What is hysteria, and why were so many women diagnosed with it? - Mark S. Micale

Do you ever feel tired? Overwhelmed? Nervous? Depressed? Do you have headaches, dizziness, cramps, difficulty breathing? From 300 BCE to the early 1900s, if you answered yes to these questions and you had a uterus, a European or American doctor would likely diagnose you with hysteria. No, not mass hysteria. Ladylike hysteria.

The catch-all term “hysteria” was used by physicians, who were mostly men, to describe just about any unexplainable medical condition suffered by female patients. By some interpretations, being a woman was itself long considered a pathology from which all kinds of problems arose. Throughout its long history, hysteria was used as a cultural signifier for what men with authority found contemptible and incomprehensible in the behavior of women who lacked, or tried to exercise, power.

The term hysteria is derived from the Greek word for uterus, and was first used in the 4th century BCE. Drawing on earlier Egyptian beliefs, and not a great deal of medical rigor, the Greeks viewed hysteria as a malady of the womb, arguing that the uterus could dislodge and move throughout the body, causing a variety of ailments. They believed the uterus wandered because it longed to bear children, and for that reason, unmarried women were the most likely to get a hysteria diagnosis.

The usual prescription was immediate marriage, impregnation, or the use of uterine fumigations to entice the rebellious organ back into place. By the 2nd century CE, Roman physicians rejected the wandering womb theory. But they still viewed the uterus as the source of hysteria, believing, without much evidence, that it produced a secretion similar to semen, which— if not released— corrupted the blood and irritated the nerves.

As a result, midwives would often treat hysteria by manually inducing orgasms in female patients. By the late Middle Ages, Christianity had spread throughout Europe, and its influence had likewise infiltrated Western medical practice. Physicians started to posit that hysteria was a malady not of the womb, but of the soul, and reflected Satanic influence.

Doctors continued to dismiss women’s symptoms and pain, now misogynistically shifting the blame to their supposed inherent weak wills and susceptibility to sin. This situation worsened through the 16th and 17th centuries, as women, especially those who didn’t conform to social expectations, risked being accused of witchcraft, which often carried heavy consequences.

In late Victorian Europe and North America, some medical doctors started arguing that hysteria’s true origin lay not in the body or soul, but rather, in the mind. Middle class women, facing intense demands of social respectability and strict codes of sexual conduct, were often referred to “nerve doctors” who’d use isolating and unfounded rest cures to treat any emotional and psychological distress.

When writing her semi-autobiographical short story, “The Yellow Wallpaper,” Charlotte Perkins Gilman drew from the distressing treatment she underwent for her so-called hysterical tendencies. The narrator, suffering from what would now likely be diagnosed as postpartum depression, describes being confined alone in an attic and being denied any intellectual activity, including reading or writing.

Around this same time, Sigmund Freud was rising to fame. He believed hysteria, like other nervous conditions, was caused by repressed emotional trauma. His treatment required drawing these memories out of the unconscious so they could be acknowledged and addressed. Freud also dismissed the idea that hysteria was unique to women.

Belief in “male hysteria” became prominent during and after the First World War, but was framed as the more masculine-sounding “shell shock.” Over the 20th century, the term hysteria was slowly replaced by specific, less gendered diagnoses, including anxiety, depression, PTSD, and epilepsy. And hysteria was officially removed from the “Diagnostic and Statistical Manual of Mental Disorders” in 1980.

Today, most scholars argue that the blanket disease hysteria was always a figment of doctors’ imaginations. As outright medical sexism declined, so did its diagnosis. Nevertheless, its legacy reflects Western medicine’s long, storied, and ongoing history of misattributing and trivializing women’s pain.