Historiography

And historians of hysteria have characteristically followed in their footsteps: it was no accident that the first substantial chronicles of hysteria were written by Charcotian protégés.^[35] Such works have assumed that the annals of medical history, down the centuries and across the cul-

tures, point to outcrops of a disorder now identifiable as hysteria, and that the medical mission of understanding, classifying, and treating it can be recounted as a progression from superstition to science, ignorance to expertise, prejudice to psychoanalysis. The standard English-language history, Ilza Veith's Hysteria: The History of a Disease (1965), is wholly cast within this mold.^[36]

As her title indicates, Veith's premise is that hysteria is an objective disease, the same the whole world over. It had been known to doctors—East and West—at least from 1800 B.C ., Veith contended, though it was the Greeks who had given it its name. Medieval Christendom's gestalt switch, treating psychosomatic symptoms as the stigmata of Satan, had entailed a gigantic regression.^[37] Fortunately, far-sighted Renaissance physicians such as Johannes Weyer had recaptured hysteria from the theologians, seeing it as a disease, not a sin.

Even so, true understanding (and treatment) continued to be hamstrung by a fallacious medical materialism misconstruing hysteria as organic—standardly, an abnormality of the womb, or, in later centuries, of the nervous system and brain stem. Veith particularly deplored the "increasingly sterile and repetitive neurological basis that had emanated from Great Britain for nearly two hundred years," sparked, above all, by George Cheyne's "nervous" theory, whose "affectation and absurdities are such that it scarcely merits elaborate discussion"—even the Scottish iatromechanist's "references to his own distress," Veith uncharitably grumbled, "seem inconsequential."^[38] Not least, she argued, somatic hypotheses had been marred by misogyny. Overall, such ideas were precisely the obstacles that, in Freud's view, had "so long stood in the way of [hysteria] being recognized as a psychical disorder."^[39]

Fortunately, according to Veith, a counterinterpretation had emerged, albeit by fits and starts. Brave spirits such as Paracelsus, Edward Jorden, Thomas Sydenham, Franz Anton Mesmer, Philippe Pinel, Ernst von Feuchtersleben, and Robert Carter began to develop "an amazing amount of anticipation" of the insight—finally triumphant with Freud—that hysteria was psychogenic, the monster child of emotional trauma aggravated by bourgeois sexual repression, especially of females.^[40] Thanks principally to Freud, this libidinal straitjacket had finally been flung off, leading to the disorder's demise in the present century: Veith's narration concluded with Freud.

It says something for the vitality of medical history that, twenty-five years later, Veith's recension appears hopelessly outdated. For one thing, hers was heroes-and-villains history, being particularly free with bouquets for those who "anticipated" Freud's psychosexual theory. Among these,

the mid-Victorian practitioner Robert Carter received her most fulsome floral tributes, for having effected "a greater stride forward" than "all the advances made since the beginning of its history."^[41] This rosy interpretation of Carter grates, however, upon a modern generation primed on antipsychiatry and feminism. After all, it was precisely his judgment that hysteria was psychogenic that enabled Carter to indict hysterical women as not sick but swindlers, sunk in "moral obliquity," cynically exploiting the sick role to manipulate their families and getting perverse sexual kicks out of the repeated vaginal examinations they demanded. Carter, however, saw through their tricks and advocated subjecting them to ordeal by psychiatric exposure.^[42] With Dora's case in mind, we might wryly agree with Veith that Carter did indeed "anticipate" Freud, but such a compliment would, of course, be backhanded, underlining that Freud too could be a misogynistic victim blamer and therapeutic bully. Faced with the deviousness of hysterics, Freud confided to Wilhelm Fliess his sympathy for the "harsh therapy of the witches' judges."^[43]

More generally, Veith's "history of a disease"—indeed, of a "mental disease"^[44] —conceived as a joust between benighted (somatic) theorists, who "retarded" comprehension, and their forward-looking psychological rivals, suffers from the stock shortcomings of wise-after-the-event Whiggism.^[45] Past theorists are graded by the yardstick of Freud, whose theory is taken as the last word. With hindsight derived from the psychodynamic revolution, Veith organizes her history of hysteria around an essential tension between (wrong) somatogenic and (valid) psychogenic claims.

A radically different reading is offered by Thomas Szasz. For Szasz, hysteria is not a real disease, whose nature has been progressively cracked, but a myth forged by psychiatry for its own greater glory. Freud did not discover its secret; he manufactured its mythology.^[46] Drawing upon varied intellectual traditions—logical positivism, Talcot Parsons's theory of the sick role, ethnomethodology, and the sociology of medical dominance—Szasz has made prominent, in his The Myth of Mental Illness ,^[47] psychoanalysis's "conversion" of hysteria into a primary psychogenic "mental illness" marked by somatic conversion, the translation, as William R. D. Fairbairn put it, of a "personal problem" into a "bodily state."^[48] "I was inclined," reflected Freud, "to look for a psychical origin for all symptoms in cases of hysteria."^[49]

Exposing this as a strategy integral to a self-serving "manufacture of madness," Szasz counters with a corrosive philosophical critique. By thus privileging the psyche, Freud was in effect breathing new life into the

obsolete Cartesian dualism, resurrecting the old ghost in the machine, or rather, in the guise of the Unconscious, inventing the ghost in a ghost.^[50] For Szasz, on the other hand, the expectation of finding the etiology of hysteria in body or mind, above all in some mental underworld, must be a lost cause, a dead end, a linguistic error, and an exercise in bad faith. For the "unconscious" is not a place or an organ but, at most, a metaphor; Freud stands arraigned of rather naively pictorializing the psyche in hydraulic and electrical terms, of reifying the fictive substance behind the substantive.^[51]

Properly speaking, contends Szasz, hysteria is not a disease with origins to be excavated, but a behavior with meanings to be decoded. Social existence is a rule-governed game-playing ritual. The hysteric bends the rules and exploits their loopholes. Not illness but idiom (gestural more than verbal), hysteria pertains not to a Cartesian ontology but to a semiotics, being communication by complaints . Since the hysteric is engaged in social performances that follow certain expectations so as to defy others, the pertinent questions are not about the origins, but the conventions, of hysteria.^[52]

Sidestepping mind/body dualisms, Szasz thus recasts hysteria as social performance, presenting problems of conduct, communication, and context. Freud believed mind/body dichotomies were real, though typically mystified, and attempted to crack them. Szasz dismisses these as questions mal posées , deriving (like Freud's "discovery" of the unconscious) from linguistic reification or bad faith, and he aims to reformulate them.

If idiosyncratic, Szasz's analysis is also a child of its time. Modern linguistic philosophy, behaviorism, and poststructuralism all depreciate the etiological quest: origins, authors, and intentions are discounted, systems, conventions, and meanings forefronted. Szasz does not, of course, expect that his paradigm-switch will magically switch off all the uncontrollable sobbing, fits, tantrums, and paralyses. But it offers alternative readings of such acts, while undermining expectations that tracking hysteria will lead to the source of the Nile, that is, the solution of the riddle of mind and body.^[53]

Szasz's resolution of hysteria is bracing, but it is achieved at the cost of reducing its past to pantomime: his adoption of the language of game-playing turns everyone, sufferers and medics alike, into manipulative egoists. Illness is just a counter in a contest. So why embrace this dismissive, belittling view? It is because Szasz is at bottom an old-school medical materialist: disease is really disease only if it is organic.^[54] Were hysteria—were any so-called mental illness—somatically based, it would have a real history (afflicting people, being investigated by physicians). Lacking organic "papers," its past, rather like those of transubstantiation

or of perpetual-motion engines, is a blot, a disgrace, a fiction, a tale of knaves and fools worthy of some philosophe's pen.

Thus, for equal but opposite reasons, Veith and Szasz both short-circuit hysteria's history. Veith (oddly like Charcot) feels obliged to trace it from the pharoahs to Freud; Szasz thinks the history of hysteria begins with Freud's psychodynamic empire building. Believing hysteria psychogenic, Veith recounts her "history of a disease" as the road to Freud. Believing disease must be somatic, Szasz paints hysteria's history as the pageant of a dream. Both approaches trivialize the intricate texture of hysteria down the ages, the true understanding of which must respect, not explain away, the enigmas of multifaceted, evanescent pain in a culture within which mind/body relations have been supercharged and devilishly problematic.

Yet Veith's and Szasz's polarized readings are, in their own way, highly exemplary, for they both highlight mind/body disputes in hysteria's etiology. Down the centuries, physicians long lamented how hysteria remained sphinxlike, because mind/body relations themselves proved a conundrum. Veith's desire to divide her protagonists into ("retarding") materialist and ("progressive") psychological camps is, however, misguided, for it freezes the rhetoric of the Freudian era and anachronistically backprojects it. Yet Szasz's mythic history, subserving his own debunking and liberating polemic, also cuts corners, above all by seemingly denying any significant developments before Freud. Many recent historians, especially Mark Micale,^[55] have, by contrast, insisted on the enormous intricacy and indeterminacy of the story of hysteria. Above all, as will be explored below, it would be simplistic to imply that early theories were exclusively either somatogenic or psychogenic; most commonly they were attempts to dissect and plot the puzzling entente between the passions of the mind and the constitution of the body. Our story is thus not a matter of either/or but of both/and. And it is, above all, a history in which the very notions of mind and body, and the boundaries and bridges between them, were constantly being challenged and reconstituted.

Hence this chapter will focus on medical theorizings of mind/body pathologies. It will thus engage the metaphysics of hysteria, examining the theoretical underpinnings that made possible a succession of puzzles, problems, and solutions. The story of hysteria (I will argue) makes scant sense if restricted to internal, technical skirmishings over nerves and neurons, passions and pathogens. Far more was at stake, not least because, as Szasz has insisted, hysteria became an exemplary disease, the disorder that single-handedly launched psychoanalysis.

Small wonder this wider history is requisite, for the biomedical doc-

trines of body and brain, psyche and soma, have never been neutral post-mortem findings, hermetically sealed from the symbolic meanings accreting around sickness in daily experience, meanings of utmost significance for doctrines of human nature, gender relations, moral autonomy, legal responsibility, and the dignity of man.^[56] Medicine's authority, its prized scientificity, may have rested upon its vaunted monopoly of expertise over the human organism, but its public appeal has equally hung upon its ability to attune its terms and tones to the popular ear. The historian of hysteria must, in short, bear in mind the wider determinants: changing ideas of man, morality and culture, and the politics of medicine in society.