Gender and Sex Manifestations in Hysteria Across Medicine and the Arts

Abstract

The diagnosis of hysteria has existed for at least four-thousand years, with roots in the ancient Greek word hysterikos, referring to diseases of the womb. In the sixteenth-century medical discourses, female hysteria was caused by excess pollution of the womb, with fluids that were labelled 'female sperm' as the probable cause. In the work of Shakespeare, there is a reference to hysterica passio, a term used by King Lear to self-diagnose his affliction. Shakespeare shows how a disease associated with women, and the 'wandering womb' phenomenon could have been spoken of in an associative way. At this time, there is a transformation of the nature of hysteria from a neurological consequence of the sick womb, to sexual deviance. Portrayals of the male deviant would evolve by the Victorian era, concurrent with the diagnosis of 'spermatorrhea'. There are very direct correspondences between the hysteria of spermatorrhea and the notion in Western medicine of the direct links between female hysteria and too much or not enough sexual energy release. Hysteria in both sexes was famously diagnosed and catalogued by Jean-Martin Charcot at the end of the nineteenth century. By the twentieth century, hysteria was also depicted as a disorder of gender as well as sexuality. © 2014 S. Karger AG, Basel.

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Historical Review
Eur Neurol 2015;73: 44–50
DOI: 10.1159/000367891
Gender and Sex Manifestations in
Hysteria Across Medicine and the Arts
AdamA.Dmytriw
Department of Medical Imaging, University of Toronto, Toronto , Canada
Jean-Martin Charcot at the end of the nineteenth century. By
the twentieth century, hysteria was also depicted as a disor-
der of gender as well as sexuality. © 2014 S. Karger AG, Basel
Introduction
The following is an exploration into the images of the
male hysteric found in history, both in artistic work and
medical discourses, in order to trace whether the main
components of the disorder remain similar or reflect dif-
ferent understandings of the term, within the context of
changing gender meanings. Not only do male and female
hysteria differ in their diagnosis and supposed cause, but
the two sustain the essence of their definition from devi-
ance or distress that is caused by ambivalence towards
normative gender and sex roles. These traditional facets
were and are ultimately established by physical, behav-
ioural and personal qualities as a function of societies of
the time.
The diagnosis of hysteria has existed for at least four
thousand years, with roots in the ancient Greek word hys-
terikos , which was a reference to the diseases of the womb.
Thus, historically, hysteria has been more associated as a
Key Words
Neurology · Neuropsychiatry · Hysteria · Literature ·
Shakespeare · Sexuality
Abstract
The diagnosis of hysteria has existed for at least four-thou-
sand years, with roots in the ancient Greek word hysterikos ,
referring to diseases of the womb. In the sixteenth-century
medical discourses, female hysteria was caused by excess
pollution of the womb, with fluids that were labelled ‘female
sperm’ as the probable cause. In the work of Shakespeare,
there is a reference to hysterica passio , a term used by King
Lear to self-diagnose his affliction. Shakespeare shows how
a disease associated with women, and the ‘wandering womb’
phenomenon could have been spoken of in an associative
way. At this time, there is a transformation of the nature of
hysteria from a neurological consequence of the sick womb,
to sexual deviance. Portrayals of the male deviant would
evolve by the Victorian era, concurrent with the diagnosis of
‘spermatorrhea’. There are very direct correspondences be-
tween the hysteria of spermatorrhea and the notion in West-
ern medicine of the direct links between female hysteria and
too much or not enough sexual energy release. Hysteria in
both sexes was famously diagnosed and catalogued by
Received: July 29, 2014
Accepted: August 24, 2014
Published online: November 1, 2014
Dr. Adam A. Dmytriw
Department of Medical Imaging
University of Toronto
Toronto M5T 1W7 (Canada)
E-Mail adam.dmytriw  @  uhn.ca
© 2014 S. Karger AG, Basel
0014–3022/14/0732–0044$39.50/0
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45
female malady. In the sixteenth-century medical dis-
courses, female hysteria was an outcome of excess pollu-
tion of the body and particularly the womb, with fluids
that were labelled ‘female sperm’ as the probable cause
[1] . Via this medium, the ‘wandering womb’ was thought
to excite the nerves of any part of the body it reached. The
resultant phenomenon, as seen in French philologist Du
Cange (1610–1688) and Swiss-German physician and al-
chemist Paracelcus (1493–1541), was felt to be a ‘suffoca-
tion of the womb’ or sometimes, ‘suffocation of the moth-
er’
[2, 3] .
The fluids, linked to menstruation, were in need of
‘frictive treatments’, a medical term for frequent inter-
course, as a way to release the fluids and save women
from suffering from ‘hysterical disorders’
[1] . Treatment
was also thought to have been efficacious when applied
to the uterine appendages, and in the sixteenth century,
physicians advocated both for stimulation of the vulva
and the removal of the ovaries, which arguably were not
seen as separate from the uterine apparatus
[2] . From
English playwright William Shakespeare’s (1564–1616)
irrational King Lear to American novelist Virginia
Woolf’s (1882–1941) wounded soldier, the male hyster-
ic’s patterns emerge. The concept of hysteria undergoes
periodic revision in medical discourses from antiquity
through to the fin de si è cle , the Victorian Era and again
following World War I, as does the artistic reflection
upon it
[4] .
The Renaissance and King Lear
This association of hysteria with diseases that affect
women and their reproductive organs continues into the
Renaissance, as noted by Kaara Peterson, Professor of
English at Miami University
[1] . In the work of Shake-
speare, for example, she argues there is a reference to hys-
terica passio , a term used by King Lear to self-diagnose an
affliction, thus making it one of the earliest examples of a
reference to male hysteria
[1] . Hysterica passio was a Lat-
in term used to denote feelings of suffocation and chok-
ing, brought on by associated hysterical fits. States of ‘pas-
sio’ were identified as fits, thought perhaps to be the body
attempting to expel disease from a particular organ. In-
deed, Hippocrates (460–370 BC) also identified passio
cardiaca as another such phenomenon, which was used
by physicians to characterise syncopal events at least until
the mid-fourteenth century, as it is was employed in dis-
course surrounding the sequelae of the Bubonic Plague
[5] . Due to the clear origination of hysteria within the
context of the womb, it was often deemed impossible for
men to suffer from this affliction. Yet, Shakespeare has
Lear suggesting that he believes he is suffering from this
disease when he states, ‘O, how this mother swells up to-
ward my heart! Hysterica passio , down, thou climbing
sorrow, Thy element’s below’ (Act 2, Scene 4). This rep-
resents an early version of the male hysteria and the motif
of losing of one’s mind, and the concept of the womb
wandering to contact other organs
[1] .
Tracing a different possible explanation, Peterson
notes that the diary of an Englishman residing in Hack-
ney named Richard Mainy (life dates unknown), a novi-
tiate of the Franciscan Friars Minor who between 1583
and 1588 was involved in falsely accusing others of witch-
craft
[6] , complained of being afflicted with hysterica pas-
sio , a disease he associates with his mother. Quoting from
the diary we read:
The disease I spake of was a spice of the Mother , where-with I
had beene troubled (as is before mentioned) before my going into
Fraunce... It riseth (as he said, and I have often felt) of a wind in
the bottome of the belly, and proceeding with a great swelling,
causeth a very painfull collicke in the stomack, and an extraordi-
nary giddines in the head
[1] .
Fig. 1. 1769 Engraving of actor Ludwig Devrient (1784–1832) as
King Lear, during a fit of ‘hysterica passio’. Probably from the
production by Jean François Ducis (1733–1816) performed in
Versailles, artist unknown. Public domain image owned by Francis
Ambrière and last published in his compilation La galerie drama-
tique. (1945–1948). Le Théâtre en France depuis la liberation .
Color version available online
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Thus, Peterson attempts to show how a disease associ-
ated with women and the ‘wandering womb’ phenome-
non that can be traced as a diagnosis back to the ancient
Greeks, could have been spoken of in an associative way.
Mainy suffers as though he is a woman, or otherwise from
the weakness or affliction that was somehow passed on
through mother to son
[1] .
In either case, the description of Mainy, who was fac-
ing societal alienation and scrutiny because of his asso-
ciation with clerics who were also under suspicion for
their false accusations, shows how anxiety, fear and dis-
orientation typified as male hysteria could emerge lin-
guistically. In addition, he refers to something different
than that which is said to afflict women: primarily sexual
in nature and related to reproductive organ function or
dysfunction. Like Mainy, Lear could have been suffering
from both a somatised stomach ache and from the head
giddiness, which Shakespeare would have noted was evi-
dently a non-organic illness, but instead one related to
lack of certainty of one’s position of authority or ground-
edness. This would have had a markedly negative impact
on masculine gender definitions. Lear’s problems, par-
ticularly with his daughters throwing him out of his own
castle to face the element, and his subsequent psycholog-
ical disorientation actually do seem to correspond to the
kind of trauma that male hysteria as a term defined in the
early twentieth century
[1, 7] .
Charcot, Freud and La Salpêtrière
Medically, hysteria was regarded as a pathologic per-
sonality trait of bipartite origin. At once, it reflects a psy-
chological inability to express internal conflict verbally
and at the same time to somatise this anxiety. Ultimately,
this emotional distress is then converted to symptomatol-
ogy that resembles a neurological disorder
[4] . Paracelcus
hints at this when he hypothesises that hysteria resembles
epilepsy but is distinct from it, although his ideas are not
developed beyond this proposal
[2] .
Mitchell describes male hysteria as a physical set of
responses to a condition that is untenable
[8] . Certainly,
Lear’s predicament can be indeed interpreted as an un-
tenable one, and these responses were characterised in-
depth in nineteenth-century Europe. Hysteria in men was
described and catalogued by French neurologist Jean-
Martin Charcot (1825–1893) at the end of the nineteenth
century along with hysteria in women. Often credited as
the founder of modern neurology, he held a clinic in Par-
is and was the main practitioner dealing with female hys-
teria. Charcot established a neurology clinic La Salpêtrière
to elucidate the pathophysiology of many neurologic dis-
eases, documenting extensively the nature of stroke, epi-
lepsy and neurosyphilis in addition to hysteria
[9] . In do-
ing so, he also attracted scholars from around the world.
Goetz, Bonduelle and Gelfand show us that much of
Charcot’s work into aphasia surrounded his hysterical
patients and their presumed inability to express internal
conflict leading to ‘paralysie psychique’. He was uncer-
tain that this had an organic component, and this was
notable as a significant break from his usually strict anato-
mo-clinical method
[10] . Importantly, French physician
Ernest-Charles Lasègue (1816–1883) was probably the
first to observe the male hysteric. In his study of ‘anorex-
ie hystérique’, he noted that his anorexic patients, male or
female, were in his mind hysterics. Sigmund Freud (1856–
1939), at the beginning of his career, traveled to Paris to
expand the breadth of his neurological experience,
through observations of the work Charcot was conduct-
ing at his clinic.
Freud exami nes female hysteria in many of his essays
dealing with literature, such as his exploration of the
meaning of a Guy de Maupassant story, ‘Le Signe’. In his
reading of that story, Freud interprets character obses-
sion or agitation in a female aristocrat who pretends to
be a prostitute and elicits the attention of a man on the
Fig. 2. 1887 ‘Une leçon clinique à la Salpêtrière’ painted by André
Brouillet (1857–1914). Depiction of Jean-Martin Charcot at La
Salpêtrière with hysterical subject Blanche Wittman (1859–1913),
where hysteria appears to undergo redefinition as ‘deviant sexual-
ity’ and eventually the first diagnoses of male hysteria are also
made. Public domain image, painting owned by La Salpêtrière.
Color version available online
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street, as a description of a female hysteric [11] . In wom-
en, especially at the fin de siècle , as John Ireland, Profes-
sor of French Studies at New York University writes,
hysteria was both a means of categorising deviant fe-
male sexuality as well as a way for medical practitioners
to investigate and explore the nature of female sexuality
[11] .
As well, as Ireland notes, Charcot opened his clinic to
observers, which included literary men, newspapermen,
doctors and artists. Visiting this clinic became a kind of
voyeuristic experience for men: ‘the hysterical subjects
put on display during Charcot’s famous sessions were a
prime stimulus for many of the male fantasies previously
projected onto prostitutes’
[11] . Hence, in women there
is a definite transformation of the nature of the meaning
of hysteria from a disease of the womb to sexual deviance,
yet the prescription that women need to engage in more
sexual activity to prevent hysteria, a treatment from the
time of the Greeks onward, shows that there has always
been a component of sexuality embedded in the meaning
of the condition as it relates to female health, disease and
obsession. Freud would return to Vienna following his
training at La Salpêtrière and in 1896 famously presented
his paper, The Aetiology of Hysteria before his colleagues
stating, ‘The hysterical attack corresponds to a memory
from a patient’s life’. Using hysterics as the example,
Freud expounded upon his ‘Seduction Theory’, which at-
tributed the internal distress of an afflicted individual to
the repressed memory of child sexual abuse, usually by a
trusted caretaker
[12] .
Before the times of Charcot, Etienne-Jean Georget
(1795–1828), in his time at La Salpêtrière, wrote that hys-
teria did not observe sex or gender. By his account, hys-
terical fits were simply ‘attacks of the nerves’. At the time
of his death he was only 33 years old and what analysis of
this phenomenon he performed was buried in his prima-
ry interest of monomania, a partial insanity characterised
by fixation on a solitary concept
[4] . Tending towards the
latter half of the nineteenth century, Charcot stressed the
need for vigilance with respect to the psychological and
cultural milieu of the hysteric. While he strove to reintro-
duce the concept of hysteria in modern medical discourse,
he invited the notion of neurological and psychological
health as potentially two distinct yet inextricably linked
players. Primarily, Charcot prescribed hypnotism as the
treatment for hysteria, with mixed results. He attributed
this to the sensationalism with which hypnotism was
observed and thus its frequent misuse. By the end of his
career, he concluded that hysterics were at the very least
more susceptible to hypnotism if not necessarily helped
by the technique. The notion of sensationalism and its as-
sociation with hysteria may also have been exacerbated by
a concomitant expansion in the use of photography, and
Didi-Huberman observes that the sheer spectacle of the
hysterics of La Salpêtrière likely created a pressure to en-
tertain onlookers, which have may obscured the purity of
neurological examination
[13] .
In the early twentieth century, we are also presented
with a rare look at the interface between medical and lit-
erary interpretations in the writings of André Breton
(1896–1966) and Louis Aragon (1897–1982). While pri-
marily distinguished figures in the literature of poetry,
they also undertook neuropsychiatric training and often
joked about the murky distinction between psychiatric
notes and poetic verse. On hysteria, they concluded that
it ‘is not a pathological phenomenon and may be consid-
ered a supreme means of expression’. Through fictional
characters, they described the hysteric as one who had a
disturbance of the nervous system from expressing them-
selves at any extreme of societal norms. This was not lim-
ited to sexuality or gender identity, but merely one of the
commonest forms observed
[7] .
In males, Charcot introduced the concept of a trau-
matic hysteria particularly in the working class. Accounts
of Charcot’s stance are mixed on the concept of gender
indeterminacy. Parisian physician and contemporary
Paul Michaut reports that, ‘Charcot himself has shown a
number of times in his magisterial lessons, we must per-
manently break with the idea that hysteria in a man is
necessarily accompanied by a degree of feminism’
[14] .
However, many other writers who describe Charcot’s
teaching, such as French neurologist Alexandre-Achille
Souques (1860–1944) and French psychiatrist Jacques
Roubinovitch (1862–1950), suggest that in fact, the theme
of indeterminacy was strong in those seminars
[4] . Brief-
ly, there was a contention that perhaps male hysteria was
a uniquely French phenomenon until the description of
‘hysteria virilis’ among German patients was documented
by German neurologist (1861–1959) Max Nonne and
others
[15, 16] . However, the common element of these
accounts is the consistent concept of the hysteric as a sex-
ual deviant.
Hysteria as Sexual Deviance
In contrast, irrational, unhinged men, classified as
hysterics in the late nineteenth and early twentieth centu-
ries are men who were not living their dominant gender
characteristics: strength, power, sturdiness and stoicism.
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They are outsiders, viewed as expressing feminine char-
acteristics through their strange behaviours or their lack
of status, but these are not necessarily described in terms
of sexual behaviours, although they could be. For in-
stance, homosexuality was viewed as a kind of hysteria
from Freud’s time through to the Diagnostic and Statisti-
cal Manual of Mental Disorders-III which was first pub-
lished in 1980
[17, 18] . Hysterical men could also be men
who were shell-shocked from the war and unable to func-
tion in a normal way, which would also include sexual
dysfunction. Donald & Jean Carveth, Professors of Soci-
ology at York University, observe that the attributes of
hysteria and shell shock were mostly the same. However,
hysteria steadily became reserved for the homosexual
man as a result of the additional quality of a perceived
feminization
[19] .
In general then, men labelled hysterics in nineteenth
century and early twentieth century modernist texts are
deemed more like women, more feminine than men are
supposed to be. They are more like women because they
are hyper-emotional and prone to psychosomatic afflic-
tions due to the fragility of their state, where fragility is
considered a characteristic stereotype of feminine gender,
where gender is viewed as essential. Male hysteria is there-
fore related to, but different from, the set of conventional
historical stereotypes about female hysteria and deviant
sexuality that became particularly elevated during the
Victorian era in England and France
[20] .
In modernity (1900–1989), the hysterical male is the
man who suffers at the end of World War I with shell
shock; he is the gender invert before the rise of homo-
sexual subcultures that engaged in self-definitions; it is
the man suffering from posttraumatic stress as evident in
the physical and emotional states of a disordered nature
[8] . Male hysteria often appears in creative work as a sym-
bol or metaphor for personal disorder or fragmentation.
It is more than, but certainly including ‘shot nerves’; it is
a means of understanding or relating to character, and
how character is shaped by environmental and social cir-
cumstances.
In her post-World War I novel, Mrs. Dalloway , Vir-
ginia Woolf presents a portrait of a classic male hysteric
named Septimus. The shell-shocked veteran – internal,
alone, brooding – is portrayed as psychologically and so-
matically damaged by his experience in the trenches. He
is also denied proper care and treatment; no one knows
how to help him, including his wife and his doctor. This
Dr. Holmes, to whom Septimus goes in search of answers
to his ailments concludes, ‘There was nothing whatever
the matter…’
[21] . It is obvious in the passages leading up
to this pronouncement that Septimus is severely troubled,
and his ultimate suicide resounds as a commentary on the
failure of society to help the male hysteric, or even under-
stand him.
All of his thoughts, dark and violent, are effects of the
war on his psyche. Woolf presents his internal mono-
logue, which is troubling and revealing of an unhinged
persona.
…Amelia Whatsername, handling round cups of tea punctu-
ally at five – a leering, sneering, obscene little harpy; and the Toms
and Berties in their starched shirt fronts oozing thick drops of vice.
They never saw him drawing pictures of the naked at their antics
in his notebook. In the street, vans roared past him; brutally blared
out on placards; men trapped in mines, women burnt alive; and
once a maimed file of lunatics being exercised or displayed for the
diversion of the populace (who laughed aloud) ambled and nod-
ded and grinned past him…
[21] .
Her goal is an anti-war statement, a pacifist manifesto,
using Septimus as one of her illustrations of the horror of
war and its impact on the soul
[22] .
A feminist, Woolf does not undermine Septimus,
though she clearly shows his inability to function norma-
tively according to the prescriptions of his gender
[22] .
The disregard that he faces from society, represented by
the doctor as well as his inability to play his proper role as
masculine husband in the marital relationship, empha-
sises his marginality and his deviance. However, while
they are internal to him in the sense of his response, the
causes lie outside him, just as they do in Lear. There may
be weaknesses inherent in the individual that lead to a
hysterical breakdown or alienation from reality in a male
hysteric, especially when hysteria is configured to psychic
disturbances that are of a traumatic type, but it is not as
essential a definition of difference or otherness as found
in the characterisation of the female hysteric, whose prob-
lems stem inherently from her femininity and her repro-
ductive capacity.
The Victorian Era
Male hysteria was not only a feminisation of men, in
gender terms, but could also be related to fluids and male
reproductive systems. Ellen Rosenman, Professor of Eng-
lish at the University of Kentucky, demonstrates this in
her essay on the history of male sexuality. A disease called
spermatorrhea, which was of serious concern to both
doctors and those who believed they might be suffering
from the affliction, is described in an essay by Rosenman.
There are very direct correspondences between the hys-
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teria of spermatorrhea and the notion in Western medi-
cine of the direct links between female hysteria and too
much or not enough sexual energy release. Spermator-
rhea is the name for a condition in which men masturbate
excessively, thereby leading to a wealth of neurological
symptoms and disease outcomes. She writes the disease is
‘Defined as the excessive discharge of sperm caused by
excessive sexual activity, especially masturbation, the dis-
ease was understood to cause anxiety, nervousness, las-
situde, impotence, and in its advanced stages, insanity
and death’
[23] .
As Rosenman notes, its origins as a labelled condition
stem back to a panic surrounding the perils of masturba-
tion prevalent in the eighteenth century in England. By
the nineteenth century, the Victorians were determined
to police sexuality by denying pleasure, maintaining it
was deviant outside the boundaries of the institution of
marriage
[20, 23] . Masturbation was seen as a medical evil
for both women and men in Victorian England, linked in
the medical literature with venereal diseases
[23] . She ob-
serves that spermatorrhea was designated a disease of
middle-class men, and characterised as an expression of
male sexual hysteria that was related to the pressures of
life and career on them
[23] . Much like with female hys-
teria, induction of ‘sexual release’ was thought to be of
medical benefit. Techniques such as external genital stim-
ulation as well as physical or water stimulation of the
prostate were employed. Castration was also considered
a viable option for treatment. Interestingly, as early as
1874, the Journal of Materia Medica recommended the
use of ergots and other agents traditionally used to facili-
tate abortion or uterine expulsion of retained material
both in the treatment of hysteria and spermatorrhea
[24] .
In the United States, contemporaneously with Victorian
England, physicians advocated these same treatments.
Pennsylvanian physician Frederick Hollick (1818–1900),
an authority on sexual health at that time declared that
hysteria and spermatorrhea were, ‘limitations on pleasure
that nature enforced’
[25] .
In Victorian England, a good middle-class man was
supposed to refrain from sexual activity outside of mar-
riage, though he had access to do so through visiting
prostitutes. In contrast, aristocratic men and working-
class men were deemed beyond salvation, more prone
for different reasons related to class stereotypes, to be
overly sexual and deviant in nature
[23] . Rosenman calls
the spermatorrhea craze ‘an epidemic of ambivalence’
on the part of middle-class professional men, including
doctors themselves, towards their own sexuality; a form
of, what Foucault calls the sexual policing of behaviour
that could lead in the nineteenth century to the label of
male hysteria for those who transgressed the accepted
norms.
Excessive masturbation or intense verbal or written
rants that display out-of-control psychic disturbances are
different ways in which, historically, male hysteria devel-
ops as a separate physical and then psychological set of
disturbances. When spermatorrhea was recognised not as
an organic illness but rather as a psychological problem,
the brutal treatments to cure it, which included removing
the testicles as a cure, faded away
[26, 27] .
Concluding Remarks
There is evidently a wide range of representations of
male hysteria in literature as well as in medical discourses.
The obvious element in the condition is the partial femi-
nization of the man, through loss of control over self in a
public and private setting, with control designated as key
ways to configure masculine privilege as opposed to fem-
inine passivity and fragility. Male and female hysteria dif-
fer in their diagnosis and cause, but both are related to
disorders of gender and to some extent in men, sexuality
as well. Thus, it is a set of conditions used to describe, de-
fine and label deviance or neuropsychiatric trauma that
rests primarily in ambivalence towards normative gender
and sex roles.
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