Model Text Research Essay: “The Hysterical Woman”

The Hysterical Woman^[1]

Hysteria was a medical recognition dating back to 1900 BC, diagnosed by physicians liberally until recent times. The term Hysteria comes from the Greek word “Hystera,” which literally translates into “uterus.” The diagnosis and treatment of Hysteria were routine for hundreds of years in Western Europe and the United States, mainly for keeping women in line. Symptoms that indicated Hysteria were broad and all encompassing: nervousness, sexual desire, faintness, insomnia, irritability, loss of appetite, depression, heaviness in abdomen, etc. The number of diagnosed cases of Hysteria slowed as medical advancements proceeded, and in the early 1960’s (coinciding with the popularization of feminism) the “disease” ceased to be considered a true medical disorder. In modern medicine, the treatment and diagnosis of female medical issues continues to be vague and potentially harmful due to lack of knowledge. Does the concept of female Hysteria have continuity today? Although the vocabulary has changed, it is clear that the practice of ignoring serious medical ailments based on sex remains prominent in the world of medicine, and contributes to the continuation of harmful gender stereotypes.

The beginnings of Hysteria can be followed back to ancient Egypt, around 1900 BC, when a “misplaced womb” was commonly thought to be the cause of the disease. Plato later expanded on this concept around 500 BC with his explanation of the womb as a living creature that sought to disrupt biological processes, impede breathing, limit emotional regulation, and cause disease (Adair). While Plato agreed with the prevailing theories of the time in regard to the effect of Hysteria, his ideas differed slightly on the cause. It was taken as fact that Hysteria was due to a hormonal imbalance within the female body, causing those afflicted to act out irrationally, or fall into a fit of anger. Plato, however, introduced the idea that Hysteria was due to a “moving psychological force, which arises from the womb: sexual desire perverted by frustration” (Adair). It is important to note that his theory, more insightful than anything that had been proposed before, would be opposed by physicians and commentators for nearly two thousand years following. A more sophisticated and medically forward concept of a psychiatric rather than physical affliction would not be seen for years to come.

The time and place that Hysteria saw its highest peak in relevance was around 1800-1900 in Western countries. Where Hysteria was previously diagnosed to females who “acted out” or showed signs of irritability, the diagnoses were given out for less specific symptoms in the 1800s. The women who attempted to deviate from the domestic standards of their gender, those who were depressed, and those who were irritable were now also labeled as “hysterical” (Culp-Ressler). Perhaps not so coincidentally was the simultaneous increase in frequency of Hysteria diagnoses and rise in popularity of Freudian psychoanalysis (Scull). This is necessary to consider because Freud himself placed a great deal of importance on gender roles and normative societal behavior of the sexes. It should then come as no surprise that both the stigma for being diagnosed with Hysteria, as well as the treatments and “cures” for the disease, were sexist during this time.

Women labeled “hysterical” in the 1800s and 1900s were placed in insane asylums, given the Rest Cure, and in some extreme cases given hysterectomies (Culp-Ressler). The main goal of the Rest Cure treatment was to confine women in rooms that were not distracting, over-feed them with the goal of weight gain, and allow them no visitors in order to limit their “stressors” and revive them back to their normal temperaments. An article published within the American Journal of Nursing in 1936 describes the daily life of a Rest Cure patient: “I’m having a rest cure and I can’t see anybody … and all I have to do is eat and sleep and not worry about anything. Just rest … and that’s just what I’m doing. I may not look it but that’s just what I’m doing” (“The Rest Cure” 451). The article is just one of many accounts, fictional and otherwise, that provide a look into how women that were labeled “hysterical” were treated. It was believed that if women were able to limit their stressful tasks that they would be likely to remain delicate, proper, and feminine—desirable traits in a Victorian wife and mother. John Harvey Kellogg’s book titled Ladies’ Guide in Health and Disease: Girlhood, Maidenhood, Wifehood, Motherhood was a common source on explaining to women the necessary steps they ought to take in order to lead healthy, childbearing lives. On the topic of Hysteria, Kellogg notes that the common causes are “sexual excess, novel reading, perverted habits of thought, and idleness” (586). As Kellogg mentions that the disease is one of “morality”, he further shames women into lives free of hard work and free thinking. Charlotte Perkins Gilman, author of “The Yellow Wallpaper” (a fictional tell-all of her experience with the Rest Cure), once wrote a letter detailing the lifestyle she was told to lead in order to keep her unruly nerves at bay. She was given advice to “live as domestic a life as far as possible”, to “have but two hours’ intellectual life a day”, and “never touch pen, brush, or pencil again” as long as she lived (Gilman). As gender norms went unquestioned in the Victorian era, as did the sexism visible in the medical world.

Due to Hysteria’s feminine association, it was further deemed shameful and embarrassing. This stereotype was promoted after the Second World War, when many soldiers returning home from battle were diagnosed with nervous diseases, most specifically Hysteria (Scull). Due to nervous diseases being seen as feminine afflictions of the imagination, these men received little to no treatment—similar to females diagnosed with Hysteria. These men were seen as cowardly and inferior for a malady that today would be easily recognizable as post-traumatic stress disorder. While the patients were male, they were seen as contracting a feminine disease that was “made up in the mind” (Scull), therefore hindering the help that they needed. The lack of attention shown to these soldiers reinforces the idea of a bias that exists with illnesses that are associated with women.

During the 1960s and 1970s, feminist writers were quick to isolate Hysteria’s literal definition in order to successfully convey criticisms of Freud’s psychoanalytic treatments of the “disease” (“Brought”). Women of this age began to critique the healthcare system, and were able to expose the effect of sexism in medicine. Because of fervent denunciations, the term slowly fell out of medical use but remained a common phrase in day-to-day conversations. Hysteria was officially removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 (Culp-Ressler), and is now considered a derogatory term. Many physicians and psychologists attempted to continue the diagnosis of the disease, but under new, more socially acceptable terms. Freud himself claimed to change focus to one’s “sexual conflicts” within (Scull), and the effects. He then created a way of disguising old ideas of Hysteria behind fresh words. This trend carries on today despite opportunities to change the culture.

One of the more surprising turns in the history of Hysteria as a concept, is the reclamation of the word by 1990s feminists. In striking contrast to the views held by progressive women of the ‘60s, ‘70s, and ‘80s, some ‘90s women sought to recover and take ownership of the inherently feminine rights of Hysteria. Elaine Showalter, an author of the 90s on the topics of Hysteria, gender, and feminism, claims that “for some writers, Hysteria has been claimed as the first step on the road to feminism, a specifically feminine pathology that speaks to and against the patriarchy” (286). Interestingly, prior to this time, Hysteria was dubbed a tool of the patriarchy and that notion held true amongst feminists. This insight from Showalter addresses the lengths that sexism can reach. Internalization of patriarchal views on sex is a common effect, especially with views that are enforced blindly without question. The concept of an irrational woman, or a woman possessed by emotion rang true for some women of the ‘90s, but they saw this falsehood as something to be proud of, and something to aspire to. In their attempts to argue the reclamation of Hysteria, they succumb to the long-enforced stereotypes that many fought to destroy. While emotion, passion, and vulnerability aren’t necessarily traits to be ashamed of, they were used through the trustful relationship of physicians as a tool to suppress the social, economic, and personal growth of women through the diagnoses of nervous diseases.

Stereotypes of the feminine gender have made their way into modern medicine as well. As women are socialized from birth to be passive and to respect authority, more specifically male authority, it is uncommon for a woman to resist the diagnosis received from a physician. Typically, if a woman is told that she is a hypochondriac, or that her symptoms are psychosomatic (all in her head), she will most likely internalize the notion that she is imagining all of her issues. The term “psychosomatic” is a cover-all diagnosis commonly used by physicians to attribute to any symptoms that cannot be explained. As a result, many women continue suffering through treatable and preventable diseases because they are fearful of being told that they are overreacting (Culp-Ressler). This demonstrates that even within ourselves, women fear falling into the feminine gender stereotypes of irrational and excessive behavior—internalized misogyny presents itself here.

From this, we must ask why do we, as individuals and as a society, not trust women to know their own bodies? We see this in cases ranging from the extreme to the everyday—from the treatment of rape survivors to a typical visit to the doctor’s office. Aside from flaws in women’s reproductive health care, there is also a well-documented gap in the treatment of pain between men and women. Of the 25% of Americans suffering from chronic pain, women make up a disproportionate majority (Edwards). Not only are women more likely to suffer from chronic pain, but that pain is more likely to be categorized as “emotional,” “psychogenic,” or “not real”. Women are also less likely than men to receive aggressive treatment after being diagnosed with autoimmune diseases that cause chronic pain (Edwards). Multiple studies have found that women are far less likely to receive any kind of medical intervention to manage pain (Culp-Ressler). Why? Pain is self-reported and subjective, and treatment of pain fully relies on the idea that a physician trusts the patient reporting symptoms. However, trusting a woman to be a reliable source on her own body is still not the norm. This practice contributes to the long-standing cycle of attributing women’s pain to mental disorders, thus reinforcing the stereotype of the Hysterical Woman.

While many medical professionals would agree that there needs to be a shift in how we look at both the gender and sex dynamics of healthcare, there is little being done about it. Clinical trials are just one example. Women make up roughly half of the country’s population, but an astonishing majority of participants in clinical trials within the United States are men. According to the Journal of Women’s Health, in 2004, women made up less than 25% of all patients enrolled in clinical trials for that year (Moyer). The reasoning for this is that women present a less uniform sample population: they have menstrual cycles and hormones, making results more difficult to analyze. However, this does not eradicate the need for personalized care being available to women. This bias is decades-old, and leads doctors to preferentially study diseases and test drugs in male participants. A bias this prominent is a serious health risk for women, limits the reach of our preventative care and hinders growth of scientific knowledge. Another struggle presenting itself is the unwillingness of medical professionals to make use of what little sex-specific data has been found. For example, despite well-recognized sex differences in coronary heart disease management in critical care units, the guidelines for management are not sex-specific (Holdcroft). Unfortunately, guidelines rarely state that evidence has been mainly obtained from men; disregarding this information perpetuates inequality in treatment of disease and distribution of medication.

The limited scope of our current knowledge on gender/sex differences can be observed in newly discovered differences in disease symptoms, as well as the continuing decrease of the life expectancy gap. Biased medical research and practice focuses on gender differences, and therefore risks overlooking similarities. For example, coronary heart disease was once perceived as strictly affecting males; therefore, less research and attention was given to the possibility of women contracting the disease (Annandale). Now, perhaps as a result, coronary heart disease kills more women than men. Women in the 1960s and 70s lived markedly longer than men, but in recent years the gap has decreased (Ibid.), and shrunken more than one third since the early 80s.The exact cause of the decline in the gender life expectancy gap cannot be pinpointed due to a number of confounding variables. The increase in women working to retirement and the added stress of contributing financially as well as taking full responsibility of children are just a few. One widely debated cause of the gap decrease is the fact that the quality of men’s healthcare is surpassing that of women’s. The standard of disregarding women from clinical trials creates an unhealthy environment of willful ignorance on the topic of women’s healthcare due to stereotypes, and the effects are measurable.

With the sex-biased culture of medicine so ingrained into its academia and practice, the task of eradicating it seems all the more important. This becomes more true as a greater percent of the population becomes aware of gender stereotypes and the harm that they cause. Unfortunately, due to fear of being labeled a hypochondriac, or neurotic, women refrain from telling their medical experiences and demanding quality care. With a majority of women experiencing patriarchal authority during doctor visits, and many women sharing similar stories of struggling with a lack of accurate diagnosis, it’s a shame that this topic isn’t discussed on a broad scope. If experiences were documented, it would be a faster way to make society more aware of this specific branch of inequality and how it contributes to negative gender stereotypes.

A practical way of accomplishing this would be to implement changes into the medical school curricula. We should seize the opportunity to implement the best practices for healthcare regardless of gender identification, as well as to establish evidence-based guidance that focuses on both gender and sex differences. Informing future physicians that it is not in the best interest of the patient to quickly jump to the conclusion that their symptoms are psychosomatic, or to share stories of specific experiences would eventually trickle down into the medical culture. Informing these students that it is within the realm of possibility that these women might be presenting symptoms to an affliction that is not well understood, even by modern medicine. The exercise of attributing the valid symptoms of women to mental disorders has been commonplace for centuries—Hysteria, Conversion, etc. While the name continues to change, the meanings behind them stay the same, and women continue to be subjected to sexism, and low-quality healthcare as a result. Acknowledging the bias within is the first and most important step to moving forward and increasing the quality of women’s healthcare.

Works Cited

Adair, Mark J. “Plato’s View of the ‘Wandering Uterus’.” The Classical Journal, vol. 91, no. 2, 1995, pp. 153-163. JSTOR, www.jstor.org/stab1e/3298478.

Annandale, Ellen. Women’s Health and Social Change, Routledge, 2009.

“Brought to Life: Exploring the History of Medicine – Hysteria.” Science Museum, www.sciencemuseum.org.uk/broughttolife/techniques/hysteria.

Culp-Ressler, Tara. “When Gender Stereotypes Become a Serious Hazard to Women’s Health.” ThinkProgress, 11 May 2015, http://thinkprogress.org/when-gender-stereotypes-become-a-serious-hazard-to-womens-health-flf130a5e79.

Edwards, Laurie. “The Gender Gap in Pain.” The New York Times, 16 Mar 2013, www.nytimes.com/2013/03/17_opinion/sunday/women-and-the-treatment-of-pain.html?r=0.

Gilman, Charlotte Perkins. “Why I Wrote ‘The Yellow Wallpaper.’” 1913. Archived at The College of Staten Island, City University of New York, 8 June 1999, https://csivc.csi.cuny.edu/history/files/lavender/whyyw.html.

Holdcroft, Anita. “Gender Bias in Research: How Does It Affect Evidence Based Medicine?” Journal of the Royal Society of Medicine, vol. 100, no. 1, Jan. 2007, pp. 2-3. U.S. National Library of Medicine, doi: 10.1258/jrsm.100.1.2.

Kellogg, John Harvey. Ladies’ Guide in Health and Disease: Girlhood, Maidenhood, Wifehood, Motherhood, Modern Medicine Publishing Co., 1896. Archived by University of North Texas Health Science Center, 4 March 2011, http://digitalcommons.hsc.unt.edu/hmedbks/13.

Moyer, Melinda Wenner. “Women Aren’t Properly Represented in Scientific Studies.” Slate Magazine, 23 July 2010, http://www.slate.com/articles/health_and_science/medical_examiner/2010/07/drug_problem.html.

“The Rest Cure.” The American Journal of Nursing, vol. 36, no. 5, 1936, pp. 451-451. JSTOR, http://www.jstor.org/stable/3412197.

Scull, Andrew. Hysteria: The Disturbing History, Oxford University Press, 2011.

Showalter, Elaine. “Hysteria, Feminism, and Gender.” Hysteria Beyond Freud, University of California Press, 1993.

Teacher Takeaways “This student presents a solid and well-researched argument that builds off a clearly stated thesis in the introduction and returns to this thesis in the conclusion with a fully developed call-to-action and prompt for continued research. Each paragraph follows the path of the thesis’s spine, elaborating on the historical contexts the student first presents, to introduce new complexities and further evidence of how these claims add to the need for response to the bias against women in health care. Although the student synthesizes paraphrases, quotes, and summaries well most of the time, there are moments (mostly later in the essay) in which the student gives us information without clearly signaling or citing where that information is coming from.”– Professor Dannemiller