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'The disease category "hysteria" is as old as man -- or, rather, as woman', notes Mark S. Micale at the beginning of his provocative and fascinating study, Hysterical Men (p. 5). His book is devoted to an exploration of the hidden, masculine history of this 'most gendered' disorder -- its intrinsic connection with the female body advertised in its very name, hysteria, the condition of the restless womb.
The history of male hysteria is a history of absences: the absence of male equivalents to female disorders, the absence of female voices in the narratives woven around those disorders, the absence of the terminology to describe and legitimize the application of a condition associated with weakness, emotionality and madness to the male constitution. That hidden history, Micale argues, can now be uncovered, and needs to be uncovered as part of the continuing process of questioning received versions of masculinity and exploring masculine self-understanding, both historically and as contemporary individuals.
The history of nineteenth-century psychiatric and psychological medicine is a dense, controversial and highly complex field, but Micale is a master of his subject and this is a book that wears its learning lightly. Through five chapters, plus prologue and conclusion, Micale both defines his topic and explores it with enviable focus, concision, and an admirable lucidity and elegance of prose.
The intellectual territory to be explored and the key issues to be illuminated are mapped out at the beginning: the gendered nature of hysteria as the feminine malady, the hidden histories of masculine nervous disorder, the professional and intellectual currents within nineteenth-century medicine and wider society that shaped the discourse of hysteria and legitimized some discussions while outlawing others. The central issue, Micale points out, is that male hysteria is present despite this cultured non-recognition, in texts from the Renaissance onwards, in a widespread preoccupation with nervous symptoms, melancholia, debilitating ailments of various kinds, and in the personal ailments of figures from Charles Darwin to William James. The history of this masculine malady, Micale observes, is to be found largely in non-medical sources: letters, memoirs, novels and autobiographies. Only in strictly medical terms is it a 'hidden' history.
The title of the first chapter 'Hysterick Women and Hypochondriack Men', emphasizes the gendered channelling of discourse that has applied to this disorder, in a process Micale traces from the ancient classical world to the seventeenth and eighteenth centuries. The key point to emerge is that male hysteria was accepted in British medical literature for a century after the 1680s, in what Micale calls 'a sort of pre-psychiatric discourse on male hysteria' (pp. 46-7). The next chapter, 'The Great Victorian Eclipse', recounts the ways in which this disease was written out of medicine as part of a process of maintaining a system of difference between the sexes in biomedical knowledge. There was a political element to this process, with Micale relating the imposition of newly rigid regimes of gender difference to a wider cultural-political backlash against the late eighteenth century revolutions that had produced not only political but also social upheaval. Femininity is increasingly narrated as home-centred and passive, cyclical and inherently unstable, as against the outward-looking, active, purposive, stable characterization of masculinity. Micale is surely right in connecting medical conservatism with such wider reactionary currents, but does not perhaps pay enough attention to a parallel development that was of great significance, the increasing professionalization of medicine and the focusing of institutionalized medical power in relatively few -- inevitably male -- hands.
The three subsequent chapters move between case studies and broader socio-cultural explorations. The careers of Jean-Marie Charcot and Sigmund Freud are considered in detail on either side of a much more widely-drawn consideration of 'Male Hysteria at the Fin de Siecle'. This works well in a chronological sense, but does lead to a certain amount of recapitulation. The examination of the significance of the 'dark side' of fin-de-siecle modernity, anxieties of degeneration and decline, is generally well-balanced but does not make the important point that such concerns were never universal. The school of habitual optimism thrived in late-nineteenth and early-twentieth century medicine, but it still awaits its historian.
As might be expected from Micale's extensive previous work on hysteria, his analyses of Freud and Charcot in this book are perceptive, well-informed and well-argued, and throw new light on his subjects. In the case of Charcot, the French physician who pioneered the study of male hysteria in the 1880s just as he had established a new paradigm for investigating female hysteria in the 1870s, Micale argues that his significance is to be found in his fundamentally neurological approach to hysteria. Charcot removed the emotionalizing, sexualizing interpretations of the disorder and focused on locating the physical behaviors that characterized hysteria in the male body, freeing them from their dependence on what were seen as essentially feminine pathologies. The diagnosis of hysteria was thus in one sense liberated, but in another sense it was newly restricted by the class-based nature of Charcot's work. His new model of hysteria was applied overwhelmingly to the working-class patients who came to his hospital. He maintained the distance of difference in social, if not in gender, terms. Freud's engagement with hysteria was marked by profound fascination with the dynamic potential of the conceptions of the psychosexual that lay behind the disorder, but an ambivalence about the social consequences of his insights; not least, he excluded male patients from his published work on hysteria. Micale finds the roots both of Freud's insights and his ambivalence in the very personal significance of his attachment to Wilhelm Fliess -- an attachment which became the unspoken leitmotif of his conceptualization of male hysteria as an expression of repressed homosexual neurosis.
This book opens up an area of medical history where much remains to be done. All future investigators of the topic will owe Mark Micale a great debt of gratitude for the clarity and thoughtfulness with which he has investigated and illuminated the hidden history of male hysteria. The implications of the uncovering of the characteristics that have been seen as essentially female in men remain, he suggests, as controversial and important today as they were at the time of Charcot and Freud. Today the environment within which gender is viewed and discussed has been, he observes, 'fundamentally altered' by the social, cultural and political movements which have transformed Western culture since the middle of the last century. Yet the feminization of masculinity and the turning of the male gaze inwards, the inner acceptance of 'otherness' which that requires, remain difficult and, for many, unacceptable notions. The story which Micale tells so fascinatingly in this book remains an unfinished one.
© 2009 Ralph Harrington
Ralph Harrington, Ph.D. is a historian who has researched, lectured and published on medical history and the history of trauma, among other topics. His web site is at http://www.greycat.org