Hysterical Men

Men on the edge of a nervous breakdown

How hysteria, a nervous disorder common to men and women, got locked away in the prison of gender

Andrew Scull

Hysteria is a rum sort of subject these days. It has officially disappeared as a disease, wiped out of existence in the Diagnostic and Statistical Manual of the American Psychiatric Association, the bible of contemporary psychiatry, and hysterics themselves seem to have vanished from psychiatrists’ and neurologists’ waiting rooms. Lay people still use the term with abandon, generally with reference to women who make a spectacle of their extreme emotional lability. But an illness that has a history dating all the way back to the time of Hippocrates is no longer respectable or recognized in medical circles. In the words of one of its best-known modern historians, Etienne Trillat, “L’hystérie est morte, c’est entendu”.
A century or so ago, though, hysterics seemed to be everywhere. Gynaecologists were cutting out hysterical women’s ovaries to sever the reflex connections between their brains and their reproductive organs (and, not incidentally, to prevent such degenerate creatures from giving birth to similarly defective offspring). In fin-de-siècle France, the great neurologist Jean-Martin Charcot had made hysteria a spectacle and a circus, a scandalous circus that attracted the attention of le tout Paris. Every Tuesday, he put on performances that regularly featured scantily clad women disporting themselves in unmistakably erotic cataleptic poses, or writhing and moaning in ways that mimicked orgasms on a public stage, before an understandably rapt audience: an audience soon drawn not just from the highest ranks of French society, but also from those attracted to Paris by news of Charcot’s extraordinary lectures. The photographs of these occasions, captured in carefully staged arrangements before the supposedly objective lens of the camera and thus transmuted into indelible visual representations for a vastly greater virtual audience, have survived for later generations to inspect, and have become the iconic images of a disorder at once seen as sexual and feminine. Shortly thereafter, Sigmund Freud, who had spent four months at Charcot’s feet in 1885 and 1886, began to build the whole complex edifice that would become psychoanalysis on the basis of his own encounter with hysterics. All of his fabled published cases, Frau Emmy von N, Fräulein Elizabeth von R., Miss Lucy R., Katherina, Dora, and the rest, were women – smart, neurotic, hysterical women.
As Mark S. Micale scarcely needs to remind us (because its very name gives the game away), hysteria has always been seen as a gendered disease. Deriving from the Greek word for womb, for almost two millennia it was seen as “a pathological phenomenon exclusive to women”, one rooted, as often as not, in some defect of women’s reproductive apparatus. Yet, as his title immediately signals, it is not that mainstream history of an oppressive masculine gaze objectifying inferior, weak, emotional and mad females that interests him. Instead, his concern is with the history of male nervous maladies, a topic that, he asserts, has been greeted by a “cultivated silence”. In place of “anxiety, ambivalence, and selective amnesia . . . the greatly altered circumstances of the early twenty-first century make it possible, and important, to recover that hidden history [of male hysteria and male hysterics].”
Curiously, for a book about what purports to be a hitherto hidden history, Hysterical Men is not the only recently published book with that title. Paul Lerner’s Hysterical Men: War, psychiatry and the politics of trauma, which examines the phenomenon of shell shock and the German army in the First World War, appeared six years ago from Cornell University Press. As Lerner was far from the first to point out, the “war to end all wars” saw an outbreak of mass male nervous collapse, first diagnosed as shell shock, that produced hundreds of thousands of psychological casualties, victims of a disorder that mysteriously mimicked all sorts of neurological diseases, without any obvious organic cause. The Germans, the French, the Austrians, and the British all came to acknowledge that what they were seeing was an epidemic of male hysteria. Nothing secret or hidden about that. Yet, more curiously still, Micale ends his account of the subject with the early Freud, and without any explanation, all but ignores this most striking manifestation of the disorder that is his ostensible subject matter. In that sense, his book is a bit like Hamlet without the Prince.
In the early portions of his book Micale examines quite sensibly, in Robert Burton’s Anatomy of Melancholy, in the late seventeenth-century work of Thomas Willis and Thomas Sydenham, and in the writings of the Georgian theorists of the English Malady, the growing recognition of the existence of male nervous distempers that closely paralleled female hysteria. Since Willis and Sydenham, for example, saw all sorts of nervous disorders as rooted in the brain, not the uterus, their recognition of the commonalities across the sexes should occasion no surprise. It was a view echoed by such luminaries of the Augustan age as Bernard de Mandeville, Richard Blackmore and George Cheyne, who claimed that “good blood and bad nerves went hand in hand”, and who recited almost as many cases of male nervous prostration as female. In this era, at least, male hysteria was not only not hidden, it was ostentatiously paraded and examined.
But, Micale argues, and he marshals a good deal of evidence to support his case, that recognition was short-lived. In France in the Napoleonic age, in the England of the Regency and of Queen Victoria, and continuing through the 1860s, hysteria once more assumed its ancient identity as a female disorder, at least in medical circles. In literary circles, by contrast, he argues that there was a growing fascination with nervous vulnerability in men, and the male nervous invalid became a stock figure – a difference Micale attributes to the rise of a “masculinist” professional and scientific culture, and the identification of science with a rigorous reason that excluded the emotions, the passions and sensibility. The medical consensus was not quite unanimous – Micale discusses at some length the work of Robert Brundenell Carter in England and Pierre Briquet in Paris, both of whom acknowledged the existence of male hysteria. It was the subsequent efforts of Charcot, however, buttressed by his immense authority and professional power, that made the topic of the male hysteric a legitimate one. And then Micale makes a convoluted argument, relying on the Freud–Fliess correspondence, that masculine hysteria played a central role, perhaps the central role, in the birth of psychoanalysis (the published female cases notwithstanding), with Freud’s own hysteria, and that of a patient referred to in his correspondence as “Herr E.”, serving as the key provocation to the development of his new theories and therapy. “Freud”, Micale asserts, “didn’t just minimize the role of male hysteria in the origins of his psychology; he suppressed it.” This is all a bit reminiscent of Jeffrey Masson’s argument that Freud “really” continued to believe in the seduction theory, but suppressed the truth by manufacturing an account of hysteria that privileged fantasies, not real sexual traumas, as the root of the disorder. Micale similarly argues that, though Charcot’s discoveries about male hysteria were further extended by his followers, so that “Hysteria in the male sex, it would seem, had finally received its due”, the reality was quite different.
Instead, there emerged “a strong counter-current of resistance to the idea and the reality of masculine hysterical neurosis”. In the end, accepting the reality of male nervousness for these scientific types was simply too disturbing, too challenging to “the prevailing model of middle-class masculinity and the Victorian-Edwardian sex/gender system that it underpinned”. Hence a continuing history of “evasions, tensions, and contradictions” in the scientific literature, contrasting with a very different picture in the imaginative literature of the fin de siècle – the work of Proust, of Oscar Wilde, of Lytton Strachey, of the French “decadents”, and so forth.
For all their vaunted objectivity, Micale insists that the doctors remained essentially trapped in “the prison of gender”, a captivity from which only we, the now enlightened denizens of a post-gender-revolution society, have finally managed to escape: “In many Western cultures, a tremendous amount of observation that previously was excluded, repressed, or literally unthinkable has now become utterable . . . . The obstacles to masculine self-understanding have receded significantly, and in several cultural arenas men are exploring new kinds of discourse that can illuminate the past and present experience of masculinity”. We don’t worry any more, for instance, about the notion that a close attention by male doctors to adult men experiencing intimate emotional distress implies “an unacceptable homoerotic intimacy”. Nor do we worry that in accepting that hysteria is not just a female disorder we are also accepting that there are emotional and “feminine” components in the male psyche, for we have come to terms, as Freud did, with our bisexuality. “The masculine [has been] infiltrated by the feminine”; we have grasped “male hysteria’s considerable potential to deconstruct gender difference; and we have finally moved beyond a stultifying patriarchy”. So there you have it: history as a passage from darkness, superstition and evasion to the belated enlightenment of our own postmodern world.

Mark S. MicaleHYSTERICAL MENThe hidden history of male nervous illness 366pp. Harvard University Press. £19.95 (US $29.95).978 0 674 03166 1
Andrew Scull has written extensively on the history of psychiatry. His recent books include The Insanity of Place/The Place of Insanity, 2006, and Madhouse: A tragic tale of megalomania and modern medicine, 2007.