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Week Eleven: the "Female Mind": Hysteria

Lecture summary:

The association between female biology, the reproductive system and mental disorders has been particularly strong in the nineteenth century. An example of such an association is hysteria, which was the object of much medical debate in the nineteenth century. This week we will examine how physicians described this nervous disorder and why it was strongly associated with women.

Tutorial focus

The association between female biology, the reproductive system and mental disorders has been particularly strong in the nineteenth century. An example of such an association is hysteria, which was the object of much medical debate in the nineteenth century. This week we will examine how physicians described this nervous disorder and why it was strongly associated with women.

Guiding questions for our tutorial discussion

  • On the basis of your reading, what is hysteria? In other words, what are the emotions hysteric patients typically feel?
  • In Lecture VII and VIII, Charcot examines both male and female hysteria. What are the differences and similarities of hysteria in male and female patients?
  • What is the origin of hysteria in Charcot? What is its origin in Freud and Breuer?

Required Reading:

Primary Sources:

Scholarship

  • M. S. Micale, Approaching Hysteria: Disease and its Interpretations (1995), pp. 19-29.
  • J. Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century (1987), chap. 9 'The hysteria diagnosis and the epidemiology of hysteria', pp. 322-338.
  • F. J. Sulloway, Freud, Biologist of the Mind, (1979), ch. 2.

Further reading:

Lecture notes:

Female Body & Mind: Hysteria

In the second half of the 19th century a quarter of the female population in Europe was believed to suffer from hysteria. While it became a ‘fashionable’ disease in the 19th century, this disease has a very long history and has been traditionally associated with the mysterious nature of women.

The word ‘hysteria’ derives from the Greek word, hystera, meaning ‘womb’ or ‘uterus’. In ancient medicine, hysteria was thought to be the disease of the wandering uterus. The history of hysteria goes back at least to ancient Egypt in the form of a medical papyrus dating from around 1900 B.C., which records a series of curious disturbances in the behaviour of adult women, such as a temporary lack of control and respiratory distress. The ancient Egyptians thought the cause of these abnormalities was that the uterus, which they believed was a free-floating organism, had moved upward from its normal position near the pelvis. Such a dislocation of the uterus, they reasoned, put pressure on the diaphragm and gave rise to physical and mental symptoms. To combat this disease the Egyptians put pleasantly aromatic substances on a woman’s genitals, or made her eat rotten and smelly foods to get the uterus to move back down where it belonged.

But the Egyptians were not alone in this theory. The Greeks not only adopted the notion of the ‘migratory uterus’ to explain certain female behavioural disturbances, they also linked hysteria to an unsatisfactory sexual life. They thought that in mature women the lack of sexual relations caused their womb to move upward in search of gratification. As the uterus moved upward, it caused dizziness, motor paralysis, convulsions, paroxysms, sensory losses, respiratory distress, and extravagant emotional behaviour.

Moving forward to the Middle Ages, hysteria was associated with demonic possession, witchcraft and religious fanaticism.

From the Renaissance to the Enlightenment, hysteria was associated with melancholy (depression) in women.

In the 18th century, Carulus Linneus and Comte de Buffon, famous for classifying the natural world, linked hysteria to female sexuality and believed that it was related to sexual overindulgence. The Scottish physician, Willian Cullen, linked hysteria to nymphomania (hyperactive sexuality in women) and he proposed that hysteria was caused by the excessive pressure of blood in the female genitalia.

19th Century

But it was during the 19th century that hysteria became a major medical preoccupation. At this time, physicians who studied the specific nature of women and their differences from men became increasingly concerned with hysteria. Hysteria was so fashionable a topic and of such huge concern that even famous 19th century writers wrote about this female disease. Authors such as Gustave Flaubert, Honoré de Balzac, Henry James, George Eliot, Thomas Hardy, and William Wordsworth described the phenomenon of hysteria and linked it to internal and emotional disorder, quite often associated with repressed sexual desires. Flaubert’s Madame Bovary (1857) and Charlotte Brontë’s Jane Eyre (1847) link hysteria to the repression of sexuality.

Literary depictions of hysteria

In Flaubert’s novel, Madame Bovary, the main character, Emma (Madame Bovary), is seen to be constantly prone to dizzy spells, nervous attacks, anxiety, feelings of suffocation, instability, melancholia, and boredom – all of which were believed to be symptoms of hysteria. Emma is also portrayed as the victim of her society; she is the victim of the 19th century bourgeois sexual repression of women.

Other writers, such as Henry James in his The Bostonians (1886) and Florence Nightingale’s Cassandra (1852), associated hysteria with the cultural changes women’s role was undergoing in the 19th century society, and linked hysteria to feminism. Women who were labelled ‘hysterical’ were quite often associated with the women’s movement. Doctors had observed that hysterical women were resistant to or critical of marriage, and were believed to be strangely independent and assertive. While hysterical girls were viewed as closet feminists and rejecting traditional roles, likewise feminist activists were denigrated as hysterics, sick and abnormal women who did not represent their sex. By the 1880s, it had become common in England for the term ‘hysterical’ to be linked to feminist protests in newspapers and in the rhetoric of anti-suffragists.

The emergence of the ‘New Woman’

Hysteria in the 19th century was believed to be so common and attracted so much attention of physicians, intellectuals and the middle classes that it was called ‘the great neurosis’. But why was hysteria so popular in the 19th century? This is a complex question of course, and historians are still debating it. In many respects the 19th century bourgeois world was very similar to our own society. It was an intensely competitive economic world, high performance was expected, and there was no room for failure. Contrary to our society, however, the 19th century middle classes practiced self-control, self-discipline, and outward conformity in what historians have called ‘bourgeois sexual respectability’, and which applied especially to women. It was women who had to bear numerous pregnancies, and as wives they had to be both pure and sexually pleasing at the same time. Men were thought to be characterised by turbulent passions and ambitions, and by aggressive sentiments. In medicine, men had their own specific diseases such as hypochondria (an excessive concern about their health). By contrast, women were characterised by pure love and motherhood, and they too had their specific diseases, such as hysteria. Some diseases were typical of the male or female gender, although diseases were also differentiated in terms of class. For example, in middle-class men, neurasthenia was attributed to overwork, sexual excess, anxiety, ambition, sedentary habits, or the use of alcohol, tobacco, or drugs. In working-class men, sexual excess, trauma, and overwork were cited as the main causes of other diseases. And in all women, childbirth and reproductive disturbances came at the top of the list as causes of hysteria, with overwork a factor for working-class women and attending college a factor for middle-class women.

Evolutionary theories

Last week we saw how the spread of evolutionary theories in the 19th century promoted the idea that there were ‘natural’ differences between men and women. For example, Darwin believed that men were typically aggressive, able to create and have deep thought, while women were characterised by kindness and were only able to imitate, not create. Women’s mental features were characterised ultimately by the female role in sexual selection; that is, reproduction and maternity. More generally, physicians believed that women’s health rested on the reproductive system – the uterus, ovaries.

Gynaecology and psychiatry interacted to represent hysteria as a woman’s disease, stemming from the reproductive system and generating an emotional pathology. But how did psychiatrists conceptualise hysteria? There was no general consensus in 19th century psychiatry. From the end of the 18th century, psychiatry developed 3 major approaches to hysteria:

  • female genital neurosis
  • pure mental/psychological disorder
  • female temperament/constitution

Since the beginning of the 19th century some psychiatrists, such as Philippe Pinel [see Pinel: 16 Sept. lecture], classified hysteria as a ‘genital neurosis of women’. In the 1840s, the process of ovulation was discovered, and physicians formulated the so-called ‘ovarian theory’. Before the 19th century anatomists and physicians knew about the existence of the ovaries, but it was only in the 1840s that physicians understood the proper functioning of women’s ovaries, i.e. that in women, the release of the egg caused menstruation and that during menstruation women are not fertile. With the formulation of the ‘ovarian theory’, physicians increasingly came to believe that diseased ovaries caused hysteria, and such an explanation remained popular amongst gynaecologists and psychiatrists until the end of the century. The understanding of hysteria as a genital neurosis was a bodily understanding of hysteria.

A second approach to hysteria understood this disease as a purely mental/psychological disorder. This approach is linked to medical experiments with hypnotism, experiments that derive from the study of the phenomenon so called mesmerism or animal magnetism. Franz Anton Mesmer (1734-1815) was a Viennese physician who, in the 1770s, gained extraordinary success with his therapy called ‘animal magnetism’, and later on ‘mesmerism’. Mesmer believed that the universe was filled with a magnetic fluid and that man’s health depended upon the magnetic fluid’s volume and distribution. The cure of various diseases was achieved by laying his hands on people, and through physical contact with some objects
which conducted the magnetic fluid, such as magnets. In the 1780s, Mesmer’s demonstrations became very famous, especially amongst rich Viennese and Parisian salon ladies. Rejected as quackery by medical academic writers, Mesmer’s teaching initiated a tradition of hypnotic research into unconscious mental processes. People who followed Mesmer’s teaching explored the genesis of the mental symptoms, the nature of hysterical anaesthesias, and the psychotherapeutic relationship between doctors and hysterical patients. In 1874, a pupil of Mesmer, the Marquis de Puységur, published a study on a sleep-lime state which often occurred in the course of mesmeric treatment. This was the so-called artificial sonnambulism, which today is called hypnosis.

A third trend elaborated the notion of a ‘hysterical constitution’ or ‘hysterical temperament’. According to this approach hysteria was defined by some (negative) character traits, such as eccentricity, impulsiveness, emotionality, coquettishness, deceitfulness capriciousness and hypersexuality. Mutability (i.e. being very moody) in particular was a typical feature of hysteria because it is a characteristic of all women in general. This conceptualisation was first formulated in Germany by Wilhelm Griesinger’s Mental Pathology and Therapeutics (1845), in Britain by Robert Brudenell Carter’s On the Pathology and Treatment of Hysteria (1853) and in France during the 1860s in the essays of Jules Falret.

British attitudes toward the understanding and management of the hysterical woman followed Carter’s work, which explained hysteria by linking it to female adolescence. In general, Victorian doctors saw hysteria as a disorder of female adolescence, caused both by the beginning of menstruation and by the development of sexual feelings that could have no outlet. Later in the century this approach was adopted by psychiatrists like Henry Maudsley.

European physicians shared the opinion that some characteristics, like emotionality and mutability, were typical of the female sex, and therefore women were predisposed to hysteria. ‘As a general rule’, wrote the French physician Auguste Fabre in 1883, ‘all women are hysterical and ... every woman carries with her the seeds of hysteria. Hysteria, before being an illness, is a temperament, and what constitutes the temperament of a woman is rudimentary hysteria.’

These three approaches - hysteria understood as (1) female genital neurosis, (2) pure mental/psychological disorder, (3) female temperament/constitution - could be also combined.

Paris School: Jean-Martin Charcot

In the 19th century the most important medical figure in the history of hysteria is perhaps Jean-Martin Charcot (1825 – 1893). Charcot was a French neurologist and professor of anatomical pathology, often remembered as the founder of modern neurology. In the 1860s and 1870s Charcot worked at the Salpietre, where he searched for cerebral localisations (he searched for specific mental functions in specific parts of the brain) and multiple sclerosis. When he was already famous for his neurological work, he turned his attention to hysteria, the ‘great neurosis’.

Charcot did not systematise his work on hysteria; instead, he worked out his ideas in a series of formal lectures presented to his medical students on Tuesday mornings and during informal weekly bedside demonstrations to his students on Friday afternoon. Charcot’s lectures became famous as leçons du mardi and medical students came from all over Europe and America to attend his lectures. Charcot believed that men could also suffer from hysteria, although this was less common than in women. Rejecting medical theories that linked hysteria to genital causes, the reproductive system or repressed sexual desires, Charcot believed that hysteria was a dysfunction of the central nervous system, similar to epilepsy and other neurological diseases. He believed that hysteria was the result of a lesion which would eventually be discovered through pathological anatomy. Such neurological defect resulted from a combination of hereditary predisposition or nervous degeneration, and emotional shock.

Charcot divided the hysterical convulsion into stages:

  • Epileptic phase
  • A period of great movements, which included the famous arched back position
  • A period of passionate/erotic attitude
  • A period of delirious withdraw

During his lessons, Charcot showed how his female patients, under hypnosis, produced spectacular attacks of hysteria, or ‘hystero-epilepsy’, a prolonged and elaborate convulsive seizure. Charcot believed that the hysteric had some zones on her body which, if compressed, could start or stop a hysterical seizure. Indeed he induced the attacks or relieved them by placing pressure on certain areas of the body. Charcot called these hysterogenic zones and were especially be found in the region of the ovaries. But Charcot was not interested in applying a therapy. He was not interested so much in treating hysteria as he was in understanding its functioning. Following Mesmer’s tradition, Charcot used hypnosis to study hysteria. Charcot considered hypnosis to be a pathological state that occurred only in hysterics. Before Charcot, hypnosis was neglected in academic circles, but due to his use of it, hypnosis became a legitimate field of study and treatment.

The Nancy School: Hippolyte Bernheim

Despite Charcot’s efforts to understand hysteria and his successful lectures, he was not able to find a brain lesion which produced hysteria and many physicians became sceptical about the possibility to find one. This pessimism grew and, as a consequence, physicians at the turn of the century found themselves open to alternative conceptualisations. In the 1880s, Hippolyte Bernheim, a psychiatrist from the University of Nancy, challenged Charcot’s view on hysteria, promoting instead a psychological medicine that was opposed to Charcot’s neurology. Bernheim, and other members of the so-called ‘Nancy School’, interpreted hysteria as an exaggerated psychological reaction that was potentially universal. Under the right circumstances everyone could be hysterisable. He believed that the role of suggestibility, rather than reproductive anatomy or innate neuropatic predisposition, was the key to understanding the cause of hysteria. Unlike Charcot, Bernheim was deeply interested in the psychological therapy of hysteria and pioneered a therapy of ‘de-suggestion’, which included hypnosis.

Contrary to Charcot, Bernheim believed that everyone could be hypnotised.He regarded hypnosis as a state related to natural sleep. Just like deep sleep, the hypnotic state facilitated the carrying out of suggestions, which, in the waking state, would be impossible because of rational thinking, attention and judgement. Bernheim thought that during hypnosis, the patient was under a psychological influence. He found no evidence for the transmission of anything physical during hypnosis, as had been assumed by the Charcot school. His studies of the hypnotic states seemed to prove the existence of latent memories which produced some explanations for the patients’ behaviour. Bernheim also believed that neurotic patients did not need to stay in asylums, and promoted out-patients. At the end of the 19th century, an ‘out-patient psychiatry’ grew in Europe, even if asylums never disappeared.

Freud and Psychoanalysis

Despite the fact that Charcot and Bernheim had opposite approaches to hysteria, both of them influenced Sigmund Freud. In the first half of the 20 century, Freud was the most celebrated physician of his time. Freud grew up in Vienna, first training as a neurologist before turning to general medicine for financial reasons. He initially believed that mental disorders were brain disorders, and had a somatic approach to mental disorders (i.e. approach which emphasises i.e. brain-biology, brain-chemistry, genetics and heredity) [See somatic/organic interpretation of mental disorders, 8 Oct. lecture]. While in Vienna, Freud learned about Josef Breuer’s treatment of a complex case of hysteria in 1880-2 – the case of Anna O. (real name Bertha Pappenheim ). When in a quasi-hypnotic state, Anna was able to trace her individual hysterical symptoms back to specific emotionally disturbing events in the past. Remembering these events with Breuer, Anna was able to bring them into her consciousness, which in turn caused the symptoms to disappear, a process the patient termed ‘the talking cure’, and which Freud later defined as the ‘cathartic method’. Freud began working with Breuer before heading to Paris to study at the Salpêtrière, between 1885 and 1886, where he was overwhelmed by Charcot’s personality and originality. Charcot became Freud’s professional role model, as well as a mentor. Then in 1889, Freud went to Nancy to study with Bernheim.

In his Studies on Hysteria (1895), which was written with Breur, and in Fragment of an analysis of a Case of Hysteria (1901), Freud reconceptualised medical thinking about hysteria. Like Bernheim, Freud claimed that hysteria was a psychological disorder, but he believed that its cause rested in the repression of traumatic memories which had a sexual origin. Because these memories were painful, they were unable to find conscious psychological expression; hysterical symptoms (convulsions) were the symbols of repressed psychological experiences. In contrast to Charcot, who examined, measured and observed hysterics, but paid no attention to what they said, Freud and Breuer were actually listening to hysterical women and to heed their complaints.

In Studies on Hysteria (1895), Breuer and Freud worked out the fundamental technique of psychoanalysis. Most of their patients were middle-class Jewish women who found themselves imprisoned in traditional roles as dutiful daughters. Frustrated in their intellectual ambitions and expected to stay home and care for their brothers and father until they married, these bright and imaginative young women developed a wide range of symptoms — limps, paralysis, crippling headaches, and most significantly, aphonia (loss of voice). By encouraging them to talk, to recount their dreams, to recall repressed memories of sexual traumas and desires, Freud and Breuer found that they could cure the women’s symptoms. Some historians have argued that Breuer’s and Freud’s Studies on Hysteria laid the groundwork for a culturally aware therapy that respected women’s words and lives. However, many feminist scholars disagree with this interpretation and there is an ongoing debate about Freud’s approach to women’s psychology/female psychosexual development.

Feminist criticisms

Shortly after their joint publication, Freud and Breuer grew distant. Freud gradually reached the conclusion that in all neurotics, hysterics, and people affected by anxiety etc, sexual difficulties were the cause of their illness. Breuer was not prepared to go so far. Furthermore, Freud believed that hysteria and other neurosis in general could be cured by having the patient recall and relive the original trauma, whether by hypnosis or through the process of dream analysis and free association. The symptoms of hysteria, Freud noted, were created through a process of symbolisation and expressed emotional states. While Charcot had de-sexualised hysteria, with Freud, hysteria became sexualised again.

Treatments of Hysteria

  • Hypnotism
  • Psychoanalysis (20th century)
  • Rest cure: middle-class women were the best candidates for the rest cure. Women were not allowed to read, work, do anything; only sleep and eat. This cure was not used for working class women, and men in general, as these were unlikely to be willing to spend six to eight weeks in idleness.
  • Hydrotherapy: already at the turn of the century, hydrotherapeutic devices were available at Bath (UK) and, by the mid-19th century, they were popular at many high-profile bathing resorts across Europe and in America.
  • Massages on pelvic areas: another solution was the invention of massage devices, which shortened treatment from hours to minutes, removing the need for midwives and increasing a physician’s treatment capacity. By 1870, a clockwork-driven vibrator was available for physicians. In 1873, the first electromechanical vibrator was used at an asylum in France for the treatment of hysteria.

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