Hysteria and the Female Patient Today

Asti Hustvedt’s book Medical Muses: Hysteria in Nineteenth Century Paris focuses on the three women — Blanche, Augustine, and Genevieve — who together with neurologist and physician Jean-Martin Charcot represent an important moment in the history of hysteria.

The disease disturbs the border between social condition and medical disease, and the book poses questions about its causes, and the status of hysteria and women’s mental health today. During antiquity the disorder was attributed to the wandering womb, and in the Renaissance, to demonic possession. Medical Muses documents Charcot’s regime as director of the Salpetriere Clinic in Paris during the 1870s, and his attempts to legitimize the disease, to find a physiological source in the brain. But how much more legitimate were Charcot’s claims?

Charcot believed hysteria was an inherited neurological disorder — not a madness or malingering — and he searched for a brain lesion to explain the confounding symptoms. But his attempts to find a biological root of the bizarre behaviors, their fits and spasms, were unsuccessful. And some argue that Charcot induced the symptoms of his patients through hypnosis and a medical system in which the best, most reliably hysterical patients were rewarded with prestige and fame at the clinic.

This is a complicated picture of mental illness. With limited social power or control over their lives, the hysterics seized the roles Charcot prescribed for them. The hysterics were encouraged to reproduce and help determine the ideal hysterical profile, and they performed for crowds in Charcot’s amphitheater to not only students and doctors, but also members of the general public, including actors, artists, politicians, visiting royalty, and other members of high society. Hustvedt calls these patients the “aristocracy of the hospital” who collaborated in what was an iatrogenic condition, “forged between patient and doctor.”

But, Hustvedt explains, Charcot refused to write off the women’s illness as purely a consequence of suggestion, or say that their suffering was not real. On her deathbed, Blanche looked back over her career as a celebrity hysteric and insisted that every aspect was genuine. When she was asked whether the hysterical attacks were simulated, she answered, “Simulation!  Do you think it was easy to fool Monsieur Charcot? Oh yes, there were certainly some jokers who tried! He would look them straight in the eye and say, ‘Be Still.'”

Charcot’s proposed biological model and its ultimate failure suggested a new path. The black box of the mind he left behind became Freud’s unconscious. At the end of his career Charcot wrote “The Faith Cure,” admitting that the mind could extend its influence on physiology. Hustvedt suggests that if Charcot was pre-Freud, then we are living in a post-Freudian era, one in which we similarly cling to medical causes to explain and legitimize suffering. Perhaps again we have reached a point for re-evaluation of the medical model, and appreciation for the mysteries of that black box of the mind.

Hustvedt calls hysteria “that bizarre rupture between symptom and source.” For Hustvedt, the stories of Blanche, Augustine, and Genevieve resonate with those of women today whose physical symptoms cannot be accounted for — and the proliferation of diseases like chronic fatigue syndrome, or fibromyalgia, or borderline personality disorder. The hysteric today still announces herself, or himself, through the symptom that cannot be accounted for, the symptom that destabilizes the dominant scientific discourse. The stories of the Medical Muses speak to the breakdown that is present when there is an incomprehension of the reality of particular subjectivity, or an interpersonal dynamic that cannot be spoken of.

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