Hysteria, by Stefania Cobbinah

I am very pleased to share this wonderful 2nd year essay by my student Stefania Cobbinah. I awarded it 90%, and as you can see she deserves such a high mark. I can’t wait for your final year work. Stefania!

Hysteria is a pathological condition with a fascinating and tortuous medical and cultural history (Scull, 2009). As many diseases, it was defined based on traditional assumptions and prejudices; the word itself tells a lot about its history. Indeed, “hysteria” comes from the Greek word hystera, which means “uterus” as this was thought to be the origin of the disease (Kowaleski-Wallace, 2009). Distinguished medical writers like Hippocrates and Galen talked about the female body as structurally inferior and weak and dominated by the womb that, like a voracious and predatory animal, wondered around her body making her always unstable and frail and causing all sorts of organic manifestations (Jouanna et al., 2012). This notion from the Classical Age was abandoned only in the seventeenth century, when it was proven that the uterus was actually not mobile and the cause was rather found in the nervous system (Scull, 2009). For years, many scholars studied hysteria and many arguments were brought forward, but great characters like Jean-Martin Charcot and Sigmund Freud made the nineteenth century the golden age of this condition. This essay will focus on this period presenting the interpretation Charcot and Freud gave to hysteria; it will later analyse the cases of “Anna O.” and “Dora” adopting the point of view of some feminist criticisms that were later advanced. It will be argued that “hysteria” is mostly a language of voiceless women rather than a medical condition.

The modern medical history of hysteria begins just over a century ago in Paris with Jean-Martin Charcot (1825-93) and his clinic the Salpêtrière (Showalter, 1997). Son of a humble wagon-maker, Charcot turned this clinic into his “Temple of science” and he made hysteria become a spectacle and a circus by instituting two weekly public performances (Scull, 2009). On Tuesdays, in the leçon du mardi, he publicly diagnosed patients he had never seen before and on Fridays he gave lecture-demonstrations, bringing in patients to show the symptoms. Physician of great ambition and talent, he made important discoveries in internal medicine using the anatomical-clinical method and his aim was to define the organic laws of hysteria in the same way. He declared that this was a somatic disease caused by hereditary defect or traumatic wound in the central nervous system , but was never able to find proof in post-mortem examinations. He stood as the “Napoleon of neurosis” and gained international fame, but he was mostly a showman. The famous painting by Pierre-Andrè Brouillet ”Un Leçon Clinique à la Salpêtrière” (A clinical lecture at the Salpêtrière, 1887) shows Charcot in one of his Friday lectures: the audience hangs on his every word, all eyes are pointed at him and Blanche Wittman, famous hysterical woman, tragically abandoned in the arms of one of the assistants.

Charcot adopted liberal positions by the standards of his time on women’s rights: he accepted women among his pupils and declared that hysteria was not a disease of the female reproductive system, recognising cases of male hysteria (Scull, 2009). However, he still fell into stereotypes and many criticisms can be observed in his collection of photographic images . The majority of his patients were working-class women that he classified according to the stage or symptom that they were manifesting (Showalter, 1997). He did not care about them as people suffering, but just as cases that had to fit into his theoretical cage. The huge number of hysterics diagnosed in Paris made some doctors, even in his time, suspect he was actually creating iatrogenic illness. His focus on la grand hysterie was so obsessive that he ended up surrounded by a bunch of mediocre men, so frightened to contradict him that they would even stage the performances for his benefit (Scull, 2009). His patients, people with emotional responses to their unhappy lives, were given a diagnosis that as a consequence took away their dignity, turned them into iatrogenic monsters and confined them into his clinic, sometimes for a lifetime. After his death in 1893, his fame rapidly declined and hysteria moved to the scene of fin-de-siècle Vienna.

Sigmund Freud (1856-1939) was a devoted disciple of Charcot and, fascinated by his charm, he worked for a period with him as a young assistant, translating his works to German and he was profoundly impressed and influenced by his lectures. Returned to Vienna, he started working on hysteria with the physician Joseph Breuer with whom he elaborated the “talking cure” (Showalter, 1997). In the Studies on Hysteria (1895) they argue that hysteria was caused by the repression of disturbing sexual experiences that were converted into bodily symptoms; by talking to the patient also with the help of hypnosis, she was brought to recall those traumatic memories in order to bring about a cure. Anna O., pseudonym given to the hysteric Bertha Pappenheim, was considered the successful proof of this new theory. By the end of the century, he started working independently on hysteria as he wanted to develop a more complex theory of the mind, in which, contrary to what Charcot claimed, the roots of the condition were found to be psychological rather than physical (Scull, 2009). The underpinning cause of hysteria was considered to be libido, the energy that was supplied by unconscious sexual drives . He argued that Oedipal desires of the infant were repressed throughout the process of maturity because unacceptable and therefore led to psychical conflict. “Dora’s case” , name given to the young Ida Bauer, appeared to him as his great chance to incorporate all his discussion on hysteria. As she abruptly interrupted analysis after just three months, Freud abandoned hysteria focusing on other forms of neurosis.

Freud’s work on psychoanalysis undoubtedly made him one of the greatest characters of the twentieth century. Unlike Charcot, he focused on the petite hystèrie analysing the everyday symptoms like coughs, headaches and loss of voice (Showalter, 1997). He recognised that his patients were sick people and that the cure to their sufferings was by talking to them, making the unconscious conscious. However, just like Charcot, he imposed his theories on them, not listening to what they were really saying. His unwillingness to believe the reports of incest of his female patients led him to develop his concepts of infantile sexuality, preferring to blame the symptoms on their “uncontrolled sexual drives” (Herman & Hirschman, 1977). Unsurprisingly, he was not able to conclude his research, although he was tormented by this incompleteness and tried assiduously to reformulate his theories.

Charcot and Freud can be considered the pinnacle of the study on hysteria. They changed the perspective and tried to develop more comprehensive and scientific theories. However, we have just seen how both failed, mainly because, perhaps unconsciously (to use a Freudian word), they kept considering hysteria as an objective dysfunction of the female body. The problem is that hysteria has never been a disease de facto: feminist historians argue that it is rather a silent complaint, ‘a feminine body language addressed to patriarchal thought’ (Kowaleski-Wallace, 2009, p. 288). In this light, it is the voice of people who were not able to express themselves in the society and the nineteenth century can be considered the threshold for the 20th century women’s movements. Because both Charcot and Freud belonged with the oppressors, their analysis is quite fallacious. We will now examine the cases of “Anna O.” and “Dora” in more detail, adopting a feminist perspective and trying to understand what their behaviour really meant.

The feminist Dianne Hunter (1983) gives an interesting account of the case of “Anna O.”. Before getting into more detail, it is important to give first a framework of who Bertha Pappenheim was and the context she grew up in; (she will be now referred to with her real name as “Anna O.” imprisons her in the hysterical identity). Bertha was born in 1859 in Vienna in a wealthy prominent family of the Jewish society. Both her elder sisters died in childhood, leaving her as the only daughter of a very authoritarian mother. She, however, received adequate education as she spoke perfect English and read French and Italian; she also practiced embroidery and lacemaking, her lifelong passions. Although her remarkable intellectual and poetic gifts and a lively and charming personality, she was assigned monotonous household tasks while her younger brother entered the University of Vienna, an institution at the time closed to women. She was only allowed to participate in charitable activities, the only work traditionally permitted to women outside the home. Her resentment for her inferior position as a daughter in an orthodox Jewish family led her at the age of 21 to develop a complex form of “hysteria” while she was nursing her terminally ill father. She was treated for two years by the physician Joseph Breuer, Freud’s colleague, but he had to interrupted the therapy when, on a hysteric attack, she mimicked giving birth to his child. Later in life, she became an important figure of the German Jewish women’s movement embodying the fight against double standards; after her death in 1936 she was honoured in 1954 by the Republic of West Germany as a “Helper of Humanity”.

Bertha’s hysteria was interpreted as a split between two personalities: the “unconscious” and the “normal” state. We are told that she used to indulge in systematic day-dreaming that she described as her “private theatre”, her own way to break the everyday monotony. This abundance of creativity was considered the source of the conflict, later exacerbated by the grief for her father’s death. Freud never met her, but “Fraulein Anna O.” is the hysteric most named and discussed as she is considered to be the inventor of the talking cure, a technique that profoundly impressed him. Hunter’s (1983) interpretation of Bertha’s hysteria suggests that it was rather a desperate cry for freedom. Among other symptoms, Bertha suffered for a period from a profound disorganization of speech that culminated with a total aphasia. When she regained ability to talk, she was unable to understand her native tongue although she was fluent in English. From a feminist perspective, this has an implicit liberating motive: German represented the cultural identity she wanted to reject, a recognition of the father’s power, so she rather got everybody to speak her language, her own way to take control. Her hallucination of her father’s face as a death’s head and then her own reflection in a mirror as the same image, pushed her to suicidal impulses. Interpreted as grief, they were rather a way to escape the guilt generated by the sense of liberation and relief for the loss of the father. Bertha was a highly intelligent young woman and she felt her lack of formal education as a defective spiritual nourishment, explanation of her anorexic symptoms. She did not have any friendly figure in her life as her sisters had died and her mother was authoritarian, so the therapy was her only way to talk to someone, to have a spectator to her “private theatre”. Curiously, as she described one of her symptoms it was somehow permanently removed. The relationship she had with Breuer was so intimate, that it is not absurd to assume a mutual infatuation. Unsurprisingly, the jealousy of Mrs Breuer and the fear of a public scandal, led him to interrupt the therapy, although he portrayed it as a recovery of the patient. Her giving birth to Breuer’s child was a desperate attempt to summon one last session.

Bertha used psychoanalysis to speak out her story. Once Breuer failed to be the saver she was looking for, she assumed the role herself. Her philanthropic and political activities, made her the shelter of many abused and abandoned women and children. She remained resentful for double standards, promoting female education and cofounding the League of Jewish Women. She was a strong woman, so independent that she refused to marry and even wrote five obituaries for herself as she was determined to have the last word. Her fight against prostitution was her way to liberate women that like her were imprisoned in the patriarchy of the society. In this light, her hysteria is better explained as feminism lacking a social network in the outer world (Hunter, 1983).

More complex is the case of “Dora”, hapless prisoner of her time (Decker, 1981). As Bertha, Ida Bauer (1882-1945) was the only daughter of a bourgeoisie family. Her symptoms had begun when at the age of eight she fell behind with her studies compared to her brother Otto, who later became a prestigious and influential politician. Ida was depressed, dissatisfied with herself, unfriendly and she spent her time going to lectures for women or studying on her own. She was brought to Freud at 18 when her father found a suicide note. What seemed like an ordinary case of petite hystèrie, was rather a complex story of manipulation and sexual abuse (Robinson, 1988). Indeed, Frau K., a family friend, was having an affair with Ida’s father and her husband Herr K. had made sexual proposals to the young lady. So Ida was being used as a pawn in a perverted game: Herr K. accepted his wife’s lover if he had his daughter in return. Therefore, the real reason of the therapy was for Ida to accept her role in this exchange. Throughout the sessions, she wanted Freud to recognize the injustices that had been made to her and persuade her father to end the relationship. Freud acknowledged that Ida was a victim, but wanted to use his theory on interpretation of dreams to explain her symptoms. By insisting on her version of events, Ida was rocking a boat that served everybody’s interest but her own (Hanrahan, 1998). Frustrated, she interrupted the therapy after only three months.

Freud himself acknowledged that “Dora’s case” was a failure and his hesitation before publication mark an unusual degree of uncertainty and ambiguity; the title Fragment of an Analysis of a case of hysteria clearly express this incompleteness (Moi, 1981). He still proceeded to the publication to incorporate his theories; he therefore imposed a narrative coherence to a fragment of pieces from separated periods of time in order to render the narrative readable . Ellis (1980) argues that the whole case study is a ‘drama of psychological victimization of unusual intensity’ (p. 207) as Freud skilfully poses himself as the all-knowing author who makes the reader feel no disagreement could be valid. He reserved for himself the active role in the analysis without bothering whether his interpretations convinced Dora; he used her for his own intellectual gratification seeing her rather than the situation as the problem of the abnormality (Hanrahan, 1998). Ida was being forced to admit her infantile masturbation (interpreted from her fiddling with her purse) and her unconscious attraction to Herr K. Freud was convinced that denial or doubts could have the value of affirmation; a complete analysis was just a question of time and the patient’s cooperation. In his phallocentric epistemology, he refused to consider the female sexuality as an independent, active drive (Moi, 1981) and his whole argument can be seen as an ideological construct developed in defence of the patriarchal phantasy of femininity and female sexuality (Ramas, 1980). When she abruptly interrupted the therapy he blamed it to her transference of feelings from her father and Herr K. into him.

Lacan (1966) however, argued that Freud did not recognise the opposite phenomenon of countertransference in which he unconsciously identified with Herr K. in his relationship with Dora; he turned out to be as abusive by forcing his version of the facts on her, actively refusing other explanations. Ida was looking for a liberator, but her therapists happened to be on the side of the oppressors. In this light, her hysteria was a declaration of defeat and realization that there was no way out (Moi, 1981). Her aphonia stood as her inability to take control of how to express herself (Robinson, 1988). In the play Portrait de Dora (1976) Hélène Cixous feels the need to rewrite Dora’s case, literally giving her a voice to present her own version of facts. Sadly, however, Ida never had this chance and lived a miserable and joyless life (Deutsch, 1957), failing to secure identity either as a wife, mother, volunteer worker or a professional woman; hers was a history of succumbing rather than overcoming circumstances (Decker, 1981). Ramas (1980) highlights that Dora’s name derives from the Greek word for gift and it was also the name of the servant in the Freud family ; in it there is the implicit recognition of servitude as a metaphor for femininity, idea shared by both Freud and Ida.

Many thinkers in the twentieth century have declared that mental illness is just a myth, a term coined to mask sufferings of another origin (Szasz, 1961). This essay has indeed discussed how “hysteria” was mostly a social phenomenon of women who passively expressed through the language of their body the anger and assertiveness they were not allowed to exhibit openly, especially after the Victorian middle-class ideal of feminine as passive and weak (Decker, 1981). The strict division of people into the codes of masculine and feminine identity were the underlying cause of this condition (Brivic, 2002): like many others, Bertha Pappenheim and Ida Bauer where punished with the only fault of being women. The former was able to emancipate herself and actively fight for women’s rights; the latter, on the other hand, saw her femininity as an enslavement and gave up to a miserable life full of resentment and hatred. The American Psychiatric Association removed hysteria from the list of identifiable and specific clinical disorders in 1980, but this does not mark the end of hysteria. Hysteria goes beyond a medical status; it represents the struggle for identity that it is not comprehensible to the patriarchal ideology, a mentality in which the womb remains a site for the contesting of women’s rights (Devereux, 2014). People are still fighting for gender equality and in these terms it is not wrong to say that yesterday’s hysterics are today’s feminists.

Stefania Sarsah Cobbinah was born in Verona, Italy in 1995, and her parents have Ghanaian origins. Her primary and secondary education was completed in Italy; she moved to the UK in 2014 to study Bsc Medical Science and Humanities in Swansea University.




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