How much do we know about the actual meaning of ‘Hysteria’?

J. M. Charcot demonstrating hysteria in a patient, 1887. (A painting by by André Brouillet)

Hysteria was recognised as a medical condition long before the nineteenth-century. Despite its prevalence, however, the understanding of its exact aetiology altered over time and was never clearly defined, since different medical authorities at different times suggested varying causes for the manifestation of the disease. Yet, Elaine Showalter delineated the last thirty years of the nineteenth-century as ‘the golden age of hysteria’ in her remarkable book The Female Malady: Women, Madness and English Culture, 1830–1980, due to the fact that the diagnosis of hysteria was tremendously rife from the 1870s onwards.

The concept of gender has always played a predominant role in defining the grounds for hysteria throughout its history, which is firstly indicated in that the term itself has its origins in the Greek word hystera meaning ‘womb’. As far as the etymology of the word indicates, physicians and gynaecologists associated hysteria with the female gender and thus conveniently filled a major gap in their medical understanding of the female body. Despite significant scientific progress during the nineteenth-century, medical discourse was dominated by a fairly similar view, as Jane M. Ussher argues when referencing the Victorian period that ‘the close association between femininity and pathology became firmly established …madness became synonymous with womanhood’.

Jean-Martin Charcot, the foremost medical authority at the time when hysteria reached its zenith, made contentious contributions to its understanding. He defined hysteria as ‘a physical illness caused by a hereditary defect or a traumatic wound in the central nervous system’, which constituted a break with the previously organic relationship assumed between hysteria and the womb. He made a controversial claim that men were also susceptible to hysteria and developed a significant amount of case studies in this field, as well as treating several male patients during his routine hospital sessions in the 1880s.

Charcot asserted that hysteria was a neural disease and that observation was the most reliable method for discerning the pathological features of hysteria. Under his leadership, doctors at the Salpêtrière hospital used distinct methods of treatment, such as rest-cure therapy and the punishment/reward system. However, Charcot’s interaction with science is significantly more complex than it first appears. The extent to which his observations were ‘scientific’ and his diagnosis were based on ‘empirical data’ is debatable. There is a juxtaposition between his extensive definition of the illness and the methodology used in its diagnosis and treatment, which one could argue was designed for and best suited to middle-class female patients.

Charcot’s seminal contribution to the definition of hysteria was his belief that men could also suffer from the illness, thus aiding in debunking the idea that womanhood and hysteria were synonymous. In addition, Mark S. Micale states that Charcot’s theory of male hysteria did not necessitate feminine characteristics on the part of its male sufferers, which is demonstrated in Charcot’s description of certain male patients, some of whom were ‘robust labourers’, as being ‘rigorously built’, or having ‘very developed’ musculature.

As such, Charcot’s claim established a previously non-existent connection between hysteria and manliness. However, whilst appearing to achieve a greater degree of equality between the sexes, class discrepancies were to be crucial to Charcot’s actual diagnosis and treatment of his new male patients. For example, the upper-class patients he often saw in his private office were rarely diagnosed with hysteria due to its notoriously shameful connotation. Instead they were diagnosed with neurasthenia, which was in reality very similar to hysteria in its symptoms. This diagnosis was exclusive to his private patients, those from the working-class were still diagnosed with hysteria without much concern for its shameful connotation. Therefore, a clear class-specific pattern may be discerned in Charcot’s diagnosis and treatment of men, demonstrating that class played a pivotal role in his interaction with male hysteria. A similar pattern of class-based bias appears in his treatment of female patients as well, in spite of the prevalent idea that hysteria in women was linked to their reproductive capacities and thus free from class boundaries.

Showalter draws attention to this by highlighting that, in France, female patients from the working-class were looked upon with hostility by medical authorities of the Salpêtrière hospital, emphasising that, in Charcot’s view, they were not even worthy of being listened to. Therefore, considering the fact that Charcot valued observation above all else as a means of diagnosing his patients and developing his theory, the diagnosis of impoverished women served no higher purpose than to add weight to Charcot’s theory of female hysteria.

Contrarily, upper-middle class women were regarded as the ideal specimen of hysteria because the treatments offered by the Salpêtrière hospital were far more suited to them than to any other. Treatment mostly comprised of rest-cure therapy, which took eight weeks to complete and was therefore only really applicable to patients from the bourgeoisie, as they could afford not to work for weeks at a time. It is therefore clear, that Charcot did not remain true to his own theory of hysteria when treating patients from varying social classes and thus allowed discrepancies to develop between his theory and its implementation.

A significant apparition of this difference in theory and practice is in Charcot’s diagnosis of male patients. He cites many different reasons for the diagnosis of hysteria or neurasthenia, but a pattern can be perceived amongst the common symptoms given for patients of upper class and those of working class origins. A poor, working man’s symptoms would most often be attributed to ‘sexual excess, trauma or overwork’. However, in the case of men of higher means, additional symptoms were often added to the list, such as anxiety, ambition, the use of drugs or the consumption of alcohol. Although these symptoms do not conform to traditional class bias as based on social stereotypes, it could be said to indicate an assumption that deeper and more complex emotional lives are led by those from a wealthier background.

This could also be said to throw into question Charcot’s belief that his observations were the best means of developing a scientific theory of hysteria. This is because the attribution of values to observed behaviours is intrinsic to this method of diagnosis, as Charcot ‘observed’ behaviours and decided which were relevant to his diagnosis of hysteria and which were not. It is interesting to note at this point, that a digression from the grounds of his theory on the basis of social class was significantly less common amongst Charcot’s female patients.

The most commonly given reason for a diagnosis of hysteria amongst women from all social backgrounds was childbirth or reproductive disturbances, indicating that Charcot had not entirely distanced the neurological illness from its etymological roots. Although class appears thus far to have had little bearing on Charcot’s treatment of his female patients, their gender in itself appears to have been another reason for which he diverted from his theory. The Tuesday Lectures (Les Leçons du Mardi) enabled Charcot to outline the stereotypical hysterical patient in front of an audience, with women centre stage. In almost exclusively selecting female patients for these sessions, Charcot casts the ideal hysterical patient as a woman and thus undermines his premise that men and women were equally susceptible to the illness.

The painting Une Leçon Clinique à la Salpêtrière by André Brouillet is the paragon of this phenomenon. Brouillet depicts a scene from one of Charcot’s Tuesday Lectures in which we can see a fainting woman surrounded by a large group of male doctors who observe the ‘spectacular show’ intently or take notes. Just as is shown in the painting, Charcot dominates the situation firstly in selecting what he will show to the audience and secondly in his interpretation.

A similar kind of conscious selection may be seen in the production of the Iconographie Photographique de la Salpêtrière, a collection of photographs depicting various female patients with hysterical symptoms. The fact that Charcot chose only to use women in his albums is significant in that it once again served to strengthen the relationship between women and hysteria rather than to promote his own controversial claim about the masculine aspect of the illness.

Charcot’s practices were not always compatible with his theoretical claims and the methodology and the structure of his practices could be said to diminish the cogency of his definition of hysteria. Although his definition embraced both sexes, the connection between the female gender and hysteria appears to be ingrained in his understanding of the disease.

Thanks to his strong commitment to the degeneration theory, Charcot maintained that hysteria was a genetically transmitted illness and his conclusion was that ‘twenty-three out of thirty cases examined inherited a tendency to the disease from their mothers’. In other words, this shows once again that Charcot appeared to believe the origins of the illness to be driven from female genetics, therefore reinforced the inextricable link between hysteria and women.

Charcot believed it to be evident that damaging lesions in the nervous system were often stimulated by traumatic real-life incidents. It is therefore once again the case that the causes of female hysteria were intrinsically related to female experiences such as childbirth or breastfeeding, whereas male hysteria was considered to be provoked by external factors such as over-labouring or occupational hazards. The significance of this lies in that Charcot’s definition was not, in reality, irrespective of gender binary.

His understanding of hysteria also considerably prioritises nature over nurture, and thus rendering his theory far less distinct from its antecedents than previously thought. The same phenomenon can be found in Charcot’s four stages for explaining a hysterical attack. The third stage, attitudes passionnelles, incorporates a performance of a wide range of emotions, and is therefore devoted to femaleness. However, the range of those emotions documented was noticeably narrower in Charcot’s clinical reports on male hysteria.

Contrarily, Charcot paid the most attention to the epileptiform stage in men, which refers to the manifestation of physical symptoms such as muscular spasms. It is therefore fair to argue that Charcot’s engagement with hysteria and gender is a complex one. On one hand, his contribution to the late nineteenth century definition of hysteria was revolutionary because he established hysteria as a male illness. On the other hand, he maintained the subcategorization of male and female hysteria as ‘conspicuously unalike’ concepts, which reinforced the gender roles imposed by patriarchal society.

Considering these two opposing views as either end of a spectrum, it is difficult to define where Charcot stands as a nineteenth century medical authority. Some of his contributions to the understanding of hysteria were unprecedented. However, some of his beliefs remained open to debate until the disappearance of hysteria from medical discourse. As well as his counterparts, Charcot was influenced by the notion of ‘separate spheres’, which sought to control women’s position in society through the imposition of patriarchal values and norms.

This is because Charcot himself was a product of the nineteenth-century society, and medical diagnosis and treatment provided a convenient way of achieving this goal. This is exemplified in the fact that different emancipatory behaviours in women were cited as causes of hysteria, such as overwork for working-class women or having gone to college for middle-class women. The case study of ‘Blanche’, as outlined by Asti Hustvedt, shows that doctors at the Salpêtrière were able to enforce their ideas about which behaviours were acceptable and which were not by means of a system of punishment and reward.

The threat of public shame or confinement in a hospital contributed to their process of ‘curing’ women of behaviours viewed negatively by society, such as sexual excess or being educated to the same standard as men. Even though Charcot’s theory of hysteria was revolutionary for his time, it is inevitable that the notion of ‘separate spheres’ still had a considerable impact upon his understanding of hysteria.

As Showalter explains, it is not merely coincidental that feminism and hysteria became prevalent in public discourse at the same time; ‘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’. It is thus highly relevant from a feminist perspective that Charcot reinforced the status-quo in his methods of diagnosis and treatment of women.

There are numerous criticisms of Charcot’s engagement with hysteria in the feminist literature, but one should be mindful of calling Charcot a misogynist and thus committing an ad hominem fallacy. Even though it might be true to a great extent, the criticism itself is anachronistic because Charcot developed his theory in an era during which ‘stories about hysteria were told by men, and women were always the victims …rather than the heroines’.

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