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A Brief History of Hysteria

In search of a cure for the outspoken woman.

Image: “The Hysterical Woman,” Women’s Museum of California
“Not only is the actual word Hysteria gendered — it once referred to an exclusively female disease, a mental illness thought to be caused by a malfunctioning uterus.
There is a very long history of critics using accusations or innuendo about women’s mental health or emotional stability in order to shut down their political voices.“
— Sady Doyle

Much of human behavior is shaped by gendered constructs. In different cultures over time, sexuality has been constructed differently, and gender definitions have included different behaviors. In many ways, gender is a fiction- but in the fact of history, power, technology, and, of course, their tool medicine- it is a very real fact that shaped values, identity, economies, and lives.

Medicine and science, despite our modern obsession with empiricism, are not comprised of absolute facts, but rather changing definitions that exist within cultures to mitigate complex dynamics and resolve social problems, desires, or constructions of reality. Medicine and science, by the nature of their alleged objectivity, are easy and powerful tools for solidifying the rule and validity of power structures in the eyes of the public. Just as religion shaped understanding of medicine, and medicine as practice evolved to reflect and function within a broader hierarchy of world, medicine served, in its own way- as social constructions always do- to uphold the powers which shaped its creation and sustain the validity of their dominance.

Three areas where dominance and popular ideology converge perhaps most powerfully are race, class, and gender. All three are interrelated in their constructions, and the varying economic status, race, or gender role shaped, fundamentally, the way society constructed someone’s identity, their function, their power, and their societal role. These identities were not just constructed but implicitly enforced by social and cultural institutions of power that regulated and restricted the movements of bodies, the importance of bodies, and the power/inferiority of bodies.

Certain physiological properties or qualities were assigned or expected based on gender category- and for Victorian-era women this included frivolity, excessive emotion, temperamentality, flightiness, childlike intellect, susceptibility, deceptiveness, sensuality, softness, nurturing qualities, a biological inclination to serve others and perform domestic work, inability to decipher reality from fiction, and a lack of general groundedness in (or even a capacity for) reason.

In fact, these interpretations and constructions of female behavior were so deeply embedded (particularly by a patriarchal, male-dominated field of medicine) that these traits were not just considered to be “feminine” (read: inferior)- they were diseased.

With the rise of materialism and the so-called rational sciences in the 19th century, notions of spirituality began to decline, and new modes for enforcing power structures (that had previously been upheld by aristocracy and religion) emerged. Science, in the place of religion, soon became the new moral authority, and science came to serve the role of sustaining these same social beliefs of good and evil, just and unjust, wise and sinful, in religion’s place. Much of the power lost by the Catholic Church was now in the hands of a small segment of equally powerful, equally dogmatic men.

These elements converged in the seriously problematic, and relatively young, discipline of psychology. In light of Victorian womanhood and the power of male medical authority (as well as the impact of gender constructions on medical theory), the most poignant and historically rich example of the convergence of gender and medicine is Hysteria.

Hysteria was a uniquely feminine disease. It was, in a way, pathological “aspects” of femininity. It is described almost entirely in gendered or sexual terms, and the symptoms of hysteria are just caricatures of what were considered to be feminine qualities. Most notable for examining this are the works of Pierre Janet and Frederick Hollick.

In an attitude indicative of the times, 1840s psychologist Frederick Hollick wrote of the catch-all Hysteric diagnosis, and explicitly names it in terms of gender. His statement virtually sums up male practitioners’ vague but unrelenting fixation on “diagnosing” the mysterious nature of womanhood. He writes, not-so-subtly (in that familiar tone of history’s most perennial figure, the sagacious white male philosopher): “We now come to the most mysterious, confusing, and rebellious of all female diseases… The symptoms of this disease comprise, if we were to enumerate them all, those of nearly every other disease under the sun.”

Hollick attributes all causes of Hysteria to the pathological nature of imperfection of female organs.:

The causes of hysteria are as abscure [sic] as the symptoms are diversified… Young persons just about being regulated are very subject to it… and those who have deranged menstruation, also widows, those who have no children… Some of the immediate causes are, the first period, suppressed menstruation, late marriage, chronic inflammation of the womb, vicious habits… disappointment, particularly in love, reading sentimental and exciting romances, and disagreeable, painful, or sorrowful sights.

Like others in his time, Hollick believed Hysteria originated from a moral (yet also fundamentally biological) deficiency or a violation of good social behavior (“female licentiousness”). Hollick depicted the Hysteric as devious, conniving, and deceptive, describing her in accordance with derisive stereotypes of females as duplicitous (the “lying woman”). In the 1915 article “Hysteria as a Weapon in Marital Conflicts,” psychologist Abraham Myerson agreed, arguing that women often became afflicted with Hysteria to manipulate or deceive men. In every narrative of Hysteria, male psychologists viewed men at the center of the female psyche, and everything the woman did was defined or interpreted in terms of her relationship to or desirability to men.

When describing the typical Hysteric, Hollick tells the story in terms of the woman’s character, and he describes the temperament of a typical Hysteric in terms of male stereotypes about women, depicting her as frivolous, deceptive, and emotional- with these characteristics comprising the total depth of her nature, and also, thereby, being indicators of her Hysteric disease (again illustrating Hysteria as men’s construction of a pathological and deviant femininity).

Hollick writes:

Women disposed to hysteria are generally capricious in their character, and often whimsical in their conduct. Some are seemingly excitable and impatient, others obstinate, or frivolous; the slightest thing might make them laugh, or cry, and exhibit traits they are not ordinarily supposed to possess. Like children, the merest trifles may make them transcendently [sic] happy, or cast them into the most gloomy despair. Very frequently they are made much worse by seeing that those around them have no real commiseration for their sufferings… A delicate attention, and properly exhibited sympathy, will soothe and calm the excited feelings more than almost anything else.

Beyond being a feminine disease, Hysteria was the pathologizing of women who violated Victorian definitions of female sexuality. Many aspects of newly evolving definitions of sexuality and gender roles were personified in this case of the “pathological” woman. She- or rather, the men’s diagnosis of her- exemplified society’s internal conflict over definitions of sexuality and gender roles in the mid-19th century with the dawn of the Industrial Age.

In “Hysteria: the Case of the Good Girl,” historian Elizabeth Lunbeck examines prominent early 20th century psychologist L. E. Emerson’s medical case studies of his Hysteric patients. Emerson’s 1913- 1916 case notes provide rich insight to the state of the Hysteric in her own words, as Emerson often directly transcribed the women’s accounts as well as his own observations.

Based on a close reading of Emerson’s case notes, Lunbeck theorizes that the accounts of these Hysterical patients could be delineated into three categorical types:

  1. Women suffering from overt sexual abuse (but lacking terms to describe it or social context to explain it/as well as society lacking a framework to contextualize experiences like PTSD and the impact of sexual abuse on the psyche).
  2. Women who said male behaviors (such as a wandering hand, implied sexual pressure, sexual intimidation, verbal harassment or abuse) made them feel discomfort, despite the fact that these male behaviors were considered permissible social norms at the time.
  3. Women who were totally withdrawn from heterosexual participation, or had failed to meet the anticipated objectives of romance, childbearing, and “a woman’s place”- as well as those who did not desire them. (Naturally, in the eyes of a Freudian psychologist like Emerson, women who did not desire reproduction, submission, or heteronormativity were, obviously, diseased.) All three types of women were diagnosed with Hysteria, and the only shared indicator among them was a failure to conform to Victorian definitions of female sexuality.

Hysterics were, among other things, women who did not fit into (but were described in terms of) Victorian definitions of womanness. Hysterics included women reporting a lack of sexual desire, or women who exhibited their sexual desire too freely (the latter behavior, despite being the problem, actually implicitly encouraged by and in fact induced by treatment models the male clinicians provided. (i.e. these women embraced prevailing ideas of themselves as passive, morally flawed, or capricious; & their exaggerated imitations of these roles was a way for these women to express their dysphoria with or discomfort with Victorian gender roles and with male violence at large more generally, as popular society lacked the language for accurately describing male violence and abuse at that time.

In “Revolt of the Good Girl,” Lunbeck argues that these women- and their male clinicians- truly had no framework for constructing evolving definitions of sexuality, or for narrating their deep discomfort with patriarchal abuse. She argues that many women who had experienced assault, or even a hostile male environment felt a discomfort with it that they then projected onto themselves as indicative of their own failure. Lunbeck argues that most of these women and their male clinicians at the time simply lacked the language to criticize these abusive behaviors, and lacked a rhetorical construct for alternative philosophies that would have provided a contextual framework within which women might situate their feelings of discomfort as valid or as indicative of broader social problems rather than their own personal failures.

Lacking any other means for constructing their discontent with Victorian female sexuality (or, some argue, of circumventing its restrictions), many women were relieved to embrace male clinicians’ explanations for their feelings, and they readily delivered the symptoms these male clinicians anticipated them to perform (and that, in many ways, male clinicians overtly conditioned them to perform).

L. E. Emerson’s 1912- 1915 handwritten case studies of female Hysterics, and the corresponding scholarly articles he wrote about them, chronicle how the male clinician constructed the female Hysteric’s experience, and the accounts the Hysteric provided to her doctor.

Emerson reports many patients recounting experiences of sexual abuse, as narrated in terms of Victorian definitions of sexuality. Emerson’s diagnosis always places the burden (both medical and moral) on the afflicted victim. He describes women’s failure to conform to or accept the inevitable norms of patriarchy (aka their failure to conform to submissive behaviors) as problems of their moral character or intellectual capability, and Emerson, like Hollick, constructs the disease almost entirely in sexual or gendered terms. Emerson’s portrayal of the woman who has violated proper conceptions of “a woman’s place” depicts her as not only morally flawed, but somehow, he implies, incapable of full human consciousness. He writes:

The greatest endeavor of the hysteric is to avoid self-conscious thinking, and the very essence of self-consciousness is dependent on social relations, hence the unintelligibility of the end-product of uninterpreted unconscious thought. The end-product of all thought is an action of some sort or other. The hysteric chooses the grossest forms for this expression and thus conceals the more refined and higher meanings. This regression to more elemental forms of expression is very unpleasant to the trained thinker who has labored strenuously for long years to escape just that crude, gross, and infantile form of thinking and acting.

Understandings of the ‘moral woman’ juxtaposed with understandings of the simple-minded or duplicitous woman also resonate in Emerson’s case notes, and he depicts the failure of the Hysteric to embody the ideals of moral fortitude and intellect:

So far as my experience goes, the hysteric always has the highest of ideals, only there is a wide chasm between his ideals and his acts, and he is blind to his own limitations and absolutely unaware as to just where the conflict really lies. This follows, of course, from his repressions, and the consequent narrow conception of wherein virtue consists.

As ridiculous and even humorous as Hysteria might sound to the modern mind, at its root, the construction of Hysteria was not funny- and it was not one that would die with the American Psychological Association’s abandonment of the diagnosis in 1952. Power, implicitly or not, always constructs the tools of culture in its own image. Science and medicine, and the criminalization of class, race, and gendered characteristics, actively excluded and justified the persecution of already disenfranchised populations, while celebrating others. Much as the history of medicine has witnessed in the bizarre impregnability of Galenic theory to the sands of time, scientists are far more likely to use “empirical” tools to reinforce existing beliefs than to question them. Gender in the Victorian era of medicine was no exception.

Hysteria was, at its core, a way of rationalizing theories of female intellectual inferiority and regulating female bodies. As Emerson wrote, “One cannot help but be struck by the ethical implications of hysteria. Hysteria is essentially a disease of personality..” Its rhetoric was not only derisive and restrictive psychologically or socially, it even manifested- as medicine, by definition, is ought to do- in physical applications. One treatment of Hysteria (that disease of the “wandering womb”) was a hysterectomy, or the removal of the uterus, and not based on a woman’s informed preference, but on a male doctor’s analysis of her behavior. One need only examine the case of Carrie Buck and the thousands like it to see the worst of how this framework of justification would evolve. What this was, at its root, was physical mutilation or surgery without the patient’s consent, in order to modify the woman’s body to conform to society at large, or, to not only regulate her sexual agency (as the agency she had in society, i.e., the potential to produce male offspring), but to strip her of it should she use it wrongly in a way that threatened the comfort or convenience of men.

While it did reflect confused sexual roles in context of a changing 20th century, and while it did provide some women with an explanation for their existential discomfort with the Victorian female situation (and Victorian male behavior), Hysteria was, ultimately, a much darker thing. The construction of female inferiority feels now, in contemporary times, like an ugly lingering prejudice or a primitive hyperbole of the past, but in the early 20th century this argument of female “deficiency” was not quaint, hypothetical, or social deviance. It was not a well-meaning accident. Female inferiority was a discipline, a thesis topic, a psychiatric specialty, and both a moral and medical fact. It was not an abstraction or epithet- it was a structured framework of thought developed by educated men who utilized applied philosophy, biological determinism, psychiatry, sociology, and virtually every aspect of data available to construct what truly felt like an apolitical, logical, critical, and scholarly depiction of womanhood- and much of the theory that backed up Hysteria and this depiction of animal womanness made (not coincidentally frequent use of a specific term that would soon serve as a legal determinant, medical diagnosis, and scholarly explanation for the American eugenics movement- “feeblemindedness.”

Pierre Janet, an even more prominent psychologist than Emerson or Hollick, even constructed illustrations and theoretical models to describe female inferiority. Janet also described the Hysteric’s affliction in terms of feminine weakness, moral failure, intellectual weakness, and, most importantly, as fundamentally tied to a woman’s female anatomy and her menstrual process. His 1920 compilation “The major symptoms of hysteria: Fifteen lectures as given at Harvard University” reveals the enthusiasm for prevailing ideas about sex and racially based inferiority even, and perhaps especially, among the most educated and esteemed of academics.

The aforementioned Frederick Hollick allegedly claims to be more conservative in regards to Hysteria compared to Janet, a pioneer in the field; nonetheless, Hollick corroborates Janet’s description of the Hysteric, describing the Hysteric as ‘childlike’:

..[We] have just noted with our hysterical patients… their first moral stigma, suggestion, already shows us the isolation of the ideal; it is because there is no re-action [sic] between the various impressions that each word, each emotion, each remembrance, takes an inordinate development which we called suggestibility. Suggestion, it is always said, depends on the absence of control… If it is wanting, it is because the mind is too narrow to contain several ideas opposing one another. The second characteristic, exaggerated absent-mindedness… is but another aspect of the same phenomenon… We may say that their fundamental mental state is characterized by a special moral weakness.

Hollick continues to characterize the Hysteric as somehow of a lower form than that of what he would consider to be a completed person:

It is easy to summarize, in a word, these general disturbances… It is a mental depression characterized by the disappearance of the higher functions of the mind, with the preservation and often with an exaggeration of the lower functions; it is a lowering of the mental level… Besides these feelings of incompleteness, we might enumerate with our hystericals, as with all neurasthenics [sic] whatsoever, the innumerable lapses of all the mental functions. We note in the intelligence a certain apparent vivacity, associated with a fundamental state of laziness and especially of reverie. These patients pay attention to nothing, can bear no mental work. Hysteria, like all neuroses, begins, among girls, with the cessation of their studies and the complete incapacity of learning anything.

Hollick (again) attributes a variety of maladies all pertaining to the sexual organs as the root cause of feminine “personality deficiencies,” rooted in the pathological nature of imperfection of female organs:

In regards to the starting point, or original seat of Hysteria, there seems to be no doubt of its being in the Uterus, which becomes subject to a peculiar excitement, or disturbance, that exerts a wonderful sympathetic influence on the whole system. The Uterus, it must be remembered, is the controlling organ in the female body.

A few of Frederick Hollick’s attributed causes for Hysteria include “unnatural growth of the clitoris, inversion of the womb, inflammation of the vulva, dropsy of the Fallopian tubes, closure of the vagina, profuse menstruation” etc. Hollick includes an additional appendix with essays of his on female pathology, entitled “Headache, Solitary vices, the Internal Female Organs, [and] Sexual Excess.”

Attributing feminine characteristics to biology illustrates the newly emerged construction of biological womanhood, and the construction of a femaleness that makes the bodies of women inherently sexual, inferior, and fundamentally different than the bodies of men. In this framework, Hysteria is the apex of “biological womanhood” in context of Victorian sexuality. Hysteria explains these womanly symptoms as related to a deficiency of the female body, and/or its natural state.

Conversely, the psychiatric profession also claimed that the development of these symptoms (despite being natural inclinations of the woman), was produced by these specific women’s failure to conform to Victorian gender norms more broadly. Many aspects of femininity and an evolving definition of sexuality and gender roles, as modern America shifted into the industrial age, were personified in this case of the “pathological” woman. She- or rather, the men’s diagnosis of her- exemplified society’s internal conflict over definitions of sexuality and gender roles in the late 19th and early 20th century.

Like Hollick, Pierre Janet believed the Hysteric’s moral and intellectual deficiencies were rooted in biological causes, specifically the inferior sex organs of “womanhood.” Janet includes not just the “wandering womb,” but also menstrual periods:

I described, long ago, those women who are suggestible only three days a month, during their menstrual period. Experimental suggestion has never existed with any persons but with Hystericals.

Pierre Janet, with innumerable arguments too disturbing to recount entirely without the author of this essay losing her sanity, tried to posit that not only do women have inferior intellect and cognitive capacity, but that they literally do not have fully formulated consciousness or identity, and that they can’t visually see the way men can. It was very much a way of dehumanizing women in a scientific, very specific, very concrete way. All evidence psychiatrists found seemed to support their claims, and all contradictory evidence also supported their claims. In the end, the disease had “all symptoms” and could be caused by “all causes” (though primarily the weak-woman type ones), and it was less a disease of transient affliction than it was a permanent nature of a “type of person,” the “type” of person being the Hysteric.

In many ways, Hysteria was a precursor to the American eugenics movement (including the passing of Virginia’s 1924 Eugenical Sterilization Act, which involved the compulsory confinement of and forced sterilization of “feebleminded” women), which functions for “the public whole” by using medicine and science to deem the disenfranchised as less than human, and thereby necessitate their expulsion and/or justifies their oppression as a way of weaponizing medicine to uphold and sustain the power structures of imperialism, patriarchy, and white supremacy as they stood in the 20th century, as, in the context of an increasingly urbanized and changing world, concepts of identity were ever more in flux, and collective anxiety over rapid lifestyle changes began to manifest as a rabid kind of moralism, backlash, and exclusionary politics.

Science is not, and has never been, objective. Culture is, by its nature, a shared creation and a shared process. Science is a technological- and in many ways, ideological- function that develops from and works to sustain the dominant ideology of the culture from which it has emerged. In other words, science, medicine, and constructions of disease are all operative applications of larger values and beliefs we hold about reality, the nature of matter, and “certain kinds” of people. Science and medicine, however, have powerfully dangerous potential to be weaponized or used to implement public harm, because of both their assumed moral irreproachability and their ability to directly impact human life. Science and medicine reveal more about our culture and its values than they do, in any way, reveal some kind of objective reality. After all, they are nothing more than a lens for creating and delineating elements of a whole- a whole whose nature we have already defined. Science and medicine don’t reflect objective truth. Science and medicine reveal the values of a culture, which makes it, by definition, both a dangerous tool of power and an invaluably rich artifact of history.


References:

Frederick Hollick, Diseases of woman: their causes and cure familiarly explained, with practical hints for their prevention, and for the preservation of female health. New York: American News Company, 1849.

Pierre Janet, The major symptoms of hysteria: fifteen lectures given in the Medical School of Harvard University. New York: The Macmillan Company, 1920.

Abraham Myerson, “Hysteria as a Weapon in Marital Conflicts,” Journal of Abnormal Psychology 10 (1915–16): 1–6.

Charles C. Mapes, “Sexual Assault,” Urologic and Cutaneous Review 21 (1917): 431–433.

Ernest Jones, M.D., “The Relation Between the Anxiety-Neurosis and Anxiety-Hysteria, ” Journal of Abnormal Psychology (April-May 1913): pp. 1–6.

L E. Emerson, “The Psychoanalytic Treatment of Hystero-Epilepsy,” Journal of Abnormal Psychology 10 (1915–16). Handwritten transcriptions: cases 26, 48, 81, 85, 244.

L. E. Emerson, “The Case of Miss A: a Preliminary Report of a Psychoanalytic Study and Treatment of a Case of Self-mutilation,” Psychoanalytic Review, 1 (1913–14), pp. 41–46, 49–54.

L. E. Emerson, “A Psychoanalytic Study of a Severe Case of Hysteria,” Journal of Abnormal Psychology 7 (1912–13): 308, 385–406.

L. E. Emerson, “A Psychoanalytic Study of a Severe Case of Hysteria (Conclusion),” Journal of Abnormal Psychology 8 (1913–14): 44–56, 180–207.

Margarethe Kossack, “The Sexual Life of the Hysteric,” American Journal of Urology and Sexology 11 (1915): 505–507.

Gurney Williams, “Rape in Children and Young Girls,” International Clinics 2 (1913): 245–262.

Elizabeth Lunbeck, “Hysteria: the Revolt of the ‘Good Girl’,” in The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton, NJ: Princeton University Press, 1997), pp. 209–28. Print.

Elizabeth Reis, American Sexual Histories. Oxford: Blackwell Publishers Ltd., 2001. Print.

Laura Briggs. “The Race of Hysteria: “Overcivilization” and the “Savage” Woman in Late Nineteenth-Century Obstetrics and Gynecology,” American Quarterly 52, №2 (2000): 246–73.