In Our Time - Hysteria

Episode Date: April 22, 2004

Melvyn Bragg and guests discuss a problematic notion which can be an emotional condition, a syndrome, an extreme or over-reaction, or the physical signs of trauma. The term ‘hysteria’ was first used in Greece in the 5th century BC by Hippocratic doctors. They were trying to explain an illness whose symptoms were breathing difficulties and a sense of suffocation, and whose sufferers were seen chiefly to be recently bereaved widows. The explanation was thought to be a wandering womb putting pressure on other organs. The use that Sigmund Freud put to the term was rather different, but although there is no wandering womb in his notion of hysteria, there is still a mysterious leap from the emotional to the physical, from the mind to the body. What is hysteria? How can emotional experiences cause physical illnesses? And has hysteria’s association with old stereotypes of femininity put it off the modern medical map? With Juliet Mitchell, Professor of Psychoanalysis and Gender Studies at the University of Cambridge and author of Mad Men and Medusas: Reclaiming Hysteria and the Effects of Sibling Relations on the Human Condition; Rachel Bowlby, Professor of English at the University of York who has written the introduction to the latest Penguin translation of Sigmund Freud and Joseph Breuer’s Studies in Hysteria; Brett Kahr, Senior Clinical Research Fellow in Psychotherapy and Mental Health at the Centre for Child Mental Health in London.

This BBC podcast is supported by ads outside the UK. Thanks for downloading the In Our Time podcast. For more details about In Our Time and for our terms of use, please go to BBC.co.com.uk forward slash radio 4. I hope you enjoy the program. Hello, the term hysteria was first used in Greece in the 5th century BC by Hippocratic doctors. They were trying to explain an illness whose symptoms were breathing difficulties and a sense of suffocation and whose sufferers were seen chiefly to be recently

bereaved widows. The explanation was thought to be a wandering womb, putting pressure on other organs. The use that Sigmund Freud put to the term was rather different, but although there was no wandering womb in his notion of hysteria, there's still a mysterious leap, from the emotional to physical, from mind to the body. But what is hysteria? How can emotional experiences cause physical illnesses? And has hysteria's association with old stereotypes of femininity, put it off the modern medical map? With me to discuss hysteria is Professor Rachel Bilby, who has written the introduction to the Penguin Edition of Studies in Hysteria by Sigmund Freud and Joseph Breyer. Julie Mitchell, Professor of Psychanalysis and Gender Studies at Cambridge University, who has written a book on reclaiming hysteria,

and Brett Carr, Senior Clinical Research Fellow in Psychotherapy at the Centre for Child Mental Health in London. Julie Mitchell, I referred briefly to the Greek notion of hysteria. Could you develop that a little? Yes, I think what we have to consider is that hysteria comes along a line, really, from, how we use it colloquially to mean something that the Greeks are really referring to there, which is hysterical behaviour, dramatising, all sorts of physiological symptoms, which have no organic base as far as we can discover, and probably as far as the Greeks could discover.

One can find treatments for them, but one can't find actually causes of those illnesses. You can think of somebody like Alice James, sister of Henry and Henry James, the novelist. She had a paralysed leg and was incapacitated to all her life. it had no organic base whatsoever. So it can be a very serious condition or it can be just as we use it, as I said, colloquially, like in a hysterical crowd in a football game or something like that, when what seems to be happening is a sort of contagion between people

as though one person's emotion becomes somebody else's emotion and you get a movement of hysterical sort between people. So it is along a spectrum, the whole concept of hysteria, I think, but from the mild episode, which is a hysterical outbreak of eating disorders, anorexia or something in what used to be girls boarding schools were very typical places for that, right the way through to really quite serious conditions. I mean, I knew somebody who had symptoms of a heart attack

but was finally discharged from a major London teaching hospital only a few years ago with devil's grip. One of the factors that you brought up immediately, I wonder the difficulties that we might try to, well, we'll try to resolve during this programme, is, as you say, the range of it, hysterical conditions. be at the very an outburst, a hysterical outburst

which most people suffer from or over-arap. And at the burst we've got hysterical blindness as you mentioned hysterical paralysis called hysterical because the cause is an outside event, not an organic event, not an inside event. But it's interesting that the Greeks were on to it. It was there

in their society and they gave it the name which has stayed with it and they themselves were associating it with women, with bereavement, with an outside event. Do you find that, has that been significant throughout the study of hysteria, Julia?

Yes, I think so. It seems to be often what today we would call a trauma somewhere in the background of hysteria. It's a response to something that may be what another person would define as traumatic, but certainly the person feels it to be traumatic. So the Greeks thought, for example, that if you married and had babies or something,

you might overcome the traumatic experience of being widowed, which would be the end of a sexual relationship when that could be experienced as traumatic. So that notion of trauma somewhere there throughout its history in some ways. But you have to search for it at certain points. In the 17th century, Edward Jordan brought something fresh to bear on it, didn't he? Can you just tell us about that? Suffocation of the mother.

He felt, well, he felt, first of all, something very similar to Greeks. And there is the idea that from the Renaissance onwards, we went back to the Greeks to understand it. And he looked at breathing disorders and thought that actually it was the womb rising in some ways. I mean, as King Lear says, I feel the mother rise in me, just as he becomes hysterical before he goes actually mad. And that would be the suffocation of the mother, which was synonym for hysteria at the period.

What do you exactly mean by the suffocation of the mother? People listening say, how's the mother being suffocated and why? The mother was the uterus. It was actually a reference to the Greeks. The mother was the uterus, which was felt as though, as with the Greeks, a wandering womb. But it was by then not thought there was actually a wandering little dog inside one, as it were, eating one hour, pours up.

something which is the sort of image behind some of Garland's work, but it was actually a sensation of the uterus rising to choke the person. So again, you get the same symptoms as the Greeks had of choking feelings, which make the person feel hysterical, so they're going to die, which gets you back to the sort of trauma, as though you're near to death in some ways, choking something uncontrollable inside you. And that's the mother, the uterus rising in you.

But then in the 17th century, which is actually Jordan Bridges the two, you move to an explanation to do with something in the brain, but you still have the notion that there are vapors that rise from the uterus that affect the brain. But by... But what it's in the brain, it becomes cross-gender, doesn't it? That's right. Men are allowed to be hysterical as well as women.

Men can be described, is more sensible as hysterical as well as women. And yet, Rachel Berber, when Freud is, and Roy are talking about hysteria, they concentrate women. but let's start with Freud's first association with it. He'd been studying under the famous French psychiatrist, Charcot. Can you tell us how Freud came to understand hysteria through that relationship with Charcot? Well, I think he took from Charcot

an idea of the importance of hysteria as kind of the place to look if you're thinking about mental illness because Charco was a sort of celebrity neurologist who had made hysteria and study of hysteria into big cultural news. It was internationally very important. There were books and books and books pouring out about hysteria as sort of the disease of the century.

This is the late 19th century. Late 19th century, 1870s, 1880s, is when Charcot is working at this big hospital in Paris called the Sao Petriere. And he has responsibility for all the hysterical patients which number literally thousands. And Charco set himself the task of, as it were, classifying this notoriously

unclassifiable, absolutely amorphous all over the place kind of illness. And he did this by looking at it, by having it photographed, by hypnotising patients, by putting them on show in front of audiences and in front of groups of

students. There are two things I'd like to get, which, two things, the hypnosis and the putting on show. Let's do the pudding on show first, because I don't think it's quite as important for what we're going to talk about as the hypnosis. He did have these great theatrical demonstrations, and crowdstone up, including Freud and Breuer, where he put hysterical patients and demonstrated in public.

What was he trying to do there? Why was he doing that? He was trying to show... Apart from showing off, which must have been part of it, frankly. There was an element of it. He was himself a showman. But he made it into the spectacle of something that could be artificially induced

so that it would be evident that hysteria wasn't something fixed once and for all time as an illness which the sufferers were, for example, born with, or that they were doomed to live with forever. It was something that could come and go. But one of the points was that under hypnosis, the patient was, as it were, out of normal life. So you're getting not a conscious but an unconscious voice,

the idea of there being a deep division inside the brain, which was played out in literature later in the time, wasn't it, with Jekyll and Hyde and Doreen Gray and so on and so forth. So you have that drive going to, going on at the end of the century. And it is that division in the mind that Freud seizes on. And that keys in when he and Breuer's own patients come along and begin the only way they can get the cure for inexplicable, as Juliet was pointing out, paralyzed legs and heart attacks that don't exist. Was what Breuer's first patient called the talking cure.

That's right. Which is to try to reach the unconscious through a form of, what can we call it? Regulated hypnosis almost. Yes, and Breuer's first patient, Anna Rowe, was already in daydreaming and trance-like states. And she lived, as it were, in two alternating states of consciousness so that sometimes she'd be her apparently normal self and at other times she'd be off somewhere else. Brett Karr, you're a clinical psychoanalyst working today. What effected this notion that Rachel just outlined this notion of facing up through reminiscence

and talking about the reminiscence in an inverted commas, unconscious way, is the way to tackle what a physical, physical, serious physical disabilities. Charcot taught us that hysterical symptoms can be reversed. They are reversible, they can be removed through hypnosis, or as Breuer and Freud later discovered, through the talking cure. And I think that gave Freud great hope, because you must remember that Freud trained at the medical school of the University of which was very, very much based in the kind of brain pathology movement of the mid-19th century, late-19th century.

And physicians, especially those working with psychiatric patients and neurological patients, very much believed that once you had a symptom, it was there to stay, and you would have an inexorably deteriorating course to your symptomatology. So Charcot, Breuer and Freud really gave hope to the hysterical sufferer and gave us a sense that actually these symptoms could be taken away. They could ultimately disappear. And the business of the way in which this symptom of the body, symptom of the body was transferred to a different part of the mind

and then reasserted his influence on the body. What progress, as it were, did Freud make in that? And what's gone on since? Well, Freud made huge progress. I think he's probably the single most important figure in the history of hysteria studies because he began with a cohort of 18 hysterical patients, all women. He had seen some men,

but when he comes to write his classic paper of 1896 on the etiology of hysteria, he talks about a cohort of 18 female patients. And what he discovered is that actually, if you let these women come into your consulting room, lie down on a couch, put their feet up, and have a conversation He was doing something so radical in the history of medicine and in the history of psychiatry

because many of his fellow physicians at the time, treating nervous disorders, treating hysterical conditions, would either neglect the patient or dismiss the patient as either a malingerer or a phony that these symptoms were not really real, for example. Freud took these women's symptoms very seriously and he wanted to find out what lay at the origin of their symptoms, what were the childhood conditions? And as Juliet and Rachel have both begun to tell us, Freud often believed that at the root of every hysterical symptom lay a trauma, and often, if not invariably, a trauma of a sexual nature.

It's interesting because actually listening to Brett on talking about Charcot. Actually, for me, one of the most significant things about Charcot is that he very much put on the map that there was the male hysteric. I mean, he did lots of all the things that both Rachel and Bretta mentioned as well, But for me, male hysteria is extremely important for Freud. He did actually study male hysteria, including his own, and a lot of the dreams in the volumes of interpretation of dreams, which is really the breakthrough work,

is dreams into the unconscious, into psychoanalysis. A lot of the dreams are his own, and he often refers to him as dreams of hysterical nature. So he put hysteria into the map of normality. Now let me just say briefly what I mean by that. hadn't had male hysteria, you could never think of hysteria as a universal possibility. Today is a bit unfashionable, but nevertheless, I think clinically we do, I want to say, almost know that it's true that anybody can become hysterical or can have hysterical elements,

or can be an entrenched hysteric, if you like, male and female. Rachel. Although at the point of the studies in hysteria, what's interesting is that Freud and Breuer aren't yet universalising it, they still think of these women who have illnesses and they're wondering about what kind of a hysterical disposition did this patient or that patient have. Well, it doesn't seem that she had much wrong with her before this. So what was it in her? Was it hereditary? Was it this particular thing? And then right after the studies in hysteria is when Freud starts thinking about all these general, universal psychological factors, such as dreams

and slips of the tongue and parapraxes, all those things which become generalized to everybody's possibility of oddities of the unconscious mad behaviour in everyday life, if you like. Can I come to you, to ask you the really key question as far as I'm going. So the leap from mind to body. We can with certain illnesses or people can't,

work out what is happening. What happens to our brains when we're in a state of profound depression, that the feeling of depression becomes a fact, a physical fact. We don't seem to have a at that with hysteria, do we? No. So why not?

Not at all. Hysteria has been very, very little studied by biological psychiatrists, organic psychiatrists. We know much more about the putative biological bases of depression, schizophrenia, even alcoholism, for example. But there's been very, very little

formal psychiatric research on the origins of hysteria, and I suspect that most psychiatrists have felt that this was never a fruitful area to plum. Why not? Precisely because there are, no overt biological markers. As we had, the Greeks looked in vain for the wandering womb or whatever it might have been in the body that was causing the hysterical symptom.

One of the classic symptoms of old-style hysterical neurosis is what is called a globus hystericus, that may be a term that some people are familiar with, literally from the Latin meaning an hysterical globe. Women especially would present with a choking sensation at the back of their throat, and they would say, oh, God, it feels as though I've swallowed a ball. There's something, and some of the early theories were that the womb had dislodged itself was traveling up the elementary canal and was then getting stuck in the back of the throat, and this was called the Globus hystericus. And of course, on any basic physical examination,

there would be nothing stuck in the throat. The airways were absolutely clear. So I think it was these kinds of experiences that prompted doctors to dismiss the hysterical patient as a malingerer. Do we have any clinical evidence today? you're working today, are we across the jury? Do we have any clinical evidence today

to say that you're getting somewhere or is the whole range, as Juliet said, at the very beginning of the program so wide that maybe this is a catch-all word that needs to be, that need to be substituted a dozen or two dozen words to make interesting and

useful distinctions? Maybe is that the reason that nothing's moving forward? I don't think so, because with other kinds of psychological behavior. If we take depression, for example, as a paradigm, there are many different types of depression ranging from being irked or disappointed or being a bit glum to being severely psychotically depressed on the other end where one is suicidal and engaged in various forms of self-mutilated behavior, for example. And yet they are all

depression. And psychoanalytically, we trace them all back to experiences of loss or abandonment or disappointment of one kind or another. And I do think that the word hysteria is quite useful, though I absolutely agree with what Juliet has said, that it covers a range from a kind of mild hysterical outburst in daily conversation, all the way up to the extreme forms of hysterical neurosis, and then a controversial category, hysterical psychosis, where the person is actually quite mentally ill on many, many different dimensions,

but expressing that mental illness in an over-dramatized hysterical fashion. I know what to respond to Judy, but can we? When you respond, can I move on to the Oedibus complex and why it might be a more powerful tool to get to the bottom of this? I think I can possibly shift us there by addressing something that Brett has just brought up as an example. You use a very useful and interesting example of Globus Hystericus, which is just one of many symptoms, but it is one throughout the history of the disease.

I've had patients in the present time with Globus Hystericus. And what I want to sort of bring our attention to is the place both of sexuality and language, because I think that's what we haven't yet looked at. Now, if you take an illness like depression, which again has a range, but you are looking probably with depression at a psychosomatic relationship between the mind and the body, a phrase is that helps us to understand that it would be, you don't need to be depressed to get a cold, but it helps. And that's a relationship between two entities, your mind and your body.

Now, in hysteria, you've got something that's called conversion hysteria, in which the mind actually becomes the body. It isn't a relationship between two discrete entities, as in you don't need to be depressed, but it helps. It's actually that an idea is expressed in the body instead of through the mind. Now, for example, just to take one patient I had with Globus hystericus, what we came to, and it wouldn't it be a final result of this thing,

we'd probably go on to other sort of linguistic associations, but through associations, I said, well, what's it feel like? and it felt like a can of worms stuck in the throat. So, okay, what do you do with a can of worms? You either swallow it or you open it. Oh, you don't open a can of worms, if you said it. So if you're not going to open a can of worms, you have to swallow it. So there was a whole lot of linguistic play around what she didn't want to do

in relation to a certain idea that she had. Now, this idea would have had something sexually prohibited about it. and that's where we get sexuality and language coming together. I might have an illegitimate desire or a prohibited desire for a type of sexual relationship which culture and society does not allow. What do I do with that? I either think about it and think, oh, well, I mustn't do that, or something happens to that idea because I want to hold on to that fantasy,

that desire, that sexual desire, at the same time as I don't want to hold onto it because I'm not allowed to have it. And so you always get a conflict with that. the symptom of hysteria, a conflict of something that you both want to do, but are not allowed to do. And mostly that not wanting to do,

or always we can say, that there will have something sexual about it because of the massive taboo on incest as at the foundation of society itself. So there's always a prohibited sexuality in us somewhere. Can I bring... That's the Oedipus Complex. Yes, I was going to say, exactly,

I was going to ask you to take us on with the Oedipus Complex. How do you think that took forward? the notion of hysteria? Yes. Well, I think in the early stages, the studies on hysteria were, if you like, pre-edipus theory for Freud, though there are some germinal hints of it. And, I mean, it's such a complex notion in Freud.

I'll define it very clumsily. But essentially, the Oedipus complex for Freud or the Oedipus constellation, as we think of it now, is the idea that our behavior, our character, the way we navigate ourselves through life, is very much determined by our relationship with our early parental figures, particularly our very, very strong erotic figures, often for the parent of the opposite sex,

and our strong competitive feelings for the parent of the same sex. And what Freud found when listening to his hysterical female patients reclining on the early analytical couch and telling their stories for the first time, is that these were stories of, as Juliet said, prohibited sexuality, frustrated desire, often for family members. You have, for example, in the famous case of Freiland Elisabeth von Ar,

which is one of the, I think it's the longest study in the studies on hysteria, who had a huge passion for her brother-in-law, but this couldn't be expressed, and she developed all kinds of symptoms as a result. And when Freud actually got her to put these frustrated desires into words, into language, the symptoms began to abate. But it's interesting, isn't it, that he goes back, and not to science, but to drama,

and to Greek drama to discover the example and the, not only example, the title and the central notion of what he began to think of was the unlocking of the central part of a historically disturbed personality. Freud was an exceptionally literate man, as we know. In fact, he won a prize at school for translating Sophocles from the Greek into German and then back again. And he does turn to literature.

I mean, for example, the author whom Freud cites more frequently than any other in his collected writings is not that of any fellow neurological or psychiatric expert. It's Johann Volskang von Goethe. And then second, in terms of citation, comes William Shakespeare. So that drama background, that literary background was absolutely essential for Freud.

But is there a sense in which we're still in metaphors, as we were in metaphors about origin theories of the universe for centuries and millennia? I mean, it might have been like this, it could have been like this, we'll think of the great tree, we'll think of the great mother, we're finding ways and finding ways to discover hysteria,

finding, using Shakespeare, using Sophocles, using the moving womb, using... Are these clearly substitutes, are you clearly finding, as it were, poetic ways to look at something because you can't get at what's really going on, as a neurologist might say? Yeah, and that's something that Freud starts worrying about or being fascinated by very early on,

even in studies in hysteria. He's telling these stories, which, as he says himself, read like novellas, their entertainment. And he says, well, hang on, I'm a scientist. I'm not a short story writer. And yet that's what I seem to be doing. But he sees there being a relationship between the stories and the scientific theory that you might draw from them.

The stories are there to be interpreted, to be made something of. So there's a possible connection whereby you might be able to scientize the literature. At the same time, the literature is, as it were, center stage. And I mean you mentioned him using Sophocles' play for the Oedipus complex. There's already a connection with tragedy in the studies in Hysteria because Freud and Breuer call what Anna O, the first patient, called the Talking Cure. They call it scientifically, as it were, the cathartic method, meaning a way of getting rid of the suffering by speaking it out,

by removing something that's a bit like a foreign body. Cleansing the bowels in the cathartic, the original thing. Well, this is the whole debate, because that word catharsis comes straight out of Aristotle and classical literary criticism. And Freud and Breuer very consciously take it as that term from literary criticism. And it's a subject of exciting debates that are much more public than classical debates would be nowadays in the 19th century. And they're entering into what's then a whole debate about the meaning of catharsis in Aristotle as to whether it's a kind of. of purification or of the spirit, which would be the Gertor,

enlightenment, philosophy sort of line, or whether, as Melvin said, it's something much more pathetic and low down. It's something much more like a purgation or an excretion. And so this getting rid of the troubling symptom is something that takes a literary critical term and makes it scientific in a new way. It's rather ironic, though, isn't it,

that because of Freud's interest in literature, I mean, his great insights, his massive insights. The neurological, the more, the harder scientific community, almost throughout the 20th century, rejected him and pursued, well, I except didn't pursue very much enthusiasm, but pursued these investigations without him and deliberately turned their backs, him. To be serious about the brain was to be anti-Froid.

And yet you, Juliet, has still, your ideas of the relation of people to their siblings, which you bring. in, as it were, not to counter, but to amplify, to enrich the idea, a notion, are still working in that area, aren't you? Yes. I think my work addresses the trauma that siblings mean and make that there's a universal trauma in all of us, which is when we're displaced and replaced by somebody who has been what we were, like I was a baby.

Now there's another person, who am I, that sort of traumatic annihilation of the person, which I think makes a sort of universal trauma or potential. trauma behind his two. I'm sorry the children feel rather left out of this trauma, but no, no, they don't. Which that's the case. They have more of a problem because they think they've sort of killed them off or something like that. So it's worse.

We can join the human race again and have that trauma. Yes, I'm pretty sorry. So where are we on hysteria with the siblings? You're saying you get born and then three years later another baby, and your parents have another child, and this replaces you in so many ways that this actually is part of what becomes the basis for what might be your hysteria? For an important element of it.

For that means, does that mean that everybody who has as brother or sister has bound to be hysterical? No, I think that we all expect that brother or sister. We have to think of that. We might be last children as well as only children. That at that point we feel we're unique, we feel we're omnipotent, that we're the only person in our parents love. It's part of that Oedipus constellation, if you like,

to be also the unique, His Majesty, the baby in Freud's terms. And you suddenly are not, or if you are the last or only, child, then your friend suddenly is not because they've got a baby. So you expect another replacement. You lose your uniqueness. You lose your omnipotence. There's somewhere else on else instead of you. Do you find in these studies that you've made

introduction to a right child, do you still find points made there which are very pertinent to what you know about what's going on today? Well, I think one of the interesting things about reading the studies now is that you can't read it without knowing, as it were, what happened next, what the sequel was, and the sequel was

that the studies became the preliminary to the development of psychoanalysis and to all these much more wide conceptions of the place of fantasy and sexuality and of the unconscious and so on in human life that we've been talking about. So there's a difficulty about seeing the studies in hysteria sort of in their own light, as it were,

particularly as hysteria at that time kind of dropped out of view very shortly after that publication, in fact, it had had its moment and the next big thing became psychologically psychoanalysis. So it's hard to re-grasp, I think, that sense of what, in their own right, the studies in hysteria, signified at the time.

I would have to end there. I'm very sorry. I can't bring myself to say this, but next week we're going to talk about tea. Thanks for listening. We hope you've enjoyed this Radio 4 podcast. You can find hundreds of other programmes about history, science and philosophy at BBC.com.com.uk forward slash radio 4.