Schizophrenia: 'Leaky' blood-brain barrier may cause inflammation

  • The blood-brain barrier shields the central nervous system, which comprises the brain and spinal cord, from the immune system.
  • In a new study, researchers have hypothesized that if this barrier is compromised, it could cause inflammation in the brain, which may, in turn, trigger schizophrenia.
  • To investigate this relationship, they used cells isolated from healthy individuals and from people with a rare genetic disorder that increases the risk of schizophrenia.
  • The blood-brain barriers derived from cells of the latter group were more ‘leaky’ and produced more inflammatory molecules.

Schizophrenia is a psychiatric condition that is characterized by “positive” symptoms, such as hallucinations and delusions, and “negative” symptoms, such as social withdrawal and apathy.

For almost a century, scientists have speculated about a possible link between the immune system and schizophrenia.

Several lines of evidence suggest that the inflammation provoked by a viral infection, either before birth or during childhood, could trigger the condition in adulthood.

Some studies have also found changes in the blood-brain barriers of people with schizophrenia.

The blood-brain barrier comprises the tightly packed layer of cells that line the blood vessels in the brain and spinal cord. It prevents blood-borne immune cells from gaining entry to the central nervous system.

This is sometimes known as conferring “immune privilege” on the brain — in other words, protecting it from harmful inflammation.

Researchers at the University of Pennsylvania’s School of Veterinary Medicine in Philadelphia wondered whether a compromised blood-brain barrier in people with a rare genetic disorder known as DiGeorge syndrome or 22qDS, a genetic deletion syndrome, could be responsible for their increased risk of schizophrenia.

People born with the condition have a 1 in 4 risk of developing schizophrenia later in life. This is compared with an overall risk of schizophrenia of around 1 in 100 in the wider adult population.

People with 22qDS have a small section of DNA missing from chromosome 22 of their genome.

Leaky barrier

To test their hypothesis, the researchers isolated cells from people with DiGeorge syndrome and schizophrenia and from healthy matched controls. They then turned these cells into pluripotent stem cells, which can develop into any type of cell in the body.

In the laboratory, they transformed the stem cells into the type of cells that line the blood vessels in the brain. These are the cells that together function as the blood-brain barrier.

The researchers found that the cells derived from people with DiGeorge syndrome and schizophenia created a less effective, more “leaky” barrier than those derived from the healthy controls.

In addition, the cells produced more of a type of molecule that promotes inflammation. This allowed more immune cells to penetrate the barrier.

The researchers obtained similar results when they investigated the integrity of the blood-brain barrier in a mouse model of DiGeorge syndrome.

Finally, they performed the same tests in postmortem brain tissue from three people who had DiGeorge syndrome and from three age-matched healthy controls.

They found evidence that the effectiveness of the actual blood-brain barrier of these people had indeed been compromised.

The research, which doctoral student Alexis Crockett led, now appears in the journal Brain.

Other brain disorders

The study authors speculate that a compromised blood-brain barrier may interact with environmental or other genetic risk factors to increase the likelihood not only of psychosis but also of other brain disorders in the case of people with DiGeorge syndrome.

“[W]e think these findings could also be used to understand how the blood-brain barrier and neurological processes impact not only schizophrenia but mental disorders at large,” says senior study author Prof. Jorge Iván Alvarez, from the School of Veterinary Medicine.

In 2019, Medical News Today reported on a study that suggested that a faulty blood-brain barrier in aging mice triggered brain inflammation and cognitive impairment in the animals.

Prof. Alvarez speculates that further research into the link between inflammation and neuropsychiatric disease could lead to new therapies for these conditions.

Anti-inflammatory and immunotherapy drugs have already shown some promise as treatments for schizophrenia, alongside standard treatments.

Schizophrenia is multifactorial

It is worth noting that schizophrenia is a “multifactorial” condition. This means that there is no single, clear cause. Rather, a wealth of different genetic and environmental influences interact to increase or decrease an individual’s risk of developing it.

Prof. Alvarez told MNT that people with the DiGeorge syndrome “phenotype” — that is, the characteristics arising from interactions between genetics and environment — will respond negatively to particular environmental challenges.

“These might include prenatal infection in the mother, or an infection in childhood.”

This “second hit” would worsen their condition in distinctive ways. “In terms of a ‘second hit,’” he said, “we believe that such environmental challenges will exacerbate the phenotype described under [steady] conditions.”

In their paper, Prof. Alvarez and colleagues also report some limitations of their study.

For example, their experiments did not prove that everyone with DiGeorge syndrome has a compromised blood-brain barrier. There remains a possibility that the changes are only present in those who develop schizophrenia.

To test this possibility, Prof. Alvarez said that he and his team would repeat the experiments using pluripotent stem cells from people who have this particular genetic deletion syndrome but have not developed schizophrenia.

“[W]e are planning to run these experiments using deleted non-schizophrenia [stem cells],” he said.

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Mental well-being linked to better cardiovascular and overall health

  • The American Heart Association (AHA) have just released their latest scientific statement.
  • In it, they note that mental health is an important component to heart health, cardiovascular disease prevention and treatment, and overall well-being.

In 2019, National Institute of Mental Health data suggested that nearly 51.5 million adults in the United States had some form of mental health condition.

As the COVID-19 pandemic raged on, the Centers for Disease Control and Prevention (CDC) estimated that by late June 2020, 40% of adults had a mental health condition or substance use disorder.

Even when doctors do an excellent job of focusing on their patients’ physical condition, they can sometimes unwittingly overlook psychological health.

Nonetheless, healthcare professionals are increasingly acknowledging the connection between mental health and physical well-being. This could lead to more effective treatment and prevention strategies that focus on the patient as a whole.

To address this issue, the AHA — in conjunction with the Council on Clinical Cardiology, the Council on Arteriosclerosis, Thrombosis and Vascular Biology, the Council on Cardiovascular and Stroke Nursing, and the Council on Lifestyle and Metabolic Health — published a scientific statement in the journal Circulation.

This statement is an evaluation and summary of 128 studies relating to the association between psychological wellness and cardiovascular health.

The impact of adverse psychological health on the body

The statement’s authors began their investigation by looking at negative psychological health and its connection to cardiovascular disease. This included looking at research into chronic and traumatic stress, anger and hostility, anxiety, depression, and pessimism.

The overall data analysis showed an increase in heart rate irregularities, blood pressure readings, inflammatory markers, and reduced blood flow to the heart associated with the above traits or with mental health conditions.

People with mental health conditions or related traits were also more likely to have cardiovascular disease, type 2 diabetes, high blood pressure, high cholesterol levels, and weight-related issues.

Additionally, the authors found that these individuals were more likely to engage in behaviors that affect health, such as smoking, being inactive, eating an unhealthful diet, and not taking medications as prescribed.

Positive mental health enhances physical well-being

The AHA team also reviewed a number of studies into how positive psychological factors affect cardiovascular health.

Study participants who reported greater optimism, sense of purpose, happiness, mindfulness, life satisfaction, emotional vitality, well-being and gratitude, and resilience were less likely to experience stroke and cardiovascular disease, and they had a lower risk of mortality.

Specifically, people who reported a positive mental health status were more likely to have lower blood pressure, better glucose control, less inflammation, and lower cholesterol.

In general, the mentally healthy study participants were more likely to engage in beneficial behaviors, such as having higher levels of physical activity, adopting heart-healthy eating habits, adhering to medication schedules, regularly visiting the doctor, and not smoking.

The mind-body connection

Data analysts also investigated how interventions for psychological conditions or symptoms impacted cardiovascular and general wellness outcomes.

The review team looked at research into interventions used to reduce stress, promote coping skills, or cultivate positive psychological well-being.

They found that, in the studies they reviewed, engagement in psychological therapy and mind-body programs led to better cardiovascular health and overall wellness.

Effective psychological health programs include cognitive behavioral therapy, psychotherapy, collaborative care management approaches, stress reduction therapy, and meditation.

Dr. Glenn N. Levine, chair of the writing committee and a professor of medicine at the Baylor College of Medicine in Houston, TX, summarizes the team’s findings, saying: “Wellness is more than simply the absence of disease. It is an active process directed toward a healthier, happier, and more fulfilling life, and we must strive to reduce negative aspects of psychological health and promote an overall positive and healthy state of being.”

“In patients with or at risk for heart disease, healthcare professionals need to address the mental wellness of the patient in tandem with the physical conditions affecting the body, such as blood pressure, cholesterol levels, chest pain, etc.”

– Dr. Glenn N. Levine

Study-related limitations

Because many of the studies the team analyzed were observational and relied heavily on self-reporting, it is difficult to establish specific cause-and-effect relationships.

However, because of the sheer volume of study data that reflects an association between adverse psychological health and cardiovascular risk, the authors say that this is enough to suggest a tangible connection between the mind, heart, and body.

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Aphantasia: The inability to visualize images

Researchers have uncovered distinct differences between people who can create visual images in their mind and those without this ability. They found more proof that ‘mind-blindness’ is a legitimate condition.

The inability to voluntarily form mental images was first described in medical literature by Francis Galton in 1880. People with this condition experience difficulty picturing scenes or objects in their mind, a phenomenon known as mind-blindness.

Since Galton first reported its existence, it wasn’t until a 2015 study published in the journal Cortex that scientist Adam Zeman labeled the condition as “aphantasia.”

Aphantasia is rare, but scientists have identified two types of the disorder, including acquired aphantasia, which can occur after a brain injury or occasionally after periods of depression or psychosis, and congenital aphantasia, which is present at birth.

The impact of aphantasia

People without visual imagery can experience a host of challenges. For example, the ability to recall faces or familiar places can cause frustration and social difficulties.

Being unable to visually remember important events, such as what the flowers or dress looked like on a person’s wedding day, can also be disheartening. Even simple imagery tasks, such as counting sheep to fall asleep, is a challenge.

Interestingly, a recent article in Scientific Reports notes that people with this condition experience images while dreaming, although they are not as vivid or frequent. This observation suggests that while unintentional visual imaging may remain mostly intact, intentionally recalling images is more challenging.

To probe deeper into the inner workings of the “mind’s eye,” a group of researchers recently set out to investigate the differences between individuals who have aphantasia and people with typical imagery skills.

The researchers used drawing tasks requiring visual memory to ascertain differences between the two groups. Their findings appear in the journal Cortex.

The study

The study team showed photographs of three rooms to 61 people with aphantasia and 52 without the condition. The scientists then asked participants in both groups to draw the rooms, once from memory and once while using the photo as a reference. The drawings were scored objectively by 2,795 online volunteers.

After gathering the data, the team adjusted for age, differences in art abilities, and visual recognition performance, and compared the participants’ abilities to perform imagery tasks with individual objects versus spatial relations among several items.

When drawing from memory, those with aphantasia had difficulty remembering objects in the picture. They drew significantly fewer objects — 4.98 on average compared to 6.32 for the control group. Their items were colorful, and they spent less time drawing them than those with typical imagery skills.

The aphantasia group also used more symbols and text in their renditions, often relying on verbal strategies by labeling a piece of furniture or architectural component instead of drawing the details.

‘Seven to nine details’

Study lead Wilma Bainbridge, an assistant professor of psychology at the University of Chicago, said:

“One possible explanation could be that because [individuals with aphantasia] have trouble with this task, they rely on other strategies such as verbal-coding of the space. Their verbal representations and other compensatory strategies might actually make them better at avoiding false memories.”

However, participants with aphantasia showed no impairments in spatial memory. This group accurately placed objects in their drawings with fewer mistakes than participants with typical imagery abilities.

When asked to draw directly from an image, both groups completed the task without significant performance differences. This result leads researchers to believe that although those with aphantasia lack visual imagery abilities, they appear to retain spatial memory, possibly indicating these two memory functions are stored differently in the brain.

From the participant’s perspective, when asked about their study experience, one person with aphantasia said, “When I saw the images, I described them to myself and drew from that description, so I could only hold seven to nine details in memory.”

Another explained, “I had to remember a list of objects rather than the picture.”

Bainbridge and her colleagues hope to use MRI scanning in future studies to clarify where and how aphantasia manifests in the brain. Until then, the current body of research is significant, as it reaffirms the existence of this rare condition and gives more insights on what it is like to live without the ability to create images through the mind’s eye.

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Thanksgiving 2020: 5 tips to protect mental health

For most people, Thanksgiving will be very different this year. In this article, we provide 5 basic tips to help bolster our mental health before, during, and after the 2020 holiday season.

Thanksgiving is traditionally a time to share food and frolics with our nearest and dearest. For most of us, this is unlikely to be the case this year. With travel restrictions and quarantines in place, we will need to adjust.

Although the pandemic has affected everyone in different ways, there seems to be little doubt that the average mental health of the population in the United States has declined.

At a time when family and friends are normally the closest, this year, they will be farther away. Looking after our mental health in a proactive way is more important than ever as we enter the holiday season.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

In this Special Feature, we will look at ways to fend off the seemingly inevitable blues of a physically distant Thanksgiving. Even without a pandemic to deal with, the holiday season brings stresses and strains, so with the added pressures this year has presented to us, we need to focus.

Right from the get-go, it is important to make it clear that nothing we provide below can fill the void or heal the anxiety that COVID-19 has produced. Perhaps, though, it might nudge the needle in the right direction. Sometimes, small steps, taken together, can produce significant benefits.

Before we dive in, here is something to bring to the forefront of your mind as often as possible over the coming days and weeks:

Each day, scientists are learning more about how SARS-CoV-2 works. Vaccines are coming. Yes, 2020 has been challenging, but, with medical research in our armory, we will defeat COVID-19.

1. Sleep

No article on maintaining mental health would be complete without mentioning sleep. We do not give it the space that it needs in our modern, neon-lit world. We all need to do better.

Losing sleep interferes with our mood. This is intuitive, but it is also backed by research. For instance, one study concludes, “Sleep loss amplifies the negative emotive effects of disruptive events while reducing the positive effect of goal-enhancing events.”

In other words, if we do not sleep enough, we are more likely to feel negative when things go wrong, and we are less likely to feel good when they go well.

Similarly, another study found that “individuals become more impulsive and experience less positive affect after a period of short sleep.” Once again, reduced sleep duration appears to dampen mood.

At a time when the mood of the nation is at a low ebb, sleeping a little extra might be a relatively simple way to tip the scales in our favor. For advice on getting better sleep, click here.

It is worth noting, though, that the relationship between sleep and mental health is complex and two-way — mental health issues can impact sleep quality, and a lack of sleep can damage mental health.

2. Keep active

As with sleep, any article that aims to boost mental health has to include exercise. As the temperature drops, forcing ourselves outside can become increasingly challenging. Scientists have shown that physical activity can boost mood both in the short and long term.

A review published in 2019, for instance, found a relationship between cardiorespiratory fitness and the risk of common mental health disorders. Similarly, a 2018 meta-analysis concluded that “[a]vailable evidence supports the notion that physical activity can confer protection against the emergence of depression.”

Importantly, we do not need to run a 4-minute mile to gain mental benefits from exercise. A study from 2000 found that short, 10–15-minute walks boosted mood and increased calmness.

So even if it is something simple, such as dancing in your kitchen or walking your dog for a little bit longer, it all counts.

It is true that neither exercise nor sleep can replace a hug from a friend or relative, but if our mood is momentarily boosted or our overall average mood is upped, it might help us manage disappointment better and reframe this difficult year.

3. Addressing loneliness

For many people, loneliness has already been a significant feature of 2020. Reflecting on friends and family during Thanksgiving is likely to intensify those feelings of isolation.

To combat this, make an effort to make contact. Whether it is a simple phone call or a video chat, schedule some conversations in. Remember, you are not the only one feeling lonely. If it is safe and permissible in your area, meet up with a friend somewhere outside and take a walk.

Check in with others — emails, texts, and social media can be useful in times like this. Rather than doomscrolling, send a “How are you?” to someone you miss. They likely miss you, too.

Stay occupied. Empty time can move slowly. Find a new podcast, listen to new or old songs, pick up that guitar, start drawing again, learn a new skill, or anything else. An occupied and engaged mind is less likely to dwell on the loneliness.

A recent study found that people who get involved in an enjoyable task and enter a state of flow fared better during lockdowns and quarantines. The authors write:

“Participants who reported greater flow also reported more positive emotion, less severe depressive symptoms, less loneliness, more healthy behaviors, and fewer unhealthy behaviors.”

4. Eat and drink well

Thanksgiving is associated in no small part with overindulgence. I don’t think it would be fair or reasonable to expect people, in 2020 of all years, to reduce their turkey intake.

With that said, there is growing evidence that what we eat impacts our mood. For instance, a recent review that appears in BMJ concludes:

“Healthy eating patterns, such as the Mediterranean diet, are associated with better mental health than ‘unhealthy’ eating patterns, such as the Western diet.”

With this in mind, ensuring that we eat well in the lead-up to and the days following Thanksgiving could help us keep a steady mind.

While we are discussing consumption, it is worth mentioning alcohol. In the long term, alcohol increases the risk of developing mental health issues, such as depression and anxiety. Although, at the time, alcohol might lift mood and reduce anxiety, it will not help in the long run.

5. Align expectations

Not everyone is on the same page when it comes to the pandemic. Some people might still be shielding, while others might have succumbed to “pandemic fatigue” and be returning to normal prematurely. Others still might use terms such as “scamdemic” and refuse to wear a mask.

Some family members might be pushing for a family meal, like the long distant days of 2019. Others, sensibly, might be visualizing a Zoom-based meal plan.

These differences in position have the potential to cause disappointment and additional stress. It is important to have clear and frank discussions with family members about what they can expect this year.

Remember, with any luck, next Thanksgiving will see a return to some form of normality. Hopefully, we will only have to endure this unusual and uncomfortable Thanksgiving once. If you are not comfortable with someone’s proposed plan, say “no.” And stick to your guns.

With spikes in case numbers across much of the U.S., the most sensible option is to limit human contact as much as possible.

Although laws, rules, and regulations vary between regions, the Centers for Disease Control and Prevention (CDC) have published a document outlining factors people should consider when planning get-togethers and events.

In general, gatherings with more people are risky, as are events in enclosed spaces. People can lower the risk in a number of ways, including:

  • inviting fewer people
  • meeting outdoors
  • wearing masks (unless eating)
  • remaining 6 feet (2 meters) apart
  • washing the hands frequently
  • keeping music low so that people do not need to shout
  • limiting alcohol intake

When it comes down to it, each individual has to make their own decision about how they act within the law. To protect your own mental health, make your own decision and do not allow yourself to be railroaded into doing something that you consider to be too risky.

The safest way to enjoy Thanksgiving this year, unfortunately, is to do it virtually.

The take-home

Individually, the tips outlined above cannot replace the good times we expect from Thanksgiving. However, if we make more of an effort to eat right, sleep right, and move around, the cumulative effect might be enough to enjoy some benefit.

Remember, we are on the home straight. Reach out and talk to friends and family if you are feeling low. The odds are they are feeling low, too. Never be afraid to talk about your emotions. No one is having the holiday season they expected.

As many people struggle during this time, it might be hard to see an end in sight. If you are contemplating self-harm or if you know someone who is, we have a list of excellent resources here. We are in this together, and it will end.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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Female hysteria: The history of a controversial 'condition'

For centuries, doctors readily diagnosed women with “hysteria,” an alleged mental health condition that explained away any behaviors or symptoms that made men…uncomfortable.

A fondness of writing, symptoms of post-traumatic stress disorder or depression, and even infertility — for the best part of two centuries, all of these and more could easily fall under the umbrella of “female hysteria.”

Throughout the 18th and 19th centuries, female hysteria was one of the most commonly diagnosed “disorders.” But the mistaken notion that women are somehow predisposed to mental and behavioral conditions is much older than that.

In fact, the term hysteria originated in Ancient Greece. Hippocrates and Plato spoke of the womb, hystera, which they said tended to wander around the female body, causing an array of physical and mental conditions.

But what was female hysteria supposed to be, what were its symptoms, how did doctors “treat” it, and when did they cease to diagnose it as a medical condition?

These are some of the questions that we answer in this Curiosities of Medical History feature.

Female hysteria in the 18th century

While the original notions of female hysteria extend far into the history of medicine and philosophy, this diagnostic became popular in the 18th century.

In 1748, French physician Joseph Raulin described hysteria as a “vaporous ailment” — affection vaporeuse in French — an illness spread through air pollution in large urban areas.

While Raulin noted that both men and women could contract hysteria, women were, according to him, more predisposed to this ailment because of their lazy and irritable nature.

In a treatise published in 1770–1773, another French physician, François Boissier de Sauvages de Lacroix, describes hysteria as something akin to emotional instability, “subject to sudden changes with great sensibility of the soul.”

Some of the hysteria symptoms that he named included: “a swollen abdomen, suffocating angina [chest pain] or dyspnea [shortness of breath], dysphagia [difficulty swallowing], […] cold extremities, tears and laughter, oscitation [yawning], pandiculation [stretching and yawning], delirium, a close and driving pulse, and abundant and clear urine.”

De Sauvages agreed with his predecessors that this condition primarily affected women, and that “men are only rarely hysterical.”

According to him, sexual deprivation was often the cause of female hysteria. To illustrate this, he presented the case study of a nun affected by hysteria, who became cured only when a well-wishing barber took it upon himself to pleasure her.

Another means of “treating” instances of hysteria was through mesmerism, an alleged psychosomatic therapy popularized by Franz Anton Mesmer, a German doctor who was active in 18th-century Europe.

Mesmer believed that living beings were influenced by magnetism, an invisible current that ran through animals and humans, and whose imbalances or fluctuations could lead to health disruptions.

Mesmer alleged that he could act on this magnetic undercurrent and cure humans of various maladies, including hysteria.

Hysteria in the 19th century

Throughout the 19th century and the beginning of the 20th century, there was perhaps even more talk of female hysteria and its potential causes.

Around the 1850s, American physician Silas Weir Mitchell, who had a special interest in hysteria, started promoting the “rest cure” as a “treatment” for this condition.

Rest cure involved lots of bed rest and strict avoidance of all physical and intellectual activity. Mitchell prescribed this treatment preferentially to women who he deemed as having hysteria.

By contrast, he would advise men with hysteria to engage in lots of outdoor exercise.

Mitchell famously prescribed the rest cure to the American writer Charlotte Perkins Gilman, who found the experience so harrowing that she wrote “The Yellow Wallpaper,” a psychological horror story that maps the slow psychological deterioration of a woman who is forced by her doctor, her husband, and her brother to follow this “treatment.”

In France, neuropsychiatrist Pierre Janet, who was most active between the 1880s and the early 1900s, argued that hysteria resulted from a person’s own warped perception of physical illness.

Janet wrote that hysteria was “a nervous disease” where “a dissociation of consciousness” took place, often characterized by symptoms such as somnambulism, the emergence of “double personalities,” and involuntary convulsions.

The founder of psychoanalysis, Sigmund Freud, also took an interest in hysteria, though his views on its causes fluctuate throughout his career.

He argued that hysteria was the conversion of psychological issues into physical symptoms, often with an element of erotic suppression.

At first, he suggested that symptoms of hysteria were caused by traumatic events, though later, he said that previous trauma was not necessary for hysteria to develop.

Vibrators for hysteria?

The 2011 rom-com Hysteria popularized the view that vibrators are tools meant to cure hysteria in female patients.

This story originates from an influential book of medical history: The Technology of Orgasm, by Rachel Maines, which first appeared in 1999.

Maines argued that, in the late 19th century, doctors would often treat female patients’ hysteria symptoms by manually stimulating their genitalia. According to her, the vibrator eventually emerged as a device that would save physicians some effort when treating their patients.

However, more recently, scholars argue that Maines’s perspective was inaccurate and that there was no evidence to support her theory.

The study paper that contradicts Maines’s theory states, “none of her English-language sources even mentions production of ‘paroxysms’ [a euphemism for orgasm] by massage or anything else that could remotely suggest an orgasm.”

Yet such stories and hypotheses emerged precisely because 19th-century medical treatises did emphasize the connection between female sexuality and hysteria.

Some 19th-century doctors infamously argued that problems within the genitalia could cause psychological problems in women — including hysteria.

For instance, Richard Maurice Bucke, a Canadian psychiatrist active in the late 19th century, opted to perform invasive surgery, such as hysterectomies — where doctors remove the uterus — to “cure” female patients of mental illnesses.

Therefore, for a long time, hysteria remained an umbrella term that included numerous and widely different symptoms, reinforcing harmful stereotypes about sex and gender.

While this “condition” is no longer recognized and started to “fall out of fashion” in the 20th century, this was actually a long and unsteady process.

The first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) of the American Psychiatric Association (APA) — published in 1952 — did not list hysteria as a mental health condition.

Yet it reappeared in the DSM-II in 1968, before the APA dropped it again in the DSM-III, in 1980.

Time and again, researchers of medical history point to evidence that hysteria was little more than a way to describe and pathologize “everything that men found mysterious or unmanageable in women.”

And while medical practices have evolved incomparably over the past couple of centuries, investigations still reveal that data about females are often scarce in medical studies.

In turn, this continues to impact whether they receive correct diagnoses and treatments, suggesting that society and medical research have a long way to go to ensure all demographics get the best chance at appropriate healthcare.

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