Hysterical Men: The Hidden History of Male Nervous Illness 
by Mark Micale.
Harvard, 366 pp., £19.95, December 2008, 978 0 674 03166 1
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Mark Micale’s book opens with a scene from John Huston’s film Freud: The Secret Passion (1962), which re-creates one of Jean-Martin Charcot’s legendary demonstrations of hypnosis before an audience of doctors at the Salpêtrière. With magical ease, Charcot makes two patients’ hysterical symptoms disappear. As Micale notes, the scene is taken from André Brouillet’s well-known painting A Clinical Lesson at the Salpêtrière, a print of which Freud hung on his office wall. There are, however, two differences. In Huston’s version, one of the doctors attending the demonstration is the young Freud himself, fresh off the train from Vienna. And, more significant, while in Brouillet’s painting the audience’s eyes converge on a female subject who fully obeys the will of her Master, Huston also portrays a male patient, no less hysterical and suggestible than his female counterpart.

This might seem incongruous, so conditioned are we to think of hysteria in the feminine. Weren’t all the Salpêtrière’s hysterics women, much like the first psychoanalytic patients, from Anna O. to Dora? Even the word ‘hysteria’: doesn’t it come from the Greek hustera (womb/uterus), echoing the theories of Plato and Hippocrates on the erratic wanderings of the womb in women deprived of sexual intercourse? And yet it’s Huston who has it right: Charcot explicitly rejected the ‘uterine’ theory of hysteria, and for this reason recognised the existence of hysteria in men, whom he studied just as attentively as he did women. Indeed, it was Charcot who alerted Freud to male hysteria for the first time, before Freud made it, so Micale argues, into the unrecognised centre of his new psychoanalytic theory.

Charcot and Freud are the two heroes of Micale’s history, which narrates the slow and difficult recognition of a condition that had been concealed since antiquity by male doctors’ theories about the ‘uterine’ irrationality of women. Micale could scarcely have found a better image to introduce his ‘hidden history’ than the scene from Huston’s film. He seems, however, not to know that Huston had during the Second World War filmed a documentary on male hysteria, Let There Be Light. Initially titled Psychoneurotic Soldiers, the film showed how soldiers suffering from amnesia, paralysis or trembling due to the stress of combat were miraculously cured by hypnosis or sodium pentothal injections administered by an army doctor. Huston had no need for any extensive knowledge of Charcot’s and Freud’s texts to have a good idea of what a male hysteric was: it had been enough to enter a military hospital and see dozens of them. This complicates the story Micale wants to tell, for had he begun his book with a scene from Let There Be Light, he would not have found it so easy to end it with Freud, nor could he have turned psychoanalysis into virtually the sole source of our knowledge about male hysteria.

In a ‘note on usage’ at the beginning of the book, Micale tells us that he isn’t concerned with what hysteria ‘really’ is, but only with what innumerable doctors have had to say about it. This historical prudence is welcome, because it may well be that hysteria – this ‘Proteus’ as Thomas Sydenham called it in the 17th century – is never anything other than what we say about it, and that hysterics adapt themselves to doctors’ expectations and theories, thereby confirming them. This was the position maintained, notably, by Hippolyte Bernheim and Joseph Delboeuf, who reproached their colleague Charcot for having unwittingly fabricated (‘suggested’) the grande hystérie that Freud observed at the Salpêtrière. Start theorising male hysteria and suddenly you have an avalanche of male hysterics; stop talking about it and it disappears, or is interpreted as something else.

Micale, however, finds it even where it is concealed and unformulated: in Burton’s ‘melancholia’, the ‘hypochondriac’, ‘nervous’ or ‘splenetic’ men of the 17th and 18th centuries, the ‘neurasthenics’ and ‘decadents’ of the 19th, and in the ‘creative illnesses’ of young intellectuals such as David Hume, John Stuart Mill – or Sigmund Freud. In fact, all these men suffered from hysteria: that is, if we subscribe to Micale’s line of reasoning, from an unacceptable femininity that the body of masculine medicine could only ‘repress’ and ‘exclude’ by projecting it, misogynistically, onto the ravings of the female sex. Micale’s ‘hidden history’ is a psycho-history, in the sense that, far from sticking to the surface of the various discourses on hysteria, he retrospectively unveils a psychical reality that these discourses had avoided and concealed.

This supposes both that male hysteria has always existed (the realist assumption) and that it has always been hidden by a discourse that feminises hysteria (the hermeneutical assumption). Throughout his book, Micale evokes the ‘millennium-long dominance’ of the uterine theory and the ‘centuries of defensive rejection’ of the possibility of male hysteria: ‘For several millennia, hysteria, la maladie de la matrice, had been seen as a pathology of femininity.’ But is this really the case?

Micale presumes that the diseases of the womb the ancients spoke of were related to what we call ‘hysteria’. It’s all the more surprising, then, that he cites in a footnote the ‘able revisionist analyses’ of the classicist Helen King, which irrefutably establish that this is not the case. Not only does the term ‘hysteria’ appear nowhere in Greek texts, but the various symptoms attributed to the migrations of the hustera – including respiratory discomfort, neck pain and blackening of the skin – in no way correspond to those of modern hysteria. Hysteria, quite simply, is not found in ancient medical texts; and if one had to find it somewhere, it would be in the manifestations of what the Greeks called enthusiasmos, which meant possession by a god or a demon. But enthusiasmos belonged to the realm of religion, not of medicine, and it affected men and women equally.

We could say much the same about demonic possession and sorcery in the Middle Ages, which Micale assimilates to hysteria, affirming against all evidence to the contrary that they concerned only women. (‘There were no male witches,’ he writes. Of course there weren’t: they were called ‘sorcerers’.) Demonic possession and hysteria belong to entirely different universes, and making the second the truth of the first (following the examples of Freud and Charcot) is absurd. Using the same logic, an exorcist faced with a modern male or female hysteric would feel justified in diagnosing a demoniacal presence.

In reality, the word – and therefore the thing – ‘hysteria’ appears only towards the end of the Renaissance, when a medical interpretation of phenomena formerly attributed to the Devil begins to emerge. It is at this point that convulsions and other spectacular signs of possession are, for the first time, linked with ancient texts on ‘uterine suffocation’, as we see most notably in Edward Jorden’s anti-Puritan tract, A briefe discourse of a disease called the suffocation of the Mother (1603). Here, hysteria is possession de-demonised with the help of Hippocrates’ gynaecological theories. If it is indeed true that hysteria comes into existence cloaked with the ‘uterine’ interpretation, it doesn’t happen in Ancient Greece, but at the turn of the 17th century, in a context of religious struggles and the secularisation of demonological theory.

To this we should add that the uterine theory gave way quite quickly to another medical theory that no longer made any reference to the female sex. Starting in the years 1670-80, Willis and Sydenham attributed the ‘so-called uterine disease’ to disorders of the nervous system, thus paving the way for the long era of the ‘nerves’ and, later, the ‘neuroses’. Since the nerves are common to both sexes, there was no longer any reason to think hysteria specific to women. In fact, as Micale shows in what is probably the best chapter of his book, the majority of doctors in the 18th century didn’t grant any ontological status to the difference between female hysteria and male ‘hypochondria’, or between ladies’ ‘vapours’ and gentlemen’s ‘spleen’. Not only could men suffer just as much as women from their nerves, it was even a sign of distinction and ‘sensibility’ that in no way compromised their virility. (George Cheyne, writing in 1773 in The English Malady, went so far as to connect ‘nervous diseases’ to the progress of civilisation.) This plainly contradicts Micale’s main argument. ‘In Great Britain for a full century following the 1688 revolution, the male hysterias flourished,’ he writes. Why, then, continue to speak of the ‘centuries-long history of the non-recognition of male hysteria’?

If we disregard the first two-thirds of the 17th century, the only period to which Micale’s argument applies fully lies roughly between 1790 and 1880. For all sorts of reasons that he analyses very well, the 19th century overwhelmingly feminised, pathologised, moralised and, above all, sexualised hysteria. From Pinel to Thomas Laycock, Micale brings together an impressive anthology of misogynistic texts that unfailingly attribute hysteria to ‘onanism’, the ‘abuse of venereal pleasures’, an ‘ardent and lascivious uterine system’ (Louyer-Villermay), a ‘uterine irritation acting through the cerebro-spinal axis’ (Dubois d’Amiens), or to ‘sensual passions’ (Foville) or ‘sexual emotions’ (Carter). For all these authors, hysteria became synonymous with female sexuality and everything that men considered unmanageable and obscure in it. As the French doctor Jean-Louis Brachet succinctly expressed it: ‘L’hystérie, c’est la femme.’ In these conditions, male hysteria was impossible, indeed, unthinkable.

Yet there were notable exceptions to this process of gendering and sexualisation. Like Willis and Sydenham, leading doctors such as Etienne-Jean Georget, Pierre Briquet or Benjamin Brodie saw hysteria as a nervous and, as such, non-gendered disorder. It is to this tradition that Charcot belongs: for him, hysteria was a neurosis caused by a ‘functional’ injury to the nervous system. This is why, in a spirit simultaneously pedagogical and polemical, he took great pains from the early 1880s onwards to prove in his clinical lessons that men were just as likely as women to exhibit symptoms of the grande hystérie. He had no difficulty obtaining from his male patients the same attacks, anaesthesias, paralyses and contractures that he had previously observed (and presumably suggested) in his female patients. Thanks to Charcot’s authoritative influence, there was, from this point on, an avalanche of publications on male hysteria – as well as an epidemic of cases in the French hospital system. According to a study undertaken by Pierre Marie in 1888 at the Hôtel-Dieu outpatient clinic, there were no fewer than 525 male hysterics and only 179 female ones. The paradigm had changed: ‘Hysteria,’ wrote Marie, ‘is much more frequent in men than in women.’

Micale, oddly, isn’t satisfied by this explicit recognition. Charcot and his colleagues, he claims, deployed an ‘array of defensive procedures’ and ‘patterns of resistance’ in order to keep at bay the ‘unacceptable homoerotic intimacy’ implied by the study of male hysteria. Charcot, in particular, defeminised hysteria only at the price of desexualising and ‘de-emotionalising’ it. Micale, it seems, would have preferred Charcot and his colleagues to face their own hysteria, their own ‘mental and emotional femininity’, instead of objectifying it in the form of detached scientific observation. In this connection, he makes a big deal of a series of photos taken at the Salpêtrière that show a patient, stark naked, passing through all the phases of a grand hysterical attack. Charcot reproduced five of these photos in his Lectures on the Diseases of the Nervous System, but only, Micale tells us, in the form of ‘lifeless black-and-white engravings that omit . . . the patient’s facial features and genitalia’. The photos themselves were completely forgotten, before being rediscovered by the painter Francis Bacon in the catalogue of a Paris exhibition. Micale sees in the non-publication of these photos proof that ‘the Salpêtrière physicians . . . chose not to publicise this new knowledge, in either textual or iconographic forms, to the scientific world at large.’ But there is a much simpler explanation for Charcot’s decision: the quasi-pornographic quality of the photos obviously made their publication impossible.

Why, then, does Micale insist on seeing the intense production of male hysteria that took place at the Salpêtrière as a repression of it? Because in his view, it was Freud who first theorised ‘themes that for generations had been only latent in the medical literature of masculine hysteria’. There we have it: Micale’s ‘hidden history’ is clearly, overtly Freudo-centric. In its way, it subscribes to many elements of the ‘Freud legend’ criticised by the historian of psychiatry Henri Ellenberger, whose work Micale has ably edited in the past. Thus he recounts the episode of Freud’s lecture on male hysteria, given to the Viennese Society of Physicians on his return from studying with Charcot. The lecture was coolly received, and Freud later claimed this was because his colleagues couldn’t stomach the reality of male hysteria. Thanks to Ellenberger’s research, we now know that this was not the case and that the disagreement actually concerned Charcot’s theory of ‘grand hysteria’. As far as male hysteria is concerned, the reproach addressed to Freud by his peers was that he had taught them nothing new.

Micale’s argument runs into another considerable problem: while Charcot and his colleagues reeled off case after case of male hysteria, all of Breuer and Freud’s Studies on Hysteria concerned women. We know that Freud had among his clientele several male patients he considered to be hysterics, including Mr E. (Oscar Fellner), who is regularly mentioned in the letters to Fliess; but he never made much of this in his published writings, and thereby reinforced, even if unintentionally, the old association between hysteria and female sexuality. From this point of view, the Freudian theory of hysteria is a regression in relation to the work of Charcot. Admittedly, the sexuality Freud speaks of is not a ‘uterine’ sexuality: it is, as Micale rightly emphasises, a ‘psychosexuality that is gendered neither male nor female’. But by insisting on the role of sexuality in hysteria, and by focusing all his attention on female cases, Freud made a stunning return to the same Victorian beliefs that Charcot had battled against. This is, at any rate, how Freud’s colleagues saw things, from Michell Clarke to Möbius to Janet. Konrad Alt, for example, denounced Freud’s ‘retrograde step’, which ‘would do the greatest harm’ to hysterics by resurrecting ‘the prejudice that hysteria can only arise on a sexual foundation’.

Micale puts forward several reasons for Freud’s silence over his cases of male hysteria. Taking up the rumours spread by Freud and his biographer Ernest Jones about Breuer’s prudishness and pusillanimity, he wonders if the absence of male cases in Studies on Hysteria might not be due to ‘Breuer’s resistance to publishing data he regarded as sensitive’. However, he doesn’t provide a single piece of evidence to support this hypothesis, and recognises that it is a matter of ‘speculation’. The second explanation he offers is speculative, too, even if better supported: Freud may have avoided the subject of male hysteria because it was too close to home. What Micale is referring to here are the various ailments that plagued Freud in the mid-1890s, at the time of his intense intellectual involvement with Wilhelm Fliess: migraines, nasal affections, abrupt mood swings and cardiac arrhythmia accompanied by dyspnoea. Micale takes it for granted that these symptoms were hysterical, but neglects to mention that Freud himself, under the influence of Fliess, attributed them more specifically to a ‘nasal’ aetiology and treated them with applications of cocaine to the mucous membrane and with operations, performed by Fliess, on his turbinate bones. This point is not incidental: Elizabeth Thornton has plausibly suggested that Freud’s ‘hysterical’ symptoms may have been a consequence of the cocaine therapy that Fliess had initially prescribed for his migraines.

Ignoring this possibility, Micale boils down Freud’s ‘hysteria’ to what he calls his ‘crypto-homosexual attachment to Fliess’. Indeed, we know that Freud, in order to explain away the embarrassing quarrel with Fliess over who should receive credit for originating the concept of bisexuality, attributed his former friend’s ‘paranoia’ to a repressed homosexuality that Freud himself had managed to sublimate. ‘I have succeeded where the paranoiac [Fliess] fails,’ he wrote to Sándor Ferenczi in 1910. It is on Freud’s eminently self-serving interpretation of his relationship with Fliess that Ernest Jones and Ernst Kris, editor of the censored version of Freud’s letters to Fliess, relied when, at the beginning of the 1950s, they constructed the myth of Freud’s self-analysis, the heroic and unprecedented act that supposedly enabled Freud, by confronting his own unconscious demons, to recover from his pathological relationship with Fliess and his ‘delusional’ theories.

Micale’s only departure from the Kris-Jones version of the origins of psychoanalysis lies in his insistence that Freud’s self-analysis was incomplete. While Kris and Jones treat it as a successful therapy, Micale emphasises Freud’s repugnance towards making public the knowledge he gained by working on himself: ‘Freud didn’t just minimise the role of male hysteria in the origins of his psychology; he suppressed it’; ‘For all his striking originality as a theoretician, Freud, too, contributed . . . to the long-running tradition of male European physicians who saw but concealed, who discovered and then tried to cover up, the knowledge of male neurosis.’

Arriving at this point, the reader is justifiably baffled. Micale has already tried to persuade us that male hysteria was the object of a massive and multi-millennial repression, while giving us example after example to the contrary. Why, now, should we give the credit for its eventual unveiling to Freud, who banished it from his writings? Micale appears untroubled: wasn’t it Freud who introduced us to this type of psychoanalytic reading in which the latent is always more important than the manifest, the unsaid always more significant than the said, the absent always more decisive than the present? No matter that Freud didn’t say anything publicly about male hysteria. Indeed, so much the better, because we can see in this silence the hidden-repressed-unthought centre of his theory. This is how we make ‘Freud’ into a perpetual source of the most diverse and contradictory psychological discoveries: we magically transform his silence into an endlessly renewable discourse, legitimating whatever the preoccupation du jour may be. As Micale writes in a footnote that neatly summarises his entire project: ‘The theorisation of male neurosis, although hidden from the printed record, was present in Freud’s life and thought all along the way.’ This ‘hidden history’ is no longer history. It’s ventriloquism.

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Vol. 31 No. 20 · 22 October 2009

I am not, as Mikkel Borch-Jacobsen seems to think, interested in diagnosing Freud’s many nervous difficulties of the 1890s as hysteria in my book Hysterical Men, but rather in Freud’s own extensive descriptions of his condition, which he repeatedly diagnoses as hysterical (LRB, 27 August). Far from presenting Freud as the ‘hero’ of the story and the ‘sole source of our knowledge about male hysteria’, my chapter on Freud is intended to show that his decade-long encounter with male neurosis – his own, his patients’ and that of figures in Western literature – was fraught with inhibitions and ambiguities which reflected the wider reservations of male physicians in late Victorian Europe. It took the wars of the 20th century, the rise of military psychiatry, modernist literature and intellectual feminism to advance our knowledge.

Borch-Jacobsen came of age in the ‘Freud wars’ of the 1980s, when every piece of writing about psychoanalysis was expected to be either radically pro or radically anti. His response to my book is to assimilate it to the old pro-Freud camp, and thus require its demolition.

Mark Micale
Urbana-Champaign, Illinois

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