x Abu Dhabi, UAESunday 23 July 2017

Medical Muses: Hysteria as a societal condition

Asti Hustvedt's history of the condition called hysteria suggests illness is as much a social construct as a physical one.

Medical Muses by Asti Hustvedt.
Medical Muses by Asti Hustvedt.

Asti Hustvedt's thought-provoking history of hysteria has inspired angry reviews from ME sufferers who feel she is disparaging their condition, implying it is psychological rather than "real".

These comments miss the point - Medical Muses is not a dismissal of anyone's illness but rather a careful attempt to explore how disease is located in society and history as well as in the mind and body.

Dr Jean-Martin Charcot's famous investigations into hysteria at the Salpêtrière hospital in Paris in the late 19th century remain irresistible to artists, writers and historians, not least those with feminist sympathies. The amply documented Salpêtrière hysterics live on in a wealth of photographs, transcriptions, drawings, histories and speculations.

Well over a century later, they still evoke complex relations between gender and power, the body and the mind, making the material almost overwhelmingly suggestive.

Happily, at its best Hustvedt's history finds sufficient distance from the seething source material to begin to suggest why the hysterics still fascinate us, long after their illness vanished to be replaced by modern syndromes such as depression, eating disorders and post-traumatic stress.

Even in Charcot's time, sceptics pointed out that the symptoms he discovered in his hysterical patients were rarely reproducible outside the Salpêtrière.

Unsurprisingly, many versions of that history have depicted the doctors as manipulative patriarchs exploiting vulnerable women. But Hustvedt resists wielding this kind of ethical sledgehammer in order to pursue a more complex truth. While she is always quick to point out the currents of power and oppression in the (male) doctors' treatment of (female) hysterics, she also rehabilitates Charcot for modern medicine.

He did important groundwork in the understanding of, for example, Parkinson's disease and multiple sclerosis, while his treatment of hysteria was far more humane than any previous approaches to insanity - not least, perhaps, because he saw it not as a mental illness but organic in origin.

Freud studied with him and was inspired by Charcot and colleagues' interest in documenting patients' childhood experiences, dreams and fears.

Hustvedt also shows how, far from being blind to his own limitations, towards the end of his life Charcot reflected on how hypnotically induced states and placebo effects had potentially radical implications for medicine as a whole - implications that we have yet to fully understand today.

Medical Muses reveals that illness is as much of a social construct as it is an objective physical reality and the bulk of the book is taken up with case studies of three of the Salpêtrière's most famous patients.

Each woman enables Hustvedt to explore different aspects of the hospital. Through Blanche, we are introduced to the star system which made exemplary hysterics famous in public lectures and demonstrations. Through Augustine, we learn more about the hospital's official photographs that helped popularise and pathologise the chaotic effect of hysteria, while, finally, in the weakest chapter, Genevieve inspires Hustvedt to attempt to unpack hysteria's relation to older concepts of demonic possession and religious ecstasy.

Charcot was adept at documenting his work and drawings and photographs of his experiments are reproduced throughout the book.

Particularly creepy are photographs of "passionate poses", including a famous series of Augustine which the doctors helpfully captioned by categories such as "Auditory Hallucinations" or "Amorous Supplication".

These images are both strange and familiar - they resemble the kind of advertisement in which a model looks rapturously at a blender or jumps for joy for no apparent reason. Hustvedt brackets the book with an introduction and epilogue where she allows herself to make more explicit links between Charcot's system and modern ideas. But in the main she sticks to the almost implausibly fascinating history of her chosen case studies.

As the author says of Augustine, no fictional account can outdo "the true story of a girl who became Charcot's most photographed hysteric and then, after years of submission, fled the hospital and male medical authority, dressed as a man".

One of the book's pleasures is how these histories, without too much intervention from Hustvedt, inevitably suggest links between then and now.

Most obviously, modern disorders such as anorexia, like hysteria, predominantly affect women and exist in the same feminine grey area where what you are told to do (be emotive, obey authority figures, lose weight, etc) can leave you marginalised by society. The doctors' manipulation of the hysterics' emotional states - inducing facial expressions, making them perform elaborate fantasy scenarios - also prefigures our service-oriented times. From the fast food cashier who must smile and repeat "have a nice day", to the business executive who might perform a role-play exercise to improve his networking skills, nowadays we are all adept at performing emotion.

As Hustvedt says of Blanche: "[She] did not actually experience any of these emotions ... through hypnosis, the doctor could annihilate the natural woman's content and turn her into an empty shell. The hypnotised Blanche had been effectively changed into a machine."

Hustvedt does not spend too much time on the wider historical context of the Salpêtrière but all sorts of parallels are implicit in her account. Only four years before Charcot first entered the institution as an intern, Paris was the crucible of the 1848 "failed revolution" that swept Europe and was quickly quashed by reactionary forces.

It is as if the political tumult of the time - and its eventual disappointment - finds expression in the hysteric's crazy collection of symptoms.

More exactly, what the 19th century's revolutionary movements failed to achieve was any fundamental change in the conditions of the poor.

Hustvedt delves into the patients' pasts and finds the same story again and again - before they were victims of hysteria, all three of her chosen subjects were the victims of poverty.

Each case study conjures up a world detailing the routine abuse of children brought up by desperately poor parents who sometimes resorted to desperate measures. For instance, Genevieve, Hustvedt's third case study, was abandoned as a baby in 1843.

This was common practice among very poor families, many of whom could not afford to care for babies and young children and sometimes resorted to abandonment or even infanticide.

Hustvedt's meticulous description of "regional centres where all abandoned babies and infants from that area were sent … equipped with special depositories called "tours" built to facilitate abandonment and thereby prevent infanticide" reveals the brutal levels of poverty suffered by many ordinary people at the time.

For a lucky few, hysteria could be a way out of sorts - Blanche ended up working as a radiology technician at the Salpêtrière, although she eventually succumbed to the inevitable cancer caused by handling radioactive materials.

Much like today's celebrity culture, which also functions as one of the few ways that the ambitious but uneducated poor can hoist themselves up the social ladder, the chance of getting some social cachet as a famous hysteric depended on good looks, charisma and a certain willingness to exploit oneself for a greedy audience.

Above all, Hustvedt's account rescues hysteria from being relegated to a high-society illness of fainting corseted ladies, and gives it back its real social meaning. We are not talking about ladylike fits in posh drawing rooms here.

In his analysis of the 1848 revolution, Marx famously said that history repeats itself first as tragedy then as farce. We could add that history repeats itself a third time, as psychology. Freud, a great admirer of Charcot, built on his research to construct an entirely psychological picture of hysteria.

But Hustvedt sees Charcot's legacy differently - for her, "he did nothing less than articulate a new paradigm for illness, one that superseded the tenacious mind-body model we are still muddling about in".

We are not isolated atoms, half -intellect half-flesh, but rather complex beings constructed by our society as much as by our own will.

The impressive thing about this restrained and provocative book is how clearly this point comes across - not through theoretical arguments, but through the patient exploration of three women's lives.

Hannah Forbes Black is a writer and artist who lives in London. Her work has appeared in The Guardian and Intelligence Squared.