Mind & Brain / Mental Health

As chief of neurosurgery for a small city hospital, I’ve never had a phone call at 2 a.m. bring me good news, and this night held true to form. The emergency room had just admitted a 22-year-old convenience store clerk, whom I will call Rachel. She had awakened several hours earlier with a rather annoying problem: She could not move her legs. According to the ER physician, Rachel noticed that she could not roll over in bed and, when the fog of sleep finally cleared, discovered that she had two lifeless logs where her lower extremities used to be.

She lived alone and, not wishing to disturb her parents living miles away, managed to crawl to her nightstand and phone directly for an ambulance. When I arrived, Rachel was still strapped to a spinal board, the right sleeve of her nightgown rolled up to allow for the intravenous line.

“Does anything hurt?” I asked.

“No,” she said, shrugging. “I really feel fine . . . except for this leg thing.”

“Are they numb?” I continued, stroking her bare shins with my index finger.

“Nah, I feel that. They just feel funny, you know, heavy. Do you think this is serious? When can I go home? I have to open the store at 6.” She smiled. “Gotta make the coffee!”

Further interrogation revealed little. Rachel was healthy, no illnesses, no medications, no surgeries. A smoker since age 14, she used marijuana sporadically, but there was no other history of drug use. No traumas, no chance of pregnancy (her boyfriend had abruptly dumped her six months earlier, and she still seethed when discussing him), no history of depression or other mental illness, no significant family history. She was in good health. Except for the “leg thing.”

In addition to lacking any obvious pathology, she also lacked health insurance. The ER had already set up an MRI of her entire spine and summoned the technician from home to do it. This might yield an answer—but I suspected the truth about her condition already, and I was reluctant to saddle this poor woman with thousands of dollars of expensive pictures. The tests would all be negative anyway.

A quick examination confirmed my suspicions. When I poked her foot with a pin, she yelped but didn’t move her legs. Yet her reflexes were normal, and the tone of her leg muscles was good. Finally, her Babinski sign—a neural reflex that causes the big toe to go down when the sole of the foot is stroked—was normal. These findings, coupled with a blasé attitude toward her paralysis (a mental state known in neurology as “la belle indifférence”), made me suspect a rather distasteful diagnosis: hysteria.

The word “hysteria” derives from the Greek word for womb, and for centuries the condition was thought to be a feminine affliction arising from bad uterine humors. Women hysterics outnumber men six to one for reasons yet unknown. What is known is that the womb plays no role. Many neurological conditions, including migraine and multiple sclerosis, afflict women disproportionately. The ovaries and the hormones they produce or the double X chromosomes are more likely culprits.