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This may be considered from two aspects: the correction of the long-standing basic personality defect and relieving the recently acquired physical symptoms Little or nothing can be done about the former Psychoanalysts have attempted to modify it by longterm reeducation, but their results are uninterpretable, and there are no control studies for the few reports of therapeutic success Many psychiatrists are inclined to regard the female with hysteria who has a lifelong history of ill health as having a severe personality disorder ie, sociopathy In other, less severe cases and especially in those in whom hysterical symptoms have appeared under the pressure of a major crisis, explanatory and supportive psychotherapy appears to be helpful, and the patients have been able thereafter to resume their places in society The acute symptoms can usually be mitigated by persuasion

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and demonstration One tactic is to treat the patient as though she has had an illness and is now in the process of recovering The earlier this is done after the development of symptoms, the more likely they are to be relieved Sometimes a single symptom such as hemiparesis or tremor can be halted by a particular maneuver and this demonstration suf ces to begin recovery In chronically bedridden patients, strong pressure to get out of bed and resume function must be applied Compensation and litigation neuroses are quite dif cult to treat, and settlement of the patient s claim ( the green poultice ) is usually necessary before the symptoms subside Several approaches to discussing the symptomatology with the patient have been suggested At one extreme is a confrontative approach in which the patient is told the symptoms are psychologic, or in your head We have found this to be counterproductive and almost always to provoke an angry response that does not aid clinical improvement On the other extreme is complete avoidance on the part of the physician, an approach that is almost as unproductive We prefer to ask the patient if the symptoms can in some way be the result of stress or an upsetting recent experience On occasion, in private we will inquire about childhood sexual abuse and often get an af rmative response from the patient, with later con rmation by a spouse or sibling Next comes nonjudgmental but rm reassurance that there is no serious disease We have found it very useful to list the diseases that have been excluded by examination and testing: brain tumor, stroke, amyotrophic lateral sclerosis, multiple sclerosis, etc This often evokes an acknowledgment by the patient that one of the diseases had been a preoccupying concern We then indicate, without using psychologic terms, that the brain may at times adopt certain patterns of behavior that do not re ect structural damage, and furthermore, these patterns can be unlearned with physical therapy and time as described below That the patient s response to these conversations varies widely is not surprising One group seems not to mind and to be relieved by the expression of concern and reassurance that there is no dangerous disease at the root of the problem They can be sent to a physical therapist and may do well in the short run Another group is indignant and not likely to consult the physician again; several have refused to pay the doctor s bill Some have objected to the explanation based on their own view, often derived from research on the internet and with similarly af icted persons, that Lyme disease, chronic viral infection, environmental toxins, allergies, etc, are to blame A few of these cases have the avor of a delusion All that the physician can offer here is an openness to see and reexamine the patient in several months; cure has no meaning in these instances and there is a great likelihood that such individuals will see a long line of doctors Persuasion and suggestion, both direct and indirect, should be employed as already noted Illustratively, the patient should be repeatedly encouraged, told that she is improving, urged to resume work or other duties, and continue participation in routine activities Medication should be withheld Some of our best results have been obtained by indicating that the neurologic symptoms are a constitutional weakness that can be overcome by physical and other therapies Once the current neurologic disorder has disappeared, it may be helpful to counsel the patient in ways to prevent its recurrence Family members should be given the same explanation A regimen of physical therapy should be instituted, utilizing an experienced therapist and setting simple goals for success Every subsequent illness in such patients should be evaluated objectively,.

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