talking to oneself while walking through a cemetery or dark alley. Whistling calms a frightened person. Nervous laughter performs the same function in relation to someone who is in an uncomfortable position.

In addition, nervous laughter helps buy time before saying something. It gives the person a little extra time to think and prepare a safe response. It's not at all surprising that there are people who always start laughing or giggling before engaging in conversation. Laughter helps them determine their reaction to what is being said. Let me give you an example. A person may laugh before answering a question asked of him.

As evidenced by nervous laughter. At the same time, nervous laughter is disarming when the situation becomes tense. A person can use well-timed laughter to release pent-up tension. Additionally, laughter is a human reaction that is easy to imitate. Therefore, it can be used to hide stress from the casual observer. Nervous laughter can show that the topic being discussed is very important or painful for the speaker, and can show evasiveness or even deception.

Nervous laughter helps buy time before saying something.

The verbal symptom of sighing has two main interpretations. Firstly, constant sighs during a conversation indicate that your interlocutor in this situation feels sorry for himself and may be experiencing depression. I don't mean to say that he suffers from clinical depression and needs the services of a psychiatrist. Perhaps now he would like to distance himself from the situation or simply end it and move on to another issue. A single deep breath after prolonged resistance or obvious aggressive behavior says the internal emotional or cognitive battle is over. The person is ready to give up and accept the other person’s point of view. Investigators often witness such sighs. After them, the suspects are ready to confess. This behavior is called "acceptance." The person no longer resists the truth or reality of the current situation.