Hysteria, Feminism, and Gender
Hysteria has taken many strange turnings in its long career, but one of the most surprising is the modern marriage of hysteria and feminism, the fascination among feminist intellectuals, literary critics, and artists with what Mary Kelly calls "the continuing romance of hysteria." Feminist understanding of hysteria has been influenced by work in semiotics and discourse theory, seeing hysteria as a specifically feminine protolanguage, communicating through the body messages that cannot be verbalized. For some writers, hysteria has been claimed as the first step on the road to feminism, a specifically feminine pathology that speaks to and against patriarchy. For others, the famous women hysterics of the nineteenth century have been taken to epitomize a universal female oppression. As the French novelist and theorist Hé1ène Cixous melodramatically inquires, "What woman is not Dora?"
This ardent reclaiming of hysteria in the name of feminism is a new twist in the history of the disorder. Throughout its history, of course, hysteria has always been constructed as a "woman's disease," a feminine disorder, or a disturbance of femininity, but this construction has usually been hostile. Hysteria has been linked with women in a number of unflattering ways. Its vast, shifting repertoire of symptoms reminded some doctors of the lability and capriciousness they associated with female nature. "Mutability is characteristic of hysteria because it is characteristic of women," wrote the Victorian physician Edward Tilt. "'La donna è mobile .'" Doctors have tended to favor arguments from biology that link hysteria with femaleness: "Women are prone to hysteria because of something fundamental in their nature, something innate, fixed or
given that obviously requires interaction with environmental forces to become manifest but is still a primary and irremediable fate for the human female." "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." The hysterical seizure, grande hystérie , was regarded as an acting out of female sexual experience, a "spasm of hyper-femininity, mimicking . . . both childbirth and the female orgasm."
In the twentieth century, these views about an essential and organic female biology that produces hysteria have mutated into more psychological portraits that link hysteria with femininity —with a range of "feminine" personality traits. In a psychoanalytic context, women have been seen as disadvantaged in mastering oedipal tasks and thus disposed to hysterical behaviors. Thus, according to the British analyst Gregorio Kohon, "A woman at heart always remains a hysteric." Paul Chodoff notes that hysterical behaviors "may present as . . . unattractive, noisy, emotional displays . . . or as the hysterical (histrionic) personality disorder—a DSM-III diagnostic label, referring to habitual and sustained patterns of behavior characteristic of some women." The diagnosis becomes "a caricature of femininity" but also an exaggeration of the cognitive and personal styles that women are encouraged to develop as attractively "feminine."
Until recently, stories about hysteria were told by men, and women were always the victims in these stories rather than the heroines. In the past few decades, however, the story of hysteria has been told by women historians as well as by male doctors and psychoanalysts. They have argued that hysteria is caused by women's oppressive social roles rather than by their bodies or psyches, and they have sought its sources in cultural myths of femininity and in male domination. What we might call the "herstory" of hysteria is the contribution of feminist social historians to this project, in works that concentrate on the misogyny of male physicians and the persecution of female deviants in witch-hunts.
But as Mark Micale notes, "No line of evolution within the historiography of hysteria is more complicated than the feminist one." The feminist romance with hysteria began in the wake of the women's liberation movement of the late 1960s and the French événements of May 1968, when a young generation of feminist intellectuals, writers, and critics in Europe and the United States began to look to Freudian and Lacanian psychoanalysis for a theory of femininity, sexuality, and sexual difference. They began with the Viennese women who were treated by
Freud and Breuer for hysteria, and who had in a sense given birth to the psychoanalytic method, the "talking cure." Feminist interpretations of hysteria in women offered a new perspective that decoded physical symptoms, psychotherapeutic exchanges, and literary texts as the presentations of conflict over the meaning of femininity in a particular historical context. Hysteria came to figure as what Juliet Mitchell calls "the daughter's disease," a syndrome of physical and linguistic protest against the social and symbolic laws of the Father.
Many Lacanian feminist critics interpret hysteria as a women's language of the body, or pre-oedipal semiotics. Still others see bisexuality as the significance of the syndrome. Thus Jane Gallop writes, "Freud links hysteria to bisexuality; the hysteric identifies with members of both sexes, cannot choose one sexual identity. . . . If feminism is the calling into question of constraining sexual identities, then the hysteric may be a protofeminist." Similarly, Claire Kahane defines "hysterical questions" as questions about bisexuality and sexual identity: "Am I a man? Am I a woman? How is sexual identity assumed? How represented?"
But could hysteria also be the son's disease, or perhaps the disease of the powerless and silenced? Although male hysteria has been documented since the seventeenth century, feminist critics have ignored its clinical manifestations, writing as though "hysterical questions" about sexual identity are only women's questions. In order to get a fuller perspective on the issues of sexual difference and identity in the history of hysteria, however, we need to add the category of gender to the feminist analytic repertoire. The term "gender" refers to the social relations between the sexes, and the social construction of sexual roles. It stresses the relational aspects of masculinity and femininity as concepts defined in terms of each other, and it engages with other analytical categories of difference and power, such as race and class. Rather than seeking to repair the historical record by adding women's experiences and perceptions, gender theory challenges basic disciplinary paradigms and questions the fundamental assumptions of the field.
When we look at hysteria through the lens of gender, new feminist questions begin to emerge. Instead of tracing the history of hysteria as a female disorder, produced by misogyny and changing views of femininity, we can begin to see the linked attitudes toward masculinity that influenced both diagnosis and the behavior of male physicians. Conversely, by applying feminist methods and insights to the symptoms, therapies, and texts of male hysteria, we can begin to understand that issues of gender and sexuality are as crucial to the history of male experience as they have been in shaping the history of women.
In particular, we need to see how hysteria in men has always been regarded as a shameful, "effeminate" disorder. In many early studies the male hysteric was assumed to be unmanly, womanish, or homosexual, as if the feminine component within masculinity were itself a symptom of disease. John Russell Reynolds wrote in A System of Medicine that hysterical men and boys were "either mentally or morally of feminine constitution." in his case studies of male hysteria at the end of the nineteenth century, Emile Batault observed that hysterical men were thought to be "timid and fearful men. . . . Coquettish and eccentric, they prefer ribbons and scarves to hard manual labor." These expectations made it difficult for doctors to accept the hysteria diagnosis in men who seemed conventionally virile. While it might be possible to "imagine a perfumed and pomaded femmelette suffering from this bizarre malady," Batault noted, "that a robust working man has nerves and vapours like a woman of the world" strained credulity.
The prejudices and stereotypes Batault protested at the Salpêtrière are alive and well in the twentieth century. "One gets the impression," an analyst notes, "that a male hysteric is one who behaves 'like a woman.'" Wilhelm Reich described the male hysteric as characterized by "softness and over-politeness, feminine facial expression and feminine behavior." The image of the hysteric in psychiatric literature is such that "the man who would most closely fit the description would be a passive homosexual." Thus discussions of male hysteria, rather than transforming the discourse of hysteria as representing the worst aspects of femininity, actually reinforce the stereotype that it is the disease of weak, passive, overly emotional people, whether female or male.
Gender constructs, moreover, are not restricted to the medical profession. They also inflect the way we write the history of medicine and psychiatry. While feminist literary critics often seem narrow in their use of history, limiting their textual interpretations to a tiny group of famous doctors and patients, historians are rarely sensitive to figurative language and to the inscriptions of gender ideology in medical texts. History can show us where to look for a more accurate and complete picture of hysteria, but literary criticism can show scientists and historians how to read the texts and gender subtexts of medicine, psychiatry, and history itself. For while social historians of hysteria have been sensitive to the ways that attitudes toward women shaped and distorted the work of doctors like Robert Brudenell Carter, Charcot, or Freud, they have written as if they too were not influenced by gender constructs. Issues of sexual difference are relevant to historiography as well as medicine.
Moreover, writing about hysteria is different for women than it is for
men. Because of traditional beliefs about the potential hysteria of all women, women scholars are more conscious of the need to find an objective, impersonal, and scientific language and discourse about the subject. How can one who is potentially hysterical, "at heart always a hysteric," transcend her nature to write about the disorder? Since feminism has often been interpreted as hysteria by male physicians and social critics, women writing about hysteria in the early part of the twentieth century may have avoided feminist interpretations of hysterical phenomena.
On the other hand, men writing about hysteria, in males or females, can masquerade their own emotions as reason, or disguise feeling and prejudice behind other terminologies and self-definitions. In his study L'hystérique, le sexe, et le médecin , the French psychiatrist Lucien Israël discusses the "unconscious complicity between sick men and male doctors to avoid the shameful and infamous diagnosis of hysteria." But when he talks about what he terms "successful hysterics," people who in their adult lives seemed to outgrow their adolescent hysteria, or transformed what had been hysterical symptoms into social causes, Israel mentions only women, such as Mary Baker Eddy, the founder of Christian Science, and Bertha Pappenheim, or Anna O., who became a German feminist leader. He sees their dedication as an evolutionary form of feminine hysteria itself, an obsessive desire to become the maître rather than submit to him, an acting out of fantasies of devotion. Thus female activism becomes merely a constructive pathology, and feminism only a healthier form of hysteria. It does not occur to Israël to label Flaubert or Sartre a successful hysteric, let alone to speculate on the way this scenario might explain the career decisions of male psychoanalysts.
Language has played a major role in the history of hysteria; to pry apart the bond between hysteria and women, to free hysteria from its feminine attributes, and to liberate femininity from its bondage to hysteria, means going against the grain of language itself. To begin with, as Helen King shows in chapter 1, hysteria has always been etymologically linked with women and the feminine because of its name. We can argue that when Freud's Viennese colleague dismissed Freud's talk on male hysteria because men didn't have wombs, he was pathetically out of date; nonetheless, the word itself has become so generically linked with the feminine in popular understanding that we need to specify male hysteria the way we specify women writers, whereas to say female hysteria sounds redundant.
Because of this understanding and the stigma it has carried, throughout the centuries doctors have sought to find other names for hyste-
ria in men. As Israel explains, "The hysteria diagnosis became for a man . . . the real injury, a sign of weakness, a castration in a word. To say to a man 'you are hysterical' became under these conditions a form of saying to him 'You are not a man.'" To avoid such a confrontation, doctors sought unconsciously to mask the hysteria diagnosis under other terms; in France in the nineteenth century, for example, it was known as "neurospasme," "tarassis," "didymalgie," "encéphalie spasmodique," or "neuropathie aigue cérébro-pneumogastrique."
Furthermore, hysteria is invariably represented as feminine through the figures of medical and historical speech. Evelyn Fox Keller, Ludmilla Jordanova, Emily Martin, and Cynthia Russett, among others, have begun in recent years to analyze the gendered rhetoric and epistemology of scientific inquiry, through close reading of the figures, metaphors, and representations that have always been part of medical discourse. Such images are not merely decorative or accidental, they argue, but are a fundamental part of the gendered language that science shares with other human discourses. As Jordanova notes, "the biomedical sciences deploy, and are themselves, systems of representation. If devices like personification and metaphor have been central to scientific thinking, then the notion of representation becomes a central analytical tool for historians." Helen King points out that the history of hysteria depends on a series of texts, on the way language was deployed and translated within these texts, and on the narratives of female power and powerlessness that were based upon them. In order to understand the longevity and cultural force of these narratives, we need to look at terminology, metaphor, and narrative techniques as well as at statistics and theories.
In his recent study, for example, Etienne Trillat discusses the theories of male hysteria that have flourished for several centuries. But his images tell a different story. "All psychoanalytic theory was born from hysteria," he writes, "but the mother died after the birth." Even in denying the sexual etiology of hysteria, thus historiography reinscribes it through language echoing the traditional terminology for hysteria, the "suffocation of the mother" or the "mother."
We could also look at the striking metaphor Breuer used in Studies on Hysteria when he called hysterics "the flowers of mankind, as sterile, no doubt, but as beautiful as double flowers." The image is botanical, sexual, and aesthetic. In cultivated flowers, doubling comes from the replacement of the stamens by petals. Like the double flower, Breuer implies, the hysteric is the forced bud of a domestic greenhouse, the product of luxury, leisure, and cultivation. Her reproductive powers have been sacrificed to her intellect and imagination. Like the curved flowers
of Art Nouveau, or the Jüngenstihl , she is also an aesthetic object, standing in relation to a more sober "mankind" as feminine and decorative. Finally, the hysteric is seductive and attractive, but incapable of maternity or creativity. From Breuer's point of view, as the case studies make clear, the hysteric's sterility and her intense abnormal flowering go together, as if to echo Victorian stereotypes about the incompatibility of uterine and cerebral development.
But from the woman's point of view, sterility may result from being in advance of one's time and unable to find a partner. The same metaphor is used by Olive Schreiner, herself an example of the New Woman who overcame hysterical disorders to lead an important career as a feminist and writer. Schreiner imagined that if sex and reproduction could be separated, human sexuality, especially female sexuality, might become like the cultivated rose, which "having no more need to seed turns all its sexual organs into petals, and doubles, and doubles; it becomes entirely aesthetic." For Schreiner, the hysteric is thus a member of the sexual avant-garde.
Male homosexuals too can be read, perhaps more precisely than women, into Breuer's metaphor of the double flower. They are Schreiner's highly evolved beings who have perforce separated sexuality from reproduction, and who must pour their creativity into art. In his study of Oscar Wilde, for example, Neil Bartlett calls Wilde's green carnation the symbolic flower of the gay man: "A homosexual, like a hothouse flower, declares his superiority to the merely natural. . . . Homosexuals are sterile . . . they blossom in the form of works of art."
It is not surprising that the metaphors of hysteria should contain double sexual messages about femininity and masculinity, for throughout history, the category of feminine "hysteria" has been constructed in opposition to a category of masculine nervous disorder whose name was constantly shifting. In the Renaissance, these gendered binary oppositions were set up as hysteria/melancholy; by the seventeenth and eighteenth centuries, they had become hysteria/hypochondria; in the late nineteenth century they were transformed into hysteria/neurasthenia; during World War I, they changed yet again to hysteria/shell shock; and within Freudian psychoanalysis, they were coded as hysteria/obsessional neurosis. But whatever the changing terms, hysteria has been constructed as a perjorative term for femininity in a duality that relegated the more honorable masculine form to another category.
If we go back to medical records from the early seventeenth century, we find a differentiation between hysteria, a disorder that was believed to have its origins in displacement of the uterus and the accumulation
of putrid humors; and melancholy, a prestigious disorder of upper-class and intellectual men. Vieda Skultans has pointed out that "the epidemics of melancholy which swept the fashionable circle of London from 1580 onwards curiously bypassed women." She sees a connection between the misogynistic literature that flourished during the late seventeenth century and the emergence of hysteria as a significant diagnostic category. By the end of the seventeenth century, melancholy and hysteria had been joined by new fashionable diseases: the spleen, vapours, and hypochondria; and these disorders were also differentiated by gender. Spleen and vapours were seen as akin to hysteria, female maladies that came from the poisonous fumes of a disordered womb. As Roy Porter has discussed in chapter 3, late seventeenth-century accounts of the neurological aspects of hysteria that moved away from the uterine theory also advanced theories of male hysteria. In these accounts physicians were agreed that hysterical men were much rarer than hysterical women, that they behaved in womanish ways, and that their affliction should be called "hypochondriasis." According to Thomas Sydenham, for example, hypochondriacal symptoms were as similar to hysterical symptoms "as one egg is to another" and could be seen in "such male subjects as lead a sedentary or studious life, and grow pale over their books and papers."
In the eighteenth century, there was a gender split in the representation of the body, with the nervous system seen as feminine, and the musculature as masculine. Doctors made a firm gender distinction between forms of nervous disorder, assigning hysteria to women and hypochondria to men. According to the French physician Jean-Baptiste Louyer-Villermay, these categories also corresponded to a psychology of sex differences. Turbulent passions, ambitions, and hate, which were natural to men, predisposed them towards hypochondria, while in women the dominant emotion was that of love. Concern with the feminizing label of hysteria obviously affected diagnosis; when Edward Jenner had hysterical symptoms, he noted that "in a female I should call it hysterical—but in myself I know not what to call it but by the old sweeping term nervous."
In England, most Victorian medical men "had the idea that there was a mental disease for each sex—hypochondriasis for the male and hysteria for the female." By the nineteenth century, the sexual specificity of hysteria and hypochondriasis had become a medical dogma, so that "when hysteria is admitted in men, it is understood nevertheless as a female affliction." Thus the Viennese doctor Ernst von Feuchtersleben in 1824 argued that if women showed signs of hypochondriasis they
must be "masculine Amazonian women," while hysterical men "are for the most part effeminate men." But whereas hypochondriasis had started as a dignified illness that a man might even claim with some masculine self-respect, during the nineteenth century it too gradually became established as a form of mental disorder that carried its own stigma. In the eighteenth century, the man of cultivation and intellect who suffered from a variety of afflictions was universally admired, but when it became embarrassing for men to acknowledge that they were hypochondriacs, and such people, like Jane Austen's Mr. Woodhouse, became figures of fun, a new masculine term was required to set alongside hysteria.
In 1873, this gap in the medical lexicon was filled by the term neurasthenia . "Undoubtedly the disease of the male subject in the late nineteenth century," neurasthenia was first identified in the United States and linked with the nation's nervous modernity. In American Nervousness , George M. Beard, who named the new disorder, defined neurasthenia as a condition of nervous exhaustion, an "impoverishment of nervous force." He believed that neurasthenia was caused by industrialized urban societies, competitive business and social environments, and the luxuries, demands, and excesses of life on the fast track. In a sense then, neurasthenia was a source of pride and a badge of national distinction and racial superiority. To be stressed was "one of the cardinal traits of evolutionary progress marking the increased supremacy of brain force over the more retarded social classes and barbarous peoples." To Beard, reports of missionaries, explorers, and anthropologists seemed to show that primitive, savage, and heathen groups were simpler and less sensitive than middle-class Americans. Bushmen and Sioux Indians did not become neurasthenic like Boston bankers and New York lawyers.
Like hysteria, neurasthenia encompassed a staggering range of symptoms, from blushing, neuralgia, vertigo, headache, and tooth decay to insomnia, depression, chronic fatigue, fainting, and uterine irritability. But unlike hysteria, neurasthenia was an acceptable and even a valuable illness for men. While it affected both men and women between the ages of fifteen and forty-five, it was most frequent "among the well-to-do and the intellectual, and especially among those in the professions and in the higher walks of business life, who are in deadly earnest in the race for place and power." it was definitely, in short, the neurosis of the male elite. Many nerve specialists, including Beard himself, had experienced crises of nervous exhaustion in their own careers, and they were highly sympathetic to other middle-class male intellectuals tormented by vocational indecision, overwork, sexual frustration, internalized cultural
pressure to succeed, and severely repressed emotional needs. When Herbert Spencer visited the United States in 1882, he was struck by the widespread ill health of American men: "In every circle I have met men who had themselves suffered from nervous collapses, due to stress of business, or named friends who had crippled themselves by overwork." But French and English men, doctors from these countries were quick to argue, could be nervous too. In Paris, Charcot noted that "the young men who graduate from the Ecole Polytechnique, who intend to become heads of factories and rack their brains over mathematical calculations, often become victims of these afflictions." The male patients in Charcot's private practice, who came from the middle and upper classes, were more likely to be called "neurasthenic" than "hysterical."
The social construction of neurasthenia reflected the romance of American capitalism and the identification of masculinity with money and property. Beard's metaphors repeatedly emphasized the economic and technological contexts of American nervousness. Neurasthenics were in "nervous bankruptcy," perpetually overdrawing their account, rather than "millionaires of nerve force." The neurasthenic man
is a dam with a small reservoir behind it, that often runs dry or nearly so through the torrent as the sluiceway, but speedily fills again from many mountain streams; a small furnace, holding little fuel, and that inflammable and combustible, and with strong draught, causing quick exhaustion of materials and imparting unequal, inconstant warmth; a battery with small cells and little potential force, and which with little internal resistance quickly becomes actual force, and so is an inconstant battery, requiring frequent repairing and refilling; a dayclock, which if it be not wound up every twenty-four hours, runs utterly down; evolving a force sometimes weak, sometimes strong, and an engine with small boiler-power, that is soon emptied of its steam; an electric light attached to a small dynamo and feeble storage apparatus, that often flickers and speedily weakens when the dynamo ceases to move.
This epic metaphor vividly suggests the specter of the masculine engine wearing out, the depletion of sperm cells, the lack of ejaculatory force. It reflects late nineteenth-century male sexual anxieties of impotence caused by mental or physical overwork. Herbert Spencer put this idea forward quite straightforwardly in an article written for the Westminster Review in 1852. "Intense mental application," Spencer argued, "is accompanied by a cessation in the production of sperm-cells," while correspondingly, "undue production of sperm-cells involves cerebral inactivity," beginning with headache and proceeding to imbecility.
This theory cut both ways. On the one hand, lack of desire for women
could be explained by devotion to intellectual tasks; on the other hand, overindulgence in sex could lead to intellectual decline. Thus for some male intellectuals, the neurasthenia diagnosis relieved anxiety about lapses from conventional masculine sexuality by classifying them under the manly heading of overwork. Spencer himself was cited by Beard as one of the world's most distinguished neurasthenics, "doing original work on a small reserve of capital force." In 1853, after a vigorous climbing expedition in the Alps, Spencer had noticed odd symptoms—palpitations, insomnia, "cardiac enfeeblement," a "sensation in the head." Although he lived another fifty years, he treated himself as an invalid, pampering himself with rest and recreation, putting in earplugs when a conversation threatened to become too exciting, "keeping up the cerebral circulation" by wetting his head with saltwater and encasing it in flannel and a rubber nightcap. Despite what one might regard today as real social handicaps, Spencer was seen by his male friends as a great marital catch, and with shrewd pre-Freudian insight into his problem, they urged him to take a wife, recommending "gynoepathy" as a cure for his ills. Spencer however resisted, and as Gordon Haight wisely remarks, with neurasthenia "he bought safety from the perils of marriage."
But the construction of neurasthenia as masculine was an illusion. In the United States, equal numbers of male and female patients were reported in the medical journals. However, cases were differentiated in terms of both gender and class. In middle-class men, the disorder was attributed to overwork, sexual excess, anxiety, ambition, sedentary habits, or the use of alcohol, tobacco, or drugs. Beard estimated that one out of every ten neurasthenics was a doctor. In working-class men, sexual excess, trauma, and overwork were cited as the main causes of the disease. And in all women, childbirth and reproductive disturbances came at the top of the list, with overwork a factor for working-class women and attending college a factor for middle-class women. Gosling notes that the case histories of male patients are much more interesting, detailed, and varied than those of women; "because men normally led more varied lives than most women, involving themselves in career, family, and social activities both within and outside the domestic circle, physicians made greater distinctions in the causes to which they attributed male nervousness. Physicians also questioned men in more detail about their habits and personal affairs, partially because they were more likely to suspect men of hidden vice and partially because of the delicacy of raising intimate issues with members of the opposite sex."
In England, neurasthenia quickly lost its sheltering power for men
and became a female malady like hysteria. Indeed, Havelock Ellis estimated that there were fourteen neurasthenic women for every neurasthenic man. Explanations for neurasthenia in women drew on some of the same sources as the explanations about men, but with a different moral emphasis. Edward Clarke in the United States and Henry Maudsley in England drew on new theories of the conservation of energy to argue that mental and physical energy were finite and competing. Women's energy, post-Darwinian scientists believed, was naturally intended for reproductive specialization. Thus women were heavily handicapped, even developmentally arrested, in intellectual competition with men. Nervous disorder would come when women defied their "nature" and sought to rival men through education and work, rather than to serve them and the race through maternity. While competition was a healthy stimulus to male ambition, it was disastrous for women, who furthermore did not have the outlet of athletics to relieve their strained nerves. The higher education of women in universities was obviously then a threat not only to their health but to their reproductive capacities. "What Nature spends in one direction, she must economise in another direction," Maudsley wrote, and thus the young woman who gave herself over to learning would find her sexual and reproductive organs atrophying, her "pelvic power" diminished or destroyed, and her fate one of sexlessness and disease. The neurasthenic Girton or Vassar girl was overworking her brain and uterus into sterility.
The standard treatment for neurasthenia was the rest cure, developed by the American Dr. Silas Weir Mitchell (1829-1914) after his experience in the Civil War. First described in 1873, the rest cure involved seclusion, massage, immobility, and "excessive feeding." For six weeks the patient was isolated from her friends and family, confined to bed, and forbidden to sit up, sew, read, write, or do any intellectual work. She was expected to gain as much as fifty pounds on a rich diet that began with milk and built up to several substantial daily meals. Mitchell was well aware that the sheer boredom and sensory deprivation of the rest cure made it a punishment to the patient: "When they are bidden to stay in bed a month, and neither to read, write, nor sew, and have one nurse—who is not a relative—then rest becomes for some women a rather bitter medicine, and they are glad enough to accept the order to rise and go about when the doctor issues a mandate which has become pleasantly welcome and eagerly looked for."
The rest cure evolved from Mitchell's work with "malingering" soldiers in the Civil War, whom he had assigned to the most disagreeable jobs, so that after a few weeks in the latrines they were eager to return
to the front. But it also depended on his feelings on the differences between men and women and their social meaning:
For me the grave significance of sexual difference controls the whole question, and if I say little of it in words, I cannot exclude it from my thought of them and their difficulties. The woman's desire to be on a level of competition with man and to assume his duties is, I am sure, making mischief, for it is my belief that no length of generations of change in her education and modes of activity will ever really alter her characteristics. She is physiologically other than man. I am concerned with her now as she is, only desiring to help her in my small way to be in wiser and more healthful fashion what I believe her Maker meant her to be, and to teach her how not to be that with which her physiological construction and the strong ideals of her sexual nature threaten her as no contingencies of man's career threaten in like measure or like number the feeblest of the masculine sex.
A determined opponent of higher education for women, a critic of Vassar and Radcliffe and especially of "the horrible system of coeducation," Mitchell, like other Victorian physicians, believed that the female reproductive system and the brain derived their nourishment from the same source, and that women should not try to learn too much during adolescence when the menstrual function was being established. "I firmly believe," he wrote, "that as concerns the physical future of women they would do better if the brain were very very lightly tasked and the school-hours but three or four a day until they reach the age of seventeen at least." He also advised mothers not to allow their pubescent daughters to take strenuous exercise. The quest for knowledge, he felt, destroyed that subtle and tender feminine charm which was the only source of masculine love: "For most men, when she seizes the apple, she drops the rose."
While Mitchell was aware that hysteria in women of the middle and upper classes was largely caused by "the daily fret and wearisomeness of lives which . . . lack those distinct occupations and aims" that sustained their brothers and husbands, he did not seem to make the connection between his program of female ignorance and passivity, and women's later inability to lead healthy lives. He preferred women patients who were silent and acquiescent to those with inquiring minds. "Wise women choose their doctors and trust them," he wrote in Doctor and Patient . "The wisest ask the fewest questions. The terrible patients are nervous women with long memories, who question much where answers are difficult, and who put together one's answers from time to time and torment themselves and the physician with the apparent inconsis-
tencies they detect." In his novel Roland Blake , Mitchell created such a terrible patient in the figure of Octapia Darnell, a repugnant hysteric whose sickly tentacles wound themselves about her hapless family. He preferred to use women's trust in him in effecting a cure: "If you can cause such hysteric women as these to believe that you can cure them, you enlist on your side their own troops, for as you can create symptoms, so you can also create absence of symptoms."
Furthermore, the treatment assumed that the patient be "pliant and wealthy": one who did not work, or at least did not need to work. Middle-class women were thus the best candidates for the rest cure, since men and the poor were unlikely to be willing to spend six to eight weeks in idleness. Doctors thus modified the treatment for their male patients, who might simply be advised to get to bed early and to travel first-class. As the Chicago neurologist Archibald Church observed, "We cannot put [men] to bed with any expectation that they will stay there. I have tried it repeatedly and have nearly always failed. Men do not take to the recumbent position for any considerable length of time with equanimity. The fact of their being in bed constitutes an aggravation; and irritation is what we wish to exclude."
Women were just as irritated by isolation and enforced idleness as men. Mitchell's patients indeed included many of the leading feminist intellectuals, activists, and writers of the period, including Jane Addams, Winifred Howells, Charlotte Perkins Gilman, and Edith Wharton. For them, feminist scholars have argued, the rest cure seemed like a regression to infancy, in which the patient was forced back into "womblike dependence" on the parental team of godlike male doctor and subservient female nurse, and reeducated to "make the will of the male her own"; or a disciplinary treatment that punished unconventional aspirations; or even a pseudo-pregnancy that symbolically put the deviant woman back in her biological place. Forbidden by Mitchell to write or draw, Gilman came close to a breakdown: "I would crawl into remote closets and under beds—to hide from the grinding pressure of that profound distress." Casting Mitchell's advice to the winds, she went to work again, "work, in which is joy and service, without which one is a pauper and a parasite." For Gilman, hysteria was the result of passive acquiescence to the strictures of a patriarchal society, but it could be overcome by purposeful activity, in her case writing. She wrote the chilling short story "The Yellow Wallpaper" (1892), a Gothic tale of a young mother suffering from a "temporary nervous depression—a slight hysterical tendency," who goes mad during a rest cure, as a protest against Mitchell, but there is no evidence that he ever read or responded to it. Similarly,
Dr. Margaret Cleaves insisted on the importance of work for women's mental health, and the dangers of the rest cure: "The hardest cases I have had to take care of professionally," she wrote, "are those who have acquired the rest cure habit. I have a physician under care now, this time a woman, who regrets piteously that she was not given something to feed her intelligence instead of an unqualified rest cure."
But even women doctors did not have the cultural authority to contest medical dogmas. Later Freud did have the authority to criticize Mitchell. In Studies on Hysteria , in a passage that might be seen as a medical acknowledgment of Gilman's experience, he advised combining the rest cure with analysis: "This gives me the advantage of being able . . . to avoid the very disturbing introduction of new psychical impressions during a psychotherapy, and . . . to remove the boredom of a rest-cure, in which the patients not infrequently fall into the habit of harmful daydreaming." Still, the rest cure was not really discredited until World War I, when it was discarded as inappropriate and even harmful as a therapy for men.
The rest cure was one form of fin-de-siècle therapy that asserted male medical domination over the nervous woman. Treatments for hysterical women in the late nineteenth century were even more tyrannical, and doctors found reasons not to apply them to men. In England the model for this approach, based on established notions about the charismatic male physician and the manipulative sickly woman, had been pioneered by Robert Brudenell Carter and described in his book On the Pathology and Treatment of Hysteria (1853). Only twenty-five when he wrote his book, Carter adopted the tone of a much more mature and established man, a persona that was very much part of his whole program for asserting sexual and medical authority over the wayward hysterical girl. While Carter recognized that there were also cases of hysteria in men, he insisted that they were rare and anomalous. Not only were emotional derangements "much more common in the female than the male," but also women were forced by social pressure to conceal their feelings and desires, especially sexual ones. Moreover, the "morbid and insatiable . . . craving for sympathy" that led to sick behavior was "ten times stronger in women than in men."
During a season when he served as the director of an agricultural workhouse, Carter had to contend with a number of young married women who had been separated from their husbands and children. These women had no real outlet for their feelings of loneliness and anxiety, and some had begun to have daily fits of crying and screaming. Carter found the attacks an administrative nuisance and set out to stop
them. Whenever a woman had an attack, he made a large group of the others nurse her, insisting that none of them could have any food until all the symptoms of the attack had subsided. Very quickly the "hysterical" women became so unpopular with the others that the fits ceased to occur.
Carter's attitude toward middle-class hysterics was equally antagonistic, but his methods of managing them had to be more subtle. In his view, the hysterical girl is a clever, persistent, and desperate person who has entered into a sustained deception, and would "lose caste" if exposed. Therefore she is prepared for a long siege against the doctor who would make her well—that is, make her give up her symptoms. While he thoughtfully considers the efficacy of rough treatments for hysterics, such as unpleasant medicines, blows, or buckets of cold water, Carter concludes that most hysterical girls would be able to tolerate such attacks and turn them against the doctor, undermining his authority: "A young woman who is living at home will have too much courage and endurance to be beaten by the torture, and . . . a certain amount of perseverance on her part will exalt her into a martyr in the eyes of her family, and will enable her to bid defiance to professional denunciations." Thus he advocated removing the patient from her family to the doctor's home, where she could be under constant surveillance.
The plan for treatment he outlines is basically a form of blackmail, threatening the hysteric that if she does not reform her ways, the doctor will expose her malingering and disgrace her in the eyes of her family and friends. In fact, by the time this threat is pronounced, the doctor has already secretly told the family his diagnosis and sworn them to secrecy, so the hysteric is operating in the midst of a conspiracy or game in which everyone is collaborating to trick her. Telling the family of the plot is necessary to effect the patient's separation from them. When she is removed from all her accustomed sources of sympathy and support, the doctor can have full power over her habits and treatment.
British attitudes toward the understanding and management of the hysterical woman followed Carter's example. In general, Victorian doctors saw hysteria as a disorder of female adolescence, caused both by the establishment of the menses and by the development of sexual feelings that could have no outlet or catharsis. Adolescence was a risky time for girls, many doctors observed, not only because the reproductive organs had so great an influence on their entire well-being but also because "the range of activity of women is so limited, and their available paths of work in life so few . . . that they have not, like men, vicarious outlets for feelings in a variety of healthy aims and pursuits." While men, wrote
Charles Mercier, had the "safety-valve" of exercise, women's feelings were bottled up, so that in adolescence, "more or less decided manifestations of hysteria are the rule." "All kinds of . . . barriers to the free play of her power are set up by ordinary social and ethical customs," wrote Dr. Bryan Donkin. "'Thou shalt not' meets a girl at every turn." F. C. Skey, who delivered a series of lectures on hysteria to the medical students at St. Bartholomew's Hospital in 1866, noticed that his patients were primarily adolescent girls with domineering parents, girls who "exhibited more than usual force and decision of character."
Despite their sympathy for the plight of Victorian girls, Victorian doctors found their hysterical patients selfish, deceitful, and manipulative. Henry Maudsley denounced the "moral perversion" of hysterical young women who "lie in bed" all day, "when all the while their only paralysis is a paralysis of the will." Skey followed Carter's lead in recommending "fear and the threat of personal chastisement" for hysterical women. In the title of one American medical text, hysteria was a matter of "trials, tears, tricks, and tantrums."
In France, working-class hysterical women patients at the Salpêtrière were regarded with the same hostility by such doctors as Jules Falret. Falret denounced the women as "veritable actresses; they do not know a greater pleasure than to deceive . . . all those with whom they come in touch. The hysterics who exaggerate their convulsive movement . . . make an equal travesty and exaggeration of the movements of their soul, their ideas, and their acts. . . . In a word, the life of the hysteric is nothing but one perpetual falsehood; they affect the airs of piety and devotion, and let themselves be taken for saints while at the same time abandoning themselves to the most shameful actions; and at home, before their husbands and children, making the most violent scenes in which they employ the coarsest and often most obscene language and give themselves up to the most disorderly actions."
Why did hysteria become such a frequent phenomenon in the late nineteenth century? Why were doctors like Carter, Mitchell, Falret, and Skey so contemptuous of their female patients and so dictatorial in their treatments? A number of theories have been advanced to explain the phenomenon of fin-de-siècle hysteria. The feminist historian Carroll Smith-Rosenberg gives an answer that is sympathetic to both hysterical women and their male physicians. She sees female hysteria as stemming from sex-role conflicts that emerged in the nineteenth century. She has argued that the American hysteric was typically the idle middle-class woman, both "product and indictment of her culture." Reared to be weak, dependent, flirtatious, and unassertive, many American girls grew
up to be child-women, unable to cope with the practical and emotional demands of adult life. They defended themselves against the hardships and obligations of adulthood "by regressing towards the childish hyper-femininity of the hysteric." Faced with real responsibilities and problems, these women fled from stress by choosing a sick role in which they won continued sympathy and protection from the family. Thus hysteria provided a solution to the feminine conflict between idealized sex roles and quotidian realities: "The discontinuity between the roles of courted young woman and pain-bearing, self-sacrificing wife and mother, the realities of an unhappy marriage, the loneliness and chagrin of spinsterhood, may all have made the petulant infantilism and narcissistic self-assertion of the hysteric a necessary social alternative to women who felt unfairly deprived of their promised social role and who had few strengths with which to adapt to a more trying one."
Male physicians like Mitchell dealing with these women may sometimes have been harsh and insensitive, Smith-Rosenberg concludes, but they were not necessarily more misogynistic than other men of their time. Their profession made it necessary for them to make analytic statements about femininity, while their gender demanded that they establish an authoritative relationship with their patients. Thus the physician too was a product of his gender and culture, "standing at the junction where the cultural definitions of femininity, the needs of the individual female patient, and masculinity met." If hysterical women were victims of a culture that did not prepare them to meet the responsibilities of adulthood, their doctors too were victims of a sex-role conflict that required them both to identify with the fathers and husbands of their patients, and to provide answers and cures for the problems of the women in a way that threatened to feminize them.
In The History of Sexuality , Michel Foucault suggests that hysteria was a label bestowed on female sexuality by male physicians. Rather than seeing hysteria as a solution to the double binds and dilemmas of fin-de-siècle women, Foucault describes the "hysterization of women's bodies" as one of the crucial features of psychiatric and medical power. Hysterization was "a three-fold process whereby the feminine body was analyzed . . . as being thoroughly saturated with sexuality; whereby it was integrated into the sphere of medical practices, by means of a pathology intrinsic to it; whereby, finally, it was placed in organic communication with the social body . . . the family space . . . and the life of children; the Mother, with her negative image of 'nervous woman,' constituted the most visible form of this hysterization."
Women's needs, roles, conflicts, feelings, and voices have little to do
with the scenario of power outlined by Foucault. Instead, women are passive and apparently powerless bodies and figures who are inscribed by unnamed forces. "It is worth remembering," he insists, "that the first figure to be 'sexualized' was the 'idle' woman. She inhabited the outer edge of the 'world', in which she always had to appear as a value, and of the family, where she was assigned a new destiny charged with conjugal and parental obligations. Thus there emerged the 'nervous' woman. . . . In this figure the hysterization of woman found its anchorage point." Through his use of quotation marks, Foucault casts ironic doubt on the reality of the hysterical woman's idleness or sexuality, but since his focus is on the large anonymous forces of psychiatric power, he does not supply an explanation for the hysteric's collusion or helplessness before such labeling. Nor, unlike Smith-Rosenberg, does he attempt to explain some of the motives doctors might have had for exerting such power over the definition of female hysteria, or the reasons why it became epidemic in the last decades of the century.
Neither of these influential theories can really account for the varieties and causes of hysteria in their respective contexts. To begin with, I need to emphasize once again that they exclude male hysteria from their analysis, although both are aware of its existence. Smith-Rosenberg comments in a footnote that male hysteria does not undermine her arguments about its relation to female experience for four reasons. First, "to this day hysteria is still believed to be principally a female 'disease' or behavior pattern." Second, the male hysteric is "different"—homosexual or working class. Third, "one must hypothesize that there was some degree of female identification among the men who assumed a hysterical role." Finally, she argues, male hysteria had its most typical form in shell shock. These circular arguments, which Smith-Rosenberg did not reconsider when she revised her original essay for publication in the book, make it impossible for the "difference" of male hysteria to modify her concept of the "hysterical role." Male hysteria is simply a subset of female hysteria, and mimics its motives and behaviors. Applying Smith-Rosenberg's model to male hysterics, then, one would see them as childish, weak, and escapist. The alternative approach—analyzing hysterical symptoms as a response to powerlessness—does not come up.
Despite his interest in forms of discursive power, Foucault too does not consider hysteria from the point of view of the patient, although some of his references hint at the dilemma of young hysterics, both male and female, caught between domineering parents and domineering doctors. He quotes Charcot's insistence that hysterical girls and boys must be separated from their mothers and fathers and hospitalized. But the
idea that these power struggles might have contributed to the problems of adolescent patients is extraneous to Foucault's concerns. He is interested instead in mapping the elements by which doctors took control of the definition of sexuality.
Both Smith-Rosenberg and Foucault identify the bourgeois mother as the representative fin-de-siècle hysteric. But this picture does not correspond to the realities they each describe, nor to the clinical picture. Smith-Rosenberg acknowledges that hysteria crossed class and economic boundaries, and that it also affected working-class and farm women, immigrants and tenement dwellers. In her view these women too had failed "to develop substantial ego strengths." But American doctors who treated poor women in their hospitals and dispensaries had a different view. E. H. Van Deusen, who saw many hysterical farm women at his asylum in Michigan, blamed the social isolation and intellectual deprivation of their lonely lives. Similarly, most of the girls and women Falret and Charcot were treating for hysteria at the Salpêtrière came from poor families and had worked since childhood to support themselves. They were neither idle nor, for the most part, mothers. In case after case, they were the victims of poverty, sexual and financial exploitation, and ignorance. The working-class men Charcot treated in his ward, whose hysteria was usually precipitated by some kind of violent accident, seem like the brothers of the women. Foucault's highly schematic and abstract account of discursive power ignores both context and agency; it neither explains why patients manifested symptoms of distress nor explains why physicians were so eager to focus on these complaints in women and to see them as threats to the family and the state.
The "hysterisation" of women's bodies which Foucault describes can also be seen from a feminist perspective as "a reassertion of women's essentially biological destiny in the face of their increasingly mobile and transgressive social roles." That hysteria became a hot topic in medical circles at the same time that feminism, the New Woman, and a crisis in gender were also hot topics in the United States and Europe does not seem coincidental. During an era when patriarchal culture felt itself to be under attack by its rebellious daughters, one obvious defense was to label women campaigning for access to the universities, the professions, and the vote as mentally disturbed. Whether or not women who were labeled "hysterical" were associated with the women's movement, they were often seen by doctors as resistant to or critical of marriage, and as strangely independent and assertive. These characteristics are most vividly present in the Viennese women dissected by Breuer and Freud, but English physicians like Skey and Bryan Donkin also commented on
the intelligence and ambition of their hysterical patients. Any woman manifesting symptoms of hysteria aroused suspicions of a silent revolt against her domestic, class, and reproductive role. Thus nervous women received much more attention than nervous men, and were labeled as "hysterical" or "neurasthenic" in the contexts of a highly charged rhetoric about the dangers of higher education, women's suffrage, and female self-assertion in general.
In every national setting where female hysteria became a significant issue, there were parallel concerns about the ways that new opportunities for women might undermine the birthrate, the family, and the health of the nation. Intellectually competitive women, doctors warned, were sterile flowers doomed to bring forth only blossoms of hysteria and neurasthenia. In the United States, gynecologists warned against the brain-fag, headache, backache, spine-ache, and all-around sexual incompetence that New Women would produce. in France, the femme nouvelle was blamed for the declining birthrate; new divisions of labor seemed to threaten the stability of the family and the state. As women made their first inroads into public and professional space, a fascinating alliance of artists, traditional women, and neuropsychiatrists like Charcot united in a campaign to celebrate maternity and the interiority of Woman. in England the New Woman as neurotic feminist intellectual had become a recognizable type by the 1890s; "the New Woman ought to be aware that her condition is morbid, or at least hysterical," wrote one journalist. She had also become a standard figure in literature, whether Thomas Hardy's Sue Bridehead in Jude the Obscure (1895) or George Gissing's Alma Rolfe in The Whirlpool (1897), whom Ian Fletcher calls "a new type of woman, the névrose , the modern hysteric."
While hysterical girls were viewed as closet feminists and reprogrammed into traditional roles, feminist activists were denigrated as hysterics, sick and abnormal women who did not represent their sex. By the 1880s in England, it had become customary for the term "hysterical" to be linked with feminist protest in the newspapers and in the rhetoric of antisuffragists. As Lisa Tickner notes in her study of the British suffrage movement, "for half a century and more, feminism and hysteria were readily mapped on to each other as forms of irregularity, disorder, and excess, and the claim that the women's movement was made up of hysterical females was one of the principal means by which it was popularly discredited." Women who found a public voice for their concerns were lampooned as "the shrieking sisterhood," a term coined by the antifeminist writer Eliza Lynn Linton, who wrote in 1883 that "one of our quarrels with the Advanced Women of our generation is the hysterical
parade they make about their wants and their intentions. . . . For every hysterical advocate 'the cause' loses a rational adherent and gains a disgusted opponent."
Jean-Martin Charcot's clinic at the Salpêtrière offered the best opportunity to examine the different ways that women and men were diagnosed and treated for hysteria at the turn of the century. Studies of hysteria at the Salpêtrière took their form from Charcot's charismatic style. So powerful was his influence in the 1880s that the Salpêtrière was often called the "Hôpital Charcot," and the group of disciples and admirers around him was known as the charcoterie . They were strongly influenced by his work on male hysterics; although the Salpêtrière had traditionally been a women's hospital, under Charcot's direction a small men's ward was opened; male patients were also seen at the outpatients' clinic. Charcot took pride in his research on male subjects and regarded the study of male hysteria as one of the specialties of his clinic and of late nineteenth-century French medicine. By his death in 1893, he had published sixty-one case studies of male hysterics, and he left notes on many more. In a lecture-presentation on hysteria in men, Charcot noted that:
In some ways, this question of male hysteria is the order of the day. In France it has preoccupied physicians for the past several years. Between 1875 and 1880, there have been five dissertation defenses on male hysteria at the Faculté de Paris, and M. Klein, the author of one of these theses, done under the supervision of M. le Dr. Olivier, was able to catalog 80 cases. Since then have appeared the important publications of M. Bourneville and his students; of MM. Debove, Raymond, Dreyfus, and several others; and all these works tend to demonstrate, among other things, that cases of male hysteria can be found fairly frequently in common practice.
He decried the popular belief that "the characteristic trait of hysteria is the instability and the mobility of the symptoms." Even in women, he explained, there "were hysterias of sturdy, permanent phenomena . . . which sometimes resist all medical intervention." Furthermore, men too were sometimes emotionally erratic or exhibited depression and melancholy.
Charcot's clinic was noted for the large number of female patients who, under hypnosis, produced spectacular attacks of grande hystérie or "hystero-epilepsy," a prolonged and elaborate convulsive seizure. The attack could be induced or relieved by pressure on certain areas of the body—what Charcot called hysterogenic zones—and these were especially to be found in the ovarian region. A complete seizure involved three
phases: the epileptoid phase in which the patient lost consciousness and foamed at the mouth; the phase of "clownism" (Charcot was a great fan of the circus), involving eccentric physical contortions; and the phase of "attitudes passionnelles," or sexual poses. The attack ended with a back-bend called the arc-en-cercle .
It was crucial to Charcot's theory of hysteria that it took the same course in men and women. Thus he insisted that there were "numerous striking analogies" between male and female grande hystérie . Charcot's disciple Emile Batault reported with pleasure that a hysterical young man named Gui "presents the symptoms most characteristic of grande hystérie . The attacks are always preceded by the phenomena of testicular aura; he feels something which mounts from the inguinal region towards the esophagus; he has then a feeling of thoracic constriction which oppresses him, his temples throb violently, he has ringing in his ears and hears heavy noises like the fire of distant cannons. His head spins, he loses consciousness, and the attack begins." Because he was young and athletic, Gui's arc-en-cercle was also a splendid affair, which impressed Batault very mightily, as an "acrobatic performance as beautiful as it was varied." Batault also found a hysterogenic zone on Gui's body located around the right testicle.
Just as it was possible to stop a hysterical attack by compressing the woman's ovaries, doctors at the Salpêtrière were convinced that it should be possible to affect the course of a man's attack by putting pressure on the testicles. But this procedure did not always have the desired effects. The doctors found that the attacks were relieved by the compression of the testicles. Others, however, obtained no effect from putting pressure on the seminal gland, and one doctor discovered, perhaps not to our surprise, that squeezing the patient's testicles made the convulsions stronger.
One of Charcot's most original contributions to the theory of male hysteria was his insistence that it should not carry the stigma of effeminacy. He emphasized the fact that hysteria often appeared among tough manual laborers; most of the cases had occurred in the aftermath of a traumatic accident, either at work or in travel. Furthermore, he stressed the working-class status, physical strength, and virile emotions of his male patients, and he mocked other doctors who had problems accepting both the class and gender of patients who clashed with their stereotypes of hysteria: "One is willing to concede that a young, effeminate man may, after indulging in excessive behavior, suffering heartache, or experiencing deep emotions, exhibit several hysterical phenomena; but that a manly artisan, solid, unemotional, a railway engineer, for ex-
ample, might, following a railway accident, a collision, a derailing, become hysteric, the same way as a woman—this, it appears, surpasses the imagination."
Nonetheless, there were significant sexual differences in Charcot's concept of male hysteria. In terms of language, it was often called "hystérie virile" or "hystérie traumatique" to mark its distinction from female hysteria. Although it followed the same course of behavior in men and women, Charcot believed hysteria had different causes that depended on gender. As Mark Micale observes, "Women in his writings fell ill due to their vulnerable emotional natures and inability to control their feelings, while men got sick from working, drinking, and fornicating too much. Hysterical women suffered from an excess of 'feminine" behaviors, hysterical men from an excess of 'masculine' behaviors."
Moreover, although some of Charcot's male hysterics were as colorful and dramatic as the women, they did not attract as much attention from doctors, writers, artists, and journalists. The "wild man" Lap . . . sonne, for example, was covered with symbolic tattoos, such as a veiled woman he called "the night," and he earned his living eating live rabbits in fairs. But while Blanche Wittmann became the "Queen of Hysterics" performing at the Salpêtrière clinic, Lap . . . sonne is remembered only as a case study. The actual numbers of male hysterics were few; overall, male patients comprised no more than five to ten percent of the whole immense hospital population. On the other hand, during the 1870s, the percentage of women patients at the Salpêtrière diagnosed as "hysterical" rose as high as twenty percent.
In addition to the theoretical and statistical differences between male and female hysteria, there were differences in its representation. As Sander Gilman explains in chapter 5 in this book, the hysterical clinic of Charcot was organized primarily around the visual, the photographic, the theatrical, and the spectacular. He was famed for his probing gaze that seemed to penetrate not only to the heart of the patient but also to the souls of his assistants, interns, and associates. His student and biographer Georges Guillain described the examination sessions in which the naked patient sat like an artist's model while Charcot silently studied every detail of the body. Roger Martin du Gard wrote about Charcot's "piercing, prying gaze" and his "tyrannical way of fixing you with his stare." Havelock Ellis too recalled Charcot's "disdainful expression, sometimes even it seemed, a little sour.
This intensely scrutinizing male gaze mingled the mesmerizing power of the hypnotist and the commanding eye of the artist with the penetrating vision of the scientist piercing the veil of nature. It was very much
associated with masculinity itself. Charcot's stare was contrasted with the downcast eyes of his hysterical women patients, and with the "soft, poetic and languorous" gaze of his hysterical male patients.
Through his theatrical lecture-demonstrations (Sarah Bernhardt, acting in cross-dressed parts at the same time, was often compared to the hysterical queens of Charcot's amphitheater ), and even more through the photographic atelier that captured images of the hysterical women for the volumes of iconographies , Charcot emphasized the visual manifestations of hysteria and the hysterical body as an art object. His representations of gender were allied to aesthetic conventions about the female body, whether in painting, photography, or drama. Charcot not only borrowed from art in making the female body the focus of his investigation, but through his photographic atelier also contributed to the historical emergency of a "regime of representation" in which, according to the art critic Griselda Pollock, "the hysterized body of woman. . . was made the object of pathological scrutiny and deciphered in terms of masculine gaze and speech."
The fascination with the female body as art and symbol extended also to Charcot's influence on his family. His wife and daughters were artists who worked with him in the family atelier. In 1892, Madame Charcot showed her work in the Exhibition of the Arts of Woman in Paris, contributing a large carved and decorated coffer, whose dark surfaces and fantastically painted inner panels suggested both the structure of the mind her husband had studied in hysteria—"a rational facade and an irrational interior"—and the image of woman promoted by the Central Union of the Decorative Arts and the Women's Committee of which she was a member. As Debora Silverman has shown, "a prominent part of the Central Union program in the 1890s was the definition of interior space as distinctively feminine and the promotion of . . . woman as the queen and artist of the interior," in response to "the challenge of the femme nouvelle or 'new woman,' who was perceived as threatening to subvert women's roles as decorative objects and decorative artists." Through the performances of Blanche Wittmann, the "Queen of Hysterics," and other famous hysterics at the Salpêtrière, Charcot too promoted women as artists of the interior, and paradoxically returned them to the status of decorative objects.
Even Charcot's contemporaries, however, were critical of the callous way that Charcot exhibited his hysterical stars and of his exposure of their secrets. In his antimedical satire Les Morticoles (1894), Leon Daudet caricatured Charcot as the voyeuristic neurologist "Foutange," who sadistically interrogates a hysterical girl: "And so, in front of two hun-
dred sniggering persons, these wretches must display their shame, their own, and their families' taints, and reveal their intimate secrets. . . . Foutange penetrates with diabolical skill to the depths of these stunted creatures." Axel Munthe, a Swedish doctor practicing in Paris at the time, gave a vivid description of Charcot's Tuesday lectures, when "the huge amphitheatre was filled to the last place with a multicoloured audience drawn from tout Paris, authors, journalists, leading actors and actresses, fashionable demimondaines." The hypnotized women patients put on a spectacular show before this crowd of curiosity seekers. "Some of them smelt with delight a bottle of ammonia when told it was rose water, others would eat a piece of charcoal when presented to them as chocolate. Another would crawl on all fours on the floor, barking furiously when told she was a dog, flap her arms as if trying to fly when turned into a pigeon, lift her skirts with a shriek of terror when a glove was thrown at her feet with a suggestion of being a snake. Another would walk with a top hat in her arms rocking it to and fro and kissing it tenderly when she was told it was her baby."
Feminists were indignant at Charcot's treatment of women, often comparing it to the atrocities of vivisection. Writing in the English antivivisectionist journal Zoöiphilist , one woman condemned the "no less disgusting experiments practiced on the lunatics and hysterical patients in the Salpêtrière. The nurses drag these unfortunate women, notwithstanding their cries and resistance, before men who make them fall into catalepsy. They play on these organisms. . . on which experiment strains the nervous system and aggravates the morbid conditions, as if it were an instrument. . . . One of my friends told me that she. . . had seen a doctor of great reputation make one unhappy patient pass, without transition, from a celestial beatitude to a condition of infamous sensualment. And this before a company of literary men and men of the world." In an essay in the Revue scientifique des femmes (1888), C. Renoz accused Charcot of a "sort of vivisection of women under the pretense of studying a disease for which he knows neither the cause nor the treatment."
Furthermore, the textual case studies of the hysterical women patients lend themselves to feminist interpretation of oppression and exploitation. Augustine, who spent five years as a patient at the Salpêtrière, is a particularly dramatic example. She came to the Salpêtrière at the age of fifteen in October 1875, suffering from pains in the stomach and convulsive attacks during the night which sometimes left her paralyzed. Although she had not yet begun to menstruate, Augustine had the appearance of a sexually mature woman. One does not have to search far for
the traumatic experiences that had precipitated her hysterical attacks. Beginning at puberty, she had been subjected to sexual attacks by men in the neighborhood, and at the age of thirteen, had been raped by her mother's lover, who had threatened to slash her with a razor if she did not comply. During the seizures which began immediately thereafter, she imagined that she was being bitten by wild dogs or surrounded by rats; sometimes she had hallucinations of the rapist with a knife. Treated with ether and amyl nitrate, Augustine spoke incessantly about her visions, but while the doctors recorded her words, they were not interested in the contexts of her experience. Instead she was repeatedly photographed in revealing hospital gowns demonstrating the various stages of grande hystérie . In 1879, her condition improved and she was taken on as a nurse in the hospital. But the respite was brief; by April 1880 she was once again having frequent attacks, to which the doctors responded with increasingly severe measures: ether, chloroform, strait-jackets, and finally, confinement in a padded cell. Although she was sufficiently improved to attend a concert on the Salpêtrière grounds in June, she used the opportunity to run away, but she was caught on the boulevard outside. Her health grew worse; in addition to the attacks, she injured herself in futile efforts at freedom. The last entry about Augustine is September 9, 1880: she "escaped from the Salpêtrière, disguised as a man."
One cannot help rejoicing at Augustine's escape, and her male disguise seems like a coded statement about hysteria and gender; despite Charcot's insistence on the equality of male and female hysteria, men had an easier time getting out of the Salpêtrière. Victimized by sexual predators, she endured symbolic rapes at the hands of her doctors, who endlessly recorded her menstrual periods, her vaginal secretions, her physical contortions, and her sexual fantasies, but paid no attention to her sense of betrayal by her mother and brother, as well as by the men who had abused her.
In 1928, Augustine became the pin-up girl of the French surrealists, who reproduced her photographs to celebrate the fiftieth anniversary of hysteria, which they called "the greatest poetic discovery of the end of the nineteenth century." For Louis Aragon and André Breton, Augustine was the "delicious" embodiment of the sexy "young hysterics" they so much admired. In 1982, Georges Didi-Huberman made Augustine the martyred heroine of his study of Charcot, the "masterpiece" of Charcot's hysterical museum. She is also becoming an exemplary figure for feminists. I wrote about her in The Female Malady in 1985; a group of feminist scholars, choreographers, and dancers based at Trin-
ity College in Connecticut have produced a performance work about her called "Dr. Charcot's Hysteria Shows"; and a successful play, Augustine: Big Hysteria , was staged in London in 1991.
But we need to be cautious about seeing Charcot as a misogynist. While he was famous for these performances with women, Charcot also took a liberal position on women's rights. The Salpêtrière journal Progrès Médical campaigned for women's admission to medical school, and some of Charcot's students and externs were women. The first French dissertation on hysteria by a female physician, Hélène Goldspeigel's Contribution à l'étude de l'hystérie chez les enfants (1888) was written under Charcot's supervision at the Salpêtrière.
Indeed, one of the earliest histories of hysteria was Glafira Abricosoff's L'hystérie aux XVIIe et XVIIIe siècles (1897). Abricosoff had been a student of Charcot's and dedicated her book to the memory of "my illustrious master, J.-M. Charcot." As she explained in her introduction, "It is to him that I owe my medical knowledge, and it is, in a sense, out of gratitude for my dear departed master that I have wished to retrace the historical variations of a malady on which his brilliant perspicacity and his penetration have shed so much light. Abricosoff's history makes no special case for women, but rather stresses the existence of male cases. Throughout her book Abricosoff drew attention to those writers such as Joseph Raulin who had observed and described male hysteria, and who had insisted that it could not be an exclusively female disorder. Her book is an example of one form of early feminist history of hysteria.
Another effort by a woman doctor to deal with hysteria was the book of Dr. Georgette Déga, who had studied at the medical faculty of Bordeaux. Déga attributed hysteria to the inadequacies of women's education. Hysteria, she wrote, was "the victory of the lower centers over the higher," and mathematics was the best discipline for hysterical women. One can imagine that she believed medical training to be even better.
It is interesting to speculate on the reasons why Charcot's work on male hysteria did not have a lasting effect on medical discourse, why history has remembered Augustine and forgotten the hysterical men Char-cot described. In the British medical community, there had always been resistance to the idea of male hysteria, which had been camouflaged under other terminologies, organic explanations, and forms of denial and projection. As Micale concludes, "Charcot's hysterization of the male body in the 1880s was sharply at variance with dominant medical models of masculinity, and it ran counter to reigning Victorian codes of manliness. It required from Victorian physicians the application of an ancient and denigratory label to members of their own sex. And per-
haps most disturbing, it suggested the possibility of exploring the feminine component in the male character itself."
Furthermore, Charcot's death in 1893 precipitated a long period of "dismemberment" of his work during which the concept of hysteria fell into disrepute, and some claimed that he had been a charlatan who coached his hysterical female patients in their performances or produced their symptoms through suggestion. Men were omitted from the record. Even Pierre Janet reinforced the belief that all the hysterics were women when he remarked in his lectures at the Harvard Medical School in 1920 that "by a kind of international irony, people were willing to admit, after the innumerable studies made by French physicians, that hysteria was frequent only among French women, which astonished nobody, on account of their bad reputation."
Ironically, the work of Sigmund Freud, Charcot's most famous student, also played a major role in the suppression of male hysteria after Charcot's death. Freud came to Paris to study at the Salpêtrière from October 1885 to March 1886. His original plan for the research trip was quickly changed, as he became overwhelmed by the personality, accessibility, and orginality of Charcot, who became a professional role model as well as a mentor. The ambiance of Charcot's clinic was very different from that which Freud had been used to in Berlin. Charcot was spontaneous, generous, and open to criticism and argument, and Freud found the democratic atmosphere both surprising and stimulating: "The Professor's work proceeded openly, surrounded by all the young men acting as his assistants as well as by the foreign physicians. He seemed, as it were, to be working with us, to be thinking aloud and to be expecting to have objections raised by his pupils. Anyone who ventured might put a word in the discussion and no comment was left unnoticed by the great man. The informality of the prevailing terms of intercourse, and the way in which everyone was treated on a polite footing of equality—which came as a surprise to foreign visitors—made it easy even for the most timid to take the liveliest share in Charcot's examples."
Following Charcot's lead, Freud began by emphasizing that hysteria could affect both sexes, a position that was acceptable to his medical colleagues. On October 15, 1886, when he read his paper "On Male Hysteria" to the Vienna Psychiatric Society, several of the doctors present testified that male hysteria was already well known. Theodor Meynert, who publicly expressed skepticism about Charcot's symptomatology, later "confessed to Freud that he had himself been a classical case of male hysteria, but had always managed to conceal the fact." In 1887-88 Freud translated Charcot's Leçons de Mardi , which contained most of
Charcot's case studies of men. In "Hystérie," an essay he published in a medical encyclopedia in 1888, he further condemned the "prejudice, overcome only in our own days, which links neuroses with diseases of the female sexual apparatus." Here he also noted the incidence of hysteria in both boys and girls, as well as in adult men. Although rarer in men than in women, hysteria, Freud argued, is more disruptive for men, because it takes them away from their work: "The symptoms it produces are as a rule obstinate; the illness in men, since it has the greater significance of being an occupational interruption, is of greater practical importance."
In his work on hysteria, Freud took Charcot's theories to their logical extremes. Whereas Charcot had maintained that male and female hysteria had different causes, but similar effects, Freud argued that all hysteria came from traumatic origins. But the trauma did not have to be a railway accident or an injury in the workplace; it could be a disturbing sexual experience that had been forgotten and repressed. Furthermore, hysteria could be cured by having the patient recall and relive, or abreact, the originating 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 symbolization, and expressed emotional states.
Although he continued to acknowledge the existence of male hysteria, Freud's work on hysteria in Vienna concentrated on women. In contrast to Charcot, who examined, measured, and observed hysterics, but paid no attention to what they said, Freud and his colleague Joseph Breuer were the first to actually listen to hysterical women and to heed their complaints. In Studies on Hysteria (1895), he and Breuer 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, 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, paralyses, crippling headaches, and most significantly, aphonia, or 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. Studies on Hysteria thus seemed to lay the groundwork for a culturally aware therapy that respected women's words and lives.
In the case of Anna O., or Bertha Pappenheim, the connections between hysteria and feminism seemed particularly clear because after her analysis with Breuer in 1882, she went on to become a feminist
activist. She translated Mary Wollstonecraft's Vindication of the Rights of Woman into German, wrote a play called Women's Rights , and was the cofounder and director of the Judischer Frauenbund, the League of Jewish Women. In her hysterical seizures, Anna became unable to speak her native German, and instead spoke either Yiddish, which she called "the woman's German," or a jumble of English, Italian, and French. These linguistic symptoms have been read symbolically by feminist critics as the repression of women's language or its impossibility within patriarchal discourse. Dianne Hunter analyzes Pappenheim's hysterical symptoms as a linguistic protest against the German father tongue. In Anna O.'s case, "speaking German meant integration into a cultural identity [she] wished to reject," the patriarchy in which she was an immobilized daughter. Hunter concludes that Anna O.'s hysteria was a "discourse of femininity addressed to patriarchal thought," signifying both through the body and through nonverbal language the protest that could not be put into words. As she began to verbalize this protest in her conversations with Breuer, and to relive some of her dreams and hallucinations, Anna's symptoms were relieved. But she was not cured until she took complete control of language and subjectivity in her own writing. She remained ill for seven years after her treatment with Breuer, visiting sanatoriums during relapses. Anna O. recovered completely only with the publication of her first book, In the Rummage Store , in 1890. Rather than continuing her role as the passive hysterical patient, through writing she became one who controlled her own cure.
By the turn of the century, the sympathy with women's intellectual and creative frustrations and the openness to their words so marked in Studies on Hysteria had become codified in the interests of Freud's emerging psychoanalytic system, a system that depended very much on domination over the patient. We see this increased rigidity in his famous case history of Ida Bauer, the young Viennese girl he called "Dora." Dora was brought to Freud by her father when she was eighteen. Intelligent and ambitious, Dora was stifled by the requirements of her role as the marriageable daughter of a bourgeois family, when she longed to go to the university and to have a career rather than a husband. Dora was a Viennese version of the New Woman of the 1890s, the feminist who seeks higher education and wishes to avoid marriage. Freud never met Dora's mother, whom he regarded as a boring case of "housewives' neurosis." Although Dora felt contempt for her mother's monotonous domestic life, it was the life for which she too was destined as a woman. Her mother was "bent upon drawing her into taking a share in the work of the house." Dora could find no support for her intellectual aspirations
from either parent. Although she had a governess who was "well-read and of advanced views," Dora believed that the governess was neglecting her and was really in love with her father. She arranged to have the woman dismissed. Afterward, she struggled alone with the effort to keep up her serious reading, and she attended lectures specially given for women. Her older brother, however, went off to the university, and later became a prominent Austrian politician.
Moreover, Dora was treated like a pawn or a possession by her father and denied the rights to privacy or personal freedom. He was having an affair with the wife of a friend, Herr K., who had attempted to seduce Dora when she was only fourteen, and she felt that "she had been handed over to Herr K." by her father in exchange for Herr K.'s complicity in the adultery. Professing to be anxious about her depressive state of mind, but really, Dora believed, afraid that she would betray his sexual secrets, her father then "handed her over" to Freud for psycho-therapeutic treatment. He wanted Freud to persuade Dora that her perceptions were simply adolescent fantasies. He hired Freud hoping for an advocate to "bring her to reason."
As Jeffrey Masson observes, Dora had good reason to be upset: "She felt conspired against. She was conspired against. She felt lied to. She was lied to. She felt used. She was used." Moreover, Freud's determination to label her as a hysteric did not depend upon the severity of her symptoms. Indeed, unlike the other women treated for hysteria by Breuer and Freud, Dora's "symptoms" were few and slight. She had a nervous cough, headaches, depressions. While he acknowledged that Dora's case was no more than "petite hystérie," Freud believed that the very ordinariness of her symptoms made her an ideal subject. Since he was committed from the start to the hysteria diagnosis, Freud interpreted all of Dora's behaviors and statements in accordance with his theories about the origins of hysteria in childhood sexual trauma and repressed desires. Many of his views, such as the belief that "gastric pains occur especially often in those who masturbate" and that masturbation was related to hysteria, are now seen as Victorian sexual superstition. But Freud's interpretations of Dora's fantasies, which have as little basis as his statements about her physical symptoms, are still accepted in psychoanalysis. He told her that she was really attracted to Herr K., in love with her father, and in love with himself. He ignored the appalling circumstances of Dora's family situation, and she finally broke off the therapy.
The conclusion of Dora echoes the endings of many Victorian novels about women: "Years have gone by since her visit. In the meantime the
girl has married . . . she had been reclaimed once more by the realities of life." In fact Dora's problems were not resolved by marriage, although Freud borrows it as a literary device to signify a happy resolution of the therapeutic plot. In the case histories of male patients, however, Susan Katz points out, these closed marriage plots are significantly absent; "the forms of Freud's case histories reflect his ideological positions toward women and men." Similarly, Toril Moi reminds us, when Freud writes about Little Hans, he "never ceases to express his admiration for the intelligence of the little boy," while Dora's intelligence is represented as a form of neurotic resistance.
In addition to its plot and themes, Dora's case had other literary characteristics. While Breuer, in the case of Anna O., commented on the broken language and multilingual nature of the hysteric's speech, Freud himself first drew attention in the Dora case to the fragmentary and discontinuous nature of the hysteric's narrative, and to the physician's responsibility for reorganizing it into a coherent whole. As he explained, hysterics like Dora were unable to tell an "intelligible, consistent, and unbroken" story about themselves. They repressed, distorted, and rearranged information; their volubility about one period of their lives was sure to be followed "by another period in which their communications run dry, leaving gaps untilled and riddles unanswered." And this incapacity to give an "ordered history of their life" was not simply characteristic of hysterics, Freud claimed; it was in a sense the meaning of hysteria. If the hysteric could be brought to remember what was repressed, and to produce a coherent narrative, she would be cured.
Thus the therapist's task was to construct such a narrative for the patient. Freud was confident that no matter how elusive and enigmatic the hysteric's story, the analyst could reconstruct a logical, scientific, and complete narrative. "Once we have discovered the concealed motives," he wrote, "which have often remained unconscious, and have taken them into account, nothing that is puzzling or contrary to rule remains in hysterical connections of thought, any more than in normal ones."
In doing so, moreover, he had not only to fill in the gaps in the hysteric's own story but to overcome her resistance to his narrative interpretations. In order for the therapy to work, the hysteric had to accept and believe the narrative of the analyst. In his later papers on psychoanalytic technique, Freud described the process as one of combat in which "the patient brings out of the armory of the past the weapons with which he defends himself against the progress of the treatment—weapons which we must wrest from him one by one." The analyst, Freud insisted in "The Dynamics of Transference," must win "the victory whose ex-
pression is the permanent cure of the neurosis." But Dora was quite uncooperative in this regard. She flatly denied Freud's narrative embellishments of her story, would not accept his version of her activities and feelings, and either contradicted him or fell into stubborn silence. Finally she walked out on Freud by refusing to continue with therapy at all.
Freud viewed this resistance as the problem of her transference; Dora, he argued, had projected onto him her feelings of erotic attraction for her father and Herr K. and was punishing him with her rejection. If Freud is a reliable narrator, what happened in his exchange with Dora was that he succeeded in penetrating the mystery of her hysterical symptoms. In his terminology, he unlocked her case and exposed her sexual secrets. Unable to face the truth, Dora ran away from her therapy and remained sick for the rest of her life. Freud was a heroic pioneer who was disappointed in his efforts to help.
But if Freud is an unreliable narrator, a very different plot emerges. In this case, Dora is a victim of Freud's unconscious erotic feelings about her that affected his need to dominate and control her. It's significant that Dora has no voice in Freud's text, that we get nothing of her direct dialog, and that her historical and Jewish identity are both suppressed. Unlike Anna O., she never became a subject, only the object of Freud's narrative. His interpretations of her problem reflect his own obsessions with masturbation, adultery, and homosexuality. He never understands her story at all; he simply tries to bully her into accepting his version of events. His vaunted penetration of her secrets is really a kind of verbal rape. Dora's departure is then a heroic gesture of self-assertion and defiance. Her unhappy subsequent life was the result of Freud's failing her and leaving her defenseless in a social environment hostile to intellectual women. His interpretation of her story is more about himself than about her.
Contemporary analysts agree that for a variety of reasons psychoanalysis could only have been developed out of work with hysterics. "I think . . . that psychoanalysis had to start from an understanding of hysteria," Juliet Mitchell writes. "It could not have developed. . . from one of the other neuroses or psychoses. Hysteria led Freud to what is universal in psychic construction and it led him there in a particular way—by the route of a prolonged and central preoccupation with the difference between the sexes. . . . The question of sexual difference—femininity and masculinity—was built into the very structure of the illness." Because hysterics formed strong and explicit transferences to their doctors, they were analyzable and thus were an ideal group from which to gen-
erate a psychoanalytic theory. Kurt Eissler has hypothesized that "the discovery of psychoanalysis would have been greatly impeded, delayed, or even made impossible if in the second half of the nineteenth century the prevailing neurosis had not been hysteria."
What is left unsaid in these claims, however, is that only female hysterics offered these opportunities. The gender of the hysteric was crucial in leading Freud to the theory of sexual etiology of the neuroses. Had his patients primarily been men, had he written a case study of "Dorian" rather than "Dora," the history of psychoanalysis would look very different. The gender difference depends in part on Freud's reliance on cultural myths of masculine and feminine development in shaping his interpretation of hysteria.
At the turn of the century, hysteria was still popularly and medically conjoined with female deviance. In France, despite the "dismemberment" of Charcot, the hysteric was still seen in a theatrical context as a performer: "The hysteric is an actress, a comedienne," wrote P. C. Dubois in 1904, "but we never reproach her, for she doesn't know that she is acting. The most vehement negative statements associating feminism with hysteria came during the militant suffrage campaign. "One does not need to be against women suffrage," the London Times editorialized in 1908, "to see that some of the more violent partisans of that cause are suffering from hysteria. We use the word not with any scientific precision, but because it is the name most commonly given to a kind of enthusiasm that has degenerated into habitual nervous excitement." In a notorious article called "On Militant Hysteria," Dr. Aimwroth Wright traced feminist demands to the "physiological emergencies" that constantly threatened women. Suffragist protest, especially when it involved working-class women, wrote the Daily Chronicle , was simply "hysterical hooliganism." The representations of the militant feminist and the hysteric were conflated in the popular press, reflecting the view that nervous disorders were visible and detectable through study of the physiognomy. As Sander Gilman shows in chapter 5 in this book, the face of the hysteric had been presented as the chief sign of hysterical "difference" through the popularized images and photographs of Charcot's atelier, and through his studies of religious trance and possession in art as hysterical manifestations. Thus, the Daily Mirror wrote on 25 May 1914, the "hysterical ecstasy" of the suffragettes could be seen "unmistakably in the expression of the face."
But with the outbreak of war and the abrupt end of the suffrage campaign, there were expectations that hysteria was dying out. "One doesn't dare any longer to speak of hysteria," wrote one doctor in 1914. But
the Great War changed all this confident prediction with a great epidemic of hysteria among men. There had been scattered warnings of hysteria among soldiers before 1914. During the Boer War, the British surgeon C. A. Morris noted neurasthenic problems among the troops, which he attributed to privation, exhaustion, and mental strain. There were similar instances during the Russo-Japanese War of 1904-1905, and in 1907, the term "war neurosis" was introduced at the Congrès Allemand de Médicine Internationale.
But World War I, in the words of Sándor Ferenczi, offered "a veritable museum of hysterical symptoms." In all the European armies, war neurosis was extensive. In England by 1916, nervous cases accounted for as much as 40 percent of the casualties in the combat zone. By 1918 there were over twenty war hospitals for mental patients in the United Kingdom. And by the end of the war, eighty thousand cases had passed through army medical facilities. One-seventh of all discharges were for nervous disorders. "It is a wonderful turn of fate," marveled the British psychologist W. H. R. Rivers, "that just as Freud's theory of the unconscious and the method of psycho-analysis founded upon it should be so hotly discussed, there should have occurred events which have produced on an enormous scale just those considerations of paralysis and contracture, phobia and obsession, which the theory was designed to explain."
The psychiatric theories that developed around war neurosis reflect the ambivalence of the medical establishment upon confronting hysterical behavior in fighting men. The first problem was in naming the disorder. When Dr. Charles S. Myers saw cases of amnesia, impaired vision, and emotional distress among British soldiers in France, he noted "the close relation of these cases to hysteria." But like doctors before him, Myers did not want to use the feminizing term "hysteria," and thus he argued that the symptoms could be traced to a physical injury to the central nervous system caused by proximity to an exploding shell. He christened the disorder "shell-shock." Later Myers would concede that the lack of evidence of any organic relation between exploding shells and neurotic symptoms made shell shock "a singularly ill-chosen term," but its simplicity, alliteration, and military sound made it the label that won out over such other alternatives as "anxiety neurosis," "war strain," and "soldier's heart." The efficacy of the term "shell shock" lay in its power to provide a masculine-sounding substitute for the effeminate associations of hysteria, and to disguise the troubling parallels between male war neurosis and the female nervous disorders epidemic before the war. French doctors were also reluctant to identify war neuroses as hys-
teria, partly because of the internal struggle over the reputation of Char-cot. They called war neurotics pthiatiques , in Babinski's term, or, more harshly, simulateurs . Military authorities, indeed, regarded shell shock as a form of cowardice or malingering, and some senior army officers thought that patients should be court-martialed and shot.
One of the striking aspects of shell shock was the class difference in symptoms; "shell-shocked officers tended to suffer from chronic anxiety states while men in the ranks generally suffered from acute hysterical disorders." In the ranks, symptoms tended to be physical: paralyses, limps, blindness, deafness, mutism. In officers, symptoms tended toward the emotional: nightmares, insomnia, depression, anxiety attacks. Sexual impotence was widespread in all ranks. Explanations for the differences were class-based. Myers explained that "the force of education, tradition, and example make for greater self-control in the case of the Officer. He, moreover, is busy throughout a bombardment, issuing orders and subject to worry over his responsibilities, whereas the men can do nothing during the shelling but watch and wait until the order is received for an advance." Some British doctors saw a one-to-one cause-and-effect relationship between the hysterical conversion symptom and the trauma that had caused it. According to Thomas Salmon, "A soldier who bayonets an enemy in the face develops a hysterical tic of his facial muscles; abdominal contractions occur in men who have bayonetted enemies in the abdomen; hysterical blindness follows particularly horrible sights; hysterical deafness appears in men who find the cries of the wounded unbearable, and the men detached to burial parties develop amnesia."
There were two major ways of treating shell shock during the war, both designed to get men functioning and back to the trenches as fast as possible, and these treatments were differentiated according to rank. Shell-shocked soldiers were treated with the hostility and contempt that had been accorded hysterical women before the war. As in the nineteenth century, working-class men were linked with hysterical women as the antagonists of doctors. "The case of a psycho-neuropath," wrote Frederick Mott, "really consists of a mental contest, resulting in the victory of the physician." Not only in England but in all European countries, shell-shocked ordinary soldiers were subjected to forms of disciplinary treatment, such as isolation, restricted diet, public shaming, and painful electric faradization, or shocks to the afflicted parts of their bodies. The treatments known as "quick cure," "queen square" (for the London hospital where it was practiced), "torpedoing," "torpillage," "manière forte," "terrorism," or "Uberrümplung" (hustling) were in fact
semi-tortures designed to make the hysterical symptom more unpleasant to maintain than the threat of death at the front. German physicians, for example, were divided between those who looked for the organic lesions of nervous trauma and those who believed the symptoms manifested a wish to escape that was independent of any specific traumatic incident. While in the short term these methods did terrorize patients into dropping their symptoms, when they were returned to the front, more disabling and permanent conditions emerged. H. Stern estimated that out of three hundred soldiers "cured" and sent to the front, less than two percent could be maintained. After the war, a special Austrian commission was appointed to investigate the treatment of war neurotics in the Vienna General Hospital under Professor Julius Warner-Jauregg, who believed all shell-shock cases to be malingerers. In his report for the commission, Freud testified that "there were cases of death during the treatment and suicides as a result of it," but Warner-Jauregg was acquitted.
More advanced psychiatrists adopted psychotherapeutic techniques in the treatment of shell-shocked officers, using abreactive or cathartic methods such as hypnosis, dream analysis, and free association. Officers were given various kinds of rest cures similar to those assigned to neurasthenics. When men were the patients, however, the rest cure had to be revised. Military doctors felt that intense activity was necessary for the restoration of masculine self-esteem. As H. Crichton-Miller advised, "Rest in bed and simple encouragement is not enough. . . . Progressive daily achievement is the only way whereby manhood and self-respect can be regained." The treatment of isolation and rest, G. Elliot-Smith and T. H. Pear reminded doctors, had been developed in civilian life for "well-to-do women living in the lap of luxury" and could not be good for hardy military men. Although the men of the first group of neurasthenic cases treated in English military hospitals were given the Weir Mitchell rest cure, it was later reported that these patients remained ill throughout the war.
In dealing with shell shock, doctors seemed to have forgotten or ignored Charcot's work with male hysterics. They lacked a neutral vocabulary for discussing the cases in the contexts of masculinity; instead, shell shock was described as the product of womanish, homosexual, or childish impulses in men. W. H. R. Rivers had argued that war neurosis was a form of regression to an earlier form of development, either to animal instincts, primitive defenses, or infantile behaviors. Hugh Crichton-Miller also observed that, especially among the ranks, war neurosis produced "a condition which is essentially childish and infantile in its
nature." T. A. Ross suggested that the training of a soldier "tended to make him regress to a childish attitude. . . . The soldier is above all things to learn what he is told at once without argument as a child is." Wartime regression to a lower level of maturity also seemed to explain the proliferation of superstitions, magical beliefs, rituals, and rumors that, as Paul Fussell has shown, made the Great War a "new world of myth."
When doctors dismissed shell-shock cases as malingerers or simulateurs , they were often hinting at the effeminacy that had always been part of the male hysteria diagnosis. Freudians shared this view. Karl Abraham, among the Freudians, was one who argued that war neurotics were passive, narcissistic, and impotent men to begin with, whose latent homosexuality was brought to the surface by the all-male environment. In London, the tiny group practicing Freudian psychotherapy—David Eder, David Forsyth, and Ernest Jones—also argued for a sexual etiology for shell shock.
Their interpretations, however, were greeted with predictable outrage by such anti-Freudian members of the older generation as Charles Mercier. Reporting in The Lancet on a shell-shock patient, Forsyth described him as "a case of unconscious homosexuality with marked anal eroticism." Mercier made an angry response:
Unconscious pain, unconscious homosexuality, unconscious Oedipus complex, and other unconscious states of consciousness of the psychoanalysts. . . were a great mystery to me until I learnt from one of their victims what these expressions meant. This poor man had suffered many things for many months from many psycho-analysts, until at last he turned upon his tormentors . . . with these words: "It is true . . . that I now have these filthy thoughts, but it is you that have put them into my mind ."
The following week, Mercier was seconded by Dr. Robert Armstrong-Jones, who called for the professional outlawing of psychoanalysis. Then came a rebuttal from Forsyth, wondering how "those who still repudiate psycho-analysis and the sexual etiology of the neuroses can remain blind to what must long have been recognized by every thoughtful reader of your paper—namely, that the sexual instinct is clean and pure. It will not do nowadays to dress it up in mid-Victorian prejudices as a repulsive and disreputable bogie to frighten our intelligence."
Some famous shell-shock patients, such as Siegfried Sassoon, Wilfred Owen, and Robert Graves, were indeed homosexual or bisexual. For most, however, the anguish of shell shock included more general but intense anxieties about masculinity and fears of homosexuality, even as
they refused to continue the masquerade of masculinity. What John Lynch has called "the exploitation of courage" in the Great War may be more accurately called the exploitation of manliness. Soldiers were recruited and socialized through appeals to "traditional masculine virtues" and through promises of "the fulfillment of masculinity on the battlefield." In combat, displays of manly stoicism and heroics were expected and encoded. As Paul Fussell notes in his glossary of the romantic vocabulary of World War I, to be "manly" meant not to complain. Martin Stone points out that shell shock was thus generated by the military ethos of masculinity: "The soldier was encouraged to kill at the expense of unleashing infantile sadistic impulses that had previously been successfully repressed. He was encouraged to form close emotional bonds with other men and yet homosexuality was forbidden." If the essence of manliness was not to complain, then shell shock was the body language of masculine complaint, a protest against the concept of "manliness" as well as against the war.
The impact of male hysteria in the field of psychological medicine was complex. On one hand, psychologists who had worked with shell shock challenged Freud's view that sexual factors were basic to the understanding of hysteria. Unable to revise a theory based on female hysteria in the light of male experience, these men instead argued that "shell shock had effectively 'disproved' Freud's theory of sexuality." On the other hand, the Freudian establishment did not take the lessons of shell shock as a clue to expanding the theory of hysteria. Indeed, the theory only rigidified, with psychoanalysts insisting that the cause of hysteria had to be sought in infant traumas and repressed family experiences, rather than modifying their position to take immediate social factors into account.
The one or two voices who might have had something new and important to add to the conversation were prematurely stilled. W. H. R. Rivers was one of these. Rivers was a Cambridge psychologist and anthropologist who had studied in Germany, and who took an interest in the work of Freud. In his early fifties and unmarried when he became a military doctor, he found in the study of shell shock both a rich source of material for his theories of the unconscious and a personal involvement that changed the course of his career. The war, he wrote in Instinct and the Unconscious , had been "a vast crucible in which all our preconceived views concerning human nature have been tested." In his therapeutic practice, Rivers relied on what he called "autognosis," or self-understanding, which involved the discussion of traumatic experiences; and reeducation in which "the patient is led to understand how his newly
acquired knowledge of himself may be utilized . . . and how to turn energy, morbidly directed, into more healthy channels." Rivers's work was tragically abbreviated by his death in 1922.
Rivers may have been particularly effective as a therapist because he shared some of the characteristics of his patients. Speech disorders, especially stammering, were the most common neurasthenic symptom among officers and played a prominent role in the case studies of his patients. Rivers, the son of a speech therapist who specialized in the treatment of stutterers, had stammered all his life, although his biographer speculates that he did not stammer in German. He was also sexually repressed and almost certainly homosexual.
In his postwar writings, Rivers explored the psychoanalytic issues of fear and anxiety which had come out of his war work at Craiglockhart Hospital. Proposing "suggestion-neurosis" as a term for hysteria, he argued that military training reinforced suggestibility, especially in private soldiers. In his view, "the symptoms of hysteria are due to the substitution, in an imperfect form, of an ancient instinctive reaction in place of other forms of reaction to danger." In explaining the mutism that was a frequent feature of shell shock, Rivers made connections to "the suppression of the cry or other sound which tends to occur in response to danger." He also began to apply to female hysteria, or as he called it, "the hysteria of civilian practice," some of the ideas about gender anxiety he had developed in working with men. "We have to discover why hysteria should be so frequent in women, and so rare in men, under the ordinary conditions of civil life . . .," Rivers wrote. "Women are always liable to dangers in connection with childbirth to which men are not exposed, while the danger element, real or imaginary, is more pronounced in them than in the male in connection with coitus."
But theories about women's fears seemed less important by this time because after the war and the passage of women's suffrage in England and the United States, it was believed that female hysteria declined and even disappeared. Edward Shorter has noted that "the image of the dynamic 'New Woman' of the 1920s . . . plays an obvious role in the decline of the hysterical paralyses that once were quite common among young women: the New Woman, who rode motorcycles and smoked in public, simply did not develop a paralysis as a legitimate way of communicating her distress." Other scholars have also pointed to social changes as determinants of the decline. With the gradual emancipation of women, they have argued, the social conditions that had produced hysteria were no longer operative. According to the psychoanalyst Monique David-Ménard, for example, "the repression of sexuality at the end of the nineteenth century" was the cause of hysteria; "through the
spectacular side of hysteria, women expressed what was impossible to say concerning sexuality." If hysteria was the result of the sexual repression of the past, it made sense that it would vanish in our more liberated age.
And indeed for much of this century, female hysteria seemed to be on the wane, as feminism was on the rise. It is striking as well that Freud's female disciples were virtually silent on the question of hysteria. It is not a topic in the works of Karen Horney, Melanie Klein, Anna Freud, or other members of the postwar generation. When a woman analyst, Elizabeth Rosenberg Zetzel, finally did deal with hysteria, she did not question Freudian assumptions and shibboleths. A student of Ernest Jones and D. W. Winnicott, Zetzel trained in psychiatry at Maudsley Hospital during 1938-39 and then served for six years during the war in the Emergency Medical Service and Armed Forces. Zetzel worked with hysterical soldiers and described her experiences in her first analytic paper, "War Neurosis: A Clinical Contribution," published in 1943. The three case studies, she later observed, served "as a model or blueprint" for her major work. Zetzel is quite approving of her male patients: "They were all happily married; they all had a steady work record; they had all shown ambition, social conscience, and a good capacity for sublimation."
In contrast, when she worked with female hysterics in Boston after the war, Zetzel was much more critical. Although the women she called "true good hysterics" were "notably successful in the area of work," they had "failed to achieve a mature heterosexual relationship." Zetzel echoed Freud in her indifference to the double messages in the lives of her hysterical women patients, most of whom were intellectuals and students at various Boston universities. While she noted that "all of these patients have, in addition, been able to make and keep friends," she was certain that their difficulties with men came from their unresolved oedipal conflicts and penis envy, rather than from men's discomfort with gifted ambitious women. Instead of pursuing the paradoxes of their lives, and the apparent uselessness of Freudian therapy in solving them, she focused instead on their analyzability and suitability for treatment. For, she wrote,
There are many little girls
Whose complaints are little pearls
Of the classical hysterical neurotic.
And when this is true
Analysis can and should ensue,
But when this is false
'Twill be chaotic.
In such contemporary psychoanalytic writing by women as deals with hysteria, Freudian dogma has made it difficult for women analysts to accept hysterical symptoms in their male patients. Monique David-Ménard studied psychoanalysis at the Ecole Freudienne in Paris. In her practice, like most women analysts, she sees more women than men patients. David-Ménard claims not to know "what masculine hysteria is. Sometimes I say to myself when I hear a male patient who is very identified with a woman, 'Perhaps that came from hysteria,' but I always end up saying, 'It's not really that.'" Her book Hysteria from Freud to Lacan (1983) is a densely argued philosophical comparison of Freud and Lacan, rather than a feminist reading of their work.
Yet a feminist interpretation of hysteria does not come naturally to women psychoanalysts or historians simply because they are women. David-Ménard, for example, has said in an interview, "I don't define myself as a feminist whether as a philosopher or as a psychoanalyst." A feminist standpoint is situated within a particular cultural and intellectual framework, which offers an interpretative vocabulary and a support network for those who put it to use. Thus we need to read and evaluate women's writings about hysteria within their own historical context and with an understanding of the impact of gender at a particular moment for professional women.
Ilza Veith's Hysteria (1965) is an excellent case in point. According to Mark Micale, the book "established the 'standard' historical view of the subject for an entire generation of French, British, and North American readers." Ilza Veith is one of the pioneering scholars of the history of medicine in the United States. Born in Germany in 1915, she studied medicine in Geneva and Vienna before coming to the United States in 1937. While she had hoped to become a plastic surgeon, "there was no thought in the thirties that a woman could receive a residency or assistantship in surgery." Instead she trained with Henry Sigerist at Johns Hopkins and in 1947 received the first doctorate in the history of medicine in the United States.
For contemporary historians sensitized by feminist scholarship, Veith may seem indifferent to or unaware of the feminist questions in hysteria. She accepts wholeheartedly the Freudian view of hysteria and uses it as the resolution of the book, crediting psychoanalysis with the conquest of hysteria; it was the intensified understanding of the cause of hysteria by leading psychiatrists during this century, she wrote, that "contributed to the near-disappearance of the illness." Roy Porter in chapter 3 questions Veith's uncritical acceptance of Freud and her blindness to the misogyny of prepsychoanalytic therapists like Carter. Mark Micale, too,
points out that although she "might have been expected to respond differently," Veith "maintained a studied silence on the intersexual aspects of the disorder." Yet such a judgment carries its own assumptions about gender, ignores the circumstances in which the book was written, and misses the way that Veith, like many women writing about hysteria, felt pressured to avoid a feminism traditionally linked with the disorder itself.
Veith does indeed point out a number of the intersexual issues of hysteria, albeit in a restrained language. In one of the few metaphors of her book, she comments that "the scarlet thread of sexuality" runs throughout the "tangled skein" of the history of hysteria. She thus presents the issue as sexuality rather than femininity, although the allusion to the scarlet letter (and to the great American heroine Scarlett O'Hara) suggests that this sexuality was in fact related to women. For much of the book, when Veith describes or quotes accounts that link hysteria with female sexuality and reproduction, she generalizes from them to discuss a more universal and ungendered "sexuality." With regard to the Greek origins of the term, for example, she notes that "the association of hysteria with the female generative system was in essence an expression of awareness of the malign effect of disordered sexual activity on emotional stability." Veith's careful neutrality extended also to her discussion of witchcraft and the witch trials. "It is evident from the forgoing that women were the chief targets in the witch hunts," she mildly observes, without speculating further on the clerical misogyny and profound male anxieties that were projected onto women during the witch trials. Veith is similarly tolerant with regard to nineteenth-century medicine. She attributes Robert Brudenell Carter's hostility toward women to his "youthful impatience" with his female patients, and when she talks about the "punitive" aspects of Victorian treatment of hysterical women, calls them "misanthropic" rather than "misogynistic."
In her most substantial discussion of sex roles and attitudes, however, Veith explains that the "manifestations of this disease tended to change from era to era quite as much as did the beliefs as to etiology and the methods of treatment. The symptoms, it seems, were conditioned by social expectancy, tastes, mores, and religion, and were further shaped by the state of medicine in general and the knowledge of the public about medical matters." Women created or reproduced hysterical symptoms in accordance with their age's ideas about femininity: "Throughout history, the symptoms were modified by the prevailing concept of the feminine ideal. In the nineteenth century, especially, young women and girls were expected to be delicate and vulnerable both physically and emo-
tionally, and this image was reflected in their disposition to hysteria and the nature of its symptoms. Their delicacy was enhanced by their illness, and as a result, the incidence of overt manifestations was further increased." This comes very close to contemporary feminist analyses of hysteria.
Yet to judge Veith's work by contemporary feminist standards is to misunderstand the historical nature of gender ideology. Women historians and psychoanalysts of Veith's generation, including Elizabeth Zetzel, had a very different context than our own for their thinking about sexual difference, as several recent studies have illustrated. Joan Scott shows in her overview of American women historians that the post-World War II period saw the emergence of "a new discourse . . . that emphasized the masculine qualities of historians, associating them with the preservation of national traditions and democracy." Veith, like other women historians receiving their doctorates during this period, "had the further challenge of repudiating the disabilities assumed to come with womanhood." Serious historians were judicious, unemotional, objective, impersonal. Similarly, in a series of interviews with women psychoanalysts who trained during the 1920s, 1930s, and 1940s, Nancy Chodorow found a very different gender consciousness from that of the 1980s operative in their views of feminism and psychoanalysis. Gender was not a meaningful or salient category to them; few had noticed discriminatory treatment; they had not thought about the conflicts between Freudian views of femininity and their own professional careers. But rather than accusing them of bad faith, blindness, or repression, Chodorow concluded that "gender-emphasis" or the "relative downplay of gender issues" are "not only objectively determined by a structural situation" but are also "subjective features of identity and culture." The "salience of meaning of gender" was not a historical constant but rather "a highly constructed product of one's time and place."
In Veith's case, her position as a woman academic in a male-dominated profession may have led her to emphasize objectivity, neutrality, and indirection rather than to have taken a forceful and explicit feminist stand. Her book appeared in the last moments of calm before the storm of the women's liberation movement; sexual politics, however, was a term still to be invented by Kate Millett, and feminist scholarship did not yet exist.
Ilza Veith's autobiographical writings cast much light on the circumstances under which she wrote Hysteria and make clear that she was not unaware of sexism and its effects on the female psyche. In describing herself for Who's Who , she wrote, "In a long and severely handicapped
life I have had to live with chronic illness and pain. Thanks to my husband's endless patience and helpfulness, I have learned to accept what cannot be changed, and to change what can be altered. I have had a successful and highly satisfactory academic career in spite of endless obstacles that lie in the way of a woman scholar."
Some of the details behind this summation can be found in Veith's most recent book, Can You Hear the Clapping of One Hand? (1989). Here she describes the severe stroke that she suffered in 1964 while she was completing Hysteria . Just fifty years old, and having moved to California to take up a professorship at the University of San Francisco, Veith woke up one morning to find that her entire left side was paralyzed. She had been experiencing odd symptoms for over a month, including migraine headaches, disturbed vision, and olfactory hallucinations. Yet, despite her training as a medical historian, Veith had not consulted a doctor. Why? Because symptoms like these were frequently attributed in the medical literature to women with "hysterical personality." Veith was embarrassed to think that she herself might be a hysteric, and thus she ignored the warning signals of a serious stroke. Moreover, when she experienced paralysis of the left side—the side usually afflicted in cases of hysteria—Veith was persuaded that she was only hysterical and "deluded myself that if I admitted the hysterical nature of my hemiplagia to myself and others, it would simply go away." Patronized and subtly punished by doctors in the hospital when she refused to behave like a suitably ignorant and docile female patient, Veith learned more about sexism in medicine than has ever been revealed in her professional writing. She has never recovered the use of her left arm.
In contrast to Veith's emphasis on the ungendered nature of hysteria, contemporary feminist critics have argued that while "Freud's assertion that hysteria afflicted both men and women was a liberating gesture in the nineteenth century," the most liberating gesture for feminists today is to reclaim hysteria "as the dis-ease of women in patriarchal culture." Some have argued for a continuity or even a similarity between hysteria and feminism. In the 1970s, it became an important strategy of radical feminism to redefine as terms of female power the hostile labels that had been attached to rebellious or deviant women through history. Thus early women's groups were called the Witches, the highly successful English feminist publishing company is called Virago, and a major French feminist journal was called Sorcières . Feminists saluted the hysterics of the past as heroines of resistance to the patriarchal order.
Dora has indeed become a paradigmatic figure for contemporary feminist criticism. Because she walked out on her psychoanalysis, she has
appeared to some as a defiant figure and precursor, what Mary Jacobus calls "the first feminist critic of Freud." In her manifesto on women's writing, "The Laugh of the Medusa," Hélène Cixous takes Dora's story as a revolutionary discourse of the feminine, saluting Dora as "the indomitable, the poetic body . . . the true 'mistress' of the Signifier." In The Newly-Born Woman (1975), Cixous took the position that hysteria was the "nuclear example of women's power to protest," and that Dora belonged to the pantheon of feminist history: "Dora seemed to me to be the one who resists the system, the one who cannot stand that the family and society are founded on the body of women, on bodies despised, rejected, bodies that are humiliating once they have been used." Cixous's play Portrait de Dora (1976) tries to restore Dora's subjectivity and to reconstitute the other buried female figure in Freud's case history, the mother. Interpretations of Freud's case history are now legion, and the book In Dora's Case brings some of these feminist readings together.
It's important to note, however, that the fascination with Dora and hysteria has also been controversial within feminist theory. In her debate with Cixous in The Newly-Born Woman , Catherine Clement was more skeptical about the ultimate power of hysteria as a form of feminine subversion. She maintained that the hysteric is unable to communicate because she is outside of reality and culture—that, in Lacanian terms, her expression remains in the Imaginary, outside the Symbolic. Thus "hysterical symptoms, which are metaphorically inscribed on the body, are ephemeral and enigmatic. They constitute a language only by analogy." Hysterics should be classed not with feminist heroines, but with deviants and marginals who actually reinforce the social structure by their preordained place on the margin. Indeed, their roles are ultimately conservative: "Every hysteric ends up inuring others to her symptoms, and the family closes round her again, whether she is curable or incurable." With regard to Dora, Clément is cool and level-headed: "You love Dora, but to me she never seemed a revolutionary character." In order to affect the symbolic order, or the material world, she argues, the hysteric must somehow break through her private language and act. Thus for Clément, the "successful hysteric" is one, like Anna O./Bertha Pappenheim, who becomes a writer, social worker, and feminist leader.
Overall it seems paradoxical that Dora, a notoriously unsuccessful hysteric, should have emerged as a feminist heroine in the 1970s, singled out by women writers and intellectuals who had been able to have the education and activity Ida Bauer sought in vain. It is bizarre to find Dora put forward as a feminist ideal and saluted by successful writers like Cixous, when Dora's own aspirations were to become a woman of learning,
perhaps a writer. Historically, Dora never found her own voice. While feminist artists and critics can attempt to re-imagine her story, we must recognize, with Clément, that her rebellion ultimately turned back on the self.
Dora's feminist power, paradoxically, is as a tragic literary figure. Feminist critics have taken up the concept of "hysterical narrative" to describe a story that is fragmented and incoherent, like Freud's case study; or the Lacanian concept of "hysterical discourse" to describe the metaphoric language of the body. The impasse over Dora, feminism, and hysterical narrative, however, needs to be placed within the broader contexts of gender. As Toril Moi has pointed out, what Freud describes as the "incoherence" of the hysteric's story has less to do with the nature of hysteria or with the nature of woman than with the social powerlessness of women's narratives: "The reason why the neurotic fails to produce coherence is that she lacks the power to impose her own connections on her reader/listener." How can Dora's story have plausibility for male ears in a culture when women's plots are so limited? When narrative conventions assign women only the place of object of desire, how can a woman become the subject of her own story?
In order to understand the gender issues in hysterical narrative, we need to have case studies of male hysterics by women analysts. Since "the dominant narrative of a male doctor treating a woman patient maintains the normative structure of men occupying positions of authority over women, the importance of the gender of the participants in the therapeutic dialogue is obscured." Only in the past few years have women psychoanalysts begun to look at the problem of male hysteria and to examine issues of transference and countertransference between male patients and female therapists. Such studies require a "new narrative line that specifically addresses the relationship of boys to their mothers and the quite different meanings of power and sexuality for men and women in our culture." When their case studies are published, we will be able to ask whether the body language, speech, and narrative of the hysteric is a discourse of femininity or a narrative imposed by the man who tells the story.
Other contemporary feminist theories locate in hysteria an attempt to give weight and meaning to aspects of the feminine which are despised or nonfunctional in the patriarchal social order. As Diane Herndl explains, hysteria "has come to figure as a sort of rudimentary feminism and feminism as a kind of articulate hysteria." Juliet Mitchell describes hysteria as a "pre-political manifestation of feminism," an unconscious protest by women "in terms of their definitional and denigrated charac-
teristic—emotionality. If femininity is by definition hysterical, feminism is the demand for the right to be hysterical."
This romanticization and appropriation of the hysteric nostalgically assumes that she is a heroine of the past. "Où sont-elles passées les hystériques de jadis," asked Jacques Lacan in 1977, "ces femmes merveilleuses, les Anna O., les Emmy von N.? . . . Qu'est-ce qui remplace aujourd'hui les symptômes hystériques d'autrefois?" We might answer that the despised hysterics of yesteryear have been replaced by the feminist radicals of today, by contemporary women artists and poets, and by gay activists. In the popular mind, the pejorative association of feminism with hysteria and morbidity has not died yet. In 1983, for example, a controversy erupted in the Times Literary Supplement over the use of "hysterical" as a critical term for the poetry of Sylvia Plath and other "man-hating" feminist poets. Defending her position, Anne Stevenson wrote, "Hysteria is the very stuff of revolutions—and not only female revolutions . . . a passionate single-minded psychological condition which, immune to humour as to reason, fails to achieve the detachment essential for self-criticism."
Moreover, those revolutions connected to gender and race continue to seem more "hysterical" than others. In December 1989, when the AIDS activist group ACT-UP and the abortion rights group WHAM staged a demonstration at Saint Patrick's Cathedral in New York City, interrupting the Sunday Mass, the New York Times editorialized: "Arguments over AIDS, homosexuality and abortion are not going to be advanced by hysterics, threats or the disruption of religious services." What had been hysterical hooliganism in the suffrage campaigns was now attributed to other groups.
Black activists and radicals have also been stigmatized as hysterics and neurotics, leading to distrust of psychotherapy in the 1960s and 1970s among African-Americans. Yet, from another perspective, Freudian insights can illuminate the experience of racism and its effects on the psyche. In his autobiography Dusk of Dawn (1940), W. E. B. Du Bois described the gradual effects of racial segregation on the black mind:
It is as though one, looking out from a dark cave in a side of an impending mountain, sees the world passing and speaks to it; speaks courteously and persuasively . . . [but] it gradually penetrates the minds of the prisoners that the people passing do not hear; that some thick sheet of invisible but horribly tangible plate glass is between them and the world. They get excited; they talk louder; they gesticulate. [Then some persons may become "hysterical."] They may scream and hurl themselves against the barriers. . . . They may even, here and there, break through in blood
and disfigurement, and find themselves faced by a horrified, implacable, and quite overwhelming mob of people frightened for their very own existence.
Du Bois's description of the social origins of hysterical behavior in racism has relevance for other oppressed groups, particularly because it does not minimize the costs of hysteria. When unhappiness and protest go unheard for a long time, or when it is too dangerous for these negative emotions to be openly expressed, people do lose their sense of humor and their powers of self-criticism, whether they are feminists, people with AIDS, black activists, or East Germans, Rumanians, and Bulgarians. Anger that has social causes is converted to a language of the body; people develop disabling symptoms, or may even become violent or suicidal. "Hysteria," as Du Bois knew, is painful and disfiguring; rather than being a romantic ideal, it is a desperate behavior for women or men. It is much safer for the dominant order to allow discontented men and women to express their dissatisfaction through psychosomatic illness than to have them agitating for economic, legal, and political rights. It is thus that Dianne Hunter calls hysteria "feminism lacking a social network in the outer world."
What about hysteria now? In 1986, Etienne Trillat declared, "Hysteria is dead, that's for sure. It carried its mysteries with it to the grave." Phillip Slavney describes his study Perspectives on "Hysteria" (1990) as "perhaps the last book with hysteria in its title written by a psychiatrist." The terms "hysteria, hysteric and hysterical ," he argues, "are on the verge of becoming anachronisms."
These announcements of hysteria's death are surely premature, for they neglect the cultural and symbolic meanings of the term, which cannot be obliterated by professional fiat. To write a history of hysteria at the end of the twentieth century we need also to recognize the correspondence that has developed between the two words. While for centuries the etymological link between "hysteria" and hystera dictated certain assumptions about female sexuality, today the correspondence between "hysteria" and histoire seems much more important. Above all, the hysteric is someone who has a story, a histoire , and whose story is told by science. Hysteria is no longer a question of the wandering womb; it is a question of the wandering story, and of whether that story belongs to the hysteric, the doctor, the historian, or the critic. The stories of race and gender in hysteria still remain to be told, and thus this book cannot be the final narrative, but is only another installment in the long and unfinished history of hysteria in Western civilization.