Psychogenic nonepileptic seizures: A historical perspective

Psychogenic nonepileptic seizures have been documented, if not recognized, for over 2000 years. Conventionally, the term hysteria has been used successfully used to describe patients with nonorganic or medically unexplained convulsions. Therefore, the history of psychogenic nonepileptic seizures is closely woven within the texture of hysteria. It is possible to identify a progressive shift from the ancient concept of a female malady caused by an allegedly wandering womb to a neurological disorder that dominated the clinical practice of Victorian physicians in England and, most importantly, Charcot's school in France. Freud's contribution was essential to the development of individualized etiological models within the psychological framework. Over time, causation shifted away from the uterus to the brain, and then to the mind, but was never fully elucidated. The paradigm shift that led from psychodynamic psychiatry to biological psychiatry was accompanied by the operationalization of diagnostic criteria. Historical developments were also mirrored by changes in the terminology, which have led to the recent dismissal of the term hysteria, among a few other medical labels. Psychogenic nonepileptic seizures are currently categorized as functional neurological symptoms, and remain a mysterious, although relatively common, neuropsychiatric condition at the borderlands between epileptology and psychiatry.