wandering womb history

Beware the Wandering Wombs of Hysterical Women

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From ancient Greek physician Hippocrates to the infamous doctor Isaac Baker Brown of the 19th century, the pains and ailments of women were thought to be because of a ‘wandering womb’, better known as ‘hysteria’.

Hysteria, of the Greek translation 'hysterika,' which meant 'that which proceeds from the uterus’ was the generalized term given to women who suffered discomfort of every manner, ranging from mental illness to sexual deviancy, the lack of sexual desire, and even migraines.

Throughout history, medical practitioners have been in a constant struggle with their own codes of morality and treatment. This resulted in the creation of several techniques and machines, which inevitably resulted in the clinical and uncomfortable act of pelvic massage, and even masturbation. Still, the treatments never provided a cure and no matter what physicians did, the problems of a dissatisfied and uncomfortable woman remained.

In certain times in history, hysteria became known as the precursor to a complete demonic possession, resulting in priests having to perform exorcisms and root out potential witches in the area. The belief of hysteria as a symptom continued into European medicine and was extended to encompass several more symptoms with every passing century.

It was only in the early 20th century that hysteria became phased out due to its over-generalized use and diagnosis. Even though hysteria is no longer relevant in the modern era, a disorder of a ‘ wandering womb ’ still exists in the form of endometriosis.

Though the diagnosis and symptoms are not the same, endometriosis is when the lining and cells of a uterus begin to expand and grow in regions where it shouldn’t. Endometriosis, by modern clinical definition, is literally a wandering womb.

How could hysteria have lasted for so long? To answer this, one will need to study its history in detail.

Women under hysteria as depicted in 1880. (Damiens.rf / Public Domain )

The Early History of Wandering Wombs

Its most notable appearances were in the writings of Hippocrates in his Hippocratic Corpus . In his earliest writings, hysteria was a disease of the womb , treatable with massage and exercise.

It was generally believed that the uterus could move within and throughout the body, depending on the health of the woman. According to Hippocratic physicians of the time, the womb itself was like an animal, and it moved to find cold and moist places within the body due to a lack of male seed irrigation.

The result of the womb’s vagabond nature was to create emotional and physical torment until the womb itself had found comfort. This resulted in women having fainting spells, menstrual pain, and a loss of verbal coherence. One treatment prescribed by Hippocratic physicians was to place sweet smells by the vaginal regions and foul salts by the nose in order to lure the uterus back to the woman’s lower groin.

However, by the 1st century AD, the philosophers Celsus and Saronus felt that the remedy for hysteria needed further additions to its treatment. Along with genital massage with sweet oil, exercise and relaxation were now added to the remedies of hysteria.

Diagnosing Hysteria

The definitions of hysteria remained similar in its multifaceted explanations for hundreds of years. Most symptoms included congestion of bodily fluids, nervousness, insomnia, sensations of heaviness in abdomen, muscle spasms, shortness of breath, loss of appetite for food or sex, being demanding, causing trouble, and deficiency of sexual gratification.

By the European Middle Ages, according to contemporary scholar Rachel Maines, the name of 'hysteria' was changed to the ‘suffocation of the uterus’. The diagnosis remained the same and so did the attitudes.

In later documents nearing the 11 th century AD, marriage and masturbation to orgasm became the untold cure for the symptom even though most medieval doctors were hesitant to prescribe this method in fear of being asked to perform it on their female patients. Most though would prefer for women to have their husbands or midwives perform the treatment.

Water massages as a treatment for hysteria 1860. (Laurascudder / Public Domain )

During the 12 th century in Europe, most medical physicians relied on the Greek Classics from Plato and Hippocrates in order to diagnose most ailments. Additional diagnosis of hysteria would now include "the retaining of blood or of corrupt and venomous uterine humors that should be purged in the same way that men are purged of seed that comes from their testicles next to the penis”, as stated by the physician Trotula. However, in the years to come, the fear of the devil would become instrumental in the extreme treatments for hysteria when the previous methods did not work.

Hysteria and Possession

The 13th century Europe was no different in their definitions of hysteria, only now recommending that widows and nuns partake in the treatment of hysteria to balance the fluids and emotional stability of such individuals. The preferred treatments, however, was still married intercourse , as well as vaginal massaging techniques. However, if these methods did not work, the alternative and most extreme explanations would be of the supernatural torment of demons.

It was a widely held belief that if hysteria was not treatable by methods of the older ways, then the symptoms were the beginnings of a demonic possession caused by a hexing witch. The most desirable victims for the alleged demons were young women suffering from depression, single women, women who were viewed as difficult, and elderly women.

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Demonic possession as a result of hysteria, 1858. (Fæ / Public Domain )

The notion of demon possession came from the misunderstanding of mental illnesses which existed during the time. Because of this, most physicians assumed that the traits for demon-possessed women, or demoniacs, were consistent: convulsions, increased intelligence accompanied by clairvoyance and spontaneous tremors, amnesia, and extreme emotional unbalance. Once this was diagnosed, the popular assumption was that there was another witch that had caused the possession of the suffering patient and would need to be found in order to reverse it.

By medieval canon law , any women suffering from either hysteria or demonic possessions were considered blameless of their actions. Thus, rather than stand trial, hysterical female criminals, or in the extreme cases, the ' possessed ' were to be sent to priests in order to have exorcisms performed . Alas, if the exorcism did not work to calm the women, it would mean they were unsavable and the priests feared being taken by the demon possessions themselves.

It wasn’t until the late 17th century when the belief of these unusual ‘possessions’ was phased out, and the possibility of seeing these troubles as mental illnesses became more present in the medical world.

Hysteria and Mental Health

In the 17th century, hysteria emerged as one of the most common female diseases that could be treated by medical practitioners. However, what was changing was attitudes about mental health . During this time, the medical thoughts on hysteria were being studied as a psychological brain disorder, rather than a wandering womb.

The French physician, Philippe Pinel , one of the first physicians to develop more humane psychological study of patients, believed that the disease hysteria, and to some extent nymphomania, were mental instabilities caused by sexual frustrations. Though the diagnosis began to change, the cures remained the same. Pinel also believed in the form of vaginal massage in order to bring balance to the brain.

Hysteria was believed to be caused by nymphomania and other mental instabilities. (robertwaghorn / Public Domain )

During the 18th century, the symptoms of hysteria would be broadened to also include hypochondriac men. However, for the most part, it was still considered a woman’s disease since most practitioners felt that it was now, not only connected with a woman's mental state but also deeply connected to female sexual organs simultaneously.

Female Hysteria in the 19th Century

During the 19 th century, for women, the western world was plagued with a plethora of fears not only consisting of catching hysteria but also with the concerns of uncurable sexual diseases such as syphilis . With such fears that were prevalent in 19 th century society, so were the extreme treatment methods for such conditions. During the 19 th century, the desires for pleasure and the self would be seen as terrible.

Though in previous years, hysteria was considered uniquely feminine and directly connected to their sexual organs, the practitioners of the time now felt that hysteria was a more negative extreme state rendering “…women difficult, narcissistic, impressionable, suggestible, egocentric, and labile; not to mention idle, self-indulgent and deceitful, craving for sympathy, who had an unnatural desire for privacy and independence…” (Donkin, 1892)

Physicians carried a fear that they were promoting the notion of sexual debauchery by having their work compared to masturbation. Due to this, during the 19th century, there was an extreme treatment, though not very popular with most physicians of the time, to perform clitoridectomy (the circumcision of the clitoris ) in order to prevent female masturbation, and therefore isolating the problems most women had with the alleged symptom of hysteria.

Gynecology or 1822, to treat hysteria doctors often performed the procedure of a clitoridectomy. (Morgoth666 / Public Domain )

Such 19 th century gynecologists such as Isaac Baker Brown (1812-1873), who was also president of the Medical Society of London, believed that the clitoris was utterly responsible for hysteria, epilepsy , and manic depression. In his opinion, if one were to surgically remove what he considered the ‘unnatural irritation’ called the clitoris, the issues which all women faced would be gone.

During this time, there was a widespread belief which most doctors of the time had that the mental and emotional disorders were directly connected to the female reproductive organs , and by simply removing them, it would make a woman compliant and trustworthy. However, by 1867, this fell out of practice.

In the second half of the 19th century, however, newer and more technical methods for treating hysteria would separate the sexual aspect of the disease and keep the physicians free from the lewd act of vaginal massage. This would come in the form of medical vibrators, and as scholar Rachel Maines would explore in her studies, there was a market that could be indefinitely exploited.

As a scholar, Rachel Maines theorized that medical practitioners from the early 19th century until the early 20th century practiced the techniques of medical masturbation upon female patients until they reached a sexual climax , in the most clinical and most non-romantic way.

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A 1918 ad with several models of mechanical vibrators, developed to treat hysteria. (PawelMM / Public Domain )

More often than not, most husbands and family members of the patient would be in the same room as a medical doctor would vaginally massage her to orgasm. This has been documented to take hours at a time and be very uncomfortable to watch.

As mentioned prior, due to the sexually perverse nature of the act, medical doctors desperately tried to recommend the technique to the patient’s husband or midwife to perform, rather than directly performing the treatment themselves. With the problems of symptoms continually returning to patients, another technique was promoted by way of mechanical automation.

Main's notion was that this tool was not only a better alternative to medical practitioners performing vaginal massage but also was a very marketable tool in terms of medical revenue: “Hysterical women represented a large and lucrative market for physicians. These patients never recovered nor died of their condition but continued to require treatment.” (Rachel Maines, 1999)

Though, even with Maine’s hypothesis, many other scholars believe this to be a skewed interpretation of the facts. Other scholars have chosen to keep the history of the vibrator and the history of hysteria as two separate and competing theories which exist in academia today.

Hysteria Redefined for the Modern Age

By the early 20th century, the number of women suffering from hysteria drastically declined due to its overgeneralized diagnosis. In the 21st century, hysteria was no longer recognized as an illness at all.

Within several hundred years, the definitions of wandering womb and hysteria seemed to stay somewhat consistent. Through time, more symptoms were added to the disease to explain further mental disorders which could not be accounted for.

However, the theme and treatment seemed to remain the same until the turn of the century. Only then was the disease hysteria phased out for further scientific and more specific definitions for ailments. Although it can be argued that advances in medical technology and thinking were the reasons for the social maturing, it may be potentially due to women attaining more rights than they had before.

Top image: Hysteria was a term used to diagnosis wandering womb a female medical condition branded by ancient Greeks. Source: rodjulian / Adobe Stock

By B.B. Wagner

Griffith. 2014. The Mysterious Case of the Wandering Womb . The University of Melbourne. [Online] Available at: https://blogs.unimelb.edu.au/sciencecommunication/2014/10/17/the-mysterious-case-of-the-wandering-womb/

Maek, H. 2009. Of Wandering Wombs and Wrongs of Women: Evolving Conceptions of Hysteria in the Age of Reason . University of Regina. [Online] Available at: https://ejournals.library.ualberta.ca/index.php/ESC/article/download/20152/15580

Maines, R. 1999. The Technology of Orgasm: “Hysteria,” the Vibrator, and Women’s Sexual Satisfaction . The Johns Hopkins University Press.

Mayo Clinic Staff. Date Unknown. Endometriosis . Mayo Clinic. [Online] Available at: https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

Rudnick, L. and Heru, A. 2017. The ‘secret’ source of ‘female hysteria’: the role that syphilis played in the construction of female sexuality and psychoanalysis in the late nineteenth and early twentieth centuries . Sage journals. [Online] Available at: https://journals.sagepub.com/doi/full/10.1177/0957154X17691472

Spanos, N. and Gottlieb, J. 1979. Demonic possession, mesmerism, and hysteria: A social psychological perspective on their historical interrelations . Journal of Abnormal Psychology. [Online] Available at: https://psycnet.apa.org/doiLanding?doi=10.1037%2F0021-843X.88.5.527

Tasca, C., Rapetti, M., Carta, M., and Fadda, B. 2012. Women And Hysteria In The History of Mental Health . Clinical Practice and Epidemiology in Mental Health. [Online] Available at: https://www.researchgate.net/publication/232746123_Women_And_Hysteria_In_The_History_Of_Mental_Health

Ussher, J. 2013. Diagnosing difficult women and pathologizing femininity: Gender bias in psychiatric nosology . University of Western Sydney, Australia. Feminism and Psychology. [Online] Available at: https://journals.sagepub.com/doi/abs/10.1177/0959353512467968

B.B. Wagner is currently working on a master’s degree in Anthropology with a focus in Pre-contact America. Wagner is a storyteller, a sword fighter, and a fan of humanity’s past. He is also knowledgeable about topics on Ice Age America... Read More

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Fantastically Wrong: The Theory of the Wandering Wombs That Drove Women to Madness

I don’t have a womb, but I know women who do. All the time, they say to me, “Sorry that I’m out of sorts, my womb just started moving around my torso yesterday!” I tell them that they should probably see a doctor--or at least a sorcerer--immediately.

Fantastically WrongIt's OK to be wrong, even fantastically so. Because when it comes to understanding our world, mistakes mean progress. From folklore to pure science, these are history’s most bizarre theories.Sounds crazy, but in Ancient Greece, this conversation would have actually come up frequently, only it would have been in Greek instead of English. You see, for the Greeks, there was no ailment more dangerous for a woman than her womb spontaneously wandering around her abdominal cavity. It was an ailment that none other than the great philosopher Plato, as well as Hippocrates, the father of modern medicine , described at length.

Greek physicians were positively obsessed with the womb. For them, it was the key to explaining why women were so different from men, both physically and mentally. For Hippocrates and his followers, these differences could be explained by a “wandering womb.” The physician Aretaeus of Cappadocia went so far as to consider the womb “ an animal within an animal ,” an organ that “moved of itself hither and thither in the flanks.”

The womb could head upward and downward, and left and right to collide with the liver or spleen--movements, argued Aretaeus, that manifest as various maladies in women. If it moved up, for instance, the womb caused sluggishness, lack of strength, and vertigo, “and the woman is pained in the veins on each side of the head.” Should the womb descend, there would be a “strong sense of choking, loss of speech and sensibility” and, most dramatically, “a very sudden incredible death.”

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William Turton

Megan Farokhmanesh

Nena Farrell

Luckily, the womb had a weakness. “It delights also in fragrant smells,” Aretaeus added, “and advances towards them; and it has an aversion to foetid smells, and flees from them.” And yeah, you guessed it: To cure a wandering womb, physicians could lure it back into position with pleasant scents applied to the vagina, or drive it away from the upper body and back down where it belongs by having the afflicted sniff foul scents.

There was a Greek dissenter, though, by the name of Soranus. This physician, writes Helen King in her essay " Once Upon a Text: Hysteria From Hippocrates ," argued that the womb was not mobile, and that the success of scent therapies was not due to an animalistic organ reacting violently to odors, but to such aromas causing relaxation or constriction of muscles.

How men could get all of the symptoms of a wandering womb--the headaches and vertigo and, of course, very sudden incredible death--without owning an actual womb, is quite problematic for the theory. But for the Greeks, the womb was clearly the seat of a woman’s wily ways, and very much a weakness (Aristotle held that a woman was a “deformed” or “mutilated” male). The womb was a rather more intimate version of the Achilles’ heel, if you will.

And how’s this for a shocker: The looming threat of a wandering womb was used to assert power over women, argues King. One prescription, for example, was for women to be pregnant as often as possible to keep the ostensibly bored womb occupied, and therefore in its rightful place. Physicians would also prescribe consistent sex.

The Romans, thankfully, distanced themselves from the notion of a truly wandering womb, with the physician Galen noting that while it may seem to be moving, it’s actually the tension of the membranes that hold it in place that pull it up slightly. The problem, he claimed, was the “suffocation” of the womb by a buildup of menstrual blood or, even worse, the female version of “seed” that mixed with male sperm. Retained seed would proceed to rot and produce vapors that corrupt the other organs.

After the fall of the Roman Empire, a Byzantine physician by the name of Paul of Aegina proposed an imaginative cure: Make the lady sneeze and, no joke, shout at her. And when the original Greek writings on womb movement, the Gynaikeia , eventually trickled into the Islamic world, physicians there adopted both Aretaeus’ concept of a wandering organ and also rolled in Galen’s idea of suffocation, greatly expanding on the causes of, and cures for, malignant womb vapors.

All of this knowledge, and I use that term loosely, arrived in Italy in the 12th century, and for the next several hundred years, much emphasis was put on scent therapy and sneezing (hey, sneezing may stop your heart, but it does wonders for the womb--OK, sneezing doesn’t actually stop your heart, and it does nothing for the womb). And by the 1500s, argues King, “the hysteria tradition was complete.” While wombs were no longer thought to wander, they were very much to blame for the ostensible irrationality of women. Over the course of several thousand years, the womb had become less and less of a way to explain physical ailments, and more and more of a way to explain psychological dysfunction.

In the 1700s, the theorized cause of hysteria began to shift from the womb to the brain. But this didn’t stop the emergence of the widespread female hysteria commotion in the 19th century , in which countless cures for haywire wombs were peddled on the population, including hypnosis and vibrating devices (not a joke) and blasting a woman’s abdomen with jets of water (sadly, also not a joke). And consider those women of Victorian literature, who were so overcome with emotion--and not at all the suffocating corsets--that they collapsed after announcing they had “a touch of the vapors.” Yes, those same vapors. And how to awaken these women? Smelling salts. Yes, those same foul odors of Hippocratic medicine .

Then along comes Sigmund Freud, who says, Whoa, let’s everyone just settle down . Men get so-called hysteria as well. Freud, in fact, attested to experiencing as much himself, and his study of male hysteria indeed eventually informed his famous Oedipus complex . Most importantly, Freud made it abundantly clear that psychological disorders come from the brain, not from a malfunctioning womb.

Today, what the ancient Greeks or Romans or Arabs would consider to be hysteria is in fact a wide range of psychological disorders, from schizophrenia to panic attacks. (The theory lingers in the word “hysteria” itself: It’s derived from the Greek for “womb.”) And the womb, that organ that so befuddled the physicians of yesteryear, is now much more widely appreciated as that thing that, you know, gave birth to all of us. Unless you're Zeus, and you give birth out of your head . Such are the mysteries of male childbirth, I suppose.

References:

King, H., et al. (1993) Hysteria Beyond Freud . "Once Upon a Text: Hysteria From Hippocrates." University of California Press

Tasca, C., et al. (2012) Women and Hysteria in the History of Mental Health. Clinical Practice and Epidemiology in Mental Health. 2012; 8: 110–119 .

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Wandering wombs and hysteria: the tortuous history of women and pain

Women face an uphill battle to have painful symptoms taken seriously by doctors. Gabrielle Jackson found out the hard way.

It wasn't in a doctors office or a hospital that Jackson learnt for the first time that her long list of painful symptoms were all typical of endometriosis.

She was sitting in a university lecture.

"I cried and I cried and I cried. For most of my life I'd doubted myself, feeling second-rate, weak and flaky," she writes.

What happened next is detailed in her book Pain and Prejudice, where she describes being diagnosed with two chronic inflammatory diseases, endometriosis and adenomyosis, in her early 20s.

Jackson's experience is not unusual. In fact chronic pain is common: it's estimated that nearly one in five Australians lives with it in some form.

But Jackson says women in particular struggle to receive a diagnosis.

It's a problem that's been around for a very long time.

Pain as punishment

For much of history, pain has been seen as an intrinsic part of womanhood.

According to the Abrahamic religions, the first woman ever was dealt pain in childbirth as punishment for disobeying God, when she and Adam dared to take a bite out of an apple plucked from the tree of knowledge.

Social and behavioural scientist Kate Young says institutions like religion, government and education have always played a big part in how we understand women's bodies.

"Women's sexuality has been constructed as volatile and in need of control," she says.

Physicians in Ancient Greece were among the first to describe and systematically categorise various diseases and medical conditions.

Chief among them was Hippocrates, inventor of the "Hippocratic Oath" to do no harm to patients, and widely considered the father of medicine.

He popularised the idea of the "wandering womb", a belief that the medical afflictions suffered by women were the fault of her uterus dislodging itself from her pelvic region and wandering freely around her body.

Hippocrates named one of these afflictions after the Greek word for uterus, hystera.

"The idea was that if they weren't having children, which is what they were 'biologically destined' to do, that must be why they were getting sick,'' Young says.

"The uterus wasn't being used for what it was meant to be so it was wandering around their body."

A hysterical woman was seen as difficult, irrational and dysfunctional, and certainly not fit for public life.

Over time, as scientific understanding of human anatomy developed, the wandering womb theory fell out of favour.

Hysteria, however, persisted in medical textbooks well into the 20th century.

During the 18th century industrial revolution, it was re-framed as a disease of the nervous system.

The transition from agriculture to industry brought with it a pace of life that was seen as incompatible with the inherent frailty of femininity.

Women in pain were victims of a rapidly changing civilisation.

Asylums in the society

In the 19th century, much of a sick woman's fate was determined by her wealth (or more often, the wealth of her husband).

"For wealthy women, the frailty became fashionable, an idle wife was proof of her husband's success,'' writes Jackson.

Poor women were more likely to be locked away in asylums for the insane.

The problem at this time was often framed as either an excess or deficiency in female sexual desire, and as such, treatments often appeared at odds with one another.

Some physicians sought to induce orgasms in their patients, others opted to remove the clitoris altogether.

Other treatments included hypnosis, and traditional blood-letting with leeches.

A persisting pain gap

These days, women's pain is better understood.

Many of those "mad" and "hysterical" women of history were likely suffering from conditions we now know as endometriosis, epilepsy, anorexia and chronic fatigue syndrome.

Hysteria has been demoted from a legitimate medical condition to an admonishment, usually levelled at a woman seen to be behaving in an overly emotional manner.

But the pain gap between men and women lingers.

"Women wait longer for pain medication than men, are more likely to have their physical symptoms ascribed to mental health issues [and] suffer from illnesses ignored or denied by the medical profession," writes Jackson.

Ms Young says there is still a strong cultural belief in western society that pain is normal for women.

Her research into endometriosis revealed that medical professionals often prioritise a woman's fertility over easing her pain symptoms.

"We know that the treatment goals of clinicians and women often conflict," she says.

"Women often privilege symptomatic relief, and want to be able to go about their everyday lives.

"Clinicians instead privilege fertility.

"One of the reasons for that is probably to do with their training, and might go back to the fact that we haven't incorporated women's perspectives and knowledge about their bodies into science and medicine.

Mice, men and difficult women

GP and ambassador for Chronic Pain Australia, Caroline West, agrees that a dearth of good research into women and their bodies had compounded the problem.

"It's in part the fault of the medical profession in not realising that there are clear gender differences in terms of how the body functions,'' she says.

"When it comes to chronic pain research there's definitely been a strong gender bias.

"The irony is that the majority living with chronic pain are women yet 80 per cent of the research is done on men or male mice.

"It's ridiculous to think that you could just study men and expect to have the answers about women's pain."

Jackson points out in her book that PubMed has nearly five times as many clinical trials on male sexual pleasure as it has on female sexual pain.

Young says while it's not the job of women to close the gaps in pain research, improvements in women's healthcare are often the result of them demanding better.

"The women who didn't take no for an answer, who came back and said to a doctor and said "this isn't good enough", they're often framed as the difficult women," she says.

"I love difficult women. I think they are challenging a long history of male-centred medicine.

"Every time they go back to their doctor and say 'I want more from you', I think they are challenging that... and that's so powerful."

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'my gp thinks it's all in my head': why some doctors don't take women's pain seriously.

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Hysteria, Witches, and The Wandering Uterus: A Brief History

Or, why i teach "the yellow wallpaper".

I teach “The Yellow Wallpaper” because I believe it can save people. That is one reason. There are more. I have taught Charlotte Perkins Gilman’s 1891 story for nearly two decades and this past fall was no different. Then again, this past fall was entirely different.

In our undergraduate seminar at the School of the Art Institute of Chicago, we discussed “The Yellow Wallpaper” in the context of the nearly 4,000-year history of the medical diagnosis of hysteria. Hysteria, from the Greek hystera or womb. We explored this wastebasket diagnosis that has been a dump-site for all that could be imagined to be wrong with women from around 1900 BCE until the 1950s. The diagnosis was not only prevalent in the West among mainly white women but had its pre-history in Ancient Egypt, and was found in the Far East and Middle East too.

The course is titled “The Wandering Uterus: Journeys through Gender, Race, and Medicine” and gets its name from one of the ancient “causes” of hysteria. The uterus was believed to wander around the body like an animal, hungry for semen. If it wandered the wrong direction and made its way to the throat there would be choking, coughing or loss of voice, if it got stuck in the the rib cage, there would be chest pain or shortness of breath, and so on. Most any symptom that belonged to a female body could be attributed to that wandering uterus. “Treatments,” including vaginal fumigations, bitter potions, balms, and pessaries made of wool, were used to bring that uterus back to its proper place. “Genital massage,” performed by a skilled physician or midwife, was often mentioned in medical writings. The triad of marriage, intercourse, and pregnancy was the ultimate treatment for the semen-hungry womb. The uterus was a troublemaker and was best sated when pregnant.

“The Yellow Wallpaper” was conceived thousands of years later, in the Victorian era, when the diagnosis of hysteria hit its heyday. Medical attention veered from the hungry uterus and was placed on a woman’s so-called weaker nervous system. Nineteenth-century physician Russell Thacher Trail approximated that three-quarters of all medical practice was devoted to the “diseases of women,” and therefore physicians must be grateful to “frail women” (read frail white women of certain means) for being an economic godsend to the medical profession.

It was believed that hysteria, also known as neurasthenia, could be set off by a plethora of bad habits including reading novels (which caused erotic fantasies), masturbation, and homosexual or bisexual tendencies resulting in any number of symptoms such as seductive behaviors, contractures, functional paralysis, irrationality, and general troublemaking of various kinds. There are pages and pages of medical writings outing hysterics as great liars who willingly deceive. The same old “treatments” were enlisted—genital massage by an approved provider, marriage and intercourse—but some new ones included ovariectomies and cauterization of the clitoris.

It is no accident that such a diagnosis took off just as some of these same women were fighting to gain access to universities and various professions in the US and Europe. A decrease in marriages and falling birth rates coincided with this medical diagnosis criticizing the New Woman and her focus on intellectual, artistic, or activist pursuits instead of motherhood. Such was the downfall of Gilman’s narrator in “The Yellow Wallpaper.”

Good chance you read the story in school, but in case you didn’t or have forgotten, here is a synopsis. Following the birth of her first child, the narrator says she feels sick, but her physician husband has dismissed her complaints as a “temporary nervous condition—a slight hysterical tendency.” He has rented a country house and has put her to rest in the former nursery. She explains,

So I take phosphates or phosphites—whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to “work” until I am well again.

Personally, I disagree with their ideas.

Personally, I believe that congenial work, with excitement and change, would do me good.

But what is one to do?

The narrator’s work is that of a writer. She sneaks paragraphs here and there when she is not being observed by her husband or his sister who is “a perfect and enthusiastic housekeeper, and hopes for no better profession.” The story documents the narrator’s frustrations with her so-called treatment and her husband’s resolve that she only needs to exercise more will and self-control in order to get better. “‘Bless her little heart!’ said he with a big hug, ‘she shall be as sick as she pleases.'”

We witness the narrator’s steady decline as she becomes increasingly obsessed with the room’s ghastly wallpaper: “the bloated curves and flourishes—a kind of ‘debased Romanesque’ with delirium tremens— go waddling up and down in isolated columns of fatuity.” Gilman—a prolific writer of fiction, poetry and profound and progressive books, including Women and Economics, a woman who drew large crowds as she made the national lecture circuit in her day—is masterful at showing us how things fall apart for her protagonist. In the final scene of the story, the narrator creeps along the edges of the former nursery amidst shreds of wallpaper, stepping over her crumpled husband who has fainted upon discovering his wife in such a state.

A number of 19th-century practitioners gained fame as hysteria doctors. S. Weir Mitchell, a prominent Philadelphia physician, was one of them. He championed what he called “the rest cure.” Sick women were put to bed, ordered not to move a muscle and instructed to eschew intellectual or creative work of any kind, fed four ounces of milk every two hours, and oftentimes required to defecate and urinate into a bed-pan while prone. Mitchell was so renowned he had his own Christmas calendar.

Mitchell was Charlotte Perkins Gilman’s physician. His rest cure was prescribed to some of the great minds of the time, including Edith Wharton and Virginia Woolf. Scores of white women artists and writers were diagnosed as hysterics in a period when rebelliousness, shamelessness, ambition, and “over education” were considered to be likely causes. Too much energy going up to the brain instead of staying in the reproductive organs and helping the female body do what it was supposed to do. As Mitchell wrote, “The woman’s desire to be on a level of competition with man and to assume his duties is, I am sure, making mischief, for it is my belief that no length of generations of change in her education and modes of activity will ever really alter her characteristics.”

Transgressing prescribed roles would make women sick. British suffragettes, for instance, were “treated” as hysterics in prison. Outspoken proponents for women’s rights were often characterized as the “shrieking sisterhood.” In our seminar discussion, we made the comparison to the numbers of African American men diagnosed as schizophrenics at a State Hospital for the Criminally Insane in Ionia, Michigan in the 1960s and 70s as documented in psychiatrist Jonathan Metzl’s powerful book The Protest Psychosis: How Schizophrenia Became a Black Disease . A diagnosis can be a weapon used as a way to control and discipline the rebellion of an entire demographic.

As we discussed “The Yellow Wallpaper” and its historical context, I could see that Allie was becoming more and more outraged. She looked as if she might bolt from her classroom seat. Her hand shot up, “Would you believe that my high school English teacher told us, ‘If this woman had followed her husband’s instructions, she wouldn’t have gone crazy?!'”

If I’d had a mouth full of something, I would have done a spit take. In all my years of teaching the story, I cannot remember ever hearing this jaw-dropping explanation. But Allie opened the flood gates. Bec raised her hand, “We read it in eighth grade. We were all concerned and confused, especially the girls. And disturbed by the ending. No one understood what was wrong with the woman. The story didn’t seem to make any sense.”

Max added, “In my A.P. Psychology class, our teacher asked us to use the DSM 4 to diagnose the woman in “The Yellow Wallpaper.” I remember a number of student guesses, like Major Depressive Disorder, General Anxiety Disorder, as well as OCD, Schizophrenia, and Bipolar with Schizotypal tendencies.”

Noëlle said she remembered a fellow high school student describing the narrator as “animalistic” and the teacher writing it on the board. There was no discussion of what “hysteria” actually meant.

Keeta encountered the story in a college literature seminar titled “Going Mad.” Class discussion focused on the insane and unreliable narrator. “A missed opportunity for me to learn about something very real and current, and in some ways I feel wronged by that,” Keeta said. They explained that they had a similar feeling when watching the film Beloved in middle school. “Here’s your heritage, and it’s dumped in your lap, and you have no idea why this enslaved woman killed her child. If you had more information about the history of slavery and reproductive resistance, then you would be able to make better sense of what you were seeing.”

Cristina hadn’t read “The Yellow Wallpaper” before but said, “In the fourth grade in my all-girls Catholic school in Bogotá, my religion teacher told the class that we should only show our bodies to our husbands and doctors. Meaning they are the only ones that can touch our bodies. I think there is some connection here, no?”

I am always moved by the associations students make between the history of hysteria and their own lives and circumstances. We discussed how it is startling to learn about nearly four millennia of this female double bind, of medical writings opining cold, deprived, frail, wanting, evil, sexually excessive, irrational, and deceptive women while asserting the necessity of disciplining their misbehaviors with various “treatments.”

“What about Hillary?” Bec chimed in.

This wasn’t just any fall semester. There couldn’t have been a more appropriate time to consider the history of hysteria than September 2016, the week following Hillary Clinton’s collapse from pneumonia at the 9/11 ceremonies, an event that tipped #HillarysHealth into a national obsession. Rudolph Giuliani said that she looked sick and encouraged people to google “Hillary Clinton illness.” Trump focused on her coughing or “hacking” as if the uterus were still making its perambulations up to the throat.

For many months, Hillary had been pathologized as the shrill shrew who was too loud and outspoken, on the one hand, and the weak sick one who didn’t have the strength or stamina to be president on the other. We discussed journalist Gail Collins’ assessment of the various levels of sexism afoot in the campaign. On the topic of Hillary’s health, Collins wrote, “this is nuts, but not necessarily sexist.” We, in the Wandering Uterus, wholeheartedly disagreed. But, back in September, we did not understand how deeply entrenched these sinister mythologies had already become.

We returned to the Middle Ages to help us understand what we were witnessing unfold during the campaign. By way of the church, the myth flourished that women were evil. Lust and carnal pleasures were the problem with women who were, by nature, lascivious and deceptive. Female sexuality, once again, was the problem. So-called witches were accused of making men impotent; their penises would “disappear” and it was claimed that witches would keep said penises in a nest in a tree. Unholy spirits were the cause of bewitchment, a condition that sounded a lot like earlier descriptions of hysteria. Its “treatment” led to the death of thousands of women. In their 1973 groundbreaking treatise, Witches, Midwives, and Nurses , Barbara Ehrenreich and Deirdre English argue that the first accusations of witchcraft in Europe grew out of church-affiliated male doctors’ anxieties about competition from female healers. The violence promoted by the church allowed for the rise of the European medical profession.

In class, we continued to discuss the construction of she-devil, foul-mouthed Crooked Hillary who extremists berated with hashtags like #Hillabeast and #Godhilla and #Witch Hillary. How could we not compare the campaign season to the witch-hunts when folks at rallies started chanting “hang her in the streets” in addition to the by-then familiar “lock her up.” In short order, we witnessed a shift from the maligned diagnosis of a single individual to an all-out mass hysterical witch-hunt against a woman who dared to run for presidential office. We discussed the brilliant literary critic Elaine Showalter whose book Hystories , written in the 1990s, focuses on end-of-the-millennium mass hysterias. Prior to the existence of social media, Showalter presciently wrote, “hysterical epidemics. . . continue to do damage: in distracting us from the real problems and crises of modern society, in undermining a respect for evidence and truth, and in helping support an atmosphere of conspiracy and suspicion.”

We discussed the fact that social media had allowed for this rapid circulation of Hillary mythologies. I explained that the witch-hunts in Early Modern Europe happened to correspond to the invention of the social media of their day. First published in 1486, Malleus Maleficarum or The Hammer of Witches by Reverends Heinrich Kramer and James Sprenger became the ubiquitous manual that spread the church’s methods of identifying witches through questioning and torture in large part by means of the contemporaneous invention of the printing press. For nearly two centuries, this witch handbook was reprinted again and again, disseminating sentences that would later inspire the anti-Hillary playbook, “She is an imperfect animal who always deceives.” “When a woman thinks alone, she thinks evil.”

By midterm presentations, we talked about the ways in which hysteria had gone viral with other women candidates, like Zephyr Teachout, a law professor and activist running for Congress, who found herself on the receiving end of attack ads that featured a close-up of her face with a red-lettered CRAZY stamped on it.

Upon closer investigation, this form of political slander was not limited to the current election season or the US. In Poland, women who marched against a recent abortion ban were called feminazis, prostitutes, whores, witches, and crazy women. While in 2013, Russian news reports suggested that members of the band Pussy Riot were “witches in a global satanic conspiracy in cahoots with the Secretary of State Hillary Clinton.” That should have been a clue to what would follow.

During the weeks running up to the election we veered from the topic of hysteria and discussed the history of gynecology and enslaved women as experimental subjects, sexual anatomy and disorders of sexual development, and queer and trans health care, but we still began each class by sharing recent developments from the campaign trail: Muslim registries, pussy grabbing/sexual assault, and bullying. We discussed Trump’s remarks that soldiers living with PTSD are not “strong enough,” echoing medical and military attitudes from the previous century that associated male hysteria with WWI and “shell shock.”

The Sunday before the election, I was invited by students belonging to the school feminist group, Maverick, to meet at the Hull-House Museum. We sat on the floor of Jane Addams’ bedroom which houses her 1931 Nobel Peace Prize as well as her thick FBI file, evidence of the one-time moniker “most dangerous woman in America.” We talked about the founding of the Settlement House, that Addams knew that “meaningful work” was important for this first generation of white women that had received a college education. At the Hull-House, Addams and other young women residents worked together with some of the poorest immigrants to improve living conditions, to promote child labor laws, to build playgrounds. They celebrated various immigrant traditions over large shared meals and Italian opera and Greek tragedy.

I told the group that Charlotte Perkins Gilman visited the Hull-House on a number of occasions. It was at the Hull-House that she developed some of her ideas about women and economics, about group kitchens and shared domestic responsibilities. I told them how amazed I was to learn that, as a young woman, Addams, as well as a number of Hull-House residents, had also been under the care of the famed Dr. Mitchell.

I read them excerpts of Addams’ writings during WWI when she was blacklisted for her promotion of peace; her health failed, and she hit the depths of depression. Remarking on her colleagues’ suffering, she wrote: “The large number of deaths among the older pacifists in all the warring nations can probably be traced in some measure to the peculiar strain which such maladjustment implies. More than the normal amount of nervous energy must be consumed in holding one’s own in a hostile world.”

When our class met two days following the election, we talked about deportations, anti-Muslim hate crimes, LGBTQ vulnerabilities, and climate change. A number of us confessed that we were physically ill as we watched the returns come in. I mentioned one friend who wrote me that he felt as though he were drinking poison. Two other friends were struck down by bouts of diarrhea and dry heaves on election night. When they went to their doctor, she said that she had seen an inordinate number of sick people. Something was going around.

For many of these students, the election results were just an added stress to that of a long-time civil war back home, to having undocumented family, to losses from gun violence, or to being targeted when walking down the street because of race and/or gender presentation and/or sexuality and age. For some of us, this next administration would be yet another thing to get through. For more of us, we were only beginning to understand that our democracy and our rights were fragile things.

I didn’t tell them that I was waking up each morning feeling nauseated, my belly distended. I knew I was clenching my gut as if I had been sucker-punched. This clenching plus many surges of adrenaline had set off an old familiar pain in my gallbladder area. A friend told me about his neck pain. Another said her hip pain had returned. I was reminded of Showalter again: “We must accept the interdependence between mind and body and recognize hysterical syndromes as a psychopathology of everyday life before we can dismantle their stigmatizing mythologies.” Who could ever claim that mind-derived illness is not true illness? Pain is not fiction.

The readings for the class immediately following the election included Billye Avery on her creation of the National Black Women’s Health Project. She wrote about the importance of really listening to each other, that issues like infant mortality are not medical problems, they are social problems. We also discussed an excerpt from Audre Lorde’s Cancer Journals , words that were remarkably fresh some 30 years later: “I’ve got to look at all my options carefully, even the ones I find distasteful. I know I can broaden the definition of winning to the point where I can’t lose. . . We all have to die at least once. Making that death useful would be winning for me. I wasn’t supposed to exist anyway, not in any meaningful way in this fucked-up whiteboys’ world. . . Battling racism and battling heterosexism and battling apartheid share the same urgency inside me as battling cancer.” We took heart in Lorde’s reference to, “The African way of perceiving life, as experience to be lived rather than as a problem to be solved.”

Our syllabus continued to portend current events even though it had been composed back in August before the start of the semester. At the escalation of the Standing Rock water protectors’ protests, we discussed Andrea Smith’s “Better Dead than Pregnant,” in her book Conquest: Sexual Violence and American Indian Genocide , about how the violation of indigenous women’s reproductive rights is intimately connected to “government and corporate takeovers of Indian land.” We discussed Katsi Cook’s “The Mother’s Milk Project” and the notion of the mother’s body as “first environment” in First Nations cultures, which led environmental health activists to the understanding that “the right to a non-toxic environment is also a basic reproductive right.”

The week the students were to begin their final presentations, we discussed the Comet Ping Pong Pizza conspiracy, that a man actually stormed a DC pizza parlor with an assault weapon because of fake news claiming that this establishment was the locus of Hillary’s child sex slave ring. I would not have been surprised if the fake news writers had taken inspiration from the Malleus Maleficarum and reported that the parlor also served Hillary the blood of unbaptized children.

Emma said she was tired of Facebook and where was the best place to get news?

A good deal of the election’s fake news had been dependent on the power of a nearly 4,000-year-old fictional diagnosis. Both news and medical diagnosis masqueraded as truth, but they were far from it. How to make sense of this fake diagnosis in relation to the idea that illness can be born from our guts and hearts and minds? Is there anything truer? And yet, psychosomatic illness continues to be deemed an illegitimate fiction.

We know that the social toxins of living in a racist, misogynist, homophobic, and otherwise economically unjust society can literally make us sick, and that sickness is no less real than one brought on by polluted air or water. In actuality, both social and environmental toxins are inextricably intertwined as the very people subject to systemic social toxins (oppression, poverty) are usually the same folks impacted by the most extreme environmental toxins. And the people who point fingers and label others “hysterical” are the ones least directly impacted by said toxins.

Then there are the lies leveled at fiction. What of the fake criticism students had encountered during their former studies of “The Yellow Wallpaper”? Our histories provide us with scant access to the so-called hysteric’s words or thoughts. But Gilman was outspoken about her experience. She wrote about it in letters, in diaries, in the ubiquitous “The Yellow Wallpaper” and in a gem of a 1913 essay titled “Why I Wrote ‘The Yellow Wallpaper.'” In this 500-word piece , required reading for anybody assigning”The Yellow Wallpaper,” Gilman describes her experience with a “noted specialist in nervous diseases,” who, following her rest cure, sent her home with the advice to “‘live as domestic a life as far as possible,’ to ‘have but two hours intellectual life a day,’ and ‘never to touch pen, brush, or pencil again’ as long as I lived.” She obeyed his directions for some months, “and came so near the borderline of utter mental ruin that I could see over.” Then she went back to work—”work, the normal life of every human being; in which is joy and growth and service”—and she ultimately recovered “some measure of power” leading to decades of prolific writing and lecturing. She explains that she sent her story to the noted specialist and heard nothing back. The essay ends,

But the best result is this. Many years later I was told that the great specialist had admitted to friends of his that he had altered his treatment of neurasthenia since reading”The Yellow Wallpaper.”

It was not intended to drive people crazy, but to save people from being driven crazy, and it worked.

I teach “The Yellow Wallpaper” because it is necessary to know and to revisit. I teach “The Yellow Wallpaper” because a deep consideration of this story in relation to its historical and medical context teaches us how much more we can learn about every other narrative we think we already know, be it fact or fiction. I teach this story because I believe it can save people.

The semester is over and New Year’s Day 2017 has passed. I am struck with a nasty flu that lingers for weeks. There is a pulling pressure in my head, a stuck feeling in my ears, unpredictable flushes. I can’t focus. I can barely write the sentences required to finish the letters of recommendations that are due.

Surfing online scratches some productivity itch. Like an obsessed survivalist chipmunk, I stock up on nuts and canned goods and vitamins that will line basement shelves. I donate to a hodgepodge of organizations and causes. . . NRDC, Standing Rock, IRC, African Wildlife Foundation, and more. I sign online petitions as quickly as they enter my inbox. I cough my way through calls to my members of Congress, imploring them to reject various cabinet picks. I come across an article about the surge of visits to therapists for “post-election stress disorder” and “post-election depression syndrome.” The fever continues and still there is that loss of appetite, all laced with a deep sense of foreboding. I sleep through President Obama’s farewell speech.

I wake up the next morning from a fever-induced delirium and am convinced that it is of the utmost importance to locate PVC-free window film. Once the right product is identified, I will affix these decorative wallpaper-like opaque sheets to the bottom sashes in the kitchen so that pedestrians on the nearby sidewalk cannot see in. Suddenly, I must have more privacy. But I want privacy and light. I look at various patterns. One pattern is called “atomic energy.” It is lovely but would probably prove monotonous. I finally land on “rhythm” for its non-descript pattern. In the end, I decide that the wood blinds that are already there work just fine.

I blow my nose and steam my head through more news of Russian election intervention and continued nasty tweets, this time aimed at civil rights legend John Lewis. As Inauguration Day inches closer, I lie on the couch under a blanket, looking out my Chicago window at the rain that should be snow.

A friend on the phone tells me that a fever is the releasing of anger. I feel semi-human. I am haunting my own couch. I leave the house only twice in 17 days to see Frank, the acupuncturist, who tells me that he is treating scores of people with the same upper respiratory thing. He has seen an uptick in ailments since the election. Maybe things will be better after the inauguration, he says hopefully, maybe the anticipation is worse.

I hear myself say aloud to my body, “Please work with me here.”

I read about Jan Chamberlin, a member of the Mormon Tabernacle Choir who refuses to sing at the inauguration. A CNN anchor says that her comparison of Trump to Hitler sounds “kind of hysterical. . . ”

I recall one student from a few years ago. She raised her hand and said that the diagnosis of hysteria was like being called a “crazy girl.” “I am called that all the time,” she said. I was confused. Crazy girl? But as she continued on about that label, many of her classmates nodded emphatically. “If I get upset about something said in conversation or on social media,” she said, “I’m dismissed as ‘crazy girl.'”

Class projects are piled on the floor of my office. There is Max’s poem about the horrifying beating he experienced as a teenager, a hate crime at a mall witnessed by his boyfriend and dismissed by the police. There is Virginia’s small book that she made for her teenage nieces, advice for being a young Latinx person in this country. There is Sylvie’s project, an artist’s book collaboration with her dead mother’s journal writing. Noëlle’s educational coloring book for kids with diabetes that she made with her eight-year-old brother as adviser. I imagine that most, if not all, of these amazing young people would have qualified at one time or another as hysterics because of gender presentation and/or sexuality, and their artistic, scholarly, or activist pursuits. Me too. We are all part of a long history, members of tribes that have been, at times, misinterpreted, misunderstood, or worse.

The misunderstandings have not stopped. Each semester that I teach this class, a few students share stories of bodily symptoms, their own or a family member’s, that could not be explained by organic causes according to conventional Western medicine. Inevitably they were told by a healthcare provider that the problem is all in their heads. These stories contribute to conversations about the power of the mind and how many great ideas and possibilities arise from the very “irrational” place that has been and continues to be so often undervalued.

That is another reason I teach “The Yellow Wallpaper.”   Gilman’s text reminds us that we must defy Mitchell’s treatment; we must use our minds, our critical faculties, and our imaginations more than ever to question and to act.

The fever has lifted, but I still cancel my trip to DC. Standing in the cold for hours would be a bad idea given what my body has been through. I know I must rest. But I can finally focus again. And write. I am so grateful. As Gilman says, “work, the normal life of every human being; in which is joy and growth and service.”

I refuse to tune in for the inauguration. I cannot bear to watch it by myself. After it is over, I read the transcript of the apocalyptic “carnage” speech and witness comparison photos between the last inauguration and this one, proving the small number of people in attendance, a fact that will become the focus of more lies. These “alternative facts” are aided and abetted by Trump’s adviser Kellyanne Conway who will be increasingly subject to strikingly familiar misogynist bitch and witch-based attacks of her own. Hysteria is a bipartisan weapon.

The following day, I watch videos and livestream of millions of participants assembled for Women’s Marches all over the world. A proliferation of photos collect online in a blink. My stomach releases a bit.

From my couch, I work on my syllabi for spring semester while reading Hannah Arendt on tyranny, Michel Foucault on defending society, and bell hooks on love. I am not teaching “The Yellow Wallpaper” this semester. But it will be on my syllabus next fall. And the following fall. And again. And again.

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Terri Kapsalis

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Women have long been seen as at the mercy of their biology.

In the ancient medical world it was believed that a 'wandering womb' caused suffocation and death. Menstruation and pregnancy were thought to make women the weaker sex, both physically and mentally. By the late nineteenth century, it was deemed scientifically proven that women’s biology made them less rational than men, unfit to participate in many areas of public life.

Rising above these attitudes, a century ago, women began securing the right to vote in the UK. Around the same time, nursing was formalised as a predominantly female profession. Since then, nurses have taken a leading role in challenging assumptions of women’s health.

Yet myths and misconceptions remain widespread. Social changes continue to alter women’s biology, as they start periods earlier and live longer beyond the menopause. What is ‘normal’ for women? And why has women’s health long been considered 'dirty' nursing'?

Did you know: Gynaecology is a Greek term literally meaning 'the study of women'. And hysteria is derived from 'hystera' meaning womb. This linguistic association between women’s health and hysteria is still in use today in the term hysterectomy.

Decisions about women’s health have historically been made by men.

For the Victorians, the menstrual cycle was considered a disease. Women found all sorts of ways to find out more about their periods and learnt from female relatives. Some would even source secret texts on women’s health, often disguised in the dust jacket of more ‘acceptable’ reading material.

How did nursing change this? As the role of women in health care grew, so did an understanding about women’s health and biological cycles. Nurses became advocates for women, in a position to air previously hidden topics. 

The introduction of the contraceptive pill in 1961 changed when and how much women bleed. It helped move away from medically assumed norms to cycle lengths and flows unique to the individual. More and more women were able to better predict the symptoms of their own biology.

Women today have more control over their periods than ever. Bolder attitudes have seen campaigns to abolish the ‘tampon tax’ and charities working to ensure all women get access to menstrual supplies. Nurses play an important part in this changing atmosphere. As more non-surgical options have become available for women, like mirena coils and hysteroscopy, nurses have been at the  forefront of embracing and delivering these treatments.

Nursing today focuses on the holistic management of menopause. This can include managing lifestyle changes and advising on prescribed medication such as Hormone Replacement Therapy. Because the effects of menopause are so complex, Clinical Nurse Specialists (CNS) are key at this advanced level of practice. Taking time to understand individual patient concerns and providing tailored support are crucial nursing skills.

A Victorian woman going through the menopause was often considered to be emotionally unstable. During this 'climacteric period', she may well have been prescribed leeching or bloodletting from the ankle. Her doctor would have advised against reading novels, going to parties and dancing. For a 45 – 50 year old Victorian woman, an onslaught of instability and madness was considered inevitable. 

In the Victorian age men were also diagnosed with climacteric insanity, as something that was defined as a broad spectrum of 'changes' in life. But men were not diagnosed as frequently as women. Today, the possibility of 'man periods' or the 'male menopause' are widely discussed, as hormone fluctuations in men are also recognized.

Hidden loss

Pregnancy loss is more common than is discussed.

Even today, some causes of miscarriage are not known. Plenty of preventative measures have been tried and tested by women all over the world for centuries. Ancient Egyptian women were known for placing protective amulets in the vulva and women of Ancient Greece would avoid bitter foods. Practically any action taken by a woman in the Middle Ages could be seen to prompt a miscarriage, making her choices wholly responsible for the outcomes of her pregnancy.

In the nineteenth century, anything from exercise, worry, even failure to meet the demands of home life was blamed. Whilst these beliefs are centuries past, the idea of miscarriage as being the ‘fault’ of the woman still exists. Stigma around miscarriage and ectopic pregnancy continues

Nurses are breaking this stigma.

The focus has shifted from the physical health of women to their emotional health. Specialist nurses within Early Pregnancy Units are leading on assessing, scanning and undertaking treatments. Counselling and strong links with support groups and charities are all part of providing expert care for their patients.

"By allowing my own experience to be reported I hope…that I might contribute in a small way to a future climate in which these matters are respected as entirely personal – rather than pored over and speculated about as they are now.”

In 1895, Dublin nurse Alice Beatty took her surgeon, Charles Cullingworth, to court.

Cullingworth operated on Beatty for 'ovarian disease', but removed both her ovaries rather than the one she had consented to. Beatty, engaged to be married and keen to start a family, claimed damages for a wrongly performed operation. She lost the case.

Victorian surgery, prescribed and performed by men, was often extreme. Hysterectomy was the treatment of choice for cervical cancer, even when death rates were high. Consent and the social and psychological effects on women were barely acknowledged. 

With the advent of new procedures, such as endometrial ablation, hysterectomy is no longer the only option. Now, Clinical Nurse Specialists (CNS) are essential in delivering and supporting these new treatments and at the same time, ensuring the rights and wishes of their patients are met. 

Gynaecological cancers are complex and the nursing role is expanding. Nurses take the majority of smear tests. They have a large role in the diagnosis of cervical cancer, from screening through to colposcopy, as well as spotting cancer reoccurrence. A CNS remains with their patient for the whole journey, from diagnosis, treatment and managing the long term effects. Unlike Alice Beatty, women now have increasing opportunities to take more control over their own care.

We all need to speak more openly about intimate health issues.

Women's biology has long been subject to speculation, comment and often control by others. It is now time for menstruation and menopause to be understood and celebrated as a normal part of female biology. 

In a field previously dominated by the perspectives of male doctors and physicians, all nurses now have a responsibility to advocate for women today. It is up to healthcare workers to recognise that each woman is different and that ‘normal’ means healthy.

Perhaps for the nurse, it is the ‘dirty’ nature of gynaecology which makes the role so unique, helping to transform a woman’s experience.

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Today, when we say someone is hysterical, we mean that they are frenzied, frantic, or out of control. Until 1980, however, hysteria was a formally studied psychological disorder that could be found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Before its classification as a mental disorder, hysteria was considered a physical ailment, first described medically in 1880 by Jean-Martin Charcot. Even before this, hysteria was thoroughly described in ancient Egyptian and Greek societies. So what was hysteria? How did it just go away? Why was it a major point of contention for second wave feminists, and how was it treated?

Throughout history hysteria has been a sex-selective disorder, affecting only those of us with a uterus. These uteri were often thought to be the basis of a variety of health problems. The ancient Egyptians and Greeks, for example, believed wombs capable of affecting the rest of the body’s health. In ancient Greece specifically, it was believed that a uterus could migrate around the female body, placing pressure on other organs and causing any number of ill effects. This “roaming uteri” theory, supported by works from the philosopher Plato and the physician Aeataeus, was called ‘hysterical suffocation’, and the offending uterus was usually coaxed back into place by placing good smells near the vagina, bad smells near the mouth, and sneezing. The philosopher and physician Galen however disagreed with the roving uterus theory, believing instead that the retention of ‘female seed’ within the womb was to blame for the anxiety, insomnia, depression, irritability, fainting and other symptoms women experienced. (Throughout these classical texts, pretty much any symptom could be attributed to the female sex organs, from fevers to kleptomania).

Other writers and physicians at the time blamed the retention of menstrual blood for “female problems.” Either way, the obvious solution was to purge the offending fluid, so marriage (and its implied regular sexual intercourse) was the general recommendation. Male semen was also believed to have healing properties, so sex served two purposes. For young or unmarried women, widows, nuns or married women unable to achieve orgasm via the strictly penetrative heterosexual sex that was common at the time, midwives were occasionally employed to manually stimulate the genitals, and release the offending liquids. A 1637 text explains that when sexual fluids are not regularly released, ‘the heart and surrounding areas are enveloped in a morbid and moist exudation’, and that any ‘lascivious females, inclined to venery’ simply had a buildup of these fluids. It’s obviously laughable to think that doctors believed everything wrong with women could be attributed to their liquid levels, but contrarily it is interesting how close doctors got to the truth, in their belief that extreme sexual desire was caused by a lack of regular orgasm.

It was Jean-Martin Charcot, in 1880 France, who first took a modern scientific sense to the female-only disease of hysteria. He lectured to his medical students, showing them photos and live subjects, on the hysteria symptoms he believed were caused by an unknown internal injury affecting the nervous system. One of these medical students was none other than Sigmund Freud, the founder of psychoanalysis. Freud, working with his partner Breuer in Austria, developed Charcot’s theories further, and wrote several studies on female hysteria from 1880-1915. He believed that hysteria was a result, not of a physical injury in the body, but of a ‘ psychological scar produced through trauma or repression’ . Specifically, this psychological damage was a result of removing male sexuality from females, an idea that stems from Freud’s famous ‘Oedipal moment of recognition’ in which a young female realizes she has no penis, and has been castrated. (I don’t have the time to open that particular bag of worms , but feel free to click here to read about it)

In essence, Freud believed that women experienced hysteria because they were unable to reconcile the loss of their (metaphoric) penis. With this in mind, Freud described hysteria as ‘characteristically feminine’, and recommended basically what every other man treating hysteria had through the years- get married and have sex. Previously this was done to allow for the ridding of sexual liquids, whereas now the idea was that a woman could regain her lost penis by marrying one, and potentially giving birth to one. If marriage wasn’t an acceptable or possible treatment however, there was another technique of treatment for hysteria, prolapsed uteri and any gynecologicals problem really, rising in popularity in the late 17th century- uterine massage.

Yes, uterine or gynecologicals massage was exactly what you think it was.

Invented by a Swedish Army Major named Thure Brandte, and though initially used to treat conditions in soldiers like prolapsed anuses, uterine massage quickly became the norm for treating everything in women from tilted uteri to nymphomania. Brandte opened several clinics, all of which were remarkably successful. He employed 5 med students, 10 female physical therapists, and had doctors from across the globe apprenticing at his clinics, which were known to treat as many as 117 patients in 1 day. Most recommended techniques were bimanual, meaning 1 hand was placed outside the body on the abdomen, and the other inserted into either the vagina or anus to perform massage, until a ‘paroxysmal convulsion’ (we now call these orgasms) was achieved. These sessions were considered ‘long and physically exhausting’ for doctors, for obvious reasons. This problem led to the creation of stimulation devices- namely, vibrators. (You can see some early vibrators by clicking here )

At least officially, the sexual nature of these treatments was not realized, or at least acknowledged. While it’s hard to not see this procedure as a primarily sexual process when looking back, doctors at the time feared it becoming conflated with sex. So much so that some advocated hurting the female patients, or at least causing them discomfort. It still baffles me how any doctor could purposefully and unnecessarily hurt patients, but this is just another example of the many unethical medical processes women have been subject to . After about 1910, gynaecological massage fell into the category of alternative medicine, and while I’m sure you can still find someone practicing it today, advancements in medical knowledge (and feminist movements) have led to the understandings that the uterus is not at the heart of most medical problems, and that many of the symptoms previously attributed to hysteria truly belonged to mental illnesses, or were just normal, if unacceptable to historic societies, behaviours for females.

Hysteria was basically the medical explanation for ‘everything that men found mysterious or unmanageable in women’, a conclusion only supported by men’s (historic and continuing ) dominance over medicine, and hysteria’s continued use as a synonym for “over-emotional” or “deranged.” It’s also worth noting how many of the problems physicians were attempting to fix in female patients, were not problems when they presented in male patients. Gendered stereotypes, like the ideas that women should be submissive, even-tempered, and sexually inhibited, have caused tremendous damage throughout history (and continue to do so today). It doesn’t seem so coincidental then that most modern treatments for hysteria involved regular (marital) sex, marriage or pregnancy and childbirth, all ‘proper’ activities for a ‘proper’ woman.

All things considered, most doctors and women alike were glad to see hysteria deleted from official Diagnostic and Statistical Manual of Mental Disorders in 1980.

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Hysteria, Witches and the Wandering Uterus: A Brief History -- Or Why I Teach "The Yellow Wallpaper"

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Terri Kapsalis is a writer, performer and cultural critic. She is also an Adjunct Professor at the School of the Art Institute of Chicago (SAIC).  For the past two decades, she has been discussing the 6,000-word short story “ The Yellow Wallpaper " with undergraduates as part of a course titled "The Wandering Uterus: Journeys Through Gender, Race, and Medicine." 

The following is an edited excerpt, which was originally published in the website Literary Hub . It is republished here to give context to the world Vireo inhabits in "Vireo: The Spiritual Biography of a Witch's Accuser," which is now available for streaming. Watch the 12 full episodes . 

I teach “The Yellow Wallpaper” because I believe it can save people. That is one reason. There are more. I have taught Charlotte Perkins Gilman’s 1891 story for nearly two decades and this past fall was no different. Then again, this past fall was entirely different.

In our undergraduate seminar at the School of the Art Institute of Chicago, we discussed “The Yellow Wallpaper” in the context of the nearly 4,000-year history of the medical diagnosis of hysteria. Hysteria, from the Greek hystera or womb. We explored this wastebasket diagnosis that has been a dumpsite for all that could be imagined to be wrong with women from around 1900 BCE until the 1950s. The diagnosis was not only prevalent in the West among mainly white women but had its pre-history in Ancient Egypt, and was found in the Far East and Middle East too.

It is no accident that [hysteria as] a diagnosis took off just as some of these same women were fighting to gain access to universities and various professions in the U.S. and Europe. A decrease in marriages and falling birth rates coincided with this medical diagnosis criticizing the New Woman and her focus on intellectual, artistic, or activist pursuits instead of motherhood.

The course is titled “The Wandering Uterus: Journeys through Gender, Race, and Medicine.” It gets its name from one of the ancient “causes” of hysteria. The uterus was believed to wander around the body like an animal, hungry for semen. If it wandered the wrong direction and made its way to the throat there would be choking, coughing or loss of voice. If it got stuck in the rib cage, there would be chest pain or shortness of breath, and so on. Most any symptom that belonged to a female body could be attributed to that wandering uterus. “Treatments,” including vaginal fumigations, bitter potions, balms, and pessaries made of wool, were used to bring that uterus back to its proper place. “Genital massage,” performed by a skilled physician or midwife, was often mentioned in medical writings. The triad of marriage, intercourse, and pregnancy was the ultimate treatment for the semen-hungry womb. The uterus was a troublemaker and was best sated when pregnant.

“The Yellow Wallpaper” was conceived thousands of years later, in the Victorian era, when the diagnosis of hysteria hit its heyday. Medical attention veered from the hungry uterus and was placed on a woman’s so-called weaker nervous system. Nineteenth-century physician Russell Thacher Trail approximated that three-quarters of all medical practice was devoted to the “diseases of women,” and therefore physicians must be grateful to “frail women” (read: frail white women of certain means) for being an economic godsend to the medical profession.

At the time, the medical community believed that hysteria, also known as neurasthenia, could be set off by a plethora of bad habits including reading novels (which caused erotic fantasies), masturbation, and homosexual or bisexual tendencies resulting in any number of symptoms such as seductive behaviors, contractures, functional paralysis, irrationality and general troublemaking of various kinds. There are pages and pages of medical writings outing hysterics as great liars who willingly deceive. The same old “treatments” were enlisted to cure these afflictions — genital massage by an approved provider, marriage and intercourse — but some new ones included ovariectomies and cauterization of the clitoris.

It is no accident that such a diagnosis took off just as some of these same women were fighting to gain access to universities and various professions in the U.S. and Europe. A decrease in marriages and falling birth rates coincided with this medical diagnosis criticizing the New Woman and her focus on intellectual, artistic, or activist pursuits instead of motherhood. Such was the downfall of Gilman’s narrator in “The Yellow Wallpaper.”

There’s a good chance you’ve read the story in school, but in case you didn’t or have forgotten, here is a synopsis. Following the birth of her first child, the narrator says she feels sick, but her physician husband has dismissed her complaints as a “temporary nervous condition — a slight hysterical tendency.” He has rented a country house and has put her to rest in the former nursery. She explains,

So I take phosphates or phosphites—whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to “work” until I am well again.Personally, I disagree with their ideas.Personally, I believe that congenial work, with excitement and change, would do me good.But what is one to do?

The narrator’s work is that of a writer. She sneaks paragraphs here and there when she is not being observed by her husband or his sister who is “a perfect and enthusiastic housekeeper, and hopes for no better profession.” The story documents the narrator’s frustrations with her so-called treatment and her husband’s resolve that she only needs to exercise more will and self-control in order to get better. “‘Bless her little heart!’ said he with a big hug, ‘she shall be as sick as she pleases.'”

We witness the narrator’s steady decline as she becomes increasingly obsessed with the room’s ghastly wallpaper: “the bloated curves and flourishes — a kind of ‘debased Romanesque’ with delirium tremens — go waddling up and down in isolated columns of fatuity.” Gilman — a prolific writer of fiction, poetry and progressive books, including Women and Economics, a woman who drew large crowds as she made the national lecture circuit in her day — is masterful at showing us how things fall apart for her protagonist. In the final scene of the story, the narrator creeps along the edges of the former nursery amidst shreds of wallpaper, stepping over her crumpled husband who has fainted upon discovering his wife in such a state.

A number of 19th-century practitioners gained fame as hysteria doctors. S. Weir Mitchell, a prominent Philadelphia physician, was one of them. He championed what he called “the rest cure.” Sick women were put to bed, ordered not to move a muscle and instructed to eschew intellectual or creative work of any kind, fed four ounces of milk every two hours, and oftentimes required to defecate and urinate into a bedpan while prone. Mitchell was so renowned he had his own Christmas calendar.

Mitchell was Charlotte Perkins Gilman’s physician. His rest cure was prescribed to some of the great minds of the time, including Edith Wharton and Virginia Woolf. Scores of white women artists and writers were diagnosed as hysterics in a period when rebelliousness, shamelessness, ambition and “over education” were considered to be likely causes. Supposedly, there was too much energy going up to the brain instead of staying in the reproductive organs and helping the female body do what it was supposed to do. As Mitchell wrote, “The woman’s desire to be on a level of competition with man and to assume his duties is, I am sure, making mischief, for it is my belief that no length of generations of change in her education and modes of activity will ever really alter her characteristics.”

Transgressing prescribed roles was thought to make women sick. British suffragettes, for instance, were “treated” as hysterics in prison. Outspoken proponents for women’s rights were often characterized as the “shrieking sisterhood.” In our seminar discussion, we make the comparison to the numbers of African American men diagnosed as schizophrenics at a State Hospital for the Criminally Insane in Ionia, Michigan during the 1960s and 70s, as documented in psychiatrist Jonathan Metzl’s powerful book “The Protest Psychosis: How Schizophrenia Became a Black Disease.” A diagnosis can be a weapon used as a way to control and discipline the rebellion of an entire demographic.

As we discussed “The Yellow Wallpaper” and its historical context, I could see that one of my students, Allie, was becoming more and more outraged. She looked as if she might bolt from her classroom seat. Her hand shot up, “Would you believe that my high school English teacher told us, ‘If this woman had followed her husband’s instructions, she wouldn’t have gone crazy?!'”

If I’d had a mouth full of something, I would have done a spit take. In all my years of teaching the story, I cannot remember ever hearing this jaw-dropping explanation. But Allie opened the floodgates. Another student, Bec, raised her hand, “We read it in eighth grade. We were all concerned and confused, especially the girls. And disturbed by the ending. No one understood what was wrong with the woman. The story didn’t seem to make any sense.”

Max added, “In my A.P. Psychology class, our teacher asked us to use the DSM 4 to diagnose the woman in “The Yellow Wallpaper.” I remember a number of student guesses, like Major Depressive Disorder, General Anxiety Disorder, as well as OCD, Schizophrenia, and Bipolar with Schizotypal tendencies.”

Noëlle said she remembered a fellow high school student describing the narrator as “animalistic” and the teacher writing it on the board. There was no discussion of what “hysteria” actually meant.

Keeta encountered the story in a college literature seminar titled “Going Mad.” That class discussion focused on the “insane and unreliable narrator." “[It was] a missed opportunity for me to learn about something very real and current, and in some ways I feel wronged by that,” Keeta said. They explained that they had a similar feeling when watching the film “Beloved” in middle school. “Here’s your heritage, and it’s dumped in your lap, and you have no idea why this enslaved woman killed her child. If you had more information about the history of slavery and reproductive resistance, then you would be able to make better sense of what you were seeing.”

Cristina hadn’t read “The Yellow Wallpaper” before but said, “In the fourth grade in my all-girls Catholic school in Bogotá, my religion teacher told the class that we should only show our bodies to our husbands and doctors. Meaning they are the only ones that can touch our bodies. I think there is some connection here, no?”

I am always moved by the associations students make between the history of hysteria and their own lives and circumstances. We discussed how it is startling to learn about nearly four millennia of this female double bind, of medical writings opining cold, deprived, frail, wanting, evil, sexually excessive, irrational and deceptive women while asserting the necessity of disciplining their misbehaviors with various “treatments.”

“What about Hillary?” Bec chimed in.

This wasn’t just any fall semester. There couldn’t have been a more appropriate time to consider the history of hysteria than September 2016, the week following Hillary Clinton’s collapse from pneumonia at the 9/11 ceremonies, an event that tipped #HillarysHealth into a national obsession. Rudolph Giuliani said that she looked sick and encouraged people to google “Hillary Clinton illness.” Trump focused on her coughing or “hacking” as if the uterus were still making its perambulations up to the throat.

For many months, Hillary had been pathologized as the shrill shrew who was too loud and outspoken on the one hand, and the weak sick one who didn’t have the strength or stamina to be president on the other. We discussed journalist Gail Collins’ assessment of the various levels of sexism afoot in the campaign. On the topic of Hillary’s health, Collins wrote, “This is nuts, but not necessarily sexist.” We, in the Wandering Uterus class, wholeheartedly disagreed. But, back in September, we did not understand how deeply entrenched these sinister mythologies had already become.

To help us understand what we were witnessing unfold during the campaign, we turned to prevailing wisdom in the Middle Ages. By way of the church, the myth flourished that women were evil. Women were seen as lascivious and deceptive by nature. Female sexuality, once again, was the problem. So-called witches were accused of making men impotent; their penises would “disappear” and it was claimed that witches would keep said penises in a nest in a tree. Unholy spirits were the cause of bewitchment, a condition that sounded a lot like earlier descriptions of hysteria. Its “treatment” led to the death of thousands of women. In their 1973 groundbreaking treatise, “Witches, Midwives, and Nurses: A History of Women Healers,” Barbara Ehrenreich and Deirdre English argue that the first accusations of witchcraft in Europe grew out of church-affiliated male doctors’ anxieties about competition from female healers. The violence promoted by the church allowed for the rise of the European medical profession.

How could we not compare the campaign season to the witch-hunts when folks at rallies started chanting “hang her in the streets” in addition to the by-then familiar “lock her up.” In short order, we witnessed a shift from the maligned diagnosis of a single individual to an all-out mass hysterical witch-hunt against [Hillary Clinton,] a woman who dared to run for presidential office.

In class, we continued to discuss the construction of she-devil, foul-mouthed Crooked Hillary who extremists berated with hashtags like #Hillabeast and #Godhilla and #Witch Hillary. How could we not compare the campaign season to the witch-hunts when folks at rallies started chanting “hang her in the streets” in addition to the by-then familiar “lock her up.” In short order, we witnessed a shift from the maligned diagnosis of a single individual to an all-out mass hysterical witch-hunt against a woman who dared to run for presidential office. We discussed the brilliant literary critic Elaine Showalter whose book “Hystories,” written in the 1990s, focuses on end-of-the-millennium mass hysterias. Prior to the existence of social media, Showalter presciently wrote, “hysterical epidemics. . . continue to do damage: in distracting us from the real problems and crises of modern society, in undermining a respect for evidence and truth, and in helping support an atmosphere of conspiracy and suspicion.”

We discussed the fact that social media had enabled this rapid circulation of Hillary mythologies. I explained that the witch-hunts in Early Modern Europe happened to correspond to the invention of the social media of their day. First published in 1486, “Malleus Maleficarum” (translated as “The Hammer of Witches”) by Reverends Heinrich Kramer and James Sprenger became the ubiquitous manual that spread the church’s methods of identifying witches through questioning and torture in large part by means of the contemporaneous invention of the printing press. For nearly two centuries, this witch handbook was reprinted again and again, disseminating sentences -- such as “She is an imperfect animal who always deceives” and “When a woman thinks alone, she thinks evil” -- that would later inspire the anti-Hillary playbook.

By midterm presentations, we talked about the ways in which hysteria had gone viral with other women candidates, like Zephyr Teachout, a law professor and activist running for Congress, who found herself on the receiving end of attack ads that featured a close-up of her face with a red-lettered CRAZY stamped on it.

Upon closer investigation, this form of political slander was not limited to the current election season or the US. In Poland, women who marched against a recent abortion ban were called feminazis, prostitutes, whores, witches and crazy women. While in 2013, Russian news reports suggested that members of the band Pussy Riot were “ witches working with a global satanic conspiracy ” in cahoots with the Secretary of State Hillary Clinton.” That should have been a clue to what would follow.

During the weeks running up to the election we veered from the topic of hysteria and discussed the history of gynecology and enslaved women as experimental subjects, sexual anatomy and disorders of sexual development, and queer and trans healthcare, but we still began each class by sharing recent developments from the campaign trail: Muslim registries, pussy grabbing/sexual assault and bullying. We discussed Trump’s remarks that soldiers living with PTSD are not “strong enough,” echoing medical and military attitudes from the previous century that associated male hysteria with WWI and “shell shock.”

The Sunday before the election, I was invited by students belonging to the school feminist group, Maverick, to meet at the Hull-House Museum. We sat on the floor of Jane Addams’ bedroom which houses her 1931 Nobel Peace Prize as well as her thick FBI file, evidence of the one-time moniker “most dangerous woman in America.” We talked about the founding of the Settlement House, that Addams knew that “meaningful work” was important for this first generation of white women that had received a college education. At the Hull-House, Addams and other young women residents worked together with some of the poorest immigrants to improve living conditions, to promote child labor laws, to build playgrounds. They celebrated various immigrant traditions over large shared meals and Italian opera and Greek tragedy.

I told the group that Charlotte Perkins Gilman visited the Hull-House on a number of occasions. It was at the Hull-House that she developed some of her ideas about women and economics, about group kitchens and shared domestic responsibilities. I told them how amazed I was to learn that, as a young woman, Addams, as well as a number of Hull-House residents, had also been under the care of the famed Dr. Mitchell.

I read them excerpts of Addams’ writings during WWI when she was blacklisted for her promotion of peace; her health failed, and she hit the depths of depression. Remarking on her colleagues’ suffering, she wrote: “The large number of deaths among the older pacifists in all the warring nations can probably be traced in some measure to the peculiar strain which such maladjustment implies. More than the normal amount of nervous energy must be consumed in holding one’s own in a hostile world.”

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A good deal of the election’s fake news had been dependent on the power of a nearly 4,000-year-old fictional diagnosis.

When our class met two days following the election, we talked about deportations, anti-Muslim hate crimes, LGBTQ vulnerabilities and climate change. A number of us confessed that we were physically ill as we watched the returns come in. I mentioned one friend who wrote me that he felt as though he were drinking poison. Two other friends were struck down by bouts of diarrhea and dry heaves on election night. When they went to their doctor, she said that she had seen an inordinate number of sick people. Something was going around.

For many of these students, the election results were just an added stress to that long-time civil war back home, to having undocumented family, to losses from gun violence or to being targeted when walking down the street because of race and/or gender presentation and/or sexuality and age. For some of us, this next administration would be yet another thing to get through. For more of us, we were only beginning to understand that our democracy and our rights were fragile things.

I didn’t tell them that I was waking up each morning feeling nauseated, my belly distended. I knew I was clenching my gut as if I had been sucker-punched. This clenching plus many surges of adrenaline had set off an old familiar pain in my gallbladder area. A friend told me about his neck pain. Another said her hip pain had returned. I was reminded of Showalter again: “We must accept the interdependence between mind and body and recognize hysterical syndromes as a psychopathology of everyday life before we can dismantle their stigmatizing mythologies.” Who could ever claim that mind-derived illness is not true illness? Pain is not fiction.

The readings for the class immediately following the election included Byllye Avery on her creation of the National Black Women’s Health Project. She wrote about the importance of really listening to each other, that issues like infant mortality are not medical problems, they are social problems. We also discussed an excerpt from Audre Lorde’s “The Cancer Journals.” Her words are remarkably fresh some 30 years later: “I’ve got to look at all my options carefully, even the ones I find distasteful. I know I can broaden the definition of winning to the point where I can’t lose. . . We all have to die at least once. Making that death useful would be winning for me. I wasn’t supposed to exist anyway, not in any meaningful way in this fucked-up white boys’ world. . . Battling racism and battling heterosexism and battling apartheid share the same urgency inside me as battling cancer.” We took heart in Lorde’s reference to, “The African way of perceiving life, as experience to be lived rather than as a problem to be solved.”

Our syllabus continued to portend current events even though it had been composed back in August before the start of the semester. At the escalation of the Standing Rock water protectors’ protests, we discussed Andrea Smith’s “Better Dead than Pregnant,” taken from her book “Conquest: Sexual Violence and American Indian Genocide.” This chapter discusses how the violation of indigenous women’s reproductive rights is intimately connected to “government and corporate takeovers of Indian land.” We discussed Katsi Cook’s “The Mother’s Milk Project” and the notion of the mother’s body as “first environment” in First Nations cultures, which led environmental health activists to the understanding that “the right to a non-toxic environment is also a basic reproductive right.”

 “For some of us, this next administration would be yet another thing to get through. For more of us, we were only beginning to understand that our democracy and our rights were fragile things.”

The week the students were to begin their final presentations, we discussed the Comet Ping Pong Pizza conspiracy, that a man actually stormed a DC pizza parlor with an assault weapon because of fake news claiming that this establishment was the locus of Hillary’s child sex slave ring. I would not have been surprised if the fake news writers had taken inspiration from the “Malleus Maleficarum” and reported that the parlor also served Hillary the blood of unbaptized children.

Emma said she was tired of Facebook and where was the best place to get news?

A good deal of the election’s fake news had been dependent on the power of a nearly 4,000-year-old fictional diagnosis. Both news and medical diagnosis masquerade as truth, but they were far from it. How can we make sense of this fake diagnosis in relation to the idea that illness can be born from our guts and hearts and minds? Is there anything truer? And yet, psychosomatic illness continues to be deemed an illegitimate fiction.

We know that the social toxins of living in a racist, misogynist, homophobic, and otherwise economically unjust society can literally make us sick, and that sickness is no less real than one brought on by polluted air or water.

We know that the social toxins of living in a racist, misogynist, homophobic, and otherwise economically unjust society can literally make us sick, and that sickness is no less real than one brought on by polluted air or water. In actuality, both social and environmental toxins are inextricably intertwined. The very people subject to systemic social toxins (oppression, poverty) are usually the same folks impacted by the most extreme environmental toxins. And the people who point fingers and label others “hysterical” are the ones least directly impacted by said toxins.

Then there are the lies leveled at fiction. What of the fake criticism my students had encountered during their former studies of “The Yellow Wallpaper”? Our histories provide us with scant access to the so-called hysteric’s words or thoughts. But Gilman was outspoken about her experience. She wrote about it in letters, in diaries, in the ubiquitous “The Yellow Wallpaper” and in a gem of a 1913 essay titled “Why I Wrote ‘The Yellow Wallpaper.'” In this 500-word piece -- required reading for anybody assigning ”The Yellow Wallpaper” -- Gilman describes her experience with a “noted specialist in nervous diseases,” who, following her rest cure, sent her home with the advice to “‘live as domestic a life as far as possible,’ to ‘have but two hours intellectual life a day,’ and ‘never to touch pen, brush, or pencil again’ as long as I lived.” She obeyed his directions for some months, “and came so near the borderline of utter mental ruin that I could see over.” Then she went back to work—”work, the normal life of every human being; in which is joy and growth and service”—and she ultimately recovered “some measure of power” leading to decades of prolific writing and lecturing. She explains that she sent her story to the noted specialist and heard nothing back. The essay ends.

"But the best result is this. Many years later I was told that the great specialist had admitted to friends of his that he had altered his treatment of neurasthenia since reading 'The Yellow Wallpaper.'

It was not intended to drive people crazy, but to save people from being driven crazy, and it worked."

I teach “The Yellow Wallpaper” because it is necessary to know and to revisit. I teach “The Yellow Wallpaper” because a deep consideration of this story in relation to its historical and medical context teaches us how much more we can learn about every other narrative we think we already know, be it fact or fiction.

Top Image: A clinical lesson about hysteria held at hospital of la Salpêtrière in Paris by French neurologist Jean-Martin Charcot | Wikimedia

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When Wombs Wandered: How Hysteria’s History Still Affects Women’s Health

History Editor

Once a common medical diagnosis for women, ‘hysteria’ has since been discarded as a sexist myth – but the legacy of the ‘disease’ still has an impact on how women are treated in medical and social settings today.

Suffocation, emotional outbursts, sexual voraciousness and frigidity were only some of the symptoms attributed to ‘hysteria’. Considered a “ garbage-bag diagnosis ” for disruptive women, hysteria has shaped Western perceptions of women’s capability and trustworthiness in both social and medical settings.

Ancient Greek and Roman doctors thought a thirsty uterus made women ill

In Ancient Greece and Rome, women’s health issues were sometimes directly attributed to the womb, or hystera in Greek. Ancient doctors believed that women experienced a myriad physical symptoms due to the uterus’s movement around the body in search of moisture, which has led to early instances of hysteria to be referred to as ‘wandering womb syndrome’.

“The symptoms womb movement produced depended on where it went,” says Professor Helen King, who focusses her research on classical studies and the history of women’s medicine. “The idea of a wandering womb was linked to the social control of women to the norm of marriage and childbearing. But wandering wombs could be caused by exhaustion or not enough to eat, they could affect pregnant women too – marriage and pregnancy weren’t guaranteed cures.”

While ancient medical documents show the womb ( hystera ) as a cause of some physical ailments, King cautions that it is important not to conflate Ancient Greek and Roman diagnoses with psychological hysteria diagnoses in the 19th century: “I’m not sure I’d even go so far as to call it wandering womb syndrome! To assume it corresponds to what a 19th-century doctor meant by hysteria is to take it too far.”

Hysteria was classified as a psychological disorder in the 19th century

Over the centuries, the thought persisted that physical ailments were caused by misplaced wombs. The commonly prescribed cure was often marriage (and marital sex by extension) or pregnancy, as they were thought to affix the uterus into its rightful place. However, by the 19th century, the understanding of hysteria began to shift from a physical ailment to a psychological one that manifested in physical and emotional symptoms.

At a time when technological advancements were influencing social change and urbanisation, a moral panic began to develop, and its focus centred on the protection of women . Rather than attribute the rise of hysteria diagnoses to the breadth of causes and symptoms, the disorder was linked to women’s inability to make sense of a modernising world.

Women who challenged this? Hysterical.

It was not unheard of for fathers, husbands or brothers to send the women in their lives to asylums for hysteria treatment . However, after treatment, many patients were often worse for wear. Protestations to hospitalisation was proof of insanity and led to longer internment. Some may have actually presented symptoms of true illness, but there were also a large number of women admitted simply because they didn’t fit the feminine ideal: quiet, pliant and pious.

Did Victorian doctors really use vibrators to cure hysteria?

While new technologies were seen as corruptive to the female psyche, they did end up playing a part in the treatment of hysteria. However, unlike the 2011 film Hysteria suggests, orgasm was not the intended outcome.

“Victorian doctors were doing some very odd things to women and their genitals, but masturbating them to orgasm with a vibrator was not one of them. For a start, Victorian doctors believed too many orgasms caused hysteria. Masturbation was viewed as seriously injurious to health and potentially fatal,” says Dr Kate Lister, who runs the website Whores of Yore , which explores the history of sex and sexuality.

The myth that the vibrator was a “godsend” for doctors who were tired of manually stimulating their patients originates from Rachel Maines’s wildly popular book The Technology of Orgasm (1998), but recent scholarship has proven the theory to be faulty.

Electric vibrators were historically used to treat muscle pain or paralysis that developed from hysterical episodes and the machines were sometimes used internally to reposition the uterus, but doctors never intentionally prescribed masturbation as a cure.

Lister says that the use of vibrators for sexual pleasure is more likely a result of what she calls the “ kink minute ”, or “the insanely short length of time between the introduction of new technology and its adaptation for sexual purposes”.

While the vibrator myth might be a flirty icebreaker, it is ultimately harmful to how women’s health is understood today. According to King: “Maines and her users play into a male fantasy of passive women waiting for men to give them pleasure and assume historical continuity in women’s sexual expectations and practices.”

Hysteria has shaped the way we conceive of women’s health and general credibility

Reconfiguring how we think of women’s agency over their bodies and minds is especially relevant in the age of #MeToo. As the majority of people affected by sexual abuse identify as women, the trauma of sexual harassment and assault is often discounted.

More concerning, depression and anxiety associated with sexual trauma – both symptoms attributed to hysteria – are sometimes cited as proof that accounts of sexual assault are unreliable.

“Women aren’t diagnosed as hysterical any more, but they are frequently called hysterical when they show strong emotions,” Lister explains. “Since the Ancient Greeks, Western medicine has taught that women are at the mercy of their emotions, are weaker and more unstable than men – because of their biology. We still see echoes of this today. The link between women, wombs and madness is entrenched and dangerous. ”

Further, women are sometimes told that their physical pain is a psychological manifestation – a sort of medical gaslighting that can result in dire consequences . When a woman’s perception of her own health is associated with the notion that a woman’s body is outside of her control, it places her under an inordinate amount of pressure to prove the credibility of her experiences.

It may seem wild, but even the idea that a uterus could suddenly become detached persisted well into the mid-20th century – uterine detachment was cited as a reason to exclude women from the Olympic cross-country skiing competition. Women’s emotional constitution continues to be questioned as female politicians like Hillary Clinton have been called unfit for office due to a biological predisposition towards menstruation. When it comes to physical and mental health, it is worth reflecting on the historical narratives that have influenced medical understanding of women’s ability to make sense of their own bodies and minds.

Wednesday 10 October is World Mental Health Day . To highlight this, Culture Trip is looking at how different societies are shining a light on this important issue in innovative and alternative ways.

The content of this article is provided for general information only and is not an attempt to practise medicine or give specific medical advice, including, without limitation, advice concerning the topic of mental health. The information contained in this article is for the sole purpose of being informative and is not to be considered complete, and does not cover all issues related to mental health. Moreover, this information should not replace consultation with your doctor or other qualified mental health providers and/or specialists. If you believe you or another individual is suffering a mental health crisis or other medical emergency, please seek medical attention immediately.

If you are experiencing mental health issues, in the UK, Samaritans can be contacted on 116 123 or email [email protected]. You can contact the mental health charity Mind by calling 0300 123 3393 or visiting mind.org.uk. Please note there are no affiliations of any kind between the aforementioned organisations and Culture Trip .

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The Wandering Uterus: A Brief History of Women’s Mental Health

“Women. They are a complete mystery.” – Stephen Hawking “She crazy.” – random guy on the 6 train

Prior to the 20 th century, the understanding of women’s mental health concerns could be summed up in two words: uterus demons. All behaviors that deviated from the culturally sanctioned “proper woman/good girl” M.O. were blamed on the uterus. An organ which, coincidentally, was believed to wander around the body, and cause all sorts of ailments from throat issues, anxiety, depression, insomnia, to fainting spells and poor disposition. True story. If the cause of female misbehavior was not the uterus, then the finger was pointed at demon possession, or in a one-two punch of mystifying patriarchal reasoning, my personal favorite: demons residing in the uterus, heretofore know as uterus demons.

The oldest mental disorder ascribed to women is a condition known as hysteria , derived from the Greek word hysterikos: of the womb . This condition was marked by emotional displays, erratic behavior, nervousness, and basically any other picadillo men found confounding about female behavior. The prevailing belief was that hysteria was the direct result of an empty uterus (read: one without a child) which leaves all sorts of space for chaos and demons to run amok; once the uterus is full, following the prevailing wisdom of the time, the symptoms would subside. In lieu of pregnancy, treatment throughout history has included a variety of interventions from water massage (basically spraying a woman with a hose directed towards her abdomen), sneezing, aromatherapy, manual stimulation (which is EXACTLY what you think it is), stays at a sanitarium/psych ward, exorcism, and more.  Up until 1980, this condition was still recognized by the American Psychological Association and included as a diagnosis in the DSM (Diagnostic and Statistical Manual of Mental Disorders ), however by then treatment was limited to hospital stays, and the occasional course of electroshock treatment coupled with persuasion, a form of “moral therapy” that would appeal to the patient’s sense of “goodness”.

According to the National Institute for Health (NIH), in 2019 an estimated 51.5 million U.S. adults were living with a mental illness, accounting for 20.6% of all adults in the country. Women had higher levels of diagnosed mental illness at 24.5% of all cases, compared to men’s 16.5%. Additionally, it has been found that women are 70% more likely to be affected by mental illness, experiencing higher levels, sometimes to double that of men, of diagnosed Generalized Anxiety Disorder (GAD), Depression, PTSD, and Anorexia. One stops to wonder why, in the face of numbers such as these, the disparity exists. Clinically speaking, we often assume a woman is presenting as anxious and exhausted due to the presence of GAD and depression, when perhaps there are other factors and causes to consider.

Thankfully, we have moved beyond blaming uterus demons, however many times women’s mental health issues get pathologized through the same, tired lens that bore this kind of thinking, rather than fully fleshed out through the lens of culture and socialization. If you have any doubt of this assertion, think of how quickly we will jump to blaming a menstrual cycle or simply “she crazy” to explain the behavior of women we find difficult or confusing.

Decades of gendered socialization and acculturation tell women they should be quiet, submissive, put together, helpful, smart but not too smart, and physically attractive, setting up fertile ground for dysfunctional self-image and expectations on all sides. Understandably, this could cause anyone, regardless of gender, to at a certain point react in ways that disrupt their daily functioning.  Often when working with women, the real existential physical threats, and microaggressions we endure daily get overlooked; one could argue this is a factor in the statistical differentials mentioned above. This is not to say women do not heroically wrestle with depression and GAD, both of which have a neurochemical basis, because they absolutely do; merely that we need to consider the impact of cultural and gendered norms in understanding better how it manifests and expresses in women. In laymen’s terms: maybe she ain’t crazy, maybe she fed up.

As we use this month as a time of reflecting and celebrating the many achievements and contributions women have made throughout history, can we also pause and consider how we can root out and dismantle the thinking that allowed for such hits as the wandering uterus and demon possession to explain women’s behavior, and instead work to validate the experiences of women? Can we check ourselves when we begin to dismiss the cries of women as nothing more than an overreaction or garden-variety craziness? And can we finally stop blaming everything on menstruation? (Seriously…no one outside of a Bible character bleeds that much!)

Believe women. Trust women.  Celebrate women. This month, and all the months.

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The History of Hysteria in Women’s Lives

What are the roots of the modern tendency to label women hysterical.

Posted March 15, 2023 | Reviewed by Vanessa Lancaster

• What Is Trauma?
• Find a therapist to heal from trauma
• Throughout history, women’s physical and psychological ailments have been labeled hysterical, and women blamed for their symptoms.
• Thanks to decades of trauma science, we can look back now to understand hysteria regarding posttraumatic reactions.
• Despite scientific progress, we still marginalize intimate violence as a women’s issue.
• Understanding history and our shared interest in addressing intimate violence is important to building a different future.

We’ve probably all heard it before: A woman expresses rage or grief and gets called hysterical. Another discloses sexual harassment or assault, and she also gets labeled hysterical.

The tendency to write off women’s emotions and experiences as hysterical isn’t an accident of history. Since it’s Women’s History Month, let’s take a look.

What is hysteria?

The term hysteria , which roughly translates from Latin to “wandering uterus,” has been applied to women for thousands of years . Though hysteria has gone in and out of fashion as a way to explain away women’s psychological and physical ailments over the millennia, the real heyday for hysteria’s study and diagnosis was in the 19th century. A central character in this history was the Salpêtrière Hospital in Paris.

For years, women labeled hysterical had been locked away at the Salpêtrière with medical symptoms that could not be explained easily – problems such as fugue states, paralysis, amnesia, sexualized behaviors, and fainting. Many women who ended up at the Salpêtrière had faced great adversity and trauma earlier in their lives, including poverty and intimate violence, as documented in medical notes at the time and traced by historian Asti Hustvedt in the book Medical Muses: Hysteria in 19th-Century Paris .

The study of hysteria was popularized in the latter half of the 19th century by a physician named Jean Charcot. Charcot held weekly salons, which doctors from across Europe attended. The salons featured lectures by Charcot and women patients whose hysterical symptoms were displayed for the audience.

For reasons that psychiatrist Judith Herman explains in the book Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terrorism , many of Charcot’s protégés strove to be the first to determine the cause of hysteria. Despite women’s histories of poverty and violence, Charcot and others sought out physical explanations for hysteria, suspicious of the role that reproductive organs or brain lesions might play.

However, two of Charcot’s protégés connected trauma and hysteria. One was Pierre Janet , who argued that hysteria was caused by psychological trauma. He posited that abuse led to unbearable emotions, which caused altered states of consciousness that drove the physical manifestations of hysterical symptoms. Janet’s work was lost to history for many decades, only re-gaining significant attention in the late 20th century as the study of dissociation grew.

The other was Sigmund Freud , who had traveled to Paris to train at the Salpêtrière . Based on observations of his female patients in Austria, Freud published The Aetiology of Hysteria in 1896. In that paper, he made the case that the ultimate cause of hysteria was sexual abuse .

As Herman detailed, Freud faced significant professional scorn for his claim. In the years that followed, he took it all back to argue, instead, that women had made up their stories of abuse – fooling themselves and him with fantasies (not actual experiences) of abuse. This led to the theories for which Freud is more famous today – ideas about repression , Oedipus, and the Elektra complex. Meanwhile, at the Salpêtrière, physicians shifted their attention to growing interest in hypnotism and the role that suggestibility – rather than violence – played in hysteria.

The Long Legacy of Blaming Women for Hysteria

The shift from recognizing abuse at the roots of hysteria to blaming women themselves cast a long shadow, setting the stage for the modern tendency to assume women invent stories of rape, abuse, and violence. That legacy lives on in other ways, such as how women’s physical pain is often minimized or denied. For example, a review of 77 chronic pain studies found that women’s reports of pain were characterized as hysterical, emotional, and malingering, while men tended to be described as stoic.

Of course, with the benefit of decades of research on traumatic stress , we can now understand 19th-century hysteria in terms of posttraumatic reactions to intimate violence and abuse. Despite that scientific understanding, the problem of intimate violence still tends to get marginalized as a women’s issue or a problem for survivors – rather than a problem that affects each of our communities and us.

Learning From History to Build a Better Future

We all lose out when we marginalize intimate violence as a women’s or a survivor’s issue. That’s because intimate violence ripples out to affect all of us, whether in terms of burdens to our health or educational systems or the lost potential and safety in our communities, as I explored in Every 90 Seconds: Our Common Cause Ending Violence against Women .

Women’s History Month offers an opportunity to understand the long shadow of hysteria better and, in turn, change how we approach the problem of intimate violence. If we approach it as a problem that we each share an interest in addressing, new collaborations and solutions are possible, and a different future is possible.

Anne P. DePrince, Ph.D., is a clinical psychologist and distinguished university professor at the University of Denver. She is an expert in trauma and violence against women and children.

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Weird History Facts

The wandering womb and female hysteria.

We have 19th-century physicians to thank for the introduction of the vibrator, which was first heralded as a cure for a widespread female “disease” known as hysteria.

Hysteria was believed to cause a number of illnesses, including anxiety, irritability, sexual desire, insomnia, fainting spells, and bloating, which is why almost all women displayed some symptoms.

The condition has its roots in ancient medical theories about “wandering wombs,” where a displaced (and disgruntled) uterus caused women’s health problems.

The treatment? A “pelvic massage” that would induce a “hysterical paroxysm”, commonly known as an orgasm. This job was in the hands of Victorian doctors who manually massaged the women.

The Wondering Womb

The wandering womb belief was the belief that the uterus can move during pregnancy, either up and down or side to side. This belief was first recorded in an ancient Egyptian medical text known as the Kahun Papyri and was used to explain the occurrence of miscarriage.

The wandering womb belief was also used to explain the symptoms of labour, including contractions that did not have a consistent direction or were too strong or too weak, as well as the occurrence of postpartum haemorrhage. The theory was that the uterus was moving around because of the release of the afterbirth.

In the Ebers Papyrus (1600 BC), there are also indications of “therapeutic measures to be taken depending on the position of the uterus, which must be forced to return to its natural position. If the uterus had moved upwards, this could be done by placing malodorous and acrid substances near the woman’s mouth and nostrils, while scented ones were placed near her vagina; on the contrary, if the uterus had lowered, the document recommends placing the acrid substances near her vagina and the perfumed ones near her mouth and nostrils.” – Source: Women and Hysteria in The History of Mental Health

Female Hysteria

It is no coincidence that hysterectomy, or removal of the uterus, resembles the word “hysteria.” Both terms come from the Greek hystéra , uterus, and this relationship dates back to classical antiquity that produced great works of thought and the arts, but whose scientific knowledge was sometimes not only very lost but was based on explanations that today would make people blush.

An example was the belief that the uterus was a kind of wandering animal capable of wandering aimlessly inside the woman’s body, and whose walks among the viscera were the cause of diseases such as “hysterical suffocation” ( Hysterike Pnix ) that it could not be arranged in any other way than, in the words of Plato ( Timaeus ), “when man and woman, united by desire and love, cause a fruit to be born”.

Plato is today a revered figure in the West as one of the fathers of Western thought, from philosophy to politics. On the other hand, he is not so well known for having also defined what we know today as ‘thinking with the penis’, when in his dialogue Timaeus wrote:

The genital parts, naturally deaf to persuasion, enemies of all yokes and restraints, resemble in man an animal rebellious to reason, and which, driven by furious appetites, strives to subdue everything and command everywhere. Dialogues, Plato

But the philosopher’s reflection did not end there, but went on to define the female uterus as “an animal eager to procreate.” “If it remains without producing fruit for a long time,” added the philosopher, “it becomes irritated and angry; it wanders throughout the body, closes the passage to the air, prevents breathing, puts the body in extreme danger, and engenders a thousand diseases.”

Although some experts doubt that the philosopher really believed in it, in reality, Plato was just following a widespread idea of his time.

The father of medicine himself, Hippocrates, a contemporary of Plato, referred in his treatise on women’s diseases to hysterical suffocation , a condition that appeared when the uterus migrated to the upper part of the abdomen in search of fluid.

This caused women symptoms such as shortness of breath, heart pain, dizziness, loss of voice and excess saliva. This supposed movement of the uterus caused suffocation and a “ ball in the throat ” ( globus hystericus ) sensation.

To force the uterus back into place, Hippocrates recommended manual massage, but also soaking a piece of wool in perfume and wrapping it around the barrel of a bird feather, then inserting it into the vagina. At the same time, some foul-smelling substance, such as vinegar, was placed in the nose or horn powder was burned for the patient to inhale.

In this way, the uterus returns attracted by the aroma of the perfume in the vagina and fleeing from the annoying smell or smoke in the nose. However, the definitive and sure cure was “marriage or pregnancy”.

The curious thing is that this idea of ​​the uterus as some kind of animal with its own will lasted for centuries, even after it was known that it was anchored in place by ligaments.

500 years after Plato and Hippocrates, the Greek physician Aretaeus of Cappadocia wrote that the uterus “closely resembles an animal” in that it “moves by itself here and there on the flanks and also upwards” toward the liver, the spleen or the heart. “In short, the uterus is like an animal within an animal,” he said.

There are descriptions of medieval exorcism to order the uterus to abandon other organs, listed in the formula from head to toe, and to remain “quiet in the place that God has assigned you.”

“I conjure you, womb, by our Lord Jesus Christ, so that you do not harm this maiden servant of God,” the ritual said . Documents like this suggest that hysterical suffocation was associated with witchcraft and demonic possession at the time. Medieval writings referred to hysterical asphyxia as “Globus hystericus”.

Hysterical Paroxysm

While the theory of the wandering uterus ended up falling, not so that of hysterical suffocation, which would later come to be known simply as hysteria. By then it was no longer considered exclusively restricted to women, but it was still maintained that they were the most affected, reflecting the misunderstanding of menstrual cycles, menopause and its physiological and psychological effects.

Some authors assumed an influence of the putrefaction of the semen retained in the uterus, while others attributed the disease precisely to the lack of penetration that deprived women of the presumed benefits of male emission.

One solution to the problem was the manipulation of the female genitalia until reaching the “hysterical paroxysm”, orgasm. But since female masturbation was considered taboo, doctors did not recommend it. Some specialists resorted to this cure, sometimes through a midwife who was in charge of massaging the patient.

Early Vibrators

The first vibrator was a hand-held device that was used to treat female hysteria. It was invented in 1869 by American physician George Taylor and dubbed “the manipulator”.

It was a steam-powered device designed to stimulate the pelvic area by vibrating in order to relax the pelvic muscles. It was believed that this would help to alleviate some of the symptoms of hysteria, such as anxiety, irritability, and insomnia. As it was a quite new technology, many people were apprehensive about using it and it took some time for it to become accepted by the medical community.

“Doctors didn’t like it because you couldn’t move it and take it with you on a house call, and they also didn’t enjoy shovelling coal into it.” Source: Daily Beast

In the 19th century, with electricity and industrialization, the first electromechanical vibrators appeared. In 1883, Dr. Joseph Mortimer Granville created an “electromechanical medical instrument colloquially known as “Granville’s hammer”, that allowed women to massage themselves at home, allowing them to cure their “wandering wombs.”

The vibrator was held against the lower abdomen and the vibration was used to massage the womb and reduce the symptoms of hysteria.

This device was much more powerful than the earlier hand-held device and it was much easier to use. It was a more efficient way of treating female hysteria without laborious manual effort and was quickly adopted by the medical community.

The vibrator was the fifth household appliance to hit the market, after the sewing machine, the fan, the kettle, and the toaster, and before the vacuum cleaner and the iron.

Battery-powered vibrators were introduced as a household appliance as early as 1899, but doctors were still trying to convince patients it was worth $2-$3 a visit to be treated by gigantic “pelvic massage” machines.

“After a while, patients realized that if they could order one from Sears for $5, why should the go to the doctor for $2 to $3 a visit?” – Source: Daily Beast

The electric vibrator led to the development of a variety of other products, such as electric massagers and vibrating chairs. These products were used to treat a variety of medical conditions, including muscle pain, headaches, and arthritis. The electric vibrator eventually made its way into the home and was used as a tool to provide relaxation and pleasure.

The Electropathic Belt (also known as  Electric Band ,  Electric Chain , and  Electro-Galvanic Band ) became the most popular among them all. Although the electric belt was briefly promoted by doctors, it had become symbolic of quackery by the 1890s.

In order not to be a wandering animal, of course, the female womb has had to travel a long historical path to be understood by a medicine dominated by an androcentric point of view.

About The Author

Interesting and unusual Weird History Facts from across the globe. From accidental Scientific Discoveries to learning the Secrets of Forbidden Knowledge.

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• April 01, 2024 | VOL. 75, NO. 4 CURRENT ISSUE pp.307-398
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The Wandering Womb: A Cultural History of Outrageous Beliefs About Women

• Roberta J. Apfel , M.D., M.P.H.

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This is an outrageous book about a subject potentially important to Psychiatric Services readers. Lana Thompson, a Florida freelance medical writer, does not deliver what she proposes, and she does not begin to address the relevance of beliefs about women for an audience of mental health professionals. The book is written to convey a history of beliefs about the uterus; its nine chapters move chronologically from ancient times to the "postmodern uterus."

Thompson's breezy, tongue-in-cheek style, intended to shock the reader by reporting outrage after outrage, is in itself so outrageous that it is difficult to take the writer seriously. By overstatement and by failure to put beliefs in their cultural and historical perspective, the author discredits herself. She has clearly read many secondary sources from which she extracts in order to prove a thesis: women have always been misunderstood by men. This concept is nothing new.

The author takes a narrow feminist stance, but does not take advantage of serious feminist scholarship. She has excellent, interesting illustrations, but the captions are not researched in a way that draws on knowledge of the historical period or the artist, such as Durer's iconography. The book has a strong antiphysician bias and displays ignorance about the history of medicine.

Thompson states that the book was "written to make people, particularly female people, aware of the tremendous social, psychological, religious, and medical pressures brought to bear upon the uterus as it traveled through history," but as a woman psychiatrist I did not find that it increased my awareness in a valuable way. Alas, the focus on the uterus as emblem of woman does not make a contribution about the psychology of women. A woman patient at a state hospital with whom I had been discussing "women's topics"—for example, her concerns about her children in custody elsewhere—asked what I was reading and picked up The Wandering Womb from my desk. After perusing the drawings with great interest, and reading a bit, she put it down and declared "Holy shit!" That about sums up my opinion too.

Dr. Apfel is associate clinical professor of psychiatry at Harvard Medical School in Boston.

by Lana Thompson; Amherst, New York, Prometheus Books, 1999, 204 pages, $19.95

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The wandering womb : a cultural history of outrageous beliefs about women

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Women And Hysteria In The History Of Mental Health

Cecilia tasca.

1 Dipartimento di Storia, Beni Culturali e Territorio, Università di Cagliari, Italia

Mariangela Rapetti

2 Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy

Mauro Giovanni Carta

Bianca fadda.

Hysteria is undoubtedly the first mental disorder attributable to women, accurately described in the second millennium BC, and until Freud considered an exclusively female disease. Over 4000 years of history, this disease was considered from two perspectives: scientific and demonological. It was cured with herbs, sex or sexual abstinence, punished and purified with fire for its association with sorcery and finally, clinically studied as a disease and treated with innovative therapies. However, even at the end of 19 th century, scientific innovation had still not reached some places, where the only known therapies were those proposed by Galen. During the 20 th century several studies postulated the decline of hysteria amongst occidental patients (both women and men) and the escalating of this disorder in non-Western countries. The concept of hysterical neurosis is deleted with the 1980 DSM-III. The evolution of these diseases seems to be a factor linked with social “westernization”, and examining under what conditions the symptoms first became common in different societies became a priority for recent studies over risk factor.

INTRODUCTION

We intend to historically identify the two dominant approaches towards mental disorders, the “magic-demonological” and “scientific” views in relation to women: not only is a woman vulnerable to mental disorders, she is weak and easily influenced (by the “supernatural” or by organic degeneration), and she is somehow “guilty” (of sinning or not procreating). Thus mental disorder, especially in women, so often misunderstood and misinterpreted, generates scientific and / or moral bias, defined as a pseudo-scientific prejudice [ 1 ].

19-20 th centuries’ studies gradually demonstrate that hysteria is not an exclusively female disease allowing a stricter scientific view to finally prevail. 20 th century’s studies have also drawn on the importance of transcultural psychiatry, in order to understand the role of environmental factors in the emotive evolution and behavioral phenomenology and in modifying the psychopathology, producing the hypotheses of a modification to hysteria from the increase of mood disorders.

1. Ancient Egypt

The first mental disorder attributable to women, and for which we find an accurate description since the second millennium BC, is undoubtedly hysteria.

The first description referring to the ancient Egyptians dates to 1900 BC ( Kahun Papyrus ) and identifies the cause of hysterical disorders in spontaneous uterus movement within the female body [ 2 , 3 ].

In the Eber Papyrus (1600 BC) the oldest medical document containing references to depressive syndromes, traditional symptoms of hysteria were described as tonic- clonic seizures and the sense of suffocation and imminent death (Freud’s globus istericus). We also find indications of the therapeutic measures to be taken depending on the position of the uterus, which must be forced to return to its natural position. If the uterus had moved upwards, this could be done by placing malodorous and acrid substances near the woman’s mouth and nostrils, while scented ones were placed near her vagina; on the contrary, if the uterus had lowered, the document recommends placing the acrid substances near her vagina and the perfumed ones near her mouth and nostrils [ 2 , 3 ].

2. The Greek world

According to Greek mythology, the experience of hysteria was at the base of the birth of psychiatry.

The Argonaut Melampus , a physician, is considered its founder: he placated the revolt of Argo’s virgins who refused to honor the phallus and fled to the mountains, their behavior being taken for madness. Melampus cured these women with hellebore and then urged them to join carnally with young and strong men. They were healed and recovered their wits. Melampus spoke of the women’s madness as derived from their uterus being poisoned by venomous humors, due to a lack of orgasms and “uterine melancholy” [ 2 - 4 ].

Thus arose the idea of a female madness related to the lack of a normal sexual life: Plato , in Timaeus , argues that the uterus is sad and unfortunate when it does not join with the male and does not give rise to a new birth, and Aristotle and Hippocrates were of the same opinion [ 2 - 4 ].

The Euripidy’s myth says that a collective way of curing (or, if we prefer, preventing) melancholy of the uterus is represented by the Dionysian experience of the Maenads, who reached catharsis through wine and orgies [ 5 ]. Women suffering from hysteria could be released from the anxiety that characterizes this condition by participating in the Maenad experience. Trance status guided and cured by the Satyr, the priest of Dionysus, contributed to solving the conflict related to sexuality, typical of hysteria disease [ 6 ].

Hippocrates (5th century BC) is the first to use the term hysteria . Indeed he also believes that the cause of this disease lies in the movement of the uterus (“hysteron”) [ 2 - 4 ].

The Greek physician provides a good description of hysteria, which is clearly distinguished from epilepsy. He emphasizes the difference between the compulsive movements of epilepsy, caused by a disorder of the brain, and those of hysteria due to the abnormal movements of the uterus in the body. Then, he resumes the idea of a restless and migratory uterus and identifies the cause of the indisposition as poisonous stagnant humors which, due to an inadequate sexual life, have never been expelled. He asserts that a woman’s body is physiologically cold and wet and hence prone to putrefaction of the humors (as opposed to the dry and warm male body). For this reason, the uterus is prone to get sick, especially if it is deprived of the benefits arising from sex and procreation, which, widening a woman’s canals, promote the cleansing of the body. And he goes further; especially in virgins, widows, single, or sterile women, this “bad” uterus – since it is not satisfied - not only produces toxic fumes but also takes to wandering around the body, causing various kinds of disorders such as anxiety, sense of suffocation, tremors, sometimes even convulsions and paralysis. For this reason, he suggests that even widows and unmarried women should get married and live a satisfactory sexual life within the bounds of marriage [ 2 - 4 ].

However, when the disease is recognized, affected women are advised not only to partake in sexual activity, but also to cure themselves with acrid or fragrant fumigation of the face and genitals, to push the uterus back to its natural place inside the body [ 2 - 4 ].

Aulus Cornelius Celsus (1 st century BC) gives a good and accurate clinical description of hysterical symptoms. In De re medica Celsus, he wrote “In females, a violent disease also arises in the womb; and, next to the stomach, this part is most sympathetically affected or most sympathetically affects the rest of the system [ 7 ]. Sometimes also, it so completely destroys the senses that on occasions the patient falls, as if in epilepsy. This case, however, differs in that the eyes are not turned, nor does froth issue forth, nor are there any convulsions: there is only a deep sleep”.

Claudius Galen ’s theories on hysteria (2 nd century AD) are comparable to those of Hippocrates. Furthermore Galen says of hysteria “ Passio hysterica unum nomen est, varia tamen et innumera accidentia sub se comprehendit ” (hysterical passion is the name, but various and several are its symptoms), highlighting the variety of hysterical events [ 7 ]. In his work In Hippocratis librum de humoribus , Galen criticizes Hippocrates: “Ancient physicians and philosophers have called this disease hysteria from the name of the uterus, that organ given by nature to women so that they might conceive [ 7 ]. I have examined many hysterical women, some stuporous, others with anxiety attacks [...]: the disease manifests itself with different symptoms, but always refers to the uterus”. Galen’s treatments for hysteria consisted in purges, administrations of hellebore, mint, laudanum, belladonna extract, valerian and other herbs, and also getting married or repressing stimuli that could excite a young woman [ 2 , 3 , 7 ].

Hysterical cures are only revolutionized by Soranus (a Greek physician from the 1 st half of 2 nd century AD, practicing in Alexandria and Rome), who wrote a treatise on women’s diseases and who is considered the founder of scientific gynecology and obstetrics : women’ disorders arise from the toils of procreation, their recovery is encouraged by sexual abstinence and perpetual virginity is women’ ideal condition. Fumigations, cataplasms and compressions are ineffectual, the hysterical body should be treated with care: hot baths, massages, exercise are the best prevention of such women' diseases [ 2 , 3 , 7 ].

4. Middle Ages

After the fall of the Roman Empire, Greek-Roman medical culture had its new epicenter in Byzantium, where physicians inherited Galen’s science without making any significant innovations (the most famous was Paul of Aegina , 625-690 AD). Sometime before, Bishop Nestorius (381-451 approx.), who took refuge in the Middle East in an area between today's Iraq and Egypt, had brought with him his knowledge of classical science, contributing to the spread of Greek-Roman medicine in these areas.

The political events of the early Middle Ages caused a rupture between Christian Europe, with its auctoritas culture - in the hands of just a few scholars - and the Middle East of the Caliphs, where thanks to a climate of tolerance and cultural ferment, the texts of Hippocrates and Galen were translated and commented on in Arabic, becoming widespread and well-known [ 3 ].

In this context, two great scientists carry out their work : the Persian Avicenna (980-1037) [ 8 , 9 ] and the Andalusian Jew Maimonides (1135-1204) [ 10 ]. Thanks to them, the legacy of Hippocrates and Galen is not only maintained, but spreads throughout Europe: the Reconquista of Spain (718-1492) and new contacts with the Near East bring important cultural exchanges, Avicenna’s Canon of Medicine and Galen’s Corpus are diffused along with the Latin translations ascribed to Gerard of Cremona (1114-1187), while Maimonides’ texts are disseminated in the Jewish world, along with other basic medical texts, thanks to translations by the Ibn Tibbon family (13-14 th centuries). In particular, the medical schools of Salerno and Montpellier were vehiclesfor the dissemination of these works [ 11 ].

This was how Hippocratic concepts of melancholia and hysteria spread in late-medieval Europe, and in informed circles these diseases were treated according to what we shall call the “scientific” vision. In particular, this advocated the use of melissa as a natural remedy nerve comforter (melissa was considered excellent even in cases of insomnia, epilepsy, melancholy, fainting fits, etc.) [ 3 , 12 ].

Besides the natural remedies, a sort of "psychotherapy" developed, practiced not only by Avicenna, but also for example by Arnaldus of Villa Nova (1240-1311). The latter, considered medieval Europe’s greatest physician, will be counted along with Galen and Avicenna in the inventories of physicians’ libraries throughout the Modern era [ 13 ].

It is also interesting to note that in the many treatises diffused at the time ( Constantine the African ’s Viaticum and Pantegni , but also the Canon of Avicenna and Arnaldus of Villa Nova’s texts) women were often not described as "patients" to be cured but rather as the "cause " of a particular human disease, defined as amor heroycus or the madness of love, unfulfilled sexual desire [ 8 ].

But we cannot talk about women' health in the Middle Ages without citing Trotula de Ruggiero from Salerno (11 th century). While as a woman she could never become a magister, Trotula is considered the first female doctor in Christian Europe: she belonged to the ranks of famous women active in the Salerno School but discredited, among others, by Arnaldus of Villa Nova [ 14 ].

Called sanatrix Salernitana , Trotula was an expert in women' diseases and disorders. Recognizing women as being more vulnerable than men, she explained how the suffering related to gynecological diseases was “intimate”: women often, out of shame, do not reveal their troubles to the doctor. Her best known work, De passionibus mulierum ante, in et post partum , deals female problems, including hysteria. Faithful to the teachings of Hippocrates, Trotula was devoted to the study of women’ diseases, of which she tried to capture the secrets, without being influenced by the prejudices and morals of her time, also giving advice on how to placate sexual desire: in her work abstinence is seen as a cause of illness and she recommends sedative remedies like musk oil or mint [ 15 ].

Trotula works at a time when women are still considered inferior to men because of their physiological and anatomical differences. Hildegard of Bingen (1098-1179), German abbess and mystic, was another female doctor. Her work is very important for the attempt to reconciliate science with faith, that happens at the expense of science. Hildegard resumes the “humoral theory” of Hippocrates and attributes the origin of black bile to the original sin [ 16 ]. In her view, melancholy is a defect of the soul originated from Evil and the doctor must accept the incurability of this disease. Her descriptions are very interesting. Melancholic men are ugly and perverse, women slender and minute, unable to fix a thought, infertile because of a weak and fragile uterus [ 16 ]. In the ideology of Hildegard, Adam and Eve share responsibility with respect to original sin, and man and woman - sexually complementary - are equal in front of God and the cosmos [ 17 ].

The mainstream view of the time is one in which the woman is a physically and theologically inferior being, an idea that has its roots in the Aristotelian concept of male superiority: St. Thomas Aquinas’ (1225-1274) Summa Theologica Aristotle’s assertions that “the woman is a failed man” [ 18 ]. The inferiority of women is considered a consequence of sin, and the solutions offered by St. Thomas’ reflection leave no doubt about what will overturn the relationship between women and Christianity: the concept of “defective creature” is just the beginning. In question 117, article 3, addressing the possibility that the human soul can change the substance, St. Thomas says that “some old women” are evil-minded; they gaze on children in a poisonous and evil way, and demons, with whom the witches enter into agreements, interacting through their eyes [ 18 ]. The idea of a woman-witch, which we shall call the “demonological vision”, almost becomes insuperable: preachers disclose the Old Testament’s condemnation of wizards and necromancers and the fear of witches spreads in the collective imagination of the European population. The ecclesiastical authorities try to impose celibacy and chastity on the clergy, and St. Thomas’ theological descriptions regarding woman’s inferiority are, perhaps, the start of a misogynistic crusade in the late Middle Ages.

From the thirteenth century onwards, the struggle with heresy assumes a political connotation: the Church aims tat unifying Europe under its banner, so breviaries become manuals of the Inquisition and many manifestations of mental illness are seen as obscene bonds between women and the Devil. “Hysterical” women are subjected to exorcism: the cause of their problem is found in a demonic presence. If in early Christianity, exorcism was considered a cure but not a punishment, in the late Middle Ages it becomes a punishment and hysteria is confused with sorcery [ 19 , 20 ].

Political and religious status quo in Europe is threatened by the first humanist ideas and the Church responds by intensifying inquisitions: the apogee is reached in 1484 with the Summis desiderantes affectibus, Innocent VIII’s Bull, which confirms the witch hunt and an obligation to “punish, imprison and correct” heretics [ 21 , 22 ]. The German Dominicans Heinrich “Institor” Kramer and Jacob Sprenger are accredited with the publication of the famous Hammer of Witches, the Malleus Meleficarum (1486) [ 21 , 22 ]. Although not an official Church manual, it takes on an official tone due to the inclusion of the papal Bull within the text. It is interesting to note that the title itself includes signs of misogyny: “Maleficarum” as witches, not “Maleficorum” as wizards… as if to say “evil is female/ evil origins from women”!

The devil is everywhere in these pages: he makes men sterile, kills children, causes famine and pestilence and all this with the help of witches. The compilers of the manual are familiar with the medicine of the age, and they investigate the relationship between sorcery and human temperaments: their descriptions rival those contained in the best psychopathology manuals [ 21 , 22 ]. The text is divided into three parts and aims at proving the existence of demons and witches (warning the reader that anyone not convinced is also a victim of the Devil) explaining how to find and punish sorcery.

But what has this to do with women's health? It is quite simple: if a physician cannot identify the cause of a disease, it means that it is procured by the Devil. The inquisitor finds sin in mental illness because, he says, the devil is a great expert of human nature and may interfere more effectively with a person susceptible to melancholy or hysteria. Hysteria is considered a woman's disease, and who more than women are prone to melancholy? This disease is the basis of female delirium: the woman feels persecuted and the devil himself is the cause of this “mal de vivre”, which deprives the women of confession and forgiveness, leading them to commit suicide.

Obviously, the women most affected are elderly and single, in most cases they have already been in mourning or victims of violence. Sorcery becomes the scapegoat for every calamity and etymological explanations are also provided: for Sprenger and Krämer, the Latin word foemina is formed from fe and minus , that is “who has less faith”. This text is the worst condemnation of depressive illness and women to be found throughout the course of Western history: until the eighteenth century, thousands of innocent women were put to death on the basis of “evidence” or “confessions” obtained through torture [ 21 , 22 ].

5. Renaissance

At the end of the Middleage, journeys along the coasts of the Mediterrinean sea contributed to a quick diffusion of Greek Classics, preserved and disseminated by the Arabians.

The humanistic movement (born with Dante, Boccaccio and Petrarch) emphasized a respect for the writings of the Antiquity. During these centuries, a new realistic approach to man as a person was born, which opposed the scholastics and introduced a fresh point of view about nature and man [ 19 ].

Italian philosopher Giovanni Pico della Mirandola (1463-1494) espoused the principle that each man is free to determinate his own fate, a concept that perhaps more than any other has influenced the developments of the last three centuries: only man is capable of realizing his ideal and this condition can, however, be achieved only through education [ 23 ]. Pico’s thesis was implemented by the Spanish educator Juan Luis Vives (1492-1540). His pragmatic orientation produced occasional flashes of insight; for instance, he thought that emotional experience rather than abstract reason detained the primary role in a man’s mental processes: in order to educate a person it is necessary to understand the complex functioning of his mind [ 19 ].

Up to this time the medical vision of hysteria, inherited from the Hippocratic-Galenic tradition, continues to dominate [ 24 ]. At the end of the 16th century, in European countries affected by the Counter-Reformation, the theological vision tends to overwhelm the medical community. During this period the most intense activity of the Roman Inquisition, in which magic has replaced the fight against heresy, is recorded. Thus in these states, a new generation of physicians emerges, which is destined to be subordinated to inquisitors [ 24 ]. It is precisely the physician and theologian Giovan Battista Codronchi (1547-1628) who, by criticizing the medical therapy of the time aimed at treating hysteria, give us a detailed description of them.

Codronchi said that midwives, recalling Galenus’ and Avicenna’s theachings, took care of the hysterical women introducing the fingers in their genital organs in order to stimulate orgasm and semen production [ 24 ]. The physician prohibited this treatment at all, an attitude due to the concern typical of that historical phase related to sex and sexual repression. The treatment for him must be practices by the spiritual guides [ 24 ]. And if Codronchi is also a proud supporter of the existence of demons, in favour of which he argued by referring to biblical and philosophical sources, the Italian Renaissance had already tried to condemn witch hunts and to give a “scientific” explanation of mental illness: among others, Girolamo Cardano (1501-1576) and Giovanni Battista Della Porta (1535-1615) were interested in sorcery and marginality, but did not see a demonic cause in them. They identified the origin of certain behaviors in fumes, in polluted water and in the suggestion (for Cardano) or in the acquisition of certain substances that induce “visions” and “pictures” (according to Della Porta) but both base most of their considerations on physiognomy [ 25 ]. Another important physician, the Dutch Johann Weyer (1515- 1588) intended to prove that witches were mentally ill and had to be treated by physicians rather than interrogated by ecclesiastics [ 19 ]. In 1550 he became the private physician of the Duke William of Cleves, who was a chronic depressive. The Duke observed that witches manifesedt many of the same symptoms as his relatives became insane. So, he sympathizes with Weyer’s theory that these women are really suffering from mental illness, but he cannot keep the witch hunter under control because of his transient psychotic episodes cause by an apopletic stroke [ 19 ]. In 1563, Weyer publishes De prestigiis Daemonum , which is a step-by-step rebuttal of the Malleus Maleficarum . He’s been called by his contemporaries “hereticus” or “insanus”, but his pages reveal that he’s not rebellious but that he’s a religious man [ 19 ].

However, for the doctors of that time, the uterus is still the organ that allows to explain vulnerable physiology and psychology of women: the concept of inferiority towards men is still not outdated.

Hysteria still remains the “symbol” of femininity [ 26 ].

6. Modern Age

The 16 th century is a period of important medical developments, as proved by the writings of Andreas Vesalius ( De humani corporis fabrica , 1543) and French surgeon Ambroise Paré (1510-1590).

These authors’ findings are the basis of the birth of modern medical science [ 24 ], combined with the "philosophical revolution", in which René Descartes (1596-1650) explains how the actions attributed to the soul are actually linked with the organs of the body, and also combined with the studies on the anatomy of the brain by physician Thomas Willis (1621-1675). Willis introduces a new etiology of hysteria, no longer attached to the central role of the uterus but rather related to the brain and to the nervous system [ 24 ]. In 1680, another English physician, Thomas Sydenham (1624-1689), published a treatise on hysteria ( Epistolary Dissertation on the Hysterical Affections ) which refers back to natural history through describing an enormous range of manifestations and recognizing for the first time the fact that hysterical symptoms may simulate almost all forms of organic diseases [ 19 ]. However, the author fluctuates between a somatic and a psychological explanation [ 27 ]. Sydenham demonstrates that the uterus is not the primary cause of the disease, which he compares to hypochondria: his work is revolutionary as it opposes the prejudices, but it will take several decades for the theory of "uterine fury" to be dismissed [ 26 ].

The scientific development does not mark a dramatic shift from a demonological vision of medicine, but progresses hand in hand with evolution of theories on exorcism. The written records tell us of several outbreaks of hysteria, the most famous of which is undoubtedly the one occurred in the village of Salem (Massachusetts) in 1692. The texts recall an episode in which a slave originally from Barbados talks about the prediction of fate and some girls creat a circle of initiation. This latter was formed by women yunger then twenty years of age and unmarried.The action of creating a circle of initiation was in itself an open violation of the precepts of the Puritans.

There is no record of the first stages of the disease: the girls result "possessed" since February 1692. The symptoms described were staring and barred eyes, raucous noises and muffled, uncontrolled jumps, sudden movements etc. The local doctor, William Griggs, referred the problem to the priest. The slave and two other women were summoned, and the former admitted witchcraft and pacts with the devil. Gradually they began to accuse each other. Eventually, 19 were hanged as "witches", and over 100 were kept in detention. Only when the girls accused the wife of the Colonial Governor of being part of this circle herself, the latter forbade further arrests and trials for witchcraft [ 27 ]. Marion Starkey , at the end of World War II, reports the case comparing it with more contemporary events [ 27 ]. Her explanation of classical hysteria is that the illness manifested itself in young women repressed by Puritanism, and was aggravated by the intervention of Puritan pastors, this leading to dramatic consequences. The incident proves thus that hysteria could be seen as a consequence of social conflicts [ 27 ].

Social conflicts do not occur exclusively in closed societies, such as small communities such as puritanical circles, but they also occur in more open and dynamic societies asbig cities. In 1748 Joseph Raulin published a work in which he defines hysteria as an affection vaporeuse and describes it as a disease caused by foul air of big cities and unruly social life. In theory, the disorder can affect both sexes, but women are more at risk for their being lazy and irritable [ 26 ].

Between the 17th and 18th centuries a trend of thought that delegated to the woman a social mission started developing. If from a moral point of view she finds redemption in maternal sacrifice that redeems the soul but it does not rehabilitate the body, from the social point of view, the woman takes a specific role. In 1775 the physician-philosopher Pierre Roussel published the treatise "Systeme physique et moral de la femme" greatly influenced by the ideas of Jean-Jacques Rousseau . Femininity is for both authors an essential nature, with defined functions, and the disease is explained by the non-fulfillment of natural desire. The excesses of civilization causes disruption in the woman as well as moral and physiological imbalance, the identified by doctors in hysteria [ 26 ]. The afflictions, diseases and depravity of women result from the breaking away from the normal natural functions. Following natural determinism, doctors confine the woman within the boundaries of a specific role: she is a mother and guardian of virtue [ 26 ]. In this context, the woman-witch appears more and more an artifice to secure the social order of ancien régime .

The Enlightenment is a time of growing rebellion against misogyny and sorcery becomes a matter for psychiatrists: in the Encyclopédie we read that sorcery is a ridiculous activity, stupidly attributed to the invocation of demons. And further: mental illness starts to to be framed within the "scientific view" and hysteria is indeed described in the Encyclopédie as one of the most complicated diseases, originally identified by ancient scientists as a problem related to the uterus. Even more interesting is the fact that the causes and symptoms of hysteria and melancholy are linked to the humor theory. Fortunately, the “demonological vision” of women's mental illness did not prevent previous medical theories from being maintained [ 28 ].

The last "witch" was sentenced to death in Switzerland in 1782, 10 years after the publication of the latest volumes of the Encyclopédie . Her name was Anna Göldi , and her memory was rehabilitated only in 2008 [ 29 ].

In the 18th century, hysteria starts being gradually associated with the brain rather than the uterus, a trend which opens the way to neurological etiology: if it is connected to the brain, then perhaps hysteria is not a female disease and can affect both sexes. But this is not such a simple shift as it may seem.

The German physician Franz Anton Mesmer (1734-1815) found in suggestion a method of treatment for his patients suffering from hysteria, practicing both group and individual treatments. He identified in the body a fluid called "animal magnetism" and his method soon became famous as "mesmerism". Indeed, it was thought that the magnetic action of the hands on diseased parts of the body could treat the patient, interacting with the fluid within the body. Only later we realized that this was a mere suggestion. Mesmerism had subsequent developments in the study of hypnosis [ 30 ].

The French physician Philippe Pinel (1745-1826) assuming that kindness and sensitivity towards the patient are essential for good care, frees the patients detained in Paris’ Salpêtrière sanatorium from their chains. Pinel's theory derives from ideas linked to the French Revolution: “mad” is not substantially different from “healthy”, the balance is broken by the illness and treatment must retrieve this balance. Nonethelsess, Pinel too considered hysteria a female disorder [ 19 , 31 ]. Jean Martin Charcot (1825-1893) the French father of neurology, pushed for a systematic study of mental illnesses. In particular, he studied the effectiveness of hypnosis in hysteria, which, from 1870 onwards, is distinguished from other diseases of the spirit. Charcot argues that hysteria derives from a hereditary degeneration of the nervous system, namely a neurological disorder .By drawing graphs of the paroxysm, he eventually shows that this disease is in fact more common amongst men than women [ 32 - 36 ].

During the Victorian Age (1837-1901) most women carried a bottle of smelling salts in their handbag: they were inclined to swoon when their emotions were aroused, and it was believed, that, as postulated by Hipocrates, the wandering womb disliked the pungent odor and would return to its place, allowing the woman to recover her consciousness [ 34 ]. This is a very important point, as it shows how Hippocrates’ theories remained a point of reference for centuries.

7. Contemporary Age

French neuropsychiatrist Pierre Janet (1859-1947), with the sponsorship of J. M. Charcot, opened a laboratory in Paris’ Salpêtrière. He convinced doctors that hypnosis — based on suggestion and dissociation — was a very powerful model for investigation and therapy. He wrote that hysteria is “the result of the very idea the patient has of his accident”: the patient’s own idea of pathology is translated into a physical disability [ 35 ]. Hysteria is a pathology in which dissociation appears autonomously for neurotic reasons, and in such a way as to adversely disturb the individual’s everyday life. Janet studied five hysteria’s symptoms: anaesthesia, amnesia, abulia, motor control diseases and modification of character. The reason of hysteria is in the idée fixe , that is the subconscient or subconscious. For what concerns eroticism, Janet noted that “the hysterical are, in general, not any more erotic than normal person”. Janet’s studies are very important for the early theories of Freud, Breuer and Carl Jung (1875-1961) [ 35 , 36 ].

The father of psychoanalysis Sigmund Freud (1865-1939) provides a contribution that leads to the psychological theory of hysteria and the assertion of a “male hysteria”. Freud himself wrote in 1897: “After a period of good humor, I now have a crisis of unhappiness. The chief patient I am worried about today is myself. My little hysteria, which was much enhanced by work, took a step forward” [ 37 ]. In 1889 he published his Studies on Hysteria with Joseph Breuer (1842-1925). The key-concepts of his psychoanalytical theory (the influence of childhood sexual fantasies and the different ways of thinking of the unconscious mind) have not yet been formulated, but they are already implicit in this text. Among the cases presented, we find the hysteria of the young Katherina, who suffers from globus hystericus . The text does not refer to the famous Oedipus complex , which emerges through the study of male hysteria, developed after this treatise [ 36 - 38 ].

We now reach a crucial point: until Freud it was believed that hysteria was the consequence of the lack of conception and motherhood. Freud reverses the paradigm: hysteria is a disorder caused by a lack of libidinal evolution (setting the stage of the Oedipal conflict) and the failure of conception is the result not the cause of the deasease [ 36 - 38 ]. This means that a hysterical person is unable to live a mature relationship. Furthermore, another important point under a historical point of view is that Freud emphasizes the concept of "secondary advantage". According to psychoanalysis the hysterical symptom is the expression of the impossibility of the fulfillment of the sexual drive because of reminiscence of the Oedipal conflict [ 36 - 38 ]. The symptom is thus a "primary benefit" and allows the "discharge" of the urge - libidinal energy linked to sexual desire. It also has the "side benefit" of allowing the patient to manipulate the environment to serve his/her needs . However, it is a disease of women: it is a vision of illness linked to the mode (historically determined) to conceive the role of women. The woman has no power but "handling", trying to use the other in subtle ways to achieve hidden objectives. It is still an evolution of the concept of "possessed" woman [ 37 , 38 ].

During 19 th Century, description of hysteria as a variety of bodily symptoms experiencedby a single patient is labeled Briquet’s syndrome. In 20 th Century several studies are based on a particular presentation of hysteria’s symptoms: a loss or disturbance of function which does not conform to what is known about the anatomy and physiology of the body, as loss of speech but not of singing. Psychiatrists note that any function of the body can be affected by hysteria [ 34 ].

An analysis of the framing of these diagnoses in British medical discourse c. 1910-1914 demonstrates that hysteria and neurasthenia, although undergoing redefinition in these years, were closely connected through the designation of both as hereditary functional diseases. Before the war these diagnoses were perceived as indicators of national decline. Continuity, as well as change, is evident in medical responses to shell-shock [ 38 ].

The identification of hysterical fit, according to Pierre Janet’s theories, was for a long time considered impossible: an example of this diagnostic dilemma is provided by the Royal Free Disease , an epidemic of neurological, psychiatric and other miscellaneous symptoms which swept through the staff of the Royal Free Hospital in London between July and November 1955 and which affected a total of 292 members of staff. In the Medical Staff Report it was concluded that an infective agent was responsible [ 34 ]. In 1970 McEvedy and Beard put forward an alternative suggestion that Royal Free Disease was an epidemic of hysteria (for example the sensory loss affected a whole limb or part of a limb but the pattern rarely followed the distribution of nerves to the skin) and also pointed out that the spread of the symptoms, predominantly affecting young female resident staff, is characteristic of epidemics of hysteria, which usually occur in populations of segregated females such as girl schools, convents and factories. They wrote also that hysteria had a pejorative meaning in their society, but that should not prevent doctors from weighing the evidence dispassionately [ 34 ].

Besides defining the nature of hysteria, 20 th Century psychiatrists also considered its history and geography. During World Wars hysteria attracted the attention of military doctors, and several authors have recorded their impressions on the frequency of hysteria in this period. Under battle conditions, the way in which hysterical symptoms provide a solution for emotional conflicts is particularly clear. A soldier torn between fear of facing death and shame at being thought a coward may develop a hysterical paralysis of his arm, sickness being a legitimate way out of the conflict [ 34 ]. For instance, in 1919 Hurst wrote that “many cases of gross hysterical symptoms occurred in soldiers who had no family or personal history of neuroses, and who were perfectly fit”. In particular, in 1942 Hadfield commented that the most striking change in war neurosis from World War I to World War II was “the far greater proportion of anxiety states in this war, as against conversion hysteria in the last war” [ 34 ]. But World War II not only allowed for a comparison with World War I in terms of patterns of neurotic symptoms, but also become a opportunity for cross-cultural comparisons between troops from widely differing cultural backgrounds [ 34 ].

Abse’s studies (1950) on hysteria in India during World War II demonstrate that, 57% of the 644 patients admitted to the Indian Military Hospital in Delhi during the year 1944, were diagnosed as suffering from hysteria and 12% were diagnosed as suffering from anxiety states. Abse also collected data from a British Military Hospital in Chester (June to October 1943) and he demonstrated the existence of a majority of anxiety states (50%) than hysteria cases (24%) [ 34 ].

Others studies confirm these data. In particular, in 1950 Williams demonstrated that Indian hysterics were often of high morale and were of all grades of intelligence, whereas among the British, gross hysterical reactions were the breakdowns of men with low stability and morale and usually of low intelligence [ 34 ]. Moreover, these studies demonstrate that from World War I to World War II there was a small relative decline of hysteria among British soldiers which was paralleled by a relative rise in anxiety states and by contrast, hysteria was still the most common form of neurosis among Indian soldiers in World War II. The contrasting patterns shown by soldiers suggest that hysteria and anxiety neurosis bear a reciprocal relationship, so that the decline of the former is compensated for by a rise in the latter [ 34 ].

But this also seems to demonstrate a different progress of hysterical disease in Western and non-Western societies. In the second half of the 20 th century, we witness a “decrease” of hysteria (as response to stress, which represents the patient concept’s of bodily dysfunction) in western societies. Data of annual admissions for hysteria to psychiatric hospitals in England and Wales from 1949 to 1978 show that they are diminished by nearly two-thirds, with a marked decline in the proportion from 1971 onwards, and a similar decrease is recorded in a study conducted in Athens as well [ 34 ]. Hysteria was in fact a major form of neurotic illness in Western societies during the 19 th Century and remained so up to World War II. Since then there appears to have been a rapid decline in its frequency and it has been replaced by the now common conditions of depressive and anxiety neuroses.

But the studies focused on Indian patients as well as on others non-Western countries as Sudan, Egypt and Lebanon [ 34 ] demonstrate that during the second half of 20 th Century hysteria, as one of the somatic ways of expressing emotional distress, remained a prominent condition among psychiatric patients, although anxiety and depressive neuroses may have gained a little ground. Hence, psychiatrists supposed that it was an unstable transitional phase and predicted the disappearance of hysteria by the end of 20 th Century [ 34 ].

There seems to be an inverse relationship between decreasing of hysteria and increasing of depression in Western society. The idea that depression was more likely to manifest itself in those born after the Second World War has been suggested in 1989 by Klerman [ 39 ]. More recently it has been documented by studies repeated over time in America and Australia, although there are exceptions in specific areas in relation to specific socio-environmental conditions and migration [ 40 - 44 ].

A systematic review of misdiagnosis of conversion symptoms and hysteria, based on studies published since 1965 on the diagnostic outcome of adults with motor and sensory symptoms unexplained by disease, demonstrate that a high rate of misdiagnosis of conversion symptoms was reported in early studies but this rate has been only 4% on average in studies of this diagnosis since 1970 [ 45 ]. This decline is probably due to improvements in study quality rather than improved diagnostic accuracy arising from the introduction of computed tomography of the brain [ 40 ].

We know that the concept of hysterical neurosis is deleted with the 1980 DSM-III: hysterical symptoms are in fact now considered as manifestation of dissociative disorders.

The evolution of this disease seems to be a factor of the social “westernization”. Several studies on mental diseases seem to validate this hypothesis. In 1978 Henry B. Murphy (1915-1987) [ 46 ] individuated the main causes of melancholy in social change and consequent socio-economic changes. A picture characterized by self-blame feelings, low self-esteem and helplessness. These features were described as being due to a rapid social change in two different social theatres: in those areas of England interested in turning the feudal economy into an industrial7at the centre of one at the end of the 17 th century, and more recently in some areas of Africa affected by rapid economic development. In both cases the onset of psychopathological symptoms has been related to two main factors: on the one hand, the disruption of an enlarged family and the loss of a close emotional support for the individual, and on the other hand by a marked striving towards economic individualism. In this new psychological and external contest destiny and future will no longer be determined by fate, but menbuildtheir own destiny, an unknown and hard responsibility towards life [ 47 ]. In 1978 Murphy wrote that in Asia and in Africa these symptoms are rare, except among the Westernized persons, and that it could be useful to examine under what conditions these symptoms first became common in different societies [ 46 ].

From the expression of discomfort "hysteria" to the expression of discomfort "melancholy" the different conception of the self isessential. The world of hysterical manifestation is a world of "dissociation": something dark (trauma, external influences) affects a symptom not directly interpretable. From here the development in the West of hypnotic therapies (up by Mesmer to Freud and Janet) [ 36 ] and, in the West more than in non-Westernized world, it is the implementation of exorcism and purificatory rituals that mark the meeting with the groups: Tarantism and Argia in South Italy [ 47 ], Narval-Wotal practices of West African immigrants [ 48 - 52 ]. A world linked to a vision of women as a means unaware of evil forces, "out of control" from reasonableness or (in European Positivism) be an "immature" with manipulative behavior that seeks to achieve an improper position of power. Also the world of Melancholy is female, predominantly female since women suffer from depression at a ratio of 2.5 to 1 compared to men [ 48 , 43 ]. But it is a reality in which, indeed, the patient (and therefore the patient woman) is aware of the conviction-conquest of being the master of its own destiny (and therefore to blame for their failures). We can see this passage in 1980s Africa.

Modern Africa is characterized by a variety of different economic and social situations which are not easy to compare, but in which urbanization and the progressive loss of tribal links is a common trend. In recent years several research projects concerning the transformation of psychopathology, based on African populations and African Immigrants in Sardinia, Italy, confirmed Murphy’s hypotheses on the role of social change and its socio-economic consequences in the genesis of a depressive symptomatology [ 48 ]. Studies involved populations in which traditional social structure still survives and which have just marginally been affected by social changes; populations undergoing a rapid change towards economic individualism, although these have now become a rarity in modern-day Africa; populations whose traditional social structures and underlying human relationships have been able to compromise and face the processes of partial change by actively adapting to the new realities [ 48 ]. is the starting point is the distinction between the character of African psychopathology , the prevalent form of which is characterized by ideas of reference, persecutory delusions and psychosomatic symptoms, and the “western” depression, which involves self-guilt, unworthiness and suicidal conduct. The “Westernization” of the pathology is expressed through the changing of symptoms, from African to West models. A detailed analysis of the African community surveys revealed in the Bantu area the existence of populations characterized by a psychopathological risk similar to the one highlighted in westernized settings such as among the women in Harare who presented a yearly prevalence rate for anxiety and depressive disorders. A psychosocial key - confirmed by several studies - may suggest that maintaining close links with the group of origin can play a protective role against mood-related disorders [ 48 ].

Several studies identify the existence of two counter-posed means of expressing depression which are most likely “culturally determinated” from a “different level of westernization” [ 42 ]. Researchers in transcultural psychiatry suggest that social factors may influence the modification of the melancholical phenomenology and modulate the risk of depression [ 53 - 55 ].

A survey on the Dagon Plateau conducted amongst farmers and nomadic Fulani herdsmen in Mali , reveals a very low frequency of depression and depressive cadres that are exclusively linked to secondary reactions of serious somatic disease in illiterate individuals [ 50 ]. In addition, the psychopathology over the Plateau is manifested with two opposing syndromic lines, first the constellation of symptoms of persecution, psychosomatic and psichastenia, loss of interest in things, syndrome guilt, sadness, suicidal ideas. This is typical of educated individuals [ 51 ].

A study carried out in the Namwera area in Malawi on the Mozambique border, during a deep micro and macro-social transformation which led to the establishment of a multiparty form of democracy following popular referendum, demonstrates that an emotional earthquake was caused by the conflict in having to choose between innovation and tradition. This situation in fact flew into a full-blown epidemic of hysteria among young women [ 48 ]. In the above context, in 1988, a dress factory, financed through an Italian co-operation, had been established in a village populated by the Yao and Chicewa groups, characterized by an agricultural economy. The project was articulated in order to allow women to redeem the equipment following a training period and set up independent activity [ 48 ].

In view of the particular condition of women in these cultures, this sudden passage from a traditional female role to a more independent activity seemed to be particularly suited for a study of the relationship between personal transformation and psychopathological changes. The study was carried out using three samples of age-matched women: dressmakers, farmers/housewives (traditional role), and a group of nurses and obstetricians [ 48 ]. The history of their development, including the presence of stressful events and other risk factors, together with the degree of satisfaction with their jobs and married life and other socio-anagraphic variables, was investigated by means of a specifically validated interview [ 51 ].

The choice of an innovative occupation (dressmaker/nurse) could be read as an adaptive answer in order to survive. Innovative occupations were source of satisfaction as job in itself, but they were causes of serous interpersonal and couple conflicts, linked to the new woman role and job. Housewives and dressmakers were more dissatisfied with their situation than nurses and they presented an increased number of psychopathological symptoms and the number of depressed subjects diagnosed according to DSM-IIIR was higher [ 48 , 51 ].

Housewives also experienced an increased frequency of psychosomatic symptoms, such as headache, excessive fatigue, feelings of worthlessness, and often reported suffering from the conviction that people did not recognize the importance of their role, and that someone could affect their health which is interpretable as an external localization of the source of their distress, in according to the character of African psychopathology. [ 48 , 51 ] On the other hand, dressmakers showed a high frequency of depressive symptoms, problems about self-esteem, belief of social uselessness and suicidal thoughts [ 48 , 51 ].

In a characteristic manner the suffering women also differed in the attribution of the causes of their discomfort. The "entrepreneurs" believed that the cause of their suffering had to be sought in their mistakes, the traditional women attributed to "evil spell" their ailments [ 51 ].

Among the three groups, nurses showed the highest frequency of psychological well-being and emotional stability. This should be interpreted as the result of good integration into a new identity due to a job related to a women’s traditional role and to satisfaction about financial stability. Without drastically breaking with tradition, according to several psychosocial lines, a cultural institution such as an innovative job is perceived by both society and the individual as being an integral part of the evolving self, and it creates conditions for cultural transmission to go on. This interpretation explains why nurses did not suffer from conflicts between tradition and innovation, while dressmakers, whose new individualistic role broke with women’s traditional one, did not feel accepted by their group and were consequently more vulnerable to mood disorders and particularly to depression, a “western” depression [ 48 ].

Instead, in populations which were far removed from the processes of westernization depressive disorders were relatively rare and nearly always secondary to severe somatic disorders, while they manifested themselves as primary disorders only in better educated subjects [ 48 ]. Several studies demonstrated that the threshold of onset of depression is situated on a higher level compared to western cultures and tend to support the hypothesis of a means of expression characterized by syndromic aggregations halfway between “western” style or “guilty” and “traditional” or “dislocation from the group”. Environmental factors seem to affect the the evolution of depressive symptoms and risk of depression, through modifications in the social organization thatelicit an attitude of “compulsive self-responsabilization” which would otherwise have been destined for extinction [ 48 ].

8. Focus on Sardinian Modern Cases

We should like to conclude by discussing some Sardinian cases which seem to contradict what has been said above: in modern times, they apparently document the continued use of Hippocrates’ and Galen’s ancient medical theories in relation to hysteria.

THE MANAGU HOSPITAL IN SIDDI, SARDINIA, ITALY

This small rural hospital, which was open from 1860 to 1890 in the small village of Siddi (in the heart of the Marmilla area, Sardinia) admitted 463 patients, the subject of our recent research. 122 were women (mainly peasants, maids and housewives), and of these, 10 were suffering from hysteria (sometimes the diagnosis was simple hysteria, on other occasions they were suffering from convulsions, constipation, intermittent fever...) [ 56 ]. In analyzing the simplest cases, where the hysteria was not combined with other diseases, we found the constant use of antispasmodics, sedatives and refreshing concoctions in the form of decoctions, infusions, creams, ointments and poultices. First of all, a decoction of tamarind and barley, extract of belladonna, valerian and liquid laudanum. Following this, infusions of fennel, mint and orange flowers, chamomile flowers and lime, cassia pulp and elder-tree ointment [ 57 ]. Only in one case (1868) was additional treatment prescribed in the form of polenta poultices, sulphates of potassium iodide, leeches, rubbery emulsions with iron carbonate and gentian extracts, and in another (1871) morphine acetate, infusions of senna leaves, citric acid and ammonium acetate ethers [ 57 ].

Treatment varied when the hysteria was associated with other symptoms such as, for example, epileptic convulsions: in the first phase the patient was administered zinc oxide, valerian extract, enemas with an emulsion of asafoetida and an egg yolk (to be repeated every 4 days) and then baking soda, water, fennel, turpentine and rosewater for rubs. Finally electuaries and polenta poultices [ 57 ].

The case of a young female patient at Managu is similar to the previous ones. Hospitalized for less than 54 days, the young woman was subjected to treatment based on emulsions of chloral hydrate, Burgundy pitch plasters, lemonade, water mint and lemon balm [ 57 ].

VILLA CLARA, CAGLIARI’S PSYCHIATRIC HOSPITAL, SARDINIA, ITALY

We are at the beginning of the twentieth century: the psychiatric hospital Villa Clara in Cagliari is an institution which ensures the implementation of the most advanced “psychiatric therapy”. In actual fact, this advanced therapy consisted in the “application of leeches, drastic purges, cold baths and in procuring groups of blisters, usually on the neck” [ 58 ]. Villa Clara’s story is contained in 16,000 archival files, still being sorted, but if there were any need of corroboration, its history is screamed out in the words of Giovanna M., Villa Clara’s Register 1. Giovanna M. was admitted to Genoa hospital when she was 10 years old, diagnosed with madness: she had a terrible headache, but preferred to say she had a “cranky head” and three years later in 1836, she was moved to the basement of Cagliari’s Sant’Antonio Hospital [ 58 ]. She describes this “as dark as a tomb, the only place on the island where the mad... or the insane... or the maniacs... or the idiots - as we were called- were locked up. We were 50 people in chains, in the smell of our own excrement, with rats gnawing at our ulcers...” [ 58 ]

In the early years of the new century, after a long break at Cagliari’s new San Giovanni di Dio Hospital, Giovanna M., now old and blind, was transferred to the Villa Clara psychiatric hospital, where Professor Sanna Salaris formulated a diagnosis of “consecutive dementia” and hysteria. But despite being constantly subjected to careful clinical observation, she was only treated here with “tonics ... two eggs and milk ... balneotherapy, rhubarb tinctures, potassium iodide, lemonade and laudanum, insulin and laxatives, a lot of purgatives: always, for everything”. Giovanna M. died in the mental hospital in 1913 due to “ageing of organs” and “senile marasmus”, as confirmed in the necrological report. Anna Castellino and Paola Loi know all there is to know about Giovanna M. and end their work Oltre il cancello with Giovanna’s words: “And you’d better believe it: I was 90 years old. Fate, which takes away healthy, free, young people, never pardoned me once. It has let me live all this time, quite lucid, but closed up in here ... since I was ten years old .... eighty years in psychiatric hospital for a headache” [ 58 ].

CONCLUSIONS

Lengthy the history, social changes seem to offer a fertile substrate for the evolution of complex innovative systems of interpreting reality, of attributing the causes and controlling events, of living emotions. A critical study of the historical development and the interpretations of mental diseases may contribute to providing an explanation for the means of psychopathological expression. Moreover, it may provoke a re-discussion of the threshold and vulnerability concept in cases where it could be hypothesized that the new cognitive systems, although adaptive to new social requirements, might represent a factor of vulnerability (“culturally specific”) to specific mental disorders.

We have seen that both the symptomatic expression of women’ malaise and the culturally specific interpretation of the same malaise witness the changing role of women. From incomprehensible Being (and therefore mean of the Evil) to frail creatures that try, however, to manipulate the environment to their own ends (in Freud's view) to creature arbiter of his fate (in the modern transformation from hysteria to melancholia), where the woman seems to have traded power with the loneliness and guilt.

ACKNOWLEDGEMENT

Declared none.

CONFLICT OF INTEREST

The authors confirm that this article content has no conflicts of interest.

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A Body Made of Glass by Caroline Crampton review – an intelligent and engaging history of hypochondria

In this fascinating book, a survivor of a life-threatening illness chronicles the history of health anxiety and ponders whether it is a rational response to our flawed bodies

I n the 14th century, King Charles VI of France suffered from a curious, but by no means original, delusion. He believed his body was made entirely of glass. A relatively new material, both fragile and transparent, glass captures the hypochondriac’s acutest fear – brittle vulnerability – with their greatest desire: visceral omniscience. This human longing to peer inside our “meaty vessel” was answered in the 20th century by medical technologies, including blood testing, microscopy and imaging, which became widely available. Rather than soothe the hypochondriacal itch, however, this intimate access – along with Google’s democratisation of medical knowledge – has fuelled health anxiety to new heights.

Caroline Crampton describes herself as a hypochondriac, but one with impostor syndrome because she previously had a severe “real” illness. She thinks back to the naivety of her 17-year-old self, unaware of “the tennis ball-sized lump” above her left collarbone that was “already big enough to cast its own shadow”. Life-threatening disease was lurking in plain sight, painfully obvious to see in old photos. More than a decade after radiotherapy, chemo, a stem cell transplant, egg retrieval and a successfully managed recurrence of Hodgkin’s lymphoma, Crampton now sees tumours everywhere. The hypochondriacal cancer survivor is, she suggests, tragicomic. A brush with malignancy is supposed to remind you what really matters; instead, Crampton feels trapped in the limbo between the “binaries of sickness and health”, poking at her body in the mirror.

With extensive experience in the worlds of the medically explained and the medically unexplained, Crampton is perfectly placed to write this fascinating and intelligent cultural history of health anxiety, suffused with the intensity of feeling that hypochondria ignites, as well as the insight that it often precludes. She is curious that hypochondria persists as a popular term, despite its vagueness and stigmatising edge. Medics don’t want to give it up either (in fact, there was a question on hypochondria in the Royal College of Psychiatrists’ membership examination just this month). While the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 , an international “bible” of psychiatric conditions, has updated its terminology to “somatic symptom disorder” and “illness anxiety disorder”, messy reality strains the seams of these diagnostic categories.

Hypochondriacs tend to have a specific preoccupation – cancer, infertility, an indwelling parasite – and scan their body for evidence to support this conviction, which sets off the “falling dominos of catastrophisation”. But hypochondria also overlaps with obsessive compulsive disorder and conversion disorder (when stress or emotion manifests as pain, weakness or similar symptoms that don’t fit a pattern that can be readily explained). Crampton also experiences complex post-traumatic stress disorder from her years as a cancer patient, characterised by flashbacks, intrusive thoughts and hypervigilance. Wading through these labels, her guiding question – “Who gets to decide what is reasonable fear and what is unreasonable?” – is exactly the right one to be asking.

A Body Made of Glass does not claim that hypochondria has a redeeming edge, unlike previous books on the topic. Brian Dillon’s Tormented Hope (2009) argued that health anxiety shares a root with creative genius. Crampton intersperses sections of memoir with historical research and the lives of renowned sufferers similarly to Dillon, including Charles Darwin, Glenn Gould, Philip Larkin, Molière, Marcel Proust and John Donne, but rather than use these as evidence of hypochondria’s artistic silver lining, she finds consolation in the eloquence they bring to their health concerns. Crampton takes us back to the origins of hypochondria – named first, supposedly, by Hippocrates and evident as a concept even earlier in Egyptian texts.

Etymologically “under the sternum”, hypochondria used to be rooted firmly in the body. Humoral medicine cast the condition as an imbalance of black bile, which then became connected to the “wandering womb” of hysteria, followed by the more ethereal “vapours” in the 17th century and nerves in the 19th century. The body faded from view as hypochondria was reconceived as an illness of the mind. For more than 100 years, hypochondria has been the firm property of psychiatry, while continuing to be a lucrative target for quacks and charlatans.

How concerned the public are encouraged to be about their health depends on the historical moment. Written over five years, A Body Made of Glass is a Covid-19 book of sorts, bearing the hallmark of a time when illness became everyone’s preoccupation and the stigma of health anxiety eased (in fact, Crampton found relative calm and companionship in the pandemic, joined in her habits of self-surveillance). To consider the number of ways the human body can malfunction is dizzying; it is a miracle to be well. In a way, hypochondria makes perfect sense. We are all dying. To the hypochondriac, most of us are just too easily soothed into a state of forgetting this.

Despite being failed by doctors in a multitude of ways, Crampton has the grace to empathise with the challenge of caring for patients with hypochondria. Clinicians can feel pressurised to either double down into a position of unearned certainty that there is nothing wrong or to overinvestigate. Faced with the task of triaging potentially fatal or life-limiting illness, doctors cannot – particularly in a rationed healthcare system such as the NHS – scan, biopsy and operate on demand. An important consideration Crampton glides past is the iatrogenic harm and collateral damage that can result from chasing “incidentalomas” – chance findings that so often turn out to be benign.

Crampton rejects the convention that illness narratives should end with either tragedy or cure. She explains how antidepressants, EMDR (eye movement desensitisation and reprocessing) therapy and cognitive behavioural therapy can help some people live with health anxiety, but are not miraculous solutions. Avoiding the trap of false reassurance, however appealing for those experiencing hypochondria, she sets an example. Historically, doctors have been far more often wrong than right, and particularly ready to unhear marginalised and minoritised voices.

A Body Made of Glass strengthened my belief that clinicians would do well to share doubts with their patients, becoming allies in uncertainty rather than antagonists. Both people in the consulting room are seeking confirmation about what is going on, but must hold the disturbing truth that there is so much about our bodies we continue not to know.

Kate Womersley is a doctor and academic specialising in psychiatry. Her work at Imperial College London focuses on sex and gender equity in biomedical research

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Doctors Say Diagnosis of Catherine’s Cancer Is a Familiar Scenario

The Princess of Wales did not reveal the type of cancer she has, but oncologists say the disease is often identified during other procedures.

By Gina Kolata

Gina Kolata previously reported on King Charles III’s cancer diagnosis .

• Published March 22, 2024 Updated March 25, 2024

Although it is not known what type of cancer Princess Catherine has, oncologists say that what she described in her public statement that was released on Friday — discovering a cancer during another procedure, in this case a “major abdominal surgery” — is all too common.

“Unfortunately, so much of the cancer we diagnose is unexpected,” said Dr. Elena Ratner, a gynecologic oncologist at Yale Cancer Center who has diagnosed many patients with ovarian cancer, uterine cancer and cancers of the lining of the uterus.

Without speculating on Catherine’s procedure, Dr. Ratner described situations in which women will go in for surgery for endometriosis, a condition in which tissue similar to the lining of the uterus is found elsewhere in the abdomen. Often, Dr. Ratner says, the assumption is that the endometriosis has appeared on an ovary and caused a benign ovarian cyst. But one to two weeks later, when the supposedly benign tissue has been studied, pathologists report that they found cancer.

In the statement, Princess Catherine said she is getting “a course of preventive chemotherapy.”

That, too, is common. In medical settings, it is usually called adjuvant chemotherapy.

Dr. Eric Winer, director of the Yale Cancer Center, said that with adjuvant chemotherapy, “the hope is that this will prevent further problems” and avoid a recurrence of the cancer.

It also means that “you removed everything” that was visible with surgery, said Dr. Michael Birrer, director of the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences. “You can’t see the cancer,” he added, because microscopic cancer cells may be left behind. The chemotherapy is a way to attack microscopic disease, he explained.

Other parts of Catherine’s statement also hit home for Dr. Ratner, particularly her concern for her family.

“William and I have been doing everything we can to process and manage this privately for the sake of our young family,” Catherine said, and “It has taken us time to explain everything to George, Charlotte, and Louis in a way that is appropriate for them, and to reassure them that I am going to be OK.”

Those are sentiments that Dr. Ratner hears on a regular basis and reveal, she says, “how hard it is for women to be diagnosed with cancer.”

“I see this day in and day out,” she said. “Women always say, ‘Will I be there for my kids? What will happen with my kids?’

“They don’t say, ‘What will happen to me?’”

Gina Kolata reports on diseases and treatments, how treatments are discovered and tested, and how they affect people. More about Gina Kolata

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