Ill but manly: male hysteria in late nineteenth-century medical discourse.
It a widely held notion, by post-Freudians as well as those who came before, that hysteria is an illness of women. The more refined version of this belief rejects the reductive sex determination in favor of gender construction, holding that hysteria is gendered feminine, applicable not just to women but also to feminized men. Two recent accounts, Daniel Boyarin's Unheroic Conduct: The Rise of Heterosexuality and the Invention of the Jewish Man and Elaine Showalter's "Hysteria, Feminism, and Gender" convincingly argue this point. (1) Boyarin draws in part on Showalter's work to claim, "Hysteria is indeed about femaleness but not ... exclusively about 'women'"; he notes that it was not just women but also "certain racially marked men"--specifically, Jewish men--who were diagnosed as hysterics. (2) And Showalter begins her essay with an imperative: "... we need to see how hysteria in men has always been regarded as a shameful, 'effeminate' disorder," with the male hysteric assumed to be "unmanly, womanish, or homosexual, as if the feminine component within masculinity were itself a symptom of disease." (3) I wish to take issue with this broad characterization of male hysteria for the sake of what may seem, given the long history of hysteria, like a narrow episode--the efflorescence of male hysteria as a medical construct in the late nineteenth century. If, as Showalter also suggests, the term "gender" offers a critical purchase on "the social construction of sexual roles," then it is crucial both to take account of, and to account for, this brief period in which male hysteria was reinvented as an illness of masculinity.
The neurological introduction of male hysteria into the late nineteenth-century medical canon addressed anew not only the issue of symptomatology (how one recognizes the illness) but also the issue of etiology (why has the patient become ill?). No physician specifically disclaimed the importance of heredity to hysterical etiology, particularly not since the great French theorist of (female and male) hysteria, Jean-Martin Charcot, insisted on heredity as the fundamental basis for hysterical breakdown. The more immediate cause of male hysteria was nevertheless most often assumed to be trauma, understood as an accident to the body having neurological effects. Those theorists, on the other hand, who argued for a psychical etiology seemed to concern themselves principally, or solely, with female hysterics, as did Freud once he entered the debate over the nature of hysteria. Traumatic effects imply that the subject has an active and injurious interaction with the modern mechanical world, while psychical disturbance implies a self-enclosed imbalance, a disruption from within. Traumatic hysteria thus establishes a discursive space in which hysterics can be masculine, as opposed to hysteria as a psychical disturbance proper to women. Given that Freud "invented" psychoanalysis within the context of debates over the etiology and gendering of hysteria by arguing for a psychical and specifically sexual etiology, I will argue that it was effectively the invention of psychoanalysis that dampened the explosion of interest in male hysteria and firmly reinstituted hysteria as a feminine affliction. The tenacity of our late twentieth-century assumptions about the feminine nature of hysteria, I contend, does not result from a failure to question or expand the gender assumptions behind hysteria, but is rather a direct legacy of the infusion of psychoanalytic tenets into our way of thinking.
I. It's Not Just For Women Anymore
The last two decades of the nineteenth century saw an efflorescence of medical research on the subject of male hysteria, usually in the form of case histories from public hospitals. The most complete source for the English- and European-language medical literature of this period, the Index-Catalogue of the Library of the Surgeon-General's Office, (4) lists under the category "hysteria in the male" some two hundred articles published in the years 1880-1900 (excluding monographs and medical dissertations, of which the Index-Catalogue lists seventeen with "male hysteria" specifically in the title). The rise of interest in male hysteria is even more condensed than it appears; though this volume of the Index-Catalogue spans a twenty-year period, the majority of the work on male hysteria occurs within a single decade, between 1885 and 1895, though a sizeable remainder appears after 1895 as interest in the subject lingers on. (5)
Two things in particular should be noted about the clinical literature on male hysteria in this period. First, despite the sudden upsurge in the use of the terra, it always remained a question of proof whether male hysteria even exists, as indicated by a recurring tone of nervousness, vigorous insistence, or skepticism in the case reports. Secondly, though male hysteria was remarked in Europe, England, and America, there are nonetheless distinctions in the national importance of male hysteria, noted by the writers not only in the frequency of male hysteria in various countries, but also by the tendency, particularly of British physicians, to (dis)place male hysteria as the affliction of a nation not their own. In terms of frequency, the French by far lead the field, with 66 articles appearing between 1880 and 1900, as opposed to 37 in German-language journals, 32 in American, and only 20 in British and Anglo-Indian journals (6) (the 37 articles in German indicate somewhat inflated national figures, since the number includes the medical professions of both Germany and Austria). The high number of publications by the French and the Americans reflects what might be called the double origin of male hysteria as a medical construct: It stems in part from American and English neurological theories about trauma following railway accidents (called "railway spine"), an issue which began to gain attention in the 1860s, and in part from the influential French neurologist Jean-Martin Charcot's expansion of interest from female to male hysteria at the Salpetriere Hospital in Paris, beginning in the early 1880s.
Due largely to feminist work in recent decades, (7) Charcot is remembered today in connection with female hysteria as the physician who both validated it as an illness by tirelessly cataloguing and classifying its symptomatology, and who famously placed women patients on stage to make them perform their symptoms for the "instruction" of a lecture hall full of male doctors. But Charcot can also, in an important sense, be considered as the inventor of male hysteria, not as a disease but as a medical construct. (8) Though the notion of male hysteria had appeared in the French medical establishment prior to Charcot, (9) it was he who collected recurrent neurological disturbances in male patients (frenzied attacks, skin areas of heightened or depressed sensitivity, motor disturbances, restrictions in the field of vision) into the nosology, or systematic categorization, that he had already begun to validate as (female) hysteria. Charcot was so influential that from the mid--1880s onward it would be difficult for any neurologist to diagnose a case of male hysteria without noting the tell-tale arc de cercle as proof of the hysterical nature of an "attack," or without checking the patient for a narrowing of the visual field, or without at least attempting to explain the lack of these marked symptoms in the case at hand. More than simply providing a symptomatology for male hysteria, Charcot found the wards at the Salpetriere filled with cases of male hysterics, some of whom he turned into well-known case studies of hysteria's etiology, nosology, and treatment (though only his female patients would ever be "professional" hysterics). In his initial lectures on male hysteria, he even seems aware that a medical construct can seem to produce the disease that it analyzes:
In proportion as the malady has become more studied and better known, the cases, as generally happens under like circumstances, have become apparently more and more frequent, and at the same time more easy of analysis. (10)
A symptomatology makes a disease legible, and this very recognizability means that it will then appear more frequently, seemingly called into being by the very construct which names it. (11) It is as though Charcot here reads his own role in the production of male hysteria, though such moments of self-reflection never caused him to think of male hysteria as anything bur a real illness. Nonetheless, hysteria always begs the same question: What kind of illness is it?
Our own post-Freudian understanding of psychopathology has caused us to forget that hysteria was viewed in the late nineteenth century as a neurological disorder, replete with a whole range of paralyses, anaesthesias, and attacks that could be traced to no "organic" or physiological cause. Despite, or because of, this abundance of symptoms, the only definition on which all physicians could agree is that hysteria is a condition of manifest physiological disturbances that have no organic basis. In this scene of diagnostic confusion, Charcot collected the symptoms of this mysterious functional disorder and endowed them with a structure. In Freud's 1886 lecture to the Society of Physicians in Vienna (Gesellschaft der Arzte in Wien), (12) be sets out the Charcotian symptomatology point by point: The extreme "type" of hysteria, called grande hysterie, involves particular attacks, disturbances to skin sensitivity (particularly right- or left-side anaesthesia), disturbances to the senses (particularly a narrowing of the field of vision and specific color blindness), hysterogenic points (that can either bring on an attack or stop it in progress), and motor disturbances such as paralyses and contractures. (13) Most importantly, Charcot rigorously laid out the four consecutive stages of the hysterical attack, which was either preceded or accompanied by a hysterical "aura" (headaches, dizziness, etc.): First, epileptoid twitches; second, the grands mouvements of the body including the signature position of the hysterical attack, the body arched from head to foot (the arc de cercle); third, the attitudes passionelles, indicating words and movements accompanying hallucinations; and finally, the delire terminal, or cool-down stage. The very rigid demarcation of stages seems to have much more to do with Charcot's will to a scientific morphology, particularly in the face of such an amorphous affliction as hysteria, than with any regularly reproducible format of the attack. One can sense a nervousness in other writers when their patients' attacks do not quite live up to the distinct stages of the Charcotian form, as well as the physician's relief or triumph when a patient actually produces an arc de cercle. Charcot himself termed the four-stage attack, accompanied by the full symptomatology, grande hysterie, in order to distinguish it from the less complete (but far more frequent) forms of the disease, known as hysteria minor.
Far from lending itself to a strict morphology, however, hysteria as a disease failed to inspire anything but the most vague definitions in other medical writers. Emmanuel Mendel, a Berlin neurologist, loosely defines it as "a functional disease of the nervous system ... which can establish itself in any part of that system." (14) J. Mitchell Clarke refuses a definition altogether, stating only that he uses the term "as implying simply the absence of any evidence of organic lesion." (15) For P.J. Mobius, hysteria designates those pathological changes to the body effected psychically, by the "imagination" (Vorstellung). (16) Paul Enke, in his medical dissertation, summarizes the characteristics most commonly associated with hysteria as a disease-formation: Irritability, mood changes, loss of will, suggestibility, increased imaginativity, and complete variability of symptoms, often in the same patient. (17) And Oskar Bodenstein, in summing up the characteristics of hysteria, calls it "protean." (18) Given that outside the Salpetriere hysteria seemed to be definable only as a functional disturbance without organic basis, expressed in variable symptoms and having, in fact, variability as its main (psychic and physical) characteristic, Charcot may be thought to have misrecognized hysteria altogether or to have created a wholly new disease when he defined hysteria according to a rigid symptomatology. Yet it is precisely in order to make of this amorphous affliction a rigorous medical construct with diagnostic usefulness that Charcot (re)constructed hysteria according to a check-list of symptoms. What had been (and would remain) unreadable as a disease could be made legible as a symptomatology, one equally applicable to both men and women.
Female hysteria has certainly had a long history of recognition, dating back to its Greek definition as the disease of the "wandering womb," (19) but for that very reason male hysteria remained a disputed construct even during its efflorescence in the late nineteenth century. After all, men cannot suffer from a disease of the uterus, and for the greater part of the medical community hysteria remained a disease suffered by women. (20) Thus, while Charcot and his fellow researchers claim that cases of male hysteria are increasingly frequent, they also insist that male hysteria is far more frequent than "most physicians" are willing to admit. This sense of being under siege goes hand in hand with a seemingly unrelated claim by the writers on male hysteria, the insistence on gender parity in the symptomatology of hysteria. For only if physicians could detach their presumptions about hysteria from its etymological roots and recognize the presence of the same symptoms in men as in women would they be able to recognize male hysteria. Thus, dissertations on male hysteria published in German in the 1890s (21) follow the lead of Emmanuel Mendel, who introduced the disease to the German medical establishment in 1884 with a clarion call: "hysteria has just as much and as little to do with the uterus as with any other organ." (22) The point seems obvious, yet the literature reflects how often the proponents of male hysteria felt it had to be made. To this end, Freud in his 1886 lecture on male hysteria stresses that Charcot found the emphasis on the "irritability" of the sex organs as the condition for hysteria to be much overestimated, (23) and Gustav Mann's medical dissertation of 1891 indicates the ongoing importance of the issue, since his entire work contends simply that the symptoms of hysteria are the same for men as for women. (24)
Charcot clarifies the grounds of the battle as an issue of presumptions about gender. Most physicians are blinded by their assumptions about the feminine nature of hysteria and therefore fail--or are unwilling--to see the hysteric in the stalwart male patient:
... if I may judge from what I daily see around me, these cases are often unrecognised, even by very distinguished physicians. One can conceive that it may be possible for a young effeminate man, after excesses, disappointments, profound emotions, to present hysterical phenomena, but that a vigorous artisan, well built, not enervated by high culture, the stoker of an engine for example, not previously emotional, at least to all appearance, should, after an accident to the train, by a collision or running off the rails, become hysterical for the same reason as a woman, is what surpasses our imagination. Yet nothing can be more clearly proved, and it is a fact which will have to be accepted. (25)
The problem, as Charcot outlines it, is clearly not that men cannot be imagined to be hysterical, but rather that hysteria in normal (read: masculine) men "surpasses our imagination." Thus "the young effeminate man" (thrice feminized by his youth, effeminate disposition, and emotionalism) embodies the cultural stereotype of the male hysteric, since it was assumed that men could be overpowered by a female disease only if they were of a type undermined by femininity to begin with. Charcot's concern, in the name of scientific objectivity, is to undermine such gender prejudices, but in doing so he replaces one powerfully prescriptive image of the male hysteric with another. What presents itself increasingly as the standard male hysteric in the clinical studies of the late century--the stoker of an engine suffering from traumatic hysteria following a train accident--offers a radically different sort of image; this male hysteric is unquestionably masculine, strong and dependable, yet "becomes hysterical" through traumatic contact with the industrial world. The very prescription of a "new" male hysteric who is as insistently masculine as the cultural stereotype is feminine, however, indicates that there is more at stake in Charcot's definition of male hysteria than clearing away the cobwebs of gender prejudice and neutralizing hysteria for the sake of science. In fact, gender demarcation is a prime effect of the Charcotian male hysteric.
II. Demarcating the Male Hysteric
Despite the insistence on equivalent symptoms in men and women, and thus on the possible hystericization of virile men, at no point in the literature does "hysteria" appear free of at least an implicit gender bias. What recurs in the literature on male hysteria is a repeated differentiation of male from female hysteria, and implicitly of men from women in general. Charcot notes as a problem for "the diffusion of a knowledge of hysteria in the male" the fact that the male malady "often presents itself as an affection remarkable for the permanence and obstinacy of [its] symptoms," while widespread medical opinion has it that hysteria manifests itself as "mobile, fleeting" and with a "capricious course," a statement founded "naturally on observations made in women." (26) Given that the "obstinacy" of male hysteria does not fit into the common conception of female hysteria, this "prejudice," says Charcot, prevents otherwise distinguished physicians from recognizing male hysteria. Charcot's answer to this dilemma, however, is not to allow for instability of symptoms in the male, but rather to defend by two examples the fact that women, too, can manifest obstinate symptoms: "Well now, gentlemen, this changeableness, this evanescence is ... far from being an invariable characteristic of hysterical affections, even in women." Even in women: In the interest of protecting masculinity from any charge of instability, even women (well, two) are shown to manifest stubborn symptoms that remain stable for decades. (27)
This distinction between the permanence of male symptoms and the capriciousness of female symptoms spreads through the medical literature following Charcot's early lectures. It quickly becomes a truism that male hysteria tends to develop "sous la forme monosymptomatique," (28) with, say, a stubborn paralysis or a seemingly incurable hemianaesthesia, while women tend to suffer from grande hysterie, with the full range of symptoms appearing, combining, and disappearing again. (29) This cannot be to say that men do not suffer full-scale hysterical attacks--that would be to cast doubt on whether men can, in fact, be diagnosed with hysteria--but on the occasions when they do, as Enke is careful to point out, it provokes much more fright in the observers because, implicitly, the attack in a man is both more severe and more out of character. (30) The British physician Francis W. Clark echoes the standard opinion that loss of will-power "lies at the root of all the symptoms of hysteria," but though common to both sexes, it appears "in stronger context" in men since "more or less deficiency in this respect is looked upon as one of the special characteristics of the weaker sex." (31) And J. Mitchell Clarke, something of a recovering sceptic when it comes to hysteria in the male subject, flatly summarizes the "fact" of the tenacity and single-mindedness of the male hysteric's symptoms: "when hysteria does appear in men it is more apt to assume a severe form." (32) Thus, even in the midst of an affliction characterized by a multiplicity of varying symptoms, mysteriously unbound to any organic cause, men still remain stubborn, tenacious, severe, even austere in the monosymptomatic nature of their hysteria. Their symptomatology remains stereotypically "masculine." And, if we extend to its logical conclusion Enke's uncompromising claim that "the sudden change of mood, so characteristic for hysteria, does not exist in the case of the man," (33) we are left with an assessment of the male hysterical patient that manages to retain hysteria as an available diagnosis while sidestepping, without at all revising, its unpleasantly "feminine" nature. The male may suffer from hysteria, but is never a hysteric. (34)
The same work of gender demarcation appears in discussions of hysteria as (dis)simulation. The diagnosis of simulation threatens to feminize the male hysteric, not least because hysteria as simulation confuses the clear demarcation of "real" disease from malingering on the one hand and from its "pseudo" forms on the other in an age when both dissimulation and mysterious diseases belong to the capricious female mentality. Thus, when the issue of simulation arises in case histories of male hysteria, it is inevitably with the intention of clearing the male hysteric in advance from false accusations by uninformed physicians. Charcot not only claims that the introduction of male hysteria as a medical category is for the good of both patient and physician (the former need no longer be accused of dissimulation; the latter need no longer find himself making false diagnoses (35)); he also defends the male hysteric by pointing out that the definition of simulation uncomfortably approximates that of hysteria. Responding to P. Garnier who argues that "it is the observation of exaggeration and disjunction between diverse phenomena which drives one most often to the diagnosis of simulation" (Semaine Medicale, 7 March 1888), Charcot counters, "All of this applies perfectly to hysteria, but in order to learn to unmask simulation in the parallel case it is necessary at least to have studied the real illness (la maladie reelle) profoundly, seriously...." (36) Charcot's argument runs counter to expectation: It is not that hysterical men may be guilty of simulation because the diagnosis of hysteria is indistinguishable from the diagnosis of simulation. Instead, by falling back on the scientific ground of the "real illness" of hysteria, Charcot implicitly draws an analogy with the "real" event, such as a train collision, which is the exemplary cause of male hysteria. Charcot's remarks on the occurrence of simulation, on the other hand, pertain to women: "You will meet with [simulation] at every step in the history of hysteria, and one finds himself sometimes admiring the amazing craft, sagacity, and perseverance which women, under the influence of this great neurosis, will put in play for the purposes of deception ..." (emphasis mine). (37) In fact, his diagnosis of simulation in the case of a Jewish girl from St. Petersburg is exemplary: As a female, a Jew, (38) and an immigrant from the East, this patient is triply demasculinized, thus keeping the category of simulation well away from the male hysteric.
Re-enter Charcot's "vigorous" engine stoker, the new homo hystericus. He is "well built, not enervated by high culture ... not previously emotional"; in other words, he is virile, not an aesthete (with its overtones of the aristocratic and effete), not feminine. Most important to his profile is the fact that he becomes hysterical "after an accident to the train," for what defines the new hysterical male is not simply physical stature and class, but the traumatic etiology of his illness. The very question of etiology as an originating event, in fact, arises concurrently with the interest in male hysteria, which is to say that the concept of traumatic hysteria enables male hysteria to come into being as a coherent medical construct. Any suggestion of "feminized" masculinity, in other words, forces one to ask how it came to be that way. Though hereditary predisposition to hysteria was the most common form of etiological inquiry for Charcot and his disciples, (39) heredity alone seems insufficient for explaining how men come to suffer from a traditionally feminine illness, for in addition to remarking the patient's medical family history Charcot focuses on a specific agent provocateur, the traumatic event that brings about male hysterical symptoms. The etiological traumatic event, in fact, forms the common link among the often disparate cases of male hysteria, Charcot's as well as other physicians'. I will argue that this "real event" etiology plays a crucial role in making male hysteria palatable; it is necessitated by a gender ideology that figures men as beings of hard external surfaces who struggle in the material world, while women are creatures of mysterious and often rebellious interiority. The development of traumatic hysteria as a neurological category thus made possible Charcot's invention of the new homo hystericus--and the resulting efflorescence of male hysteria--since it provided male hysteria with a masculinizing etiology. In contrast to the traditional view that hysteria feminized the man, the diagnosis of traumatic hysteria effectively masculinized the hysteric.
III. Masculinizing Trauma
The majority of Charcot's cases of male hysteria place an etiological event firmly at the forefront. Each of the six case studies of male hysteria from the third volume of Lecons sur les maladies du systeme nerveux recounts a clear traumatic event as the provocation for subsequent hysterical attacks, hallucinations, and hemianaesthesias. "Rig-," a shop assistant, just escaped being crushed by a rolling wine-barrel, though he received a slight wound to the left hand; "Gil-," a metal gilder, was the victim of a street assault in which he was stabbed in the head; "Gui-," a locksmith, fell from the third story of a house; "Mar-," an apprentice to a baker, was attacked in the street by two young men; "Ly-," a mason, was attacked by a comrade who hurled a stone, though he was not injured; and "Pin-," another mason, fell from a height of two metres, receiving only slight contusions on his left side. (40) In nearly every case, Charcot also mentions a previous trauma or illness, as though the provocative trauma for the hysterical attack itself needs a predisposing trauma in order to be effective. For instance, three years before his accident with the wine-barrel, Rig- had deeply cut his forearm with a razor; three years prior to his fall, Gui- had received a knife-wound to the left eye, which made him prone to nocturnal hallucinations; and Ly- had experienced "slight nervous complications" as a result of having had tapeworm. Two points about these cases are noteworthy: First, the traumatic event does not cause grievous, or even notable, bodily injury, hence the diagnosis of hysteria. Secondly, the etiological investigation of the hysterical "attack" uncovers in the pasta series of actual attacks from the external world (this applies, I would suggest, even to tapeworm), which in turn literalizes and externalizes the male hysterical attack itself as a discrete event of violence to the unsuspecting male body. Importantly, the traumatic hysteric is not just male and working-class, but is usually a strongly built man whose nervous system is attacked during occupational interaction with the mechanical or industrial world. He is, in other words, unquestionably virile. The British medical literature of the 1880s and 1890s, for instance, bears this out. In 1886, Dreschfeld notes three cases of "hysteria in the male coming on after an injury," two of which involve an ostler ("very muscular" body, "fairly well-nourished") who slipped over a tram-rail while leading horses, and an employee of the Manchester Carriage Co. ("a strong, healthy man") whose hand was caught momentarily in shears while unloading hay. In 1888 Joseph Collier presents five cases, of which three describe work-related trauma: A "nipper for a railway" who suffered attacks as a result of a fall from a "lurry," an 18-year-old who experienced hysterical mutism after falling from a ladder while cleaning a shop window, and a carter who suffered hysterical spasm after straining his shoulder against a cart. (41) The German literature on male hysteria, too, is peopled with working-class men experiencing traumatic accidents in the course of their employment: A locomotive driver whose brakes failed (Bodenstein, 1889), a postman who fell on dark stairs while delivering the post, a policeman involved in a railway collision (Auerbach, 1889), an ironworker who daily had to lie on his left side in damp sand preparing iron forms (Jez, 1896), a factory worker who experienced an industrial accident, and a miner who fell down a shaft (Enke, 1900).
The working-class man traumatized by on-the-job attacks to his body saves the figure of the male hysteric from feminization precisely because such a patient is well-suited to suffer bodily contact with the external world and, due to his physical stature and socio-economic condition, is well-suited to being a masculine male hysteric. Certain clinical writers influenced by Charcot directly address the gender and class bias of these case histories, but without ever, unsurprisingly, suggesting that male hysteria is underpinned, or in fact produced, by the masculinizing ideology of traumatic hysteria. Thus, Collier claims staidly that "men are more liable to traumatic hysteria than women--the excess of men being probably due to their leading lives more exposed to injury." Bodenstein echoes Collier: The reason why traumatic hysteria is largely a male affliction lies with the man's social position (sociale Lebensstellung) that "exposes him to all possible dangers, by far more than the other sex." Further, according to Bodenstein, men who "abound with health and full-bloodedness" (Vollsaftigkeit) must unconditionally suffer a weakening of the nervous system
when the struggle for existence ... strains their mental and physical strength to the highest point, when a dangerous occupation, connected with the greatest responsibility, for years fails to alternate with any relaxation. (42)
We should be aware, however, of the material conditions for the recurrence of the working-class man as the standard for male hysteria. On the one hand, many of these physicians collected their cases from their work in public hospitals, which were much more likely to receive working-class patients (as was the case with the Salpetriere, for example). Before Freud, private patients appeared far less as the subjects of published case studies, and since private patients tended to be those with greater financial resources, the class position of the patients whose histories did end up as research fodder was firmly delimited by material medical conditions. On the other hand, the 1860s and 1870s saw the rise of legislation requiring work- and accident-compensation in England and later in Europe, legislation that effectively created a medico-legal field of expertise to gauge the injuries of (mostly male) workers. Dreschfeld's case histories, for example, often end not with the question of a cure, but with the fact of compensation received or rejected, and this issue arises in every case history in the work of Herbert Page, who held the position of Surgeon to the London and North Western Railway Company.
Though I have said that Charcot "invented" male hysteria, he did not invent the category of traumatic hysteria. Rather, he shifted the application of English and American theories about "railway spine" to the working-class man and thus produced the new homo hystericus. Railway spine, diagnostically known as "concussion of the spine," came into being in England as a medico-legal construct, spurred by the 1864 amendment to the Campbell Act that made railway companies legally liable for the safety and health of passengers. (43) 1866 saw the landmark publication of John Eric Erichsen's On Railway and Other Injuries of the Nervous System in which he established the notion of nervous shock, a condition remarkable for the disjunction between an accident to the body and its effects. This disjunction is both temporal and quantitative in nature: It means both a delay in the appearance of symptoms as well as an incommensurability between the injuries sustained and the symptoms suffered. In the standard case history of railway spine, the sufferer walks away from the railway accident with perhaps a few contusions but "usually quite unconscious that any serious accident has happened to him"; (44) he may even help the "less fortunate" of his fellow-travelers while "congratulat[ing] himself on his escape from imminent peril." A few hours or days later, however, "nervous" symptoms arise--anxiety, emotional instability, headaches, sleeplessness, forgetfulness, speech disturbances, etc.
Though Erichsen emphatically stresses the physiological basis of these symptoms with the phrase "concussion of the spine," he nonetheless refers to mental disturbance when explaining why the railway accident produces the exemplary instance of nervous shock:
The rapidity of the movement, the momentum of the person injured, the suddenness of its arrest, the helplessness of the sufferers, and the natural perturbation of mind that must disturb the bravest, are all circumstances that of a necessity greatly increase the severity of the resulting injury to the nervous system.... (45)
The victim of the railway accident does suffer from a "perturbation of mind," but from a perfectly "natural" one that has its basis in physical forces (rapidity, momentum, sudden arrest) and in actual bodily injury. Not until the second edition of his book, in 1875, does the physiologically-minded Erichsen change "the natural perturbation of mind" to a "mental shock" that accompanies the physical shock and that "is probably dependent in a great measure upon the influence of fear." (46) Erichsen's contribution to the conception of neurological trauma occurs precisely in delimiting the disjunction between traumatic cause and effect, and dubbing it the space of "fear." Charcot follows Erichsen in reminding his audience that, with the traumatic accident,
[i]t is always necessary to bear in mind, that, along with the injury, there is a factor which most probably plays a much more important part in the genesis of these symptoms than the wound itself. I allude to the fright experienced by the patient at the moment of the accident.... (47)
Fright names the "natural" mental reaction to sudden and severe bodily impact, and railway spine situates this reaction in terms of the movement and power associated with industrial technology. The feminized image of the male hysteric that Charcot rejects as a prejudicial stereotype--the man "enervated by high culture" (48)--is replaced by the industrial-age man shocked out of masculine self-control, that is, frightened out of his wits, by advanced technology. The new male hysteric's symptoms are severe and physiologically manifested, but rather than having an organic cause they are produced out of a disjunction, a space opened between a shocking event and its injurious effects by the psychic affect of fright. In situations where a severe and immediate injury is sustained--so claims the second important English theorist of railway spine, Herbert Page--no delayed reaction of shock follows since, given the "precise" nature of the injury, no fright is involved. (49) With functional disturbances following no or only slight injury, however--hysteria, in other words--Page borrows from Paget and introduces the term "neuromimetic disorder," i.e., "the functional disorders ... which are 'mimicries of a grave disease.'" (50) The notion of mimicry suggests an etiological focus, since mimicry implies a predisposing cause:
This [etiological] view seems to be supported by the fact that some time frequently elapses before mimicry begins, time having been needful for preparation, so to say, of the nervous system for the exhibition of these disorders. (198)
The detour inscribed by fright, then, Page reads as a space of (psychic) "preparation" for the nervous system's "exhibition" of symptoms. Preparation implies production: Out of this period of preparation, physiological symptoms are produced that "exhibit" the impact of the trauma.
This temporal disjunction marks the breach between the pre- and posttraumatic male subject into which an other self, a hysteric foreign to the pretraumatic subject, seems to intercede. Norbert Auerbach, in paraphrasing Erichsen, claims that "the condition of the [trauma] sufferer in both mental and physical regard has become a different one" (ein anderer geworden ist: Literally the sufferer has "become an other" to himself). (51) The traumatic hysteric is thus the male subject attacked from without by a sudden blow that, after a delay opened up by fright, produces functional disturbances enacted on/by his body and that makes of him another man altogether--"no less emotional and hysterical than [women]." (52) The disjunction caused by fright makes possible the entry of psychic effects, but, crucially, it also serves to mask them under a normative reaction, Erichsen's "natural perturbation of mind." For a man to suffer from a psychic disturbance would suggest all too dangerously that hysteria may be internal to him as a latent condition. But the theory of traumatic hysteria, in which functional disturbances follow as a result of fright or nervous shock, refuses precisly this possibility. It postulates instead that psychic effects produce visible symptoms but themselves disappear, making trauma an affliction of the (male) body's violent contact with the external world. (53)
My focus, as I have stated before, has to do with the elements that make male hysteria a viable medical construct. Thus, it is important that the explanations that the physicians themselves offer for the recurrence of the hysterical working-class male invoke not the conditions of their medical practice but rather the qualities of danger, severity, and material/physical threat to men. For it turns out that broken masculinity--the male in the implicitly feminizing grip of hysteria--in fact reinforces masculinity, at least so long as the hysteria has a traumatic etiology. The man who becomes hysterical is, to borrow a refrain from the German literature, kraftig gebaut (strongly built), working to the best of his ability, and generally fulfilling the social role demanded of his gender when he falls prey to the "dangers" of modern industrial life. The very fact that he regularly exposes himself to these dangers reinforces his masculinity; his hysterical affliction, rather than feminizing him, only serves in retrospect to define his masculinity as exposure to danger. He is attacked by an aspect of the external, industrial world, and the attack itself is a clearly delimited, publicly verifiable event. The male hysteric's symptoms, moreover, are fixed, stubborn, possibly permanent. One can implicitly depend on the stability and strength of this masculinity to hold out against the dangers and pressures of modern working life as long as possible (as one clinician argues), but when the nervous system does "weaken," its symptomatology continues, paradoxically, to express masculine strength. Suddenly nothing seems so masculine as the male hysteric.
IV. The Turn to Psychic Narrative
The relationship between hysteria and an external provocative force is missing from the case studies of female hysterics, largely because female hysteria is presented as being free of traumatic etiology, or indeed of any coherent etiology. Charcot does refer to "hystero-traumatic paralyses" in cases of women, but what is missing in most of these cases is the clear etiological event common to the cases of male hysteria. The lack of a clear etiology implies that female hysteria comes from within, from women's capricious mentalities; as Mark Micale also notes, "Women in [Charcot's] writing fell ill due to their vulnerable emotional natures and inability to control their feelings.... (54) Thus, for instance, when Charcot presents an example of "a hysterical paralysis following a trauma" in which a woman suffers partial paralysis in her hand after slapping her 7-year old son, the emphasis of the investigating interview falls not on the event of the slapping, but on the woman's violent temper. (55) Clearly, this kind of etiological event is markedly different from the standard male trauma, since the woman could be said to have brought the paralysis on herself by slapping her son, and worse, by being violent-tempered. What further shadows this case history of apparent traumatic hysteria, however, is the sense of an incomplete story behind the traumatic event, one which may or may not provide a clear etiology but which highlights the mentality of the hysteric for the male audience. In this particular case, it transpires that the woman's son had earlier been removed from her home, though there is some dispute between the patient and the doctor as to the reason (Charcot suggests child abuse, the patient insists that her son was ill). Moreover, yet another, more shadowy story, which Charcot leaves untouched and untold, lies behind the answer to the doctor's first question, "where are your other children?": "They're dead," she replies. This case of traumatic hysteria has a pre-history to which Charcot only gestures and in comparison to which the etiological event pales.
If we compare the cases of four female hysterics from the first volume of Charcot's Lectures on the Diseases of the Nervous System (56) with the six case studies of hysterical men from the third volume mentioned previously, we find further evidence of incomplete narratives and incoherent etiologies. To begin with, the female hysterics are grouped together specifically according to "ovarian hysteria," a categorization that resolutely reinscribes the gender bias of the malady but also focuses on one symptom, making etiology a lesser concern. Of the patient "Marc-" Charcot notes only that "[i]t is not certain to what cause the origin of the disorder should be attributed." Of "Cot-," whose hysteria began at 15, he writes, "The ill-treatment she had suffered from her father, who was addicted to alcoholic excesses, and her subsequent career as a prostitute, have doubtless exerted a certain etiological influence." Clearly, there is no theory of traumatic etiology in place for female hysterics, since such a history of (implicitly sexual) abuse and prostitution would account for more than a "certain etiological influence," idly mentioned. The third hysteric, Genevieve, a "professional" in King Charcot's court, receives no word on the etiology of her illness; it is as though hysteria becomes her rather than that she ever became a hysteric. And for the fourth, "Ler-," another professional hysteric who "has frequented the Salpetriere for the last twenty years," Charcot lists a "series of frights" as the "probable cause" of her "demonic" hysteria:
at the age of eleven, she was terrified by a mad dog; at the age of 16, she was struck with horror at sight of the corpse of a murdered woman; at the same age, she was again terrified by robbers who, as she was passing through a wood, rushed out to despoil her of the money she carried.
These causes, however, are not in any way brought together or connected with the symptomatology of "ovarian hysteria"; they at best suggest rather than compose an etiology.
Interestingly, in both the second and fourth cases, the only two for which etiological material is provided, there is a suggestion of a sexual trauma (ill-treatment by a father, "robbers" rushing out of the woods) that Charcot fails to notice, despite his insistence on gendering and implicitly sexualizing the illness as an ovarian hysteria. A brief reference to another hysteric at the end of this lecture only magnifies Charcot's unwillingness to think in terms of traumatic etiology, or etiology at all, in the cases of female hysterics. Of the history of Justine Etch-, the first hysteric he mentions in the Lectures, he says,
What the circumstances [of the first fit] were we do not know. The account she gives is quite romantic, a case of rape(?),--a tangled story, the accuracy of which it is difficult to ascertain. (57) (punctuation Charcot's)
Charcot here runs across the problem which some twenty years later will trouble Freud about his seduction theory of hysteria: The problem of "ascertaining" the traumatic event when it is a (sexual) trauma that has happened to a woman. For his part, Charcot sets the issue aside altogether with a convenient condescension for tangled, romantic stories (feminine narrativization, in other words), but the implicit impasse indicates the difficulty of thinking femininity and trauma together, since women's traumatic experiences are never publicly verifiable like those of the male hysteric. All women can do is relate tangled stories of private experiences to skeptical male doctors.
Borrowing terms from Freud's second translation of Charcot, we might denote the difference between male and female hysteria as a difference between the Ursache (originating event) of male hysteria and the Vargeschichte (pre-history or story) of female hysteria. While the Vorgeschichte adumbrates a past as well as an interiority for women, thereby indicating that women are hysterics, the Ursache describes how men come to have a disease, to suffer from hysteria. These terms, "event" and "story," are so pervasively gendered in Charcot's case histories that in one of the few male cases where the terra Vorgeschichte appears, it is appropriate because the patient is neurasthenic as well as hysterical, with the neurasthenic symptoms of impotence and "fear of everything" clearly marking him as feminized. (58) (The inverse is also noteworthy, as in Charcot's series of brief case histories from 1887 in which female hysterics are provided with an etiological event only in those tare cases where they have not been prone to hysterical attacks since childhood--that is, in those few cases where hysteria is not seen to be an a priori element of their adult selves.) (59) Men and women may exhibit the same (range of) symptoms, but the question of how this condition comes to be marks a crucial difference. The Ursache of male hysteria is a traumatic event locatable outside the male psyche, while the Vorgeschichte of female hysteria fills out the space of the psyche and implies that the disturbance is internal, a condition of the woman herself. The supposed gender parity of hysteria as a nosological construct thus depends on a buried difference: Women have psychic interiority, either capricious or mysterious, whereas men consist of visible exteriority, a hard surface in contact with a hard world.
Hysteria understood in terms of the etiological traumatic event, however, does not win the day. In 1895, Breuer, in the words of Freud, makes a "momentous discovery": The hysteric suffers from memories, since hysterical symptoms "ate determined by certain experiences of the patient's which have operated in a traumatic fashion and which are being reproduced in his psychical life in the form of mnemic symbols." (60) Freud had in fact already put forward this theory, though without signing his name to it, in a footnote to his 1892 translation of Charcot's Lecons du mardi a la Salpetriere--policliniques de Prafesseur Charcot. Here he suggests that "the kernel of the hysterical attack is a memory, a hallucinatory reliving of a scene which is of particular importance for the illness." (61) Perhaps not surprisingly, the context for this foomote is the case of a young woman whose mother reports that she repeatedly hallucinates a frighteningly ugly man with a big beard. To this detail, Charcot replies, "A story may lie behind that, but there is no point in going into it." (62) Clearly, the tangled story inspiring this hallucination is precisely what Freud wants to go into, since he holds that the hysteric's traumatic experience does not have to be either a singular or particularly grievous event, but something which is "of particular importance," that is, which suggests a psychic narrative.
The hallucination of the frightening bearded man provides a suitable scene for Freud's intervention in another sense: Around 1890 Freud increasingly begins to argue that the memories of hysterics deal with sexual traumas, specifically with traumas of infantile sexuality. The result of this discovery is twofold. On the one hand, the clearly delimited traumatic event, accessible not only to personal memory but verifiable by public memory, disappears in favor of a psychic narrative of trauma that can at best be reconstructed out of a past telescoped through the refractions of fantasy. More importantly, the emphasis on sexual trauma, with its implication of ongoing sexual dysfunction, "leaves hysteria in men out of account." The quote comes from Freud himself; here is the full context:
If serious and trifling events alike ... are to be recognized as the ultimate traumas of hysteria, then we may be tempted to hazard the explanation that hysterics are peculiarly constituted creatures--probably on account of some hereditary disposition or degenerative atrophy--in whom a shrinking from sexuality, which normally plays some part at puberty, is raised to a pathological pitch and is permanently retained; that they are, as it were, people who are psychically inadequate to meet the demands of sexuality. This view, of course, leaves hysteria in men out of account. (63)
This striking passage can be read in at least two ways. On the one hand, we might say that Freud either bemoans the limitations of or ironizes a theory of hysteria that "leaves men out of account." Given, however, that the passage (except for the suggestion of hereditary disposition) reproduces the highlights of Freud's thinking about hysteria at this time, it seems that he more radically registers the fact that his theory of sexually etiological hysteria must mean the death of its male variant. Men, after all, are always assumed "adequate to meet the demands of sexuality." Thus, when the hysteric is defined as a "creature ... in whom a shrinking from sexuality ... is raised to a pathological pitch," then that creature, by definition, must be female, leaving the male hysteric "out of account" as a contradiction in terms. Freud makes the same point, less ambivalently, in a working draft on the neuroses that he enclosed in a New Year's letter of 1896 to Wilhelm Fliess. The section on hysteria begins, "Hysteria necessarily presupposes a primary experience of unpleasure--that is, of a passive nature. The natural sexual passivity of women explains their being more inclined to hysteria. Where I have found hysteria in men, I have been able to prove the presence of abundant sexual passivity in their anamneses." (64) Rethinking hysteria as the returning memory of a sexual "unpleasure" or sexual "inadequacy" kills off the masculine male hysteric, leaving only those (implicitly few) hysterical men who are feminized by their "abundant sexual passivity."
A great deal of attention has been paid in recent years to the shift in Freud's theory of hysteria from the infantile seduction of the (female) hysteric by a (male) relative, to the hysteric's fantasy of this seduction, particularly the oedipal fantasy of being seduced by the father. (65) In an article on this shift, Martha Noel Evans draws our attention to
the uncanny substitution that takes place: at the center of the seduction theory is a young girl seduced by the father; at the center of the oedipus complex, there is a young boy constructing erotic fantasies about his mother. In the new, substitute theoretical formulation, then, the little boy takes the place of the victimized girl. (66)
This "uncanny substitution," I would argue, reproduces a substitution that has taken place once before in Freud's thinking, though in the opposite direction: For the post-Charcotian Freud, the passive, sexually traumatized female hysteric takes the place of stalwart, event-traumatized male hysteria. For when the psychic etiology of hysteria replaces the traumatic etiology, Freud moves male sufferers into the category of obsessional neurosis to leave the space of hysteria clear for female occupants. (67) Put another way, Freud's inheritance of the mantle from Charcot as the explicator of hysteria means the erasure of male hysteria as a viable diagnostic construct. Freud indeed made the great imaginative leap of listening to the "tangled story" of hysterics' traumas, but in insisting on the sexual nature of these traumas, he ensured that hysterics would again be gendered feminine. In this sense, psychoanalysis completes the trajectory begun by the neurological invention of male hysteria: The ideological thrust of the neurologists was to make male trauma such a normative aspect of masculinity that male hysteria would write itself out of "hysteria" altogether.
I should clarify my intentions. I have no wish to recover the masculine male hysteric for the sake of gender equality or even in the name of medical historiography. In fact, I would take issue with the claim that there is ah object here as such to be recovered. Rather, I have sought to rediagnose the etiology of hysteria that, as a medico-cultural construct, is neither the product of in-the-world traumas nor of psychic narratives. Rereading late nineteenth-century hysteria for its etiology reveals a gendering of bodies that effects a clear demarcation of masculinity from femininity: The male body operates in the world and thus suffers from singular events of traumatic contact, while the female body is a space of mysterious interiority that always already has hysteria latent within it. The fact that men may suffer psychic affect when they become frightened, as in the theory of railway spine, or that women may suffer discrete events of traumatic contact in situations of rape or incest, as implied in some of Charcot's cases, does not change this gendered arrangement of bodies, since it is contemporary assumptions about gender that provide the "actual" etiology of hysteria in scientific and cultural discourse. In this sense, gender relations themselves can be said to constitute the nonorganic origin of hysteria. This is not to say that gender can make one hysterical--as tempting as the theory may be--but rather that gender relations affect both the material (symptomatological) and discursive (diagnostic) manifestations of hysteria as an illness. Male hysteria suffered a sudden demise in the early twentieth century, then, because the stakes of gender ideology had shifted. Psychologists, as well as a host of modernist writers and readers, became far more interested in the fragmentary, tangled stories of sexual memory than in a validation of virile masculinity in the industrial world.
University of Zurich
(1) Daniel Boyarin, Unheroic Conduct: The Rise of Heterosexuality and the Invention of the Jewish Man (U of California P, 1997), pp. 189-220; and Elaine Showalter, "Hysteria, Feminism, and Gender," in Hysteria Beyond Freud, ed. Sander L. Gilman et al (U of California P, 1993), pp. 286-3442
(2) Boyarin, pp. 192, 193.
(3) Showalter, "Hysteria, Feminism, and Gender," p. 289. Showalter does include a section on late nineteenth-century male hysteria in her essay (pp. 307-315), and she notes that the famous French neurologist Charcot insisted "that [male hysteria] should not carry the stigma of effeminacy" (p. 308). She treats Charcot, however, as a single instance of such an approach to male hysteria, and downplays the importance of the male hysterics in his clinic as compared to the female hysterics.
(4) Index-Catalogue of the Library of the Surgeon-General's Office, United States Army, Second Series (1896+), and Third Series (1918+) (Washington, D.C.).
(5) The first series of the Index-Catalogue covers the entire pre-1885 holdings of the Surgeon-General's Library, but under the category of male hysteria lists mainly works appearing between 1850 and 1885, with the majority clustering in the late 1870s/early 1880s. For the sake of comparison, let me add that the first series names 15 monographs and 82 articles, though there is some overlap with the second series of the Catalogue. The third series, which includes works through the early 1920s, lists only 5 monographs and 29 articles under "hysteria in the male." Compared even with the relatively large number of articles published before 1885, the inclusion of 200 articles in the 20-year period between 1880 and 1900 indicates a massive upsurge of interest.
(6) To complete the breakdown, there are 26 articles in Italian, 8 in Russian, four in Hungarian, three in Rumanian, three in Brazilian Portugese, three in Japanese, two in Spanish, two in Polish, two in Scandinavian tongues, and one in Czech. All translations for titles given in the original are mine.
(7) Most notably, Elaine Showalter, The Female Malady (New York: Pantheon Press, 1985); for an overview of feminist approaches to hysteria, see Mark S. Micale, "Hysteria and Its Historiography: A Review of Past and Present Writings, II," History of Science 27 (1989), pp. 319-331.
(8) For a detailed historical approach, see Mark S. Micale, "Charcot and the Idea of Hysteria in the Male: A Study of Gender, Mental Science, and Medical Diagnostics in Late Nineteenth-Century France," Medical History 34 (October 1990).
(9) Interestingly, the listings of articles and monographs on male hysteria in the first series of the Index-Catalogue (1850-1885) are largely in French, indicating that Charcot, despite his status as "inventor," had socio-medical inspiration.
(10) Jean-Martin Charcot, Clinical Lectures on Diseases of the Nervous System, Vol. III, tr. Thomas Savill (London: The New Sydenham Society, 1889), p. 222.
(11) See Sander L. Gilman, "The Image of the Hysteric," in Hysteria Beyond Freud, pp. 345-452, on the productive effect of images of hysteria.
(12) This lecture took place six months after Freud returned from a study leave in Paris (October 1885-February 1886), where he attended Charcot's weekly lectures at the Salpetriere. (As a result of this contact with Charcot, Freud translated the third volume of Charcot's Lecons sur les maladies du systeme nerveux (1886; the German translation, Neue Vorlesungen uber die Krankheiten des Nervensystems, appeared a few months prior to the French original), which contained some 25 cases of male hysteria. A few years later, Freud also translated the first volume of Lecons du mardi a la Salpetriere--policliniques de Professeur Charcot, 1387-2888 as Poliklinische Vortrage, 1892.) Freud's lecture of 1886 to the Viennese physicians has been lost or was possibly never transcribed. Instead, we are left with a schematic outline of the talk, contained in the published minutes of the meeting (Wiener medizinische Wochenschrift, No. 43 , pp. 1444-1447).
(13) To this standard list, the Manchester physician J. Dreschfeld adds another oft-discussed symptom, the alteration of the "mental condition" of the patient (Dreschfeld, "On Hysteria in the Male Coming on after an Injury," Medical Chronicle (December 1886), pp. 169-181.
(14) E. Mendel, "Uber Hysterie beim mannlichen Geschlecht," Berliner klinische Wochenschrift, Vol. 20-22 (May-June, 1884), pp. 314-317.
(15) J. Mitchell Clarke, "Some Cases of 'Hysteria' in the Male Subject," Lancet 1890ii, pp. 1322-1325.
(16) P.J. Mobius, "Uber den Begriff der Hysterie," Centralblatt fur Nervenkrankheiten, 1888.
(17) Paul Enke, Casuistische Beitrage zur mannlichen Hysterie (Jena, 1900), pp. 4-5.
(18) Oskar Bodenstein, Hysterie beim mannlichen Geschlecht (Wurzburg, 1889).
(19) See Ilsa Veith, Hysteria: The History of a Disease (U of Chicago P, 1965), pp. 1-8. For a revisionist history of early conceptions of hysteria, see Helen King, "Once upon a Text: Hysteria from Hippocrates," in Hysteria Beyond Freud, pp. 3-90.
(20) Freud's 1886 lecture to the Society of Physicians in Vienna, for instance, was met with a response from one surgeon who complained that since the word "hysteria" derived from the Greek for womb, it "by definition excluded the male sex" (cited by Ernest Jones, The Life and Work of Sigmund Freud, edited and abridged by Lionel Trilling and Steven Marcus [New York: Basic Books, 1961], p. 207).
(21) See Oskar Bodenstein, Hysterie beim mannlichen Geschlech; Paul Enke, Casuistische Beitrage zur mannlichen HysteKarl Kaufmann, Uber Hysterie beira Manne (Strassburg, 1891); Gustav Mann, Casuistische Beitrage zur Hysterie beim Manne (Berlin, 1891); and J. Zippel, Uber mannliche Hysterie (Halle a.S., 1895).
(22) Mendel, "Uber Hysterie beim mannlichen Geschlecht," p. 315.
(23) Freud, lecture report in Wiener medizinkche Wochenschrift, No. 43, p. 1445.
(24) Mann, Casuistische Beitrage zur Hysterie beim Manne, 39. Mann, however, wishes to retain some connection between hysteria and what he calls vaguely "genital malady," so be claims that men, too, can suffer from a combination of genital malady and hysteria (4). Nonetheless, Mann is unwilling or unable to give any examples of what a "genital malady" would involve in men.
(25) Charcot, Clinical Lectures, Vol. III, pp. 222-223.
(26) Ibid., p. 223.
(27) For the specific cases, see Charcot, Clinical Lectures, Vol. III, p. 225-226.
(28) E. Bitot, "Note sur l'hysterie male," Mercredi Medical (21 January 1891), pp. 25-27.
(29) According to J. Dreschfeld ("On Some Rarer Forms of Hysteria in Man," Medical Chronicle XIII [1890-1891], p. 22), male hysteria "differs but little from hysteria as observed in women, except ... that the symptoms of hysteria major are of much rarer occurrence than in the female." From Mendel: "Attacks [of hysteria gravis] are observed uncommonly often in the female sex" ("Uber Hysterie beim mannlichen Geschlecht," p. 317); and from Kaufmann: "The hysterie a crises mixtes [grande hysterie] is to all appearances more frequent in France, and especially in Paris, than in Germany, and more frequent in the female sex than in the male" (Uber Hysterie beim Manne, 1891).
(30) Enke, Casuistische Beitrage zur mannlichen Hysterie, p. 20.
(31) Francis W. Clark, "Hysteria in Men," Journal of Mental Science 33 (January 1888), pp. 543-548.
(32) J. Mitchell Clarke, "On Three Cases of Hysteria in Men," Brain 14 (1891-1892), pp- 523-537.
(33) Enke, Casuistische Beitrage zur mannlichen Hysterie, p. 19.
(34) Charcot refers a number of times to individual women patients as a Hysterica (see Poliklinische Vortrage, tr. Sigmund Freud [Leipzig und Wien: Franz Deuticke, 1892], pp. 11, 99). He never, however, to my knowledge uses the male equivalent, Hystericum, to refer to male patients.
(35) Charcot, "A propos d'un cas d'hysterie masculine," Archives de Neurologie, XXII, No. 64 (July 1891), p. 2.
(36) Charcot, Lecons du mardi a la Salpetriere--policliniques du Professeur Chareot, 1887-88, Vol. I (Paris, 2nd edition, 1892), p. 212.
(37) Charcot, Lectures on the Diseases of the Nervous System, Vol. I, tr. George Sigerson (London: New Sydenham Society, 1877), p. 264.
(38) For studies of the feminization of the Jew, see Daniel Boyarin, Unheroic Conduct, pp. 31-185; and Sander L. Gilman, The Jew's Body (London: Routledge, 1991).
(39) In the lecture published as "A propos d'un cas d'hysterie masculine," Charcot states that "hysteria is one and indivisible and ... its true cause is not in the fortuitous influence which reveals it, but in the predisposition which created the hereditary neurosis" (p. 8).
(40) Charcot, Clinical Lectures, Vol. III, pp. 226-259.
(41) Joseph Collier, "Traumatic Hysteria in the Male," Medical Chronicle VIII (1888), pp. 30-37.
(42) Bodenstein, "Hysterie beim mannlichen Geschlecht," pp. 25ff, 13.
(43) On the history of the Campbell Act and its implications within the context of industrialization, see Wolfgang Schivelbusch, The Railway Journey: The Industrialization of Time and Space in the 29th Century (U of California P, 1977, 1986), p. 134n
(44) John Eric Erichsen, On Railway and Other Injuries of the Nervous System (London, 1866), p. 95.
(45) Ibid., p. 9.
(46) Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System, in Their Medical and Medico-Legal Aspects (London, 1875), p. 195.
(47) Charcot, Clinical Lectures, Vol. III, p. 231.
(48) Ibid., p. 222.
(49) Herbert W. Page, Injuries of the Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock, in Their Surgical and Medico-Legal Aspects (London, 1883), p. 183: "The very definiteness of the injury presents a point of focus for the patient's mind" that, related as it is to a "definite and precise" injury, dissipates fright.
(50) Page, Injuries to the Spine and Spinal Cord, p. 198.
(51) Norbert Auerbach, Die traumatische Hysterie beim Manne (Berlin, 1889), p. 7.
(52) Page, Injuries to the Spine and Spinal Cord, p. 172.
(53) It is interesting to note that in Injuries to the Spine and Spinal Cord Page provides six cases of "neuromimetic disorders," of which only the first involves a woman. Despite his broad claim earlier that "men not less frequently than women" may suffer from nervous shock (p. 172), when it comes to the neuromimetic disorders (hysteria), be writes after the one case of female hysteria that "we shall do well to draw our remaining examples from patients of the sterner and usually less hysterical sex" (p. 211). An appendix of 234 cases shows that, in fact, most of Page's case histories involve the "sterner and usually less hysterical sex."
(54) Mark S. Micale, "Charcot and the Idea of Hysteria in the Male," p. 66; quoted in Showalyer, "Hysteria, Feminism, and Gender," p. 309.
(55) Charcot, Poliklinische Vortrage, pp. 96-104.
(56) Charcot, Lectures on the Diseases of the Nervous System, pp. 276ff.
(57) Ibid., p. 234.
(58) Charcot, Poliklinische Vortrage, pp. 54-57.
(59) Charcot, Clinique des maladies du systeme nerveux, Vol. I (Paris: Veuve Babe et Cie, 1892), pp. 408-423.
(60) Sigmund Freud, "The Aetiology of Hysteria," Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. III, ed. and tr. James Strachey and Anna Freud (rpt., London: Hogarth Press, z955), p. 192ff.
(61) Freud in Charcot, Poliklinische Vortrage, p. 107n.
(62) Charcot, Poliklinische Vortrage, p. 106.
(63) Freud, "The Aetiology of Hysteria," p. 201.
(64) Jeffrey Moussaieff Masson, ed. and tr., The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887-1904 (Harvard UP, Belknap Press, 1985), p. 169.
(65) See Daniel Boyarin, Unheroic Conduct, pp. 189-220; and Jeffrey Moussaieff Masson, The Assault on Truth: Freud's Suppression of the Seduction Theory (Harmondsworth, Middlesex: Penguin, 1985).
(66) Martha Noel Evans, "Hysteria and the Seduction of Theory," in Seduction and Theory: Readings of Gender, Representation, and Rhetoric, ed. Dianne Hunter (U of Illinois P, 1989), p. 80.
(67) See the hysteria section of Freud's 1896 Draft K on neuroses in The Complete Letters of Sigmund Freud to Wilhelm Fliess, p. 169.
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