The history of a controversial ‘condition’

For centuries, doctors readily diagnosed women with “hysteria,” an alleged mental health condition that explained away any behaviors or symptoms that made men…uncomfortable.

A fondness of writing, symptoms of post-traumatic stress disorder or depression, and even infertility — for the best part of two centuries, all of these and more could easily fall under the umbrella of “female hysteria.”

Throughout the 18th and 19th centuries, female hysteria was one of the most commonly diagnosed “disorders.” But the mistaken notion that women are somehow predisposed to mental and behavioral conditions is much older than that.

In fact, the term hysteria originated in Ancient Greece. Hippocrates and Plato spoke of the womb, hystera, which they said tended to wander around the female body, causing an array of physical and mental conditions.

But what was female hysteria supposed to be, what were its symptoms, how did doctors “treat” it, and when did they cease to diagnose it as a medical condition?

These are some of the questions that we answer in this Curiosities of Medical History feature.

While the original notions of female hysteria extend far into the history of medicine and philosophy, this diagnostic became popular in the 18th century.

In 1748, French physician Joseph Raulin described hysteria as a “vaporous ailment” — affection vaporeuse in French — an illness spread through air pollution in large urban areas.

While Raulin noted that both men and women could contract hysteria, women were, according to him, more predisposed to this ailment because of their lazy and irritable nature.

In a treatise published in 1770–1773, another French physician, François Boissier de Sauvages de Lacroix, describes hysteria as something akin to emotional instability, “subject to sudden changes with great sensibility of the soul.”

Some of the hysteria symptoms that he named included: “a swollen abdomen, suffocating angina [chest pain] or dyspnea [shortness of breath], dysphagia [difficulty swallowing], […] cold extremities, tears and laughter, oscitation [yawning], pandiculation [stretching and yawning], delirium, a close and driving pulse, and abundant and clear urine.”

De Sauvages agreed with his predecessors that this condition primarily affected women, and that “men are only rarely hysterical.”

According to him, sexual deprivation was often the cause of female hysteria. To illustrate this, he presented the case study of a nun affected by hysteria, who became cured only when a well-wishing barber took it upon himself to pleasure her.

Another means of “treating” instances of hysteria was through mesmerism, an alleged psychosomatic therapy popularized by Franz Anton Mesmer, a German doctor who was active in 18th-century Europe.

Mesmer believed that living beings were influenced by magnetism, an invisible current that ran through animals and humans, and whose imbalances or fluctuations could lead to health disruptions.

Mesmer alleged that he could act on this magnetic undercurrent and cure humans of various maladies, including hysteria.

Throughout the 19th century and the beginning of the 20th century, there was perhaps even more talk of female hysteria and its potential causes.

Around the 1850s, American physician Silas Weir Mitchell, who had a special interest in hysteria, started promoting the “rest cure” as a “treatment” for this condition.

Rest cure involved lots of bed rest and strict avoidance of all physical and intellectual activity. Mitchell prescribed this treatment preferentially to women who he deemed as having hysteria.

By contrast, he would advise men with hysteria to engage in lots of outdoor exercise.

Mitchell famously prescribed the rest cure to the American writer Charlotte Perkins Gilman, who found the experience so harrowing that she wrote “The Yellow Wallpaper,” a psychological horror story that maps the slow psychological deterioration of a woman who is forced by her doctor, her husband, and her brother to follow this “treatment.”

In France, neuropsychiatrist Pierre Janet, who was most active between the 1880s and the early 1900s, argued that hysteria resulted from a person’s own warped perception of physical illness.

Janet wrote that hysteria was “a nervous disease” where “a dissociation of consciousness” took place, often characterized by symptoms such as somnambulism, the emergence of “double personalities,” and involuntary convulsions.

The founder of psychoanalysis, Sigmund Freud, also took an interest in hysteria, though his views on its causes fluctuate throughout his career.

He argued that hysteria was the conversion of psychological issues into physical symptoms, often with an element of erotic suppression.

At first, he suggested that symptoms of hysteria were caused by traumatic events, though later, he said that previous trauma was not necessary for hysteria to develop.

The 2011 rom-com Hysteria popularized the view that vibrators are tools meant to cure hysteria in female patients.

This story originates from an influential book of medical history: The Technology of Orgasm, by Rachel Maines, which first appeared in 1999.

Maines argued that, in the late 19th century, doctors would often treat female patients’ hysteria symptoms by manually stimulating their genitalia. According to her, the vibrator eventually emerged as a device that would save physicians some effort when treating their patients.

However, more recently, scholars argue that Maines’s perspective was inaccurate and that there was no evidence to support her theory.

The study paper that contradicts Maines’s theory states, “none of her English-language sources even mentions production of ‘paroxysms’ [a euphemism for orgasm] by massage or anything else that could remotely suggest an orgasm.”

Yet such stories and hypotheses emerged precisely because 19th-century medical treatises did emphasize the connection between female sexuality and hysteria.

Some 19th-century doctors infamously argued that problems within the genitalia could cause psychological problems in women — including hysteria.

For instance, Richard Maurice Bucke, a Canadian psychiatrist active in the late 19th century, opted to perform invasive surgery, such as hysterectomies — where doctors remove the uterus — to “cure” female patients of mental illnesses.

Therefore, for a long time, hysteria remained an umbrella term that included numerous and widely different symptoms, reinforcing harmful stereotypes about sex and gender.

While this “condition” is no longer recognized and started to “fall out of fashion” in the 20th century, this was actually a long and unsteady process.

The first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) of the American Psychiatric Association (APA) — published in 1952 — did not list hysteria as a mental health condition.

Yet it reappeared in the DSM-II in 1968, before the APA dropped it again in the DSM-III, in 1980.

Time and again, researchers of medical history point to evidence that hysteria was little more than a way to describe and pathologize “everything that men found mysterious or unmanageable in women.”

And while medical practices have evolved incomparably over the past couple of centuries, investigations still reveal that data about females are often scarce in medical studies.

In turn, this continues to impact whether they receive correct diagnoses and treatments, suggesting that society and medical research have a long way to go to ensure all demographics get the best chance at appropriate healthcare.

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