Sabine Arnaud - On Hysteria: The Invention of a Medical Category between 1670 and 1820

The words hysteria and hysteric have become entrenched in todays everyday discourse, immediately calling to mind spectacular manifestations such as convulsions, cries, tears, excessive laughter, and catalepsy. Over the centuries, these words have been used to name an exacerbated body, untimely joy, imminent twitches, the vertigo of desire. Identified with sublime lan or derisory gestures, they alternately provoke fascination and condescension and seem destined to inhabit a world of fiction. In the web of images, disheveled women and artists yearning for spectacle cohabit with mystics in search of transcendence and those distraught by mirage. A whole gamut of oppositions emerges: the private and the public, the intimate and the social, the interior and the codified, the singular and the epidemic, the expressive and the pathological, susceptibility and alienation.

The category of hysteria has a long history in Europe,the pathology among the aristocracy and people of letters. Descriptions of hysteric disorders pervaded novels, plays, pamphlets, and correspondence. The diagnosis of hysteria was even used to describe political life, including the crises of the Convulsionaries and the revolutionaries. By 1820, when this books journey ends, the term hysteria had taken firm hold, with two approaches predominating. One determined hysteria as a womans pathology originating in the genital organs and sexuality; the other, rarer approach situated its origin within the brain. It would take all the skill of psychoanalysis to reorient this first dissemination of explanations and replace them with a model of a transfer neurosis provoked by repressed conflicts.

Over the last twenty years, despite impressive developments in the medical humanities, the exchange between medical practitioners and those who attempt to think about medical practices from the outside has remained problematic, with conflicts of authority only aggravating the debate. Indeed, if ever a topic was destined to instigate such quarrels, it is hysteria as it was constructed in the 1970s. The aim of this book is to displace such frameworks for hysteria. Hysteria is not viewed here as a symbol of masculine oppression; neither is the point to posit a historical progression making Mesmer and Puysgur forerunners of psychoanalysis. This book does not examine efforts made to cure hysteria, or otherwise attempt to explain hysteria from the viewpoint of the history of medical knowledge. Instead, it examines the history of a category in order to trace the ways that enunciations of medical knowledge operated between 1670 and 1820. In short, hysteria is studied not as an illness, but as an example.

My aim here is to lay out a series of discursive practices that played a major role in the pathologys construction. Because its fits and names were so varied, and because doctors constructed it as a pathology particularly difficult to define, studying hysteria allows us to explore a wide range of issues: (1) It offers a prime opportunity to isolate the role played by language in the definition of any medical category, because of the importance of rhetoric, references, citations, and misunderstandings in its construction. (2) It enables attention to a whole spectrum of written medical genresdialogue, autobiography, correspondence, narrative, polemicthat have been forgotten by a history of medicine interested in the nineteenth-century pursuit of objectivity. That interest has led historians readings of the eighteenth century to prioritize what would be retained in later conceptualizations of knowledge: nosologies and the identification of symptoms at the patients bedside. In contrast, this book reads the eighteenth century in the broad scope of its pursuits, keeping in mind that priorities constantly change with time. (The contemporary renewal of interest in the autobiographical narratives of patients and doctors illustrates this point.) (3) Hysteria became a category in a century marked by the coining of categories (as a result of the ambitious enterprises of Linnaeus and Sauvages, among others). As such, it exemplifies a larger movement, moving from a dozen names to just one and, along with these shifting appellations, between different understandings and definitions of the sick body. (4) The category of hysteria underwent reversals in line with political and religious history that no other category did at the time, opening up our view onto the close connections between epistemology and politics. (5) Hysteria was pictured as a pathology resulting from emerging modernity, so that men of letters, and not only doctors, accorded it great importanceanother reason for the categorys success. Before and after the French Revolution, many such writers used the pathology to frame an understanding of their time. (6) The conceptualization of hysteria was the scene of a reciprocal construction of sexual difference and a pathology. (7) Finally, the category of hysteria was an ideal means for doctors to draw close to the aristocracy and thereby try to carve out a place for themselves in relation to the higher class. The other important categories at the time, such as plague or venereal disease, lent themselves far less easily to this task. If smallpox was also a subject of literary medical writings, it did not provide a link with sensibility, and thus limited the debate to the value of therapeutic invention and its scientific purpose. Writings on hysteria, in contrast, opened up a constellation of imaginings, caricatures, medical truths, and tools for the building of knowledge that spanned all the discrepancies of observations and references.