Since the rise of the so-called ‘psychodynamic psychiatries’ early in the twentieth century, hysteria has been regarded as a psychological malady par excellence. Through most of its long medical history, however, the concept was interpreted as a disorder purely of the body, with specific causes, symptoms, and treatments that were organic.
The modern English word ‘hysteria’ derives from the Greek ‘hystera’ — uterus — which in turn derives from the Sanskrit word for stomach or belly. Inherent in these simple etymological facts is the meaning of the earliest views on the nature and origin of the disease. According to some historians, an Egyptian medical papyrus dating from around 1990 bc — one of the oldest surviving documents known to medical history — records a series of curious behavioural disturbances in adult women. As the ancient Egyptians interpreted it, the cause of these abnormalities was the movement of the uterus, which they believed to be an autonomous, free-floating organism that could move upward from its normal pelvic position. Such a dislocation, they reasoned, applied pressure on the diaphragm and gave rise to bizarre physical and mental symptoms. Egyptian doctors developed an array of medications to entice the errant womb back down into its correct position. Foremost among these measures were the vulvar placement of aromatic substances to draw the womb downward, and swallowing foul-tasting substances to repel the uterus away from the upper parts.
Hysteria in ancient history
This ancient Middle Eastern source furnished the basis for classical Greek medical and philosophical theories of hysteria. The ancient Greeks adopted the notion of the migratory uterus and embroidered upon the connections between hysteria and sexual dissatisfaction. In an often-cited passage in the Timaeus, Plato wrote colourfully about the vagaries of female reproductive physiology:
‘the animal within them [women] is desirous of procreating children, and when remaining unfruitful long beyond its proper time, gets discontented and angry, and wandering in every direction through the body, closes up the passages of the breath, and by obstructing respiration, drives them to extremity, causing all varieties of disease …’
Various texts of the school of Hippocrates, from the fifth century
bc onward, explain similarly that a mature women's deprivation of sexual relations causes a restless womb to move upward in search of gratification. As the female reproductive parts move or function irregularly — ascending or descending, convulsing or prolapsing — they cause dizziness, motor paralyses, sensory losses, and respiratory distress (including
globus hystericus, the sensation of a ball lodged in the throat) as well as extravagant emotional behaviours. Ancient Greek therapies included uterine fumigations, the application of tight abdominal bandages, and a regular regimen of marital
fornicatio.
Traditional historical accounts of the disease observe that ancient Roman physicians, too, wrote about hysteria. With the growth of anatomical knowledge, the literal hypothesis of the morbidly wandering womb became increasingly untenable. However, Roman medical authors continued to associate hysteria exclusively with the female generative system. The principal causes of hysterical disorders, they conjectured, were ‘diseases of the womb’ and disruptions of female reproductive biology, including amenorrhea, miscarriage, premature births, and menopause.
Galen of Pergamon formulated a particularly popular theory tracing the origins of the malady to the retention of excessive menstrual blood. Engraved in the
Corpus Hippocraticum and the Galenic writings, these hypotheses formed a medical ideology that remained influential for millennia of medical history. Descriptive and theoretical details evolved, but the basic doctrine of
gynaecological determinism — the crux of the classical heritage in the history of hysteria — endured until remarkably late into the modern medical period.
Christian attitudes
The coming of Christian civilization in the Latin West initiated a major paradigm shift in the history of hysteria. From the fifth to the thirteenth centuries, naturalistic pagan construals of the disease were increasingly displaced by supernatural formulations. In the writings of St Augustine, human suffering, including organic and mental illness, was perceived as a manifestation of innate evil consequent upon original sin. Hysteria in particular, with its shifting and highly dramatic symptomatology, was viewed as a sign of possession by the devil. The hysterical female was now interpreted alternately as a victim of bewitchment, to be pitied, or the devil's soulmate, to be despised. No less powerfully mythopoetic than the classical image of the disease, the demonological model envisioned the hysterical anesthesias, mutisms, and convulsions as stigmati diaboli or marks of the devil.
This sea change in thinking about the disorder brought with it changes in treatment. The elaborate pharmacopeia of ancient times was now replaced by supernatural invocations — prayers, incantations, amulets, and exorcisms. Furthermore, with the demonization of the diagnosis came the widespread persecution of the afflicted. During the late medieval and Renaissance periods, the scene of interrogation of the female hysteric shifted from the hospital and sick bed to the church and the court room, which now became the loci of spectacular interrogations. Official manuals for the detection of witches, often virulently misogynistic, supplied instructions for the detection, torture, and at times execution of the witch/hysteric.
Early medical theories
The late Renaissance, which witnessed the height of the witchcraft craze in continental Europe, also produced in reaction several substantial efforts to renaturalize the idea of hysteria. Advances in understanding the structure and function of the human nervous system provided a new model for many previously baffling nervous disorders, including hysteria. Gynecological and demonological theories waned; in their place, new neurocentric theories combined with fashionable mechanical and iatrochemical ideas from the physical and chemical sciences.
In Britain, which dominated medical thinking about the subject during the early modern period, the neuroanatomist Thomas Willis propounded a theory according to which an excess of ‘animal spirits’ was released from the brain and carried by the nerves to the spleen and abdomen, where it entered the bloodstream to circulate through the body. Robert Whytt thought the disorder was caused by a weakness of the nerve fibres, and William Cullen attributed it to a slowing of the nervous fluids through the brain. In the 1680s, the famous physician Thomas Sydenham hypothesized that the condition was caused by an imbalance in the distribution of the animal spirits between body and mind, brought on by sudden and violent emotions, such as anger, fear, grief, and love. English and Scottish medical literature about hysteria during the seventeenth and eighteenth centuries offers memorable clinical descriptions of classic hysterical phenomena, including the hysterical attack in the arched back position and the clavus hystericus, or feeling of a nail being driven into the forehead. In the 1700s in particular, in France and Britain, these ideas provided the basis for an entire ‘nervous culture’ in which men and women of high society fashioned themselves as refined, sensible, and civilized.
The 1800s brought a multiplication of theories about hysteria, including new uterine, neurological, and characterological models. During the final quarter of the century — hysteria's famous heroic age — the centre of attention shifted to France. In the 1880s, the Parisian clinical neurologist Jean-Martin Charcot, formulated a comprehensive, neurogenic model of ‘the great neurosis’. For Charcot, hysteria was strictly a dysfunction of the central nervous system, akin to epilepsy, syphilis, and other neurological diseases. Like these ailments, hysterical neuropathy, he held, was the result of a lesion of an undetermined structural or functional nature that could be studied through the methods of pathological anatomy and that resulted from defective heredity. Charcot lavished his attention on the descriptive neurosymptomatology of his cases. He developed a schematized, four-stage model of the hysterical fit, and he mapped a series of ‘hysterogenic zones’ onto the body of the hysteric.
Emergence of psychology
Socially, the late nineteenth century witnessed the appearance of ‘the Victorian nervous invalid.’ Significant numbers of men and women modelled their sickness behaviour on the contemporary teachings of hysteria doctors like Charcot until these nervous disorders seemed to reach epidemic proportions. Culturally, the character of the nervous invalid figured prominently in fictional prose writing of the time. By the time of Charcot's death in 1893, medical thinking about hysteria had reached an impasse. The search for the missing lesion of hysteria, and therefore for its somatic basis, remained fruitless. As a consequence, physicians turned to alternative conceptualizations of these mysterious, multiform disorders, including to psychological theories.
The psychologization of the hysteria concept a century ago is associated foremostly with Sigmund Freud, who worked in Vienna in the late Victorian mould of the private nerve specialist. Psychoanalysis began as a theory and therapy of hysteria. In a series of essays and monographs written between 1885 and 1900, Freud radically reconceptualized hysteria. He reversed the previously projected direction of mind-body causality, claiming that hysteria was a psychological disease with quasi-physical symptoms. Furthermore, Freud placed the emphasis on the psychological mechanism of hysterical symptom formation. According to his formulation, hysterogenesis rests in the repression of traumatic memories. These memories are usually remote in the emotional past of the individual and invariably libidinal, or sexual, in content. Because these remembrances are painful or unpleasant, they are unable to find conscious psychological expression. Freud postulated further that the negative emotional energy, or ‘strangulated affect’, associated with these memories is then unconsciously converted into the somatic manifestations of hysteria. Moreover, in this process of hysterical conversion, symptoms are not arbitrary and meaningless phenomena but complex symbolizations of repressed psychological experiences. In psychoanalytic psychology, the body is the physical field on which the wishes, anxieties, and traumas of the hysteric are dramatized.
Recent trends
The most consequential development in the history of hysteria in the last century was the rapid decline in the medically recorded incidence of the disorder. In part, this diminution is due to the liberalization of gender norms, permitting freer social, emotional, and sexual expression among women. It also traces to a process whereby many symptoms and behaviours formerly constitutive of hysteria have been reassigned to other diagnostic categories, including organic disorders, psychoses, and psychoneuroses. Since the 1970s, hysteria as an independent diagnostic entity has been deleted from the official manuals of medical diagnosis. In Anglo-American psychiatry, much of what was characterized as conversion hysteria in psychodynamic psychiatry is now classified under the more scientific-sounding rubric of somatization disorder. An exception to this rule can be found in French medicine, which continues widely to employ the concept of hysteria in psychological theory and clinical practice.
Conclusions
Several conclusions may be drawn from hysteria's long and colourful past. First, it is most likely impossible in this instance to project a single, unchanging pathological entity through history. The clinical descriptions lumped under the heading through the ages have been highly diverse, and the theoretical structures for understanding these behaviours have varied enormously. Many different morbid phenomena have no doubt been gathered under the umbrella of ‘hysteria’. Second, what has been called hysteria in the past may clearly be read as a kind of cross-gender portraiture in the field of medicine. To a very great extent, ‘the history of hysteria’ consists of a body of writing by men about women. Feminist-informed scholars of the later twentieth century emphasize that this literature often depicts, in the descriptive language of the clinic, features of the opposite sex that male élites in past patriarchal societies found irritating, incomprehensible, or unmanageable. Hysteria theory literally embodies these ideas, attitudes, and biases.
A third conclusion concerns the distinctive blend of science, sexuality, and sensationalism in the story of hysteria. Given the extravagant physical symptoms, emotional outbursts, and erotic undercurrents involved in many cases carrying this label, it is hardly surprising that hysterics have often been forced into lurid roles and vaudevillian performances. In short, hysteria has been the vehicle for astute clinical observation, pioneering neuropathological research, and brilliant psychological theorizing; it has equally been the site of much misogyny, sensationalism, and mistreatment. Fourth and finally, hysteria's history may be read as an ongoing attempt to theorize the mind-body relation within the medical sciences. Is hysteria fundamentally a psychological disorder with physical manifestations; an organic disease with mental and emotional epiphenomena; or some inseparable intermixture of the two? Studying the subject through the ages has involved a continual, relational reconfiguring of the role of psyche and soma in human mental life. Within the clinical human sciences, hysteria represents the shifting and diversely theorized interface between the history of the body and the history of the mind.
Some scholars have argued that hysteria is the oldest and most important category of neurosis in recorded medical history. Similarly, perhaps no non-fatal disorder boasts a richer metaphorical and mythological past. Over the centuries and in many different cultures, thinking and writing about the subject has mirrored dominant attitudes about health and sickness, the natural and the supernatural, the sexual and the spiritual, mind and body, and masculinity and femininity. Now, it appears, hysteria — construed variously as a term, theory, and behaviour — is vanishing. Given the remarkable cultural indispensability of the concept in the past, readers can only speculate on what will take its place in the future.
— M. S. Micale
Bibliography
- Gilman, S. L., King, H., Porter R., Rousseau, G., and Showalter, E. (1993). Hysteria beyond Freud. University of California Press, Berkeley.
- Micale, M. (1995). Approaching hysteria: disease and its interpretations. Princeton University Press, Princeton.
- Veith, I. (1965). Hysteria: the history of a disease. University of Chicago Press, Chicago
See also nervousness; psychological disorders.
