Disability Evaluation in Psychiatric Illness and the Concept of Hysteria *

In the evaluation of disability resulting from hysteria, conversion or psycho-physiological reactions, consideration should be given to the clinical effects resulting from the disturbed, or actual loss of function upon the physiological homeostasis of the patient, as well as his personal activities on a day-to-day basis. While classical forms of major hysteria are less frequent in occurrence in recent years, the etiological basis of the pattern still is clinically significant. Conversion reactions and psychophysiological reactions affecting various body systems continue to be a part of the spectrum of psychiatric illness seen in active practice. While no organic cause for the symptoms is present, the loss of function, when substantial and persistent, equates with the loss of function resulting from actual organic disease. Not all of these reactions occur in the ‘hysterical personality’, and both social and cultural patterns must be taken into account. In evaluating the severity of an impairment (loss of function) resulting from a functional illness, the psychological and physiological homeostasis of the patient is a crucial consideration. Symptoms derived from purely conscious reactions are seldom associated with actual loss of function.