The painting above is one of the most well-known displays of the no-longer recognized psychiatric disorder called hysteria. We see doctor Jean-Martin Charcot standing beside his most famous patient, Marie 'Blanche' Wittman, in the Salpêtrière hospital in Paris, as he performs hypnotic treatment to rid her of her hysterical fits. This demonstration, it has been speculated, was staged, and one could say that the diagnosis itself has questionable foundations, but its presence in medical and social discourse has been of rather great scale. I figured I'd dive into some of that history. I'll only be able to scratch the surface here, but I'll leave some extra sources at the bottom in case you want to know more.
But before we begin: what exactly is hysteria? That's actually quite difficult to say. The term comes from the Greek word for uterus: hystera. We'll see why further down. Over the years since its first emergence, hysteria seems to have turned into a blanket term for a plethora of psychological disorders. Though if we boil it down, I would say that it is a condition associated with erratic behavior and excessive displays of emotion. A general divergence from the psychological and perhaps even social norm, if you will. It's a disease that had only been diagnosed in women up until about the late-19th century.
In early medical history, and in some cases still to this day, conditions associated with the female body such as these would more often than not be attributed to a flaw in the reproductive system. Most notably to the idea of the wandering womb. So let's start there.
The wandering womb
Quite a catchy title for sure, the wandering womb. I reckon it would make a great band name. In essence, physicians back in the day believed that a woman's uterus could float inside the body, moving from place to place, putting pressure on different organs and causing various physical ailments as a result. It's almost as if it had a mind of its own, experiencing emotions and imposing its will upon the vessel in which it resided. It was not uncommon for the uterus to be described in such a personified way, for example as being angry, sad, melancholic, or even vengeful. As far as I've been able to find, this belief goes back to the ancient Egyptians, whose remedy was to smear strong-smelling salves on their patients' vulvas in order to lure the uterus back into place.
The mystique around the uterus made it the perfect scapegoat for otherwise inexplainable behaviors. While it was a time of tremendous ignorance about the female body, as women were generally excluded from medical studies and autopsies, it was known that the presence or absence of a uterus is what set the sexes apart internally. So when a disorder is discovered seemingly only presented in women, it must be related to the womb. It's difficult not to consider this a ridiculous notion with the knowledge of today, but I suppose, when viewing it in its temporal context, I can see the attempt at logic.
Though later this belief was subsided and physicians looked for answers elsewhere. As a result, hysteria has been regarded as a trauma response, a psychiatric condition, a neurological one, and, I will add, a social one. With the symptoms being as widespread as they are, the search for its root cause took centuries. Let's dive into that a little more.
Symptoms and treatments of hysteria
There has never been a set list of symptoms for this illness. Nor has there been for any illness, to be fair. This list might therefore not be complete, or it might not have appeared packaged together as such, but it can still provide us with an idea of what hysterical symptoms may have looked like. For example:
Loss of hearing, speech, and sight
Inability to swallow
Paralysis of the hands, arms, and legs
Mysterious swellings of the abdomen or throat
A sense of suffocation
Fainting
Odd breathing patterns
Loss of sensation and of reflex action
Odd postures and facial expressions
Writhing and contortions
Strange vocal tics
Anxiety
Infertility
...oh, and an unwillingness to marry.
As early as the ancient Greeks, the cause for these symptoms was traced back to sexual repression, or a lack in sexual activity, as later also echoed by Sigmund Freud. In other words: the sad uterus. Unsurprisingly therefore the prescribed treatment was marriage for the single, and sex for the married. It was presumed that pregnancy and childbirth would also help. And I can't help but notice a pattern here. The remedy for hysteria seemed to be for a woman to simply fulfill her natural roles as a wife, a mother, and a tool of sexual pleasure.
Rest helped as well. A new hypothesis for the underlying cause of hysteria was an overstimulation of the mind. That was just too much for a simple woman to handle. So over time there came into being sanatorium-like institutions for women who suffered from the condition, where they would be constantly monitored. They might be strapped to a bed, force-fed, massaged, and sometimes treated with mild electromagnetic shocks, aimed to calm the nervous system. This came after a period of treatment through mesmerism, a sort of animal magnetism in which the energy flowing in a person's body could be extracted and transferred to another through massage or transference. Hypnosis was later employed, too, and Freud introduced talk therapy to address underlying traumas.
Now I've mentioned "massages" here twice. For some reason, information as to the nature of these massages is quite vague. It has been speculated that doctors would perform pelvic stimulations, the goal being to bring the woman to orgasm to release her of her sexual frustration. That's me using proper wording. You could also call it sexual violation. But there is no recorded evidence of this, apart from a few medical drawings seeming to imply as much. It might also be good to mention that, although it is the entire plot of the 2011 movie Hysteria, the idea that the first vibrator was invented as a remedy to hysterical fits, is a myth. A very compelling one, I have to say. But that which is now considered the prototype of the modern-day vibrator was actually designed exclusively for men. Are we surprised?
The social context
This is where I can bring our the social scientist and history buff in me. Throughout history there have been multiple instances of the politicization of diseases, and hysteria is no exception. That which the medical world considers divergent from the health-norm has never been a stagnant given. Rather, it moves with the time and the culture in which these measurements reside. Homosexuality, for example, has been deemed a disease and has been criminalized for centuries, treated with chemical castration or punished with worse. And it's conditions of the mind especially that are susceptible to cultural influences, as it is not so much a matter of measuring one's count of white blood cells, spotting an abnormal growth, or taking one's temperature to discover an anomaly. The diagnosis is based on behavior and thought. And boundaries for what constitutes "normal" behavior are a lot less clear than for what constitutes "normal" vital functions. Not to mention a person's inner lifeworld is shaped by their upbringing, their culture, and their genetics, making it that much harder still to give a clear template of what a "mentally healthy" state should be. Looking at the symptoms as described above, there is much room for subjectivity. Odd posture, odd facial expressions, strange vocal ticks. How would those be measured against their "normal" counterparts?
In a way, I see hysteria as a self-fulfilling prophecy based on confirmation bias. Now this is just me speculating, to be clear. But can we imagine for a second? A doctor has deemed you hysterical (read: crazy) and admits you to his neurological wing in the Salpêtrière hospital. You're monitored every hour of every day, physicians watching your every move. You yawn? It's photographed, used as evidence of your condition. You sleep? Same thing. No agency, no freedom of movement, no freedom of expression, treated as a diseased patient rather than a human being. Who would not go crazy under those circumstances? And when you do become angry or generally emotional at a breaking point, the physicians see their hypothesis confirmed. It's a hysterical fit, clear as day. "See? We were right. You belong here."
Taking all of that into account, it has been argued that the surge in hysteria diagnoses around the 19th and 20th century was an indirect response to emancipatory social change taking place during that time. Feminist scholars argue that the women's behavior diagnosed as such does not stem from mere sexual repression, as Freud would put it, but from repression of emancipatory desires. Feelings of restriction by one's husband, father, society at large, stirred a yearning to rebel. French author Hélène Cixous (1981, 49) contends that it is the silencing of women that caused these bodily reactions. She writes: "Silence: silence is the mark of hysteria. The great hysterics have lost speech, they are aphonic, and at times have lost more than speech: they are pushed to the point of choking, nothing gets through. They are decapitated, their tongues are cut off and what talks isn’t heard because it’s the body that talks."
And it worked the other way around, too. Not only were perceived symptoms ignited by the cultural climate, so were attitudes towards those symptoms. It was a time where women's rights movements such as the Suffragette's were slowly beginning to take shape, and where women became generally more outspoken about their desire for equal rights. Anciently anchored ideas of how women and men should behave - remember the unwillingness to marry? - were being challenged. To some extent, the very notion of femininity was called for reevaluation. That can lead to conservatist resistance. Or at the very least a lot of discomfort for those who had been enjoying the privileges of patriarchal society: (white) men. Women who were found to inhibit these "radical" or "activist" ideas could be labeled hysterical, creating a sort of vicious cycle of feminists being silenced, which gave rise to a stronger desire for change, which received a stronger counter-offensive, and so on, and so forth.
Hysteria today?
It wasn't until 1980 that the diagnosis 'hysteria' was officially removed from the Diagnostic and Statistical Manual of Mental Disorders. Actual diagnoses of the illness had been dwindling since a few decades prior, instead being more accurately categorized as anxiety, epilepsy, bipolar disorder, borderline personality disorder, or other similar conditions.
But the cultural impact lingers. Being "hysterical" has attained the status of an insult, mostly directed at women when they display a perceived emotional overreaction, most notably towards women of color ('the angry black woman'). More neutrally, it is used in the context of mass hysteria, which can include anything from a collective mimicking and adopting of tics, to group panic, and sometimes inexplainable outbursts of (mental) illness amongst a certain group of people. In this sense it transcends its former gender-boundary.
And while there is no medical foundation for the condition anymore, it still impacts women's experiences at the doctor's office to this day. More often than for men, women's pain is disregarded and women's symptoms are dismissed as being merely hormonal or psychological. When men and women present the exact same pain-related symptoms, male patients are more likely to be prescribed painkillers, whereas female patients are more likely to be prescribed psychotherapy. I could dedicate an entire post just to this discrepancy, but for now, I leave you with a short podcast episode centered around the topic, in case you haven't had enough yet of this fascinating chapter of the medical world.
Reference list and further readings
Braun, Johanna, ed. 2020. Performing Hysteria: Contemporary Images and Imaginations of Hysteria. Leuven: Leuven University Press.
Briggs, Laura. 2000. "The Race of Hysteria: "Overcivilization" and the "Savage" Woman in Late Nineteenth-Century Obstetrics and Gynecology" American Quarterly 52(2): 246-273.
Cixous, Hélène. 1981. “Castration or Decapitation?” Trans. Annette Kuhn. Signs 7(1): 41-55.
Dirkx, J., and Heuves, W. Hysterie: Psychoanalytische beschouwingen. Amsterdam: Uitgeverij Boom.
Hustvedt, Siri. 2016. "I Wept for Four Years and When I Stopped I Was Blind." in: A Woman Looking at Men Looking at Women: Essays on Art, Sex, and the Mind, 400-415. London: Hodder & Stoughton Ltd.
Scull, Andrew. 2009. Hysteria: The Biography. Oxford: Oxford University Press.
Smith, Jennifer. 2012. "Reinterpreting Hysteria under Patriarchy in Emilia Pardo Bazán do Bazán’s “La novia fiel” and “Error de diagnóstico”" Decimonónica 9(1): 92-106.
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