Book Review: Asti Hustvedt (2012). Medical Muses: Hysteria in 19th Century Paris (London: Bloomsbury Publishing), pp. 372, p/b, ISBN 978-1-4088-2235-7
Asti Hustvedt (2012). Medical Muses: Hysteria in 19th Century Paris (London: Bloomsbury Publishing), pp. 372, p/b, ISBN 978-1-4088-2235-7
Shiva Kumar Srinivasan,Ph.D.
How did hysteria become an object of representation in 19th century Paris? What are the differences between the pre-Freudian and post-Freudian definitions of hysteria? What are the differences between the discursive construction of hysteria and the attempts to find a cure? And, what finally, is the legacy of hysteria in the history of French psychiatry? These then are some – though by no means all – of the questions that Asti Hustvedt, an independent scholar in the area of literature and psychoanalysis, takes up in this riveting book on hysteria in 19th century Paris. It is a good idea to begin with a note on the title. The term ‘medical muses’ is used here to indicate the three famous hysterics – Blanche, Augustine, and Geneviève – who dominate the analysis of hysteria in this book. Another term that Hustvedt invokes in this book for these three women is ‘medical divas’ – which could also have served as an appropriate term in the title in lieu of ‘medical muses.’ What we have in this book however are not medical cases as such, but a genre that is more akin to clinical profiles of these three hysterics. These clinical profiles are preceded by a historical profile of Jean-Martin Charcot, the Director of the Salpêtrière, the leading psychiatric institution in 19th century Paris which, for all theoretical and practical purposes ‘invented’ hysteria as a diagnostic category in the history of psychiatry. At first glance, while glancing through the list of contents to this book, a reader might think that Jean-Martin Charcot was the first of the hysterics that interests the attention of Hustvedt and that there are four rather than three hysterics profiled here. The reader would not be completely mistaken if she came to that conclusion though unlike, say, a cultural theorist or a feminist historian, Hustvedt does not explore that possibility at length, but merely hints at it in passing. It is important to ask whether or not psychiatrists have a symptomatic stake in their classificatory systems or methodological choices without becoming reductive in the attempt to do so.
HYSTERIA AND METHOD
Hustvedt’s methodological approach is more akin to the historian of medicine who is keen on combining both the hitherto unused material in the medical archives and in the secondary literature rather than push the data in the direction of generating tropes for a feminist critique of French psychiatry as such. Indeed one of the interesting points that Hustvedt makes is that she began with some measure of justified suspicion about the deployment of patriarchal models of hysteria in the career of Charcot, but her engagement with the archival material convinced her that the three prototypical hysterics that she invokes were really suffering the symptoms that they produced under hypnoses within the psychiatric institution and in public fora (and were not simulating their symptoms because of a predisposition to ‘histrionic personality disorders,’ or merely because they were asked to do so by the attending physicians). It is also important to remember that we are conflating technical terms here to some extent since the term ‘disorder’ is not French but American and was not used in the 19th century in the sense that we attribute to it here. The main French critique of the contemporary American classification of hysteria is precisely that it dissolves hysteria into a number of disorders which cluster around a lead symptom from which it derives its name. This, in the French model of diagnosis, leads to a situation where what interests the psychiatrist – like any other physician – is not the patient who suffers, but the structure of the symptom as such; it is the illness that is treated rather than the patient in the holistic sense that contemporary standards demand. We must therefore not conflate how psychiatrists classify hysteria now with how they went about it in the 19th century where the goal was not a cure as such but rather an attempt to ‘classify and console.’ The object of classification was the illness and the burden of the consolation was the patient. This is the main preoccupation of the psychoanalytic critique of Jacques Lacan as well who was keen on ‘recuperating’ hysteria from the history of psychiatry (Bronfen, 1998; Mitchell, 2000) rather than let the physicians dissolve hysteria into numerous disorders or syndromes, which is the mainstay of the classificatory method in psychiatry manuals like the Diagnostic and Statistical Manual (Smith, 1983; Fink, 1999a; Fink 2007). Furthermore, French psychoanalysts are interested in contrasting hysteria with neuroses like obsessional neurosis and phobia; their model of hysteria is not ontologically self-sufficient; it depends instead on a model of compare-and-contrast and a theory of the neuroses rather than a theory of hysteria as such (Laplanche and Pontalis, 1973a; Evans, 1997). This however is not something that Hustvedt attempts to do in this book since she focuses only on hysteria without a mention of the other neuroses at all.
THE PREFERENCE FOR HYSTERIA
It is not made clear to the reader why these women preferred to be hysterics rather than become obsessionals or phobics; this is known as ‘the choice of the neurosis’ problem in contemporary psychoanalysis. That is also the main difference, I argue here, between the psychiatric and psychoanalytic approaches to hysteria. So, for instance, there is not much of an analysis on the problems of ‘differential diagnosis’ in this book. It is hard to believe that Charcot did not have anything to say on this problem since the whole question of whether or not the ‘ontology of the hysterical symptom’ is akin to the ‘ontology of the pathological symptom’ is what is at stake in differential diagnosis in both the psychiatric and psychoanalytic clinics in the first instance; it is also the case that this ontology takes essentially the form of an ‘hontology’ in psychoanalysis (Ragland, 1995). To put it in layman’s terms: Are we confronted with a suffering mind or a suffering body? Further to this preliminary clinical determination is the question of what specific type of suffering can be termed as having the form of hysteria? This question is also complicated by the fact that the hysterics analyzed in this book had a propensity to mime a range of clinical syndromes. This made differential diagnosis much more difficult since the mind was racing ahead of the body by displacing not just a particular symptom but a clinical syndrome, i.e. an entire collection of symptoms (Laplanche and Pontalis, 1973b). Freud would later refer to these hysterical phenomena as akin to the symptoms ‘joining in the conversation’ with the analyst and the patient (Freud, 1893-95). It would not be far-fetched to say that what these hysterics resist then is precisely the ‘reductive’ model of psychiatric classification. Joining in the conversation is a way of recovering their moment of subjectivity lest they be reduced to symptomatic objects of patriarchal inquiry (Flieger, 1990; Schwartz, 1999; Sadoff, 1998a). In any case, as far as the psychiatrists were concerned, determining that the patient suffered from ailments of the mind rather than the body did not lead to a quick therapeutic solution since there was no method of treatment that was appropriate to hysteria as such at the Salpêtrière in the sense of actually producing a cure. Most of the hysterics were confined in psychiatric institutions rather than being subject to a cure within the conventional meaning of that term. Charcot, unlike Josef Breuer and Sigmund Freud at Vienna, was less interested in curing hysteria than in classifying, observing, studying, and conducting experiments on hysterics and hysterical phenomena (Sadoff, 1998b).
It would not be incorrect to say that what was at stake for Charcot was not the fate of any particular hysteric as such unlike Freud’s counter-transferential preoccupations with Dora’s incomplete analysis (Freud, 1905; Forrester, 1990), but with securing hysteria as a diagnostic category given the hostility that he was experiencing via-à-vis the Catholic church until the French academy became fully secular. This is because a number of catholic saints (both male and female) were being re-classified as hysterics by the psychiatric community, and a number of religious phenomena including that of demons, witches, the appearance of stigmata, and the forms of self-mortification associated with the lives of the saints were being re-interpreted as forms of hysterical jouissance. Though the term ‘jouissance’ does not feature in these psychiatric studies, the psychiatrists cottoned on to the fact that the saints experienced a combination of pain and pleasure that went beyond the confines of the pleasure principle and the pleasure-pain calculus of the Benthamite philosophers. There was a lot at stake for the Catholic Church because their business model depended on holding on to the saints and the idea of miracle cures. They therefore did not want the psychiatrists to appropriate the history of the church for pre-figurations of hysteria. That is why Charcot does not demonstrate as much of a therapeutic fervor that we might expect as the post-Freudians do in seeking a cure for psychiatric ailments.
Hustvedt is also rather restrained on these matters since the typical response in feminist criticism is to point out the ethical implications of such tests and experiments within the context of the patriarchal gaze in the history of psychiatry. Hustvedt’s ideological or methodological restraint is probably related to the backlash that Elaine Showalter suffered from when she explored the hysterical underpinnings of the Gulf War Syndrome amongst service personnel on returning to the United States. Psychiatrists have always preferred simple variations on the ‘shell-shock’ theory to theories of hysteria since the time of the First World War when a number of American veterans were diagnosed with disorders that resulted from being in close proximity to exploding shells and bombs. While Hustvedt mentions these problems towards the end of the book, these are not phenomena from the 19th century, and are therefore not discussed in detail. What is really at stake in terms of the representations of hysterics in her work is the role of photography in chronicling the representations of hysteria. It is important to realize that Breuer and Freud do not have any interest in photography. So what is the difference between the linguistic representation of the hysteric in Freud and the photographic representation of the hysteric in Charcot? When those who are interested in the history of psychoanalysis read the history of psychiatry, they often conflate the ontological distinction between the hysterics of Charcot’s Paris and the hysterics of Freud’s Vienna. Freud’s hysterics come across as extremely well-behaved even if they act-out their symptoms every now and then. What is the difference then between Charcot’s hysterics who were asked to act their symptoms and Freud’s hysterics who acted-out their symptoms without being asked to do so? Charcot’s hysterics were not purely hysterics: What they suffered from were forms of hysterical epilepsy. Freud’s patients were not epileptic to the extent that these three hysterics were. When Freud himself was a student of Charcot at the Salpêtrière, he encountered any number of these hystero-epileptics. There is however no tradition of exhibiting hysterics in Vienna as there was in Paris. So when Freud attempted to articulate a theory of hysteria and exhibit a hysteric at the Viennese Medical Academy, he was not encouraged to do so; and, in any case, even broaching this possibility severely strained his professional relationship with Breuer. Another bone of contention was whether hysteria was necessarily a ‘female malady’ as Showalter (1985) put it, or whether any attempt to theorize hysteria must include hysteria in male subjects. Needless to say, there is a tradition of reading theories of hysteria into the lives of great thinkers like Socrates, Hegel, and Gandhi (Žižek; 1996; Srinivasan, 2000; Srinivasan, 2002). But these readings are more likely to be attempted when the diagnostic category of hysteria has been adequately secured for the psychiatric and psychoanalytic communities rather than when the validity of that category itself is subject to questioning; it is also important to understand the role played by the jouissance of the hysteric (Fink, 1999b). The role played by photography in the history of medicine is a fascinating topic in itself, but what is at stake in this book is the attempt to systematically represent the contortions, passions, and attitudes of the great hystero-epileptics such as those studied here. Hustvedt also discusses how these representations entered the history of art through the surrealists and thereby affected the French model of hysteria for not only psychiatrists, but also for the members of artistic and literary communities.
Those who are encountering theories of hysteria and feminine jouissance for the first time, or mainly from the seminars of Jacques Lacan, should do well to read this book because it explains how, when, and why hysteria became not merely a clinical category in the history of psychiatry and psychoanalysis, but also a form of subjectivity within French theory. It will also provide the essential historical background to understanding how and why Lacan trained as a psychiatrist before becoming a psychoanalyst and the role that medical education plays in the formation of a psychoanalyst in France (Miller, 1996). It is again a good idea to know the history of hysteria in the French psychiatric tradition before attempting to deploy Lacanian discourse theory which valorizes the discourse of the hysteric and the discourse of the analyst over the discourse of the academic and the discourse of the master (Fink, 1995; Lacan, 2007). While Lacan has also been located in the locus of the master (Borch-Jacobsen, 1991), the prototype of the master is a legacy of 19th century psychiatry. Lacan’s relationship to psychiatry is in many ways a way of working-through his transference to Jean-Martin Charcot, the ‘Napoleon of the Neuroses’ without necessarily adopting his model or conclusions whole-scale. Lacan is more likely to discuss his debts to Gaëtan Gatian de Clérambaut, his master in psychiatry, than Charcot, but it should not be difficult to understand why that might be the case. Is not Clérambaut but a mask for the transferential authority of Charcot? Is not Lacan’s fear of belatedness, his Bloomian anxiety of influence, his desire to be a master, even while he valorized the discourse of the analyst and the hysteric over that of the master, but a strategic ruse (Bloom, 1997)? Is not Lacan’s passion but a form of Bloomian kenosis? A way of working through both a transference to the master, but a realization that he did not go far enough? Or, in Bloom’s idiom, Lacan can be read as saying that Jean-Martin Charcot in his locus as a Lacanian precursor did not ‘swerve’ strongly enough (i.e. go far enough) to effect a complete ‘clinamen’ in his interpretation of hysteria (Bloom, 2003; Bloom, 2011). This book will be an invaluable addition to courses in the history of psychiatry, history of medicine, feminism and psychoanalysis.
Bloom, Harold (1997). The Anxiety of Influence: A Theory of Poetry (New York and Oxford: Oxford University Press), passim.
Bloom, Harold (2003). ‘The Belatedness of Strong Poetry,’ A Map of Misreading (New York and Oxford: Oxford University Press), pp. 63-80.
Bloom, Harold (2011). The Anatomy of Influence: Literature as a Way of Life (New Haven and London: Yale University Press), passim.
Borch-Jacobsen, Mikkel (1991). Lacan: The Absolute Master, translated by Douglas Brick, (Stanford: Stanford University Press)
Bronfen, Elisabeth (1998). The Knotted Subject: Hysteria and its Discontents (Princeton: Princeton University Press).
Evans, Dylan (1997). ‘Hysteria,’ An Introductory Dictionary of Psychoanalysis (London and New York: Routledge), pp. 78-79.
Flieger, Jerry Aline (1990). ‘The Female Subject: (What) Does Woman Want?’ Psychoanalysis and…(New York and London: Routledge), edited by Richard Feldstein and Henry Sussman, pp. 54-63.
Forrester, John (1990). ‘The Untold Pleasures of Psychoanalysis: Freud, Dora, and the Madonna,’ The Seductions of Psychoanalysis: Freud, Lacan, and Derrida (Cambridge: Cambridge University Press), pp. 49-61.
Freud, Sigmund (1893-95). ‘Psychotherapy of Hysteria,’ Studies on Hysteria, (London: Penguin Books, 1986, Reprint), translated by James and Alix Strachey, edited by Angela Richards, The Pelican Freud Library, 3, p. 383.
Freud, Sigmund (1905). ‘Fragment of an Analysis of a Case of Hysteria,’ Case Histories I, translated by James and Alix Strachey, edited by Angela Richards, The Pelican Freud Library, 8, pp. 29-164.
Fink, Bruce (1995). ‘The Four Discourses,’ The Lacanian Subject: Between Language and Jouissance (Princeton; Princeton University Press), pp. 129-137.
Fink, Bruce (1999a). ‘A Lacanian Approach to Diagnosis,’ A Clinical Introduction to Lacanian Psychoanalysis (Cambridge and London: Harvard University Press), pp. 75-78.
Fink, Bruce (2007). Fundamentals of Psychoanalytic Technique: A Lacanian approach for Practitioners (New York and London: W. W. Norton & Co).
Fink, Bruce (1999b). ‘From Desire to Jouissance,’ A Clinical Introduction to Lacanian Psychoanalysis (Cambridge and London: Harvard University Press), pp. 205-217.
Lacan, Jacques (2007). ‘Production of the Four Discourses,’ The Seminar of Jacques Lacan, Book XVII: The Other Side of Psychoanalysis, translated by Russell Grigg (New York and London: W. W. Norton), pp. 11-26.
Laplance, Jean and Pontalis, Jean-Bertrand (1973a). ‘Hysteria,’ The Language of Psychoanalysis, translated by Donald Nicholson-Smith (London: Karnac Books), pp. 194-195.
Laplance, Jean and Pontalis, Jean-Bertrand (1973b). ‘Hysterogenic Zone,’ The Language of Psychoanalysis, translated by Donald Nicholson-Smith (London: Karnac Books), p. 196.
Miller, Jacques-Alain (1996). ‘An Introduction to Lacan’s Clinical Perspectives,’ Reading Seminars I and II: Lacan’s Return to Freud, edited by Richard Feldstein et al (Albany: State University of New York Press), pp. 241-247.
Mitchell, Juliet (2000). Mad Men and Medusas: Reclaiming Hysteria and the Effect of Sibling Relationships on the Human Condition (London: Penguin Books).
Ragland, Ellie (1995). ‘Illness and the Human Body,’ Essays on the Pleasures of Death: From Freud to Lacan (New York and London: Routledge), pp.115-143.
Sadoff, Diane (1998a). ‘The Rhetoric of Hysteria,’ Sciences of the Flesh: Representing Body and Subject in Psychoanalysis (Stanford: Stanford University Press), pp. 27-57.
Sadoff, Diane (1998b). ‘Toujours la chose génitale,’ Sciences of the Flesh: Representing Body and Subject in Psychoanalysis (Stanford: Stanford University Press), pp. 58-83.
Schwartz, Joseph (1999). ‘Hysteria and the Origins of the Analytic Hour,’ Cassandra’s Daughter: A History of Psychoanalysis (New York and London: Penguin Books), pp. 40-62.
Showalter, Elaine (1985). The Female Malady: Women, Madness, and English Culture, 1830-1980 (New York: Pantheon).
Smith, Joseph H. (1983). ‘Lacan and the Subject of American Psychoanalysis,’ Interpreting Lacan (New Haven and London: Yale University Press), Psychiatry and the Humanities Series, The Washington School of Psychiatry, 6, pp. 259-276.
Srinivasan, Shiva Kumar (2000). ‘Socrates and the Discourse of Hysteria,’ analysis, 9, pp. 18-36.
Srinivasan, Shiva Kumar (2002). ‘Why is Derrida Afraid of Hysteria?’, analysis, 11, pp. 137-158.
Žižek, Slavoj (1996). ‘Hegel with Lacan, or the Subject and its Cause,’ Reading Seminars I and II: Lacan’s Return to Freud, edited by Richard Feldstein et al (Albany: State University of New York Press), pp. 397-413.
Shiva Kumar Srinivasan has a PhD in English Literature and Psychoanalysis from Cardiff University, Wales. His PhD thesis was titled ‘Oedipus Redux: D.H. Lawrence in the Freudian Field’ (1996). He has served as a faculty at Indian Institute of Technology, Kanpur; Indian Institute of Technology, New Delhi; Indian Institute of Management, Ahmedabad; Xavier Labor Relations Institute, Jamshedpur; Indian Institute of Management, Kozhikode; and International Institute of Planning and Management, Chennai.