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Lessons from Hysteria 

By Kyr Goyette

In Western contemporary popular culture, hysteria has been perceived as a Victorian-era diagnosis commonly used to dismiss the suffering of women. Today, the suggestion that hysteria is a real condition is still likely to draw ire from those who would prefer to reject the disease altogether. To some, offering any amount of legitimacy to hysteria threatens to condone the serious abuses inflicted on women forced into psychiatric hospitals against their will after being deemed hysterics. 

Acknowledging the reality of hysteria, however, does not require endorsing how it was treated by doctors of the past, and a better understanding of how the condition once known as hysteria has evolved in contemporary times can allow us to pick through the biases that still affect the diagnosis and treatment of what are now classified as psychosomatic conditions or functional neurological disorders. 

As with many supposedly modern medical diagnoses, the idea of hysteria isn’t new. Edward H. Reynolds of the Department of Clinical Neurosciences at King’s College in London explained in a 2018 article how hysteria was mentioned in ancient texts from Babylon, Egypt, Greece, and Rome. Symptoms matching hysteria—for example, emotional disturbances, non-epileptic seizures, and uncontrollable body movements, although what counts as symptoms has changed over time—have been recorded in various texts from the past several thousand years. Individual cultures have different ideas about the root cause; the Greeks and Romans blamed the uterus in women for the symptoms. That idea persisted into the Middle Ages and gave the condition its name after the Greek word for the uterus,“hystera.” So how did a disease that has ostensibly been identified and discussed for centuries become so closely tied to the Victorian period and late 19th–century society? The answer is Jean-Martin Charcot. 

Charcot was a French doctor who oversaw the Salpêtrière, a psychiatric institution that became infamous by way of association with Charcot and his demonstrations with ‘insane’ women. As one of the first doctors to take a serious interest in the condition, he was immensely influential in shaping the original diagnosis of hysteria, and his initial definition continues to permeate contemporary understandings and perceptions of hysteria. 

The full story of how Charcot expanded the classifications for the diagnosis of hysteria, and how the diagnosis unraveled rapidly in the Western world after his death, is complex. Mark S. Micale of the Department of History at Yale University published an extensive history in 1993 of the apparent disappearance of the diagnosis of hysteria after the “belle-époque” of the late 19th century, when it was the intense and nearly sole focus of the psychological, psychiatric, and neurological fields. In short, Charcot’s studies were initially focused on finding some physical lesions of the brain that would explain hysteria. By the time he died, Charcot had yet to discover any pathological or physical cause for hysteria, but he had expanded the definition of hysteria to include a myriad of symptoms and patterns of expression, making it easy to diagnose a wide variety of illness presentations as some form of hysteria. After his death, though, the next generation of psychoanalysts and doctors had strikingly different ideas that ultimately superseded Charcot’s definition.

Charcot’s death brought about the dissolution of the classification of hysteria in the West, and various presentations that once would have been called hysteria were divided into other categories—epilepsy, schizophrenia, syphilis, and anxious neuroses were all diagnosed in place of hysteria. Advances in medicine that led to the discovery of the neurological origins of certain conditions allowed doctors to distinguish some fits as epileptic rather than hysterical, and French venereologist Alfred Fournier started to establish links between syphilitic infections and certain paralysis symptoms previously associated with hysteria. Emil Kraepelin’s extensive classifications of psychiatric disorders between 1993 and 1915 included descriptions that once would have been matched with hysteria, and Sigmund Freud—ever-present in any psychological discussion of the early 20th century—associated hysteria with anxiety neuroses and suggested that the latter diagnosis could potentially explain the former. 

The varied symptoms of hysteria were rapidly separated into entirely distinct psychiatric, psychological, and neurological conditions, and some hypothesized that hysteria as a diagnosis would eventually fall out of use entirely as alternative organic explanations for symptoms were discovered. To a certain extent, the diagnosis of hysteria did seem to disappear in the West—Julien Bogousslavsky of the Department of Neurology and Neuro-rehabilitation of the Swiss Medical Network Neurocenter explains how, aside from a brief resurgence in interest in the aftermath of World War I associated with the emergence of “shell-shock,” hysteria returned to “where it had been before Charcot, i.e. a no-man’s land between psychiatry and neurology, with a marked decrease in scientific interest and studies as an immediate consequence,” despite the fact that clinical data indicates that the actual occurrence of hysteria in the general population remained relatively consistent. Outside of the United States and Europe, hysteria took on a life of its own and is today defined and understood very differently in other regions of the world. In India, for example, hysteria is regularly diagnosed amongst women and treated primarily via psychotropic medications, and has developed an identity that is distinct from the identity that it had and has elsewhere.

With this history in mind, we can start to make sense of what ‘hysteria’ looks like today and understand how those with such mysterious illnesses are treated. In the United States and Western Europe, what was once hysteria—hysteria that couldn’t be explained by epilepsy or syphilitic symptoms or other psychiatric conditions—is now often diagnosed as functional neurological disorder (FND). It is diagnosed in an estimated 4 to 12 out of every 100,000 people; it also continues to affect predominantly those who are assigned female at birth (AFAB) and some connections have been established between the development of FND and trauma experienced during childhood. Symptoms of FND include paralysis, tics, sudden and involuntary muscle contractions, and nonepileptic seizures, among others—many of these should sound familiar from the list of symptoms of hysteria as commonly described.

Contemporary research around FND often seeks to find a neurological cause; NIH studies are focused on using MRI imaging to see if there are any biomarkers, or signs that indicate the risk of developing FND and potentially its progression, that might help us better understand it. These studies are, of course, essential—research has supported the idea that there are neurological differences associated with the development of FND, and these studies will be important for creating new treatments in the upcoming years. Currently, however, functional neurological disorder is understood for the most part as a psychosomatic condition: a condition that we agree exists, but one for which we cannot identify any error of genetics or disease that might explain it.

However, the existence of a pathological cause for a condition should not determine the attention paid to that condition by the medical establishment, nor the amount of empathy afforded to those afflicted with it. History has shown that unexplainable symptoms often become explainable with time and technological advancements; patients today who have epilepsy might have been diagnosed as hysterics just over a century ago. We now afford sympathy to those who have epilepsy, because we understand it is a condition outside of their control, but we are lacking in similar sentiment towards those whose illnesses remain a mystery. As confounding as the idea that someone can become psychosomatically paralyzed might seem, an explanation may one day emerge—and even if it doesn’t, those afflicted by FND will continue to suffer. Debating whether the origin of pain is legitimate doesn’t change the experience of those in pain, and it is ultimately a pointless exercise.

It’s easy to understand now that the Greeks were wrong to assume that the origin of hysteria was the uterus and that Charcot was wrong to exploit the pain of women in psychiatric hospitals to prove his theories. It’s more difficult to see how we treat women today when we can’t figure out exactly what is causing their pain. It is a part of that long legacy of assuming that feminine suffering is inherent to some flaw of female biology or psychology. We are still failing to understand that contemporary society’s dismissal of those suffering from psychosomatic illness—those whom we deem hysteric, even if we don’t call them that anymore—is just as callous and just as misinformed as condemnations of hysteria have always been. 

Patients deserve care regardless of whether their condition is deemed psychosomatic, and the treatment for psychosomatic illnesses is not to simply tell patients that their pain is fake. Until we stop seeing psychosomatic conditions as less deserving of formal medical attention, and in conjunction dedicate research funding to better understanding how they can be treated, we will not be able to escape the legacy of mistreatment that hovers over psychosomatic illness.