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HysteriaReview - Hysteria
The Biography
by Andrew Scull
Oxford University Press, 2009
Review by Ralph Harrington, Ph.D.
Feb 1st 2011 (Volume 15, Issue 5)

Hysteria, as far as modern medicine goes, has experienced a dramatic and almost total fall from grace. From the middle of the nineteenth century and well into the twentieth, hysterics crowded nerve-doctors' waiting rooms, papers on hysteria filled medical journals and enthralled medical conferences, and extraordinary hysterical conditions formed the foundations of the careers of doctors and patients alike. Now it seems that hysteria has become medically invisible, it is nowhere to be found: it has become purely historical, and it is left to historians to pursue its shade. So marginalized has hysteria become that Andrew Scull is able to end his Hysteria: The Biography, by wondering whether hysterics have become 'modern medicine's untouchables'.

Diseases, as the title of the Oxford University Press series of which Scull's volume forms a part, 'Biographies of Disease', implies, have their own life stories: they are born, they go through great change, they adapt, they sicken, and they die. The dominant factors in that process are often to be found not within the body of the sufferer but outside it, in the society and culture of which the body and the disease are a part. To put it another way, a disease inhabits a social and collective, as well as a physical and individual, body. Medicine is a reflection of society, its preoccupations, ideologies, fashions; and hysteria, that most mutable of diseases, a disease that can mimic anything and mean anything, has for much of its history been the ultimate in fashionable diseases. Perhaps its apparent disappearance since the 1960s reflects, not its final extinction, but rather its most recent transformation. Once there were hundreds of hysterical neuroses, addressed by interventions ranging from the electrical to the conversational; now there are thousands of psycho-pathological conditions, and pills are the almost-universal intervention. The real nature of the disorders involved, however, remains as mercurial and obscure today as it was for any eighteenth-century sufferer from the 'English malady', nineteenth-century neurasthenic or twentieth-century psychoneurotic. Hysteria, the ultimate shape-shifter, has changed its form again: we are all hysterics now.

As the medical profession has moved out, the historical profession has moved in, and hysteria has been thoroughly poked, probed and peered at over the last four decades or so by historians of every inclination from neo-Freudian to post-modern; not only historians of medicine but social, cultural and legal historians as well. Most recently a group of scholars occasionally referred to in moments of weakness as the 'new hysterians', have sought to ground our understanding of hysteria in the societies and cultures that exhibited the condition, rather than recruiting hysteria's histories into the history of a psychodynamic revolution that freed modern medicine from the somatic straitjacket worn by the doctors of other eras. The result has been a historical conception of the condition as fluid and multiform as the medical conception ever was: hysteria has been studied over the past few years for what it tells us -- about gender, class, culture, etc. -- rather than for what it may have been, and in that process there has been a certain loss of focus on the phenomenon of hysteria itself.

Andrew Scull's invaluable book restores that focus, by placing the patient at the centre of his narrative. The decline of hysteria as a medically-recognized disease, he points out, was as much a result of patients no longer presenting themselves in such numbers as formerly with 'hysterical' conditions as it was the outcome of changes in medical nosology and diagnosis. Underlying this argument is a recognition of one of the obscurer, but none the less vital, questions in medical history: the perception of disease by sufferers. Emphasis on how medical science categorized disease and how the medical profession responded to it and treated it has crowded out the issue of how sufferers saw their conditions and the ways in which they exercised ownership of them. Hysteria, Scull points out, achieved respectability in the eighteenth century when both patients and doctors saw it as attractive. The diagnosis was good for doctors and patients, and was in effect a compliment paid to society by its own members: 'Here, indeed, was an extraordinarily attractive patient population, blessed with excessively refined sensibilities and exquisitely civilized temperaments (not to mention money).' To be counted in such an elite group was itself a compliment -- as long as it was clear that the condition complained of was real, and not a mere fancy rooted in a disturbed mind rather than a diseased body. 'Such patients desperately want a neurological diagnosis', writes Scull of contemporary M.E. sufferers: 'That diagnosis will validate the reality of their disorder, and legitimize their suffering'. This question runs through the history of hysteria from the beginning: women with 'the vapours', overworked American businessmen with 'nervous exhaustion', railway accident survivors with 'railway spine', all need validation, and for the best part of two centuries nerve doctors provided that validation. Today, if everyone is hysterical, no-one now wants to be called hysterical. This is but the latest bout in what Scull depicts as a three-cornered tussle between doctors, diagnosis, and the diagnosed (or mis-diagnosed).

Hysteria is a messy disorder with a messy history, but Andrew Scull has produced a neat and well-structured book, written in a lively and stimulating style. It is much more than a superior work of historical synthesis. Scull expertly traces the story of hysteria as concept, diagnosis, cultural expression and lived experience, from the sixteenth century to the twenty-first, and sheds new light and offers new insights throughout. As an introduction to the turbulent and contested history of this most mutable but strangely enduring of disorders, Scull's book could not be bettered.

 

© 2011 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://harringtonmiscellany.wordpress.com/


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