Women, medics, and madness

How "hysteria" described a different kind of female malady

Sep 20, 2024

Hi all, and welcome back to rumblewrites. This post is essentially a summary of my undergraduate dissertation, in which I compared literary and medical approaches to ‘hysteria’ at the turn of the 19th century. There’s a lot I could say on this topic, but I’ve done my best to distil it into one article!

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This article will focus on late 18th century Britain, in a time before universal standards of care and diagnostic requirements. It was a period marked by experimentation, in which newly established asylums operated on a largely independent basis and thus their rules and conditions varied greatly. But it also saw a rise in sensibility, and along with it, a new scientific authority given to diagnoses like “hysteria”.

Male physicians on the female body

What was medical “hysteria”?

In a medical sense, “hysteria” has its origins in Ancient Greece, when it was associated with the humours and a wandering womb. Unsurprisingly, this definition remained unchallenged, and so persisted into the early modern era. Some physicians even claimed that its link to the female reproductive system meant that women could pass their hysteria onto an unborn child:

Johnstone, John, Medical jurisprudence: on madness (1800), p9. Source: The Wellcome Collection

Despite this, the aetiology of the condition came under scrutiny in this period and by 1800, it was increasingly viewed as a disorder of the nerves. Women were regarded as more susceptible to the hysterical condition as a result of the:

Rowley, William, A treatise on female nervous hysterical, hypochondriacal, bilious, convulsive diseases: apoplexy and palsy; with thoughts on madness, suicide, etc., in which the principal disorders are explained from anatomical facts, and the treatment formed on several new principles (1788), p56. Source: The Wellcome Collection

This created a link between the physical structure of the female body and their minds, implying that inherent weakness in one was evidence of inherent weakness in the other. This therefore gave new scientific authority to the traditional idea that women were inferior to men.

Symptoms of hysteria

Rowley, William, A treatise on female nervous hysterical, hypochondriacal, bilious, convulsive diseases (1788), p52. Source: The Wellcome Collection

Whytt, Robert, Observations on the nature, causes, and cure, of those disorders, which have been commonly called nervous, hypochondriac, or hysteric. To which are prefixed, some remarks on the sympathy of the nerves (1765), p102, Source: The Wellcome Collection

Suggested treatment

Perfect, William, Cases of insanity, the epilepsy, hypochondriacal affection, hysteric passion, and nervous disorders, successfully treated (c.1780), p80. Source: The Wellcome Collection

Whytt, Robert, Observations on the nature, causes, and cure, of those disorders, which have been commonly called nervous, hypochondriac, or hysteric (1765), p443. Source: The Wellcome Collection

These sources provide fascinating insights into how physicians viewed and treated hysteria at the end of the 18th century. However, there was little consensus in their reports, and Heather Meek argues that “hysteria” became a ‘productively malleable term’ during this period [Meek, ‘Medical Discourse’, p186]. It was used to mean whatever the male physician wanted it to. This argument is supported by asylum records at the time, which were dominated by single and menopausal women. “Hysteria” was therefore not necessarily viewed as a condition requiring treatment, but as a medical means of incarcerating society’s unwanted women.

The female perspective

The same sensibility which gripped the medical world inspired a similar interest in hysteria among women. Barred from practicing as physicians, they instead explored this condition through fiction. Namely, Gothic fiction.

The Gothic genre emerged at the end of the 18th century in response to the social and political changes of the period. Its unsettling storylines and vivid imagery were criticised for their seductive powers and were even viewed as contributing to the overactive imagination and anti-social behaviour of their (mostly female) readers. However, writers of Gothic fiction sought to reverse this narrative, instead using their novels to present hysterical behaviour in women as a result of their patriarchal oppression.

Ann Radcliffe’s The Romance of the Forest [1791]

The heroine of Radcliffe’s work, Adeline, is a perfect representation of the 18th century hysteric. She is an unwanted woman who is affected by irrational desires and an overactive imagination. However, it is not until she stays at a deserted Abbey that these symptoms really take hold. For it is here that she meets the Marquis, who constantly and aggressively expresses his desire to wed her. Adeline flees, suffering from ‘feverish symptoms’ and later sinking ‘into a state of stupefaction’ [full text here].

Interestingly, the novel ends on a positive note: Adeline marries Theodore, a man she seems to genuinely love. I think this is a great ending as it emphasises that Adeline was not rebelling against marriage itself, and therefore not trying to subvert social norms. Rather, her hysterical symptoms were caused by the Marquis and the patriarchal power dynamic he was attempting to trap her in.

Mary Wollstonecraft’s Maria, Or the Wrongs of Woman (1798)

Like Adeline, the heroine of Wollstonecraft’s novel, Maria, suffers from symptoms which are typical of hysteria: she is anxious, paranoid, and plagued by insomnia: ‘so accustomed was I to pursuit and alarm, that I seldom closed my eyes without being haunted by Mr. Venables’ image […] I woke, in violent fits of trembling anxiety, to assure myself that it was all a dream’ [full text here].

She is ‘haunted’ by the image of Mr. Venables, her husband, who is revealed to be an absent, abusive, and uncaring man. He is a heavy drinker, excessive gambler, and is completely disregarding of Maria. He disposes of her in an asylum at the start of the novel, ripping her away from her child and worsening her symptoms.

Maria is the novelistic sequel to Wollstonecraft’s political pamphlet: A Vindication of the Rights of Woman produced in 1792. The novel is therefore more overtly political in nature and furthers her argument that marriage as a legal union was detrimental to the social position and mental wellbeing of women. Maria’s sufferings are a direct result of her husband’s behaviour. Not only this, but it was also because of her marital status that Mr. Venables was able to institutionalise her: as she was his legal property. In this way, the asylum emerges as a physical symbol of female imprisonment by the hands of her patriarchal oppressors.

St Luke’s Hospital, Cripplegate, London: the interior of the woman’s ward, with many inmates and a member of staff. Coloured aquatint by J. C. Stadler after A. C. Pugin and T. Rowlandson (1809). Source: Wellcome Collection

Concluding remarks

I’m siding with the women on this one: “hysteria” was a uniquely female malady, but one which manifested itself socially, not biologically.

Unfortunately, women continue to suffer from a lack of research, representation, and care in the medical world:

Diagnosis quality and time. The waiting time for an endometriosis diagnosis has reached 9 years in the UK [ref]. Women with dementia receive worse medical treatment than men with the same condition [ref].
Lack of research and testing. Only 1% of healthcare research and innovation is invested in female-specific conditions beyond oncology [ref]. Women are up to 3x more likely to suffer whiplash injuries when in a car accident due to crash test dummies being based on the male physique (before 2022) [ref]. Women are overmedicated as drug testing is commonly restricted to men [ref].
The pain gap [ref]. Women who are in acute pain are less likely to be given opioid painkillers than men [ref], and they are half as likely to receive painkillers after surgery [ref]. Women are 50% more likely to be misdiagnosed following a heart attack [ref].
We have to prove that it’s not all in our head - our symptoms really are that bad. We have to prove that taking the birth control pill or a nice bath won’t solve our chronic pain. We have to prove that this is still a real issue. [anecdotes: ref, ref]

And outdated, gendered terminology like ‘hysteria’ continue to be used as a means of oppressing women socially:

In 2018, Republican Senator Benjamin Sasse used the word ‘hysteria’ 3 times in reference to women who disputed Brett Kavanaugh’s nomination to the Supreme Court, citing their fear of losing abortion rights as irrational [ref]. Of course, when this fear was proven to be justified, it was their reaction that was then classed as ‘hysterical’ [ref]. This is gaslighting, and as argued by Dahlia Lithwick, cases of ‘hysterical’ overreactions by women are usually warning signs [ref].
Earlier this year, Former Trump White House attorney Ty Cobb criticized Supreme Court Justice Sonia Sotomayor’s dissent on the high court’s presidential immunity ruling, saying: ‘I thought her dissent was a little hysterical, and it really offered no analysis, a lot of…screaming, no analysis, and I think that was unfortunate,’ [ref].

It is incredibly sad that the same issues which plagued the medical world in the 18th century continue to affect half the world’s population today. And this section barely scratches the surface: think about the combined gender and racial inequality faced by women of colour. The discrimination against disabled people. More feminine-presenting people. Lower-class women who can’t afford to skip the queue. Women living in 3rd-world countries.