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Female hysteria | |
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Women with hysteria under the effects of hypnosis, 1876–1880 | |
Specialty | Psychiatry |
Female hysteria was once a common medical diagnosis for women. It was described as exhibiting a wide array of symptoms, including anxiety, shortness of breath, fainting, nervousness, exaggerated and impulsive sexual desire, insomnia, fluid retention, heaviness in the abdomen, irritability, loss of appetite for food or sex, sexually impulsive behavior, and a "tendency to cause trouble for others". [1] It is no longer recognized by medical authorities as a medical disorder. Its diagnosis and treatment were routine for hundreds of years in Western Europe. [1]
In Western medicine, hysteria was considered both common and chronic among women. Even though it was categorized as a disease, hysteria's symptoms were synonymous with normal functioning female sexuality. [1] In the context of hysteria, every symptom and negative thought was linked to sex. [2] In extreme cases, the woman may have been forced to enter an insane asylum or to undergo surgical hysterectomy. [3]
The history of hysteria can be traced to ancient times. Dating back to 1900 BC in ancient Egypt, the first descriptions of hysteria within the female body were found recorded on the Kahun Papyri. [4] In this culture, the womb was thought capable of affecting much of the rest of the body, but "there is no warrant for the fanciful view that the ancient Egyptians believed that a variety of bodily complaints were due to an animate, wandering womb". [5] In this time, the medical issue of uterine prolapse was also known. [5]
In ancient Greece, wandering womb was described in the gynecological treatise of the Hippocratic Corpus, "Diseases of Women", [6] which dates back to the 5th and 4th centuries BC. Plato's dialogue Timaeus compares a woman's uterus to a living creature that wanders throughout a woman's body, "blocking passages, obstructing breathing, and causing disease". [7] Aretaeus of Cappadocia described the uterus as "an animal within an animal" (less emotively, "a living thing inside a living thing"), which causes symptoms by wandering around a woman's body putting pressure on other organs. [6] Timaeus also argued that the uterus is "sad and unfortunate" when it does not join with a male or bear a child. [4] The standard cure for this "hysterical suffocation" was scent therapy, in which good smells were placed under a woman's genitals and bad odors at the nose, while sneezing could be also induced to drive the uterus back to its correct place. [6] The concept of a pathological "wandering womb" was later viewed as the source of the term hysteria, [7] which stems from the Greek cognate of uterus, ὑστέρα (hystera), although the word hysteria does not feature in ancient Greek medicine: 'the noun is not used in this period'. [7]
While in the Hippocratic texts a wide range of women were susceptible – including in particular the childless – Galen in the 2nd century omitted the childless and saw the most vulnerable group as "widows, and particularly those who previously menstruated regularly, had been pregnant and were eager to have intercourse, but were now deprived of all this" (On the Affected Parts, 6.5). [6] He also denied that the womb could "move from one place to another like a wandering animal". [6] His treatments included scent therapy and sexual intercourse, but also rubbing in ointments to the external genitalia; this was to be performed by midwives, not physicians. [6]
While most Hippocratic writers saw the retention of menstrual blood in the womb as a key problem, for Galen even more serious was the retention of "female seed". [8] This was believed to be thinner than male seed and could be retained in the womb. [7] Hysteria was referred to as "the widow's disease", because the female semen was believed to turn venomous if not released through regular climax or intercourse. [9] If the patient was married, this could be completed by intercourse with their spouse. Other than participating in sexual intercourse, it was thought that fumigating the body with special fragrances would supposedly draw the uterus back to its natural spot in the female body. Foul smells applied to the nose would drive it down, and pleasant scents at the vulva would attract it. [7]
Through the Middle Ages, another cause of dramatic symptoms could be found: demonic possession. [10] It was thought that demoniacal forces were attracted to those who were prone to melancholy, particularly to single women and the elderly. When a patient could not be diagnosed or cured of a disease, it was thought that the symptoms of what would now be diagnosed as mental illness, were actually those of someone possessed by the devil. [4] After the 17th century, the correlation of demonic possession and hysteria were gradually discarded and instead was described as behavioral deviance, a medical issue. [11]
In the 16th and 17th centuries, hysteria was still believed to be due to the retention of humour or fluids in the uterus, sexual deprivation, or by the tendency of the uterus to wander around the female body causing irritability and suffocation. Self treatment such as masturbation, was not recommended and was also considered taboo. Marriage, and regular sexual encounters with her husband, was still the most highly recommended long-term course of treatment for a woman with hysteria. [4] [12] It was thought to purge the uterus of any built-up fluid, and when semen was thought to have healing properties, physicians regarded all contraceptive practices as injurious to women. Giovanni Matteo Ferrari da Gradi cited marriage and childbearing as a cure for the disease. If pleasure was obtained from them, then hysteria could be cured. [12] If a woman was unmarried, or widowed, manual stimulation by a midwife involving certain oils and scents was recommended to purge the uterus of any fluid retention. Lack of marriage was also thought to be the cause of most melancholy in single women, such as nuns or widows. Studies of the causes and effects of hysteria were continued in the 16th and 17th century by medical professionals such as Ambroise Pare, Thomas Sydenham, and Abraham Zacuto, who published their findings furthering medical knowledge of the disease, and informing treatment. [12] [4] Physician Abraham Zacuto writes in his Praxis Medica Admiranda from 1637
Because of retention of the sexual fluid, the heart and surrounding areas are enveloped in a morbid and moist exudation: this is especially true of the more lascivious females, inclined to venery, passionate women who are most eager to experience physical pleasure; if she is of this type she cannot ever be relieved by any aid except that of her parents who are advised to find her a husband. Having done so the man's strong and vigorous intercourse alleviated the frenzy.
— Rachel P. Maines, The Technology of Orgasm: "Hysteria", the Vibrator, and Women's Sexual Satisfaction, p. 29 [12]
There was continued debate about whether it was morally acceptable for a physician to remove excess female seed through genital manipulation of the female patient; Pieter van Foreest (Forestus) and Giovanni Matteo da Grado (Gradus) insisted on using midwives as intermediaries, and regarded the treatment as the last resort. [13]
In the 18th century, hysteria slowly became associated with mechanisms in the brain rather than the uterus. This is also when it was noted both men and women could contract hysteria. [14] French physician Philippe Pinel freed hysteria patients detained in Paris' Salpêtrière sanatorium on the basis that kindness and sensitivity were needed to formulate good care. Another French physician, Francois de Sauvages de La Croix believed some common signs of female hysteria were "tears and laughter, oscitation [yawning], pandiculation (stretching and yawning), suffocating angina (chest pain) or dyspnea (shortness of breath), dysphagia (difficulty swallowing), delirium, a close and driving pulse, a swollen abdomen, cold extremities, and abundant and clear urine." [14]
Anton Mesmer, a German physician, came up with the theory of “animal magnetism”, later referred to as mesmerism. Mesmer saw “animal magnetism” as energy that flowed through the nervous system. He would try to manipulate that “energy” to relieve his patients of hysteria. One of the methods he used was having his patients hold onto metal rods that were electrically charged. Mesmer's findings on "animal magnetism" were later discredited. [15]
Jean-Martin Charcot argued that hysteria derived from a neurological disorder and showed that it was more common in men than women. [4] Charcot's theories of hysteria being a physical condition of the mind and not of the body led to a more scientific and analytical approach to hysteria in the 19th century. He dispelled the beliefs that hysteria had anything to do with the supernatural and attempted to define it medically. [16] Charcot's use of photography, [17] and the resulting concretization of women's expressions of health and distress, continued to influence women's experiences of seeking healthcare. [18] Though older ideas persisted during this era, over time female hysteria began to be thought of less as a physical ailment and more of a psychological one. [19]
George Beard, a physician who cataloged an incomplete list including 75 pages of possible symptoms of hysteria, [20] claimed that almost any ailment could fit the diagnosis. Physicians thought that the stress associated with the typical female life at the time caused civilized women to be both more susceptible to nervous disorders and to develop faulty reproductive tracts. [21] One American physician expressed pleasure in the fact that the country was "catching up" to Europe in the prevalence of hysteria. [20]
In 1875, Edward Hammond Clarke wrote “Sex in Education”, a book discussing his views on men and women's education. Clarke believed that if women were educated, the energy in their bodies would go to the brain instead of the reproductive organs, hindering childbirth. He attributed clothing, food, exercise, and education for causing “Leucorrhoea, amenorrhea, dysmenorrhea, chronic and acute ovaritis, prolapsis utari, hysteria, neuralgia”. Clarke believed that men came into the world fully developed, while women were not. He stated that by imposing men's education on women, their problem would worsen. His views were condemned by many women's organizations. [22]
According to Pierre Roussel and Jean-Jacques Rousseau, femininity was a natural and essential desire for women: "Femininity is for both authors an essential nature, with defined functions, and the disease is explained by the non-fulfillment of natural desire." [4] It was during the industrial revolution and the major development of cities and modern lifestyles that disruption of this natural appetite was thought to cause lethargy or melancholy, leading to hysteria. [4] At the time female patients sought medical practitioners for the massage treatment of hysteria. The rate of hysteria was so great in the socially restrictive industrial period that women were prone to carry smelling salts about their person in case they swooned, reminiscent of Hippocrates' theory of using odors to coerce the uterus back into place. For physicians, manual massage treatment was becoming laborious and time-consuming, and they were seeking a way to increase productivity. [12]
Rachel Maines hypothesized that physicians from the classical era until the early 20th century commonly treated hysteria by manually stimulating the genitals of female patients to the point of orgasm, which was denominated "hysterical paroxysm", and that the inconvenience of this may have motivated the original development of and market for the vibrator. [1] Other hysteria treatments included pregnancy, marriage, heterosexual sex, and the application of smelling oils on female genitals. [23] Although Maines's theory that hysteria was treated by manually stimulating female patients' genitalia to orgasm is widely repeated in the literature on female anatomy and sexuality, [24] some historians dispute Maines's claims regarding the prevalence of this treatment for hysteria and its relevance to the invention of the vibrator, describing them as a distortion of the evidence or that they are only relevant to a very small group. [25] [26] [27] In 2018, Hallie Lieberman and Eric Schatzberg of Georgia Institute of Technology challenged Maines's claims for the use of electromechanical vibrators to treat hysteria in the 19th century. [28] Maines stated that her theory of the prevalence of masturbation for hysteria and its relevance to the invention of the vibrator is a hypothesis and not proven fact. [24]
Frederick Hollick was a firm believer that a main cause of hysteria was licentiousness present in women. [29]
In the 1910s, psychiatrist L. E. Emerson was heavily involved in treating patients of hysteria at the Boston Psychopathic Hospital. Emerson published case studies on his patients, who were often "young, single, native-born, and white" and either had been raped or had a lack of healthy sexual relationships. [2] One of his more famous works was a case study of a woman called "Miss A". In the study, Emerson summarized the patient's experience with sexual violence, which he said that most women with hysteria had encountered. [30] Miss A would practise self harm, and Emerson deduced that this practice was a release for the sexual assault she had previously experienced, and substituted for a form of masturbation. Another case study was of Sally Hollis, a woman who often viewed her experience with sexual assault by the terms of her own failing actions and female aggression. Believing the roots of hysteria lay in sexual conflict, Emerson paid attention to the theme of lack of sexual knowledge amongst these women, viewing them as repressed. [2] The lack of sexual knowledge ranged from not knowing what menstruation was, how conception began or what the process of giving birth was.
Some women purposefully sought out the "hysteric" diagnosis because they believed it could provide an answer to what they were experiencing. Most of the patients that Emerson saw were single because they were either young or have purposefully avoided men. Author Elizabeth Lunbeck noted that these women typically fell into three categories. They either withdrew from the heterosexual sphere entirely, despite wanting to participate; they experienced something that was sexually unwanted but would experience guilt over what happened like Sally Hollis; or they were haunted by their sexual traumas in the past. [2] As hysteria was growing into a more prominent diagnosis amongst women, it had led to the police treating any report for sexual assault or rape with skepticism, with the common belief at the time being that "sexual assault is physically impossible without consent". [2]
During the early 20th century, the number of women diagnosed with female hysteria sharply declined. Some medical authors claim that the decline was due to gaining a greater understanding of the psychology behind conversion disorders such as hysteria. [31] The understanding of the field of psychiatry was becoming more nuanced at the time, with Sigmund Freud introducing the theory of psychoanalysis, and his other ideas surrounding women and their sexuality.
With so many possible symptoms, historically hysteria was considered a catch-all diagnosis where any unidentifiable ailment could be assigned. [4] As diagnostic techniques improved, the number of ambiguous cases that might have been attributed to hysteria declined. For instance, before the introduction of electroencephalography, epilepsy was frequently confused with hysteria. [32]
Sigmund Freud claimed that hysteria was not anything physical at all but an emotional, internal condition that could affect both males and females, which was caused by previous trauma that led to the affected being unable to enjoy sex in the normal way. [12] [16] This would later lead to Freud's development of the Oedipus complex, which connotes femininity as a failure, or lack of masculinity. [16] Although these earlier studies had shown that men were also prone to have hysteria, over time, the condition was related mainly to issues of femininity as the continued study of hysteria took place only in women. [33]
Many cases that had previously been labeled hysteria were reclassified by Freud as anxiety neuroses. [32] It was Freud's theory that hysteria may have been related to the unconscious mind and separate from the conscious mind or the ego. [34] He was convinced that deep conflicts in the mind, some concerning instinctual drives for sex and aggression, were driving the behavior of those with hysteria. The illness of hysteria is a "expression of the impossibility of the fulfillment of the sexual drive because of reminiscence of the Oedipal conflict". [35] This hypothesis is a driving force behind the psychological theory of psychoanalysis, as a way to help patients that had been diagnosed with hysteria reduce internal conflicts causing physical and emotional suffering.
New theories relating to hysteria came from pure speculation; doctors and physicians could not connect symptoms to the disorder, causing it to decline rapidly as a diagnosis. [31] Hysteria was officially taken out of the DSM in 1980.
Today, female hysteria is no longer a recognized illness, but different manifestations of hysteria are recognized in other conditions such as schizophrenia, borderline personality disorder, conversion disorder, and anxiety attacks. [36]
In the 1980s, feminists began to reclaim hysteria, using it as a symbol of the systematic oppression of women and reclaiming the term for themselves. [6] The idea of hysteria became an embodiment of the oppressions against women, especially among sex-positive feminists, who believed sexual repression considered hysteria was a form of oppression. [6] The idea stemmed from the belief that hysteria was a kind of pre-feminist rebellion against the oppressive defined social roles placed upon women. Feminist writers such as Catherine Clément and Hélène Cixous wrote in The Newly Born Woman from a place of opposition to the theories proposed in psychoanalytical works. Clément, Cixous and other feminist writers pushed back against the notion that socially constructed femininities and hysteria are natural to being female. [6] [16] Feminist social historians of both sexes argue that hysteria is caused by women's oppressed social roles, rather than by their bodies or psyches. [37]
"The Yellow Wallpaper" is a short story by Charlotte Perkins Gilman that demonstrates the mistreatment of hysteria and illuminates the deep-rooted misogynistic systems that existed at the time. Published in 1892, this piece is an example of how media around feminist medical care has existed far before modern day. Throughout the story, the female protagonist is confined to an upstairs room at the instruction of her husband who is a physician. Throughout her confinement, the protagonist becomes entranced with the yellow wallpaper. At one point she says there is a woman in it, which is a reflection of her mental state and unreliability as a narrator. The full meaning of the story is up to reader interpretation, but the ending is the outcome of a woman labeled and diagnosed with “hysteria” and not taken seriously by her male husband and male doctors. Through "The Yellow Wallpaper" Perkins shows the lack of care for women's mental health and the condition of hysteria in the late 19th century.[ citation needed ]
The 1995 film Safe explores the harmful effects of sexism in healthcare on the psychological and physical health of women and girls. It explores the connections between mental illness, the misdiagnosis of mental illness when physical conditions proved difficult to diagnose, feminism, and healthcare disparities that result from deep-rooted sexism in the medical industry. Both Safe and Gilman's short story, "The Yellow Wallpaper", explore the differences between the way that men and women experience and view mental illness and healthcare. Similarly, in Fairchild's article "Feminism Is Now", she discusses modern misogyny and current examples of sexism in the modern world. The author argues against the idea that feminist goals have already been reached and uncovers how misogyny exists and is visible in many aspects of the lives of women and girls. [38]
Sigmund Freud was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies seen as originating from conflicts in the psyche, through dialogue between patient and psychoanalyst, and the distinctive theory of mind and human agency derived from it.
Hysteria is a term used to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, female hysteria was considered a diagnosable physical illness in women. It is assumed that the basis for diagnosis operated under the belief that women are predisposed to mental and behavioral conditions; an interpretation of sex-related differences in stress responses. In the twentieth century, it shifted to being considered a mental illness. Many influential people such as Sigmund Freud and Jean-Martin Charcot dedicated research to hysteria patients.
Erotic massage is the use of massage techniques by one person on another person's erogenous zones for their sexual pleasure. The process may achieve or enhance the recipient's sexual excitation or arousal and sometimes achieve orgasm. The person providing the massage is called a masseur (male) or masseuse (female). Massages have been used for medical purposes for a very long time, and their use for erotic purposes also has a long history. In the case of women, the two focal areas are the abdomens and pubis, while in case of men, the focal areas are the male breast muscles and nipples, male genitals, the anus, and the prostate. When the massage is of a partner's genitals, the act is usually referred to as a handjob for penises and fingering for vulvas.
Dyspareunia is painful sexual intercourse due to somatic or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.
Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.
Conversion disorder (CD), or functional neurologic symptom disorder (FNsD), is a functional disorder that causes abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals with CD present with highly distressing neurological symptoms such as numbness, blindness, paralysis, or convulsions, which are not consistent with a well-established organic cause and can be traced back to a psychological trigger.
Sexual medicine or psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is "that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate." Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.
Dora is the pseudonym given by Sigmund Freud to a patient whom he diagnosed with hysteria, and treated for about eleven weeks in 1900. Her most manifest hysterical symptom was aphonia, or loss of voice. The patient's real name was Ida Bauer (1882–1945); her brother Otto Bauer was a leading member of the Austro-Marxist movement.
Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis.
A vibrator, sometimes described as a massager, is a sex toy that is used on the body to produce pleasurable sexual stimulation. There are many different shapes and models of vibrators. Most modern vibrators contain an electric-powered device which pulsates or throbs. Vibrators can be used for both solo play and partnered play by one or more people. Devices exist to be used by couples to stimulate the genitals of both partners. They can be applied to erogenous zones, such as the vulva, vagina, penis, scrotum, anus, or rectum for sexual stimulation, for the release of sexual frustration and to achieve orgasm. Vibrators may be recommended by sex therapists for women who have difficulty reaching orgasm through masturbation or intercourse.
The Freudian Cover-up is a theory introduced by social worker Florence Rush in 1971, which asserts that Sigmund Freud intentionally ignored evidence that his patients were victims of sexual abuse. The theory argues that in developing his theory of infant sexuality, he misinterpreted his patients' claim of sexual abuse as symptoms of repressed incestuous desire. Therefore, Freud claimed that children who reported sexual abuse by adults had either imagined or fantasized the experience.
Human female sexuality encompasses a broad range of behaviors and processes, including female sexual identity and sexual behavior, the physiological, psychological, social, cultural, political, and spiritual or religious aspects of sexual activity. Various aspects and dimensions of female sexuality, as a part of human sexuality, have also been addressed by principles of ethics, morality, and theology. In almost any historical era and culture, the arts, including literary and visual arts, as well as popular culture, present a substantial portion of a given society's views on human sexuality, which includes both implicit (covert) and explicit (overt) aspects and manifestations of feminine sexuality and behavior.
Gender-biased diagnosing is the idea that medical and psychological diagnosis are influenced by the patient's gender. Several studies have found evidence of differential diagnosis for patients with similar ailments but of different sexes. Female patients face discrimination through the denial of treatment or miss-classification of diagnosis as a result of not being taken seriously due to stereotypes and gender bias. According to traditional medical studies, most of these medical studies were done on men thus overlooking many issues that were related to women's health. This topic alone sparked controversy and questions about the medical standard of our time. Popular media has illuminated the issue of gender bias in recent years. Research that was done on diseases that affected women more were less funded than those diseases that affected men and women equally.
Hysteria is a 2011 British period romantic comedy film directed by Tanya Wexler. It stars Hugh Dancy and Maggie Gyllenhaal, with Felicity Jones, Jonathan Pryce, and Rupert Everett appearing in key supporting roles. The film, set in the Victorian era, shows how the medical management of hysteria led to the invention of the vibrator.
The Aetiology of Hysteria is a paper by Sigmund Freud about the child sexual abuse of children before the age of puberty, and its possible causation of mental illness in adults. Presented in April or May 1896, it is where Freud first outlined his seduction theory.
Wandering womb was the belief that a displaced uterus was the cause of many medical pathologies in women. The belief is first attested in the medical texts of ancient Greece, but it persisted in European academic medicine and popular thought for centuries. The wandering womb as a concept was popularized by doctor Edward Jorden, who published The Suffocation of the Mother in 1603. Suffocation of the Mother was the first text on the subjects of the wandering womb and hysteria that was written in English.
Joseph Mortimer Granville was an English physician, author and inventor known for having first patented the electromechanical vibrator for relief of muscle aches, exclusively for male patients. It was also claimed by Rachel Maines that the device was used to treat hysteria, by bringing women to orgasm, but her work is not historically accurate.
In the nineteenth and early twentieth century, hysteria was a common psychiatric diagnosis made primarily in women. The existence and nature of a purported male hysteria was a debated topic around the turn of the century. It was originally believed that men could not suffer from hysteria because of their lack of uterus. This belief was discarded in the 17th century when discourse identified the brain or mind, and not reproductive organs, as the root cause of hysteria. During World War I, hysterical men were diagnosed with shell shock or war neurosis, which later went on to shape modern theories on PTSD. The notion of male hysteria was initially connected to the post-traumatic disorder known as railway spine; later, it became associated with war neurosis.
Pelvic massage was a gynecological treatment first recorded as being used by doctors in the 19th century. An early practitioner was the Swedish Major Thure Brandt (1819–1895), whose method was described in the New York Medical Journal and the Journal of the American Medical Association.
In keeping with Intersectionality theory, the perception of disabled people, diagnoses they receive, and treatment available to them is linked to the way they present their gender, both from a historical and a modern perspective.