:: Article

On being hysterical

By Elena Comay del Junco.

§ 1

I started shaking just before my thirteenth birthday. The night before I was home alone and, being overwhelmed by the volume of homework I had to complete, I chose to lie down on the floor between my bed and desk until my father found my apparently unconscious body. I was discharged from the hospital the same night but returned the next morning because I was dizzy and stumbled when I walked. Over the course of the day, after being question by doctors and nurses about whether I’d taken drugs over the weekend, my feet, and then my hands, began to twitch.

§ 2

Unlike lying down on the floor, these motions were not quite voluntary, but not involuntary either. By the time I was taken for a CT scan that afternoon I was convulsing so violently that the scanner could not be operated. I still have no memory of it except for a blur of beige hospital walls and, maybe, the overhead shape of the machine.

§ 3

The long twentieth century has not been particularly kind to the fin-de-siècle neurologist Jean-Martin Charcot. His role as Freud’s superior during the 1880s when the Viennese physician was visiting la Salpêtrière means that his name still has currency among psychoanalysts, but outside the history of medicine his own work has been largely forgotten. His descriptions of hysterical patients, however, can be moving. The case of a young boy seized by convulsions has made a particular—if somewhat predictable—mark on me.

§ 4

Charcot: I’m told he’s smart, but not very hard working.

Mother: No, he doesn’t like working, although he did get a scholarship.

Charcot: That shows he’s intelligent, but when it comes down to it, he can’t be bothered.

Mother: He learns anything he wants to: he plays violin and piano, he studies German and Spanish and he’s learning English

Charcot: But without studying—this shows that there’s not much stability to his intelligence. … Is he an only child?

Father: No, we had three children. He was the second oldest; now he’s the oldest.

Charcot: He was a bit spoilt?

Mother: Yes, very spoilt.

Charcot (to the father): you’ve never been sick?

Father: No.

Mother: My husband is nervous.

Charcot: What do you mean, “nervous”?

Mother: He gets upset by the smallest things and he doesn’t like debating.

Charcot: That’s the beginning of the story. All in all there’s nothing in the child’s past. He’s big enough, perhaps a little big for his age—he grew a little fast, but nothing abnormal. … Here are the details that his family doctor forwarded to me…

§ 5

For psychoanalysis, it seems like Charcot is missing the point. A clever but unengaged boy with a nervous, possibly absent father and a mother who seems eager to defend her son, is fertile ground: just the kind of mundane but complex enough scenario out of which the best sort of case history might emerge.

§ 6

My own case was similarly mundane. My mother was working abroad for a few months and I was living full time with my father. My parents separated when I was born after twenty years of a relationship that—I can only imagine, having not witnessed any of it firsthand—was marked by more or less constant upheaval. The decision to definitively end things, prompted by the birth of their first child, was probably the most sensible one they made as a couple. I spent most of my childhood shuttling contentedly and undramatically back and forth between their two houses. Living with my father was hardly a shock.

§ 7

Freud wrote that every traumatic scene at the origin of hysteria must possess two qualities, a “traumatic force” and a “determining suitability.” In the case of hysterical convulsions, a temporarily absent mother hardly seems powerful enough. But most hysterical symptoms seem out of proportion with their triggers. Freud’s trick was to suggest that a present stimulus can provoke a reaction not to the present event, but to a more traumatic incident that happened long in the past. The basic notion was simple enough. One undergoes a traumatic experience that is so hard to deal with that the only option is to ignore it—that is, to forget it by force. Freud named that process repression, though its mechanism remained and remains somewhat mysterious. What is important is that no memory can remain forgotten forever; it remains dormant, waiting for a suitable stimulus to bring it to life, not as memory, but as bodily experience.

§ 8

None of this strictly requires involuntary expression—in theory a hysteric could choose to shake as, say, a way of working through a trauma that remained unknown to her. What matters is that one hasn’t mastered the originating trauma itself. Tremors and seizures are classic but not exceptional hysterical symptoms. Mysterious pains, uncontrollable aversions to water, to food, blindness and deafness, have all been prefixed with “hysterical.”

§ 9

I continued to experience regular shaking episodes for about four months with sporadic occurrences afterward. I still have memories of being inside and in control some of the “seizures.” Of others I have recollections of semi-voluntary initiations—of feeling drawn toward convulsing—but being unable to stop once I had started. I also have memories, if they can really be called that, of completely blank moments in which I am told I shook, often violently, and that sometimes would yell.

§ 10

There are two tropes that everyone writing about hysteria repeats: that it has disappeared, for better or worse, as a clinical phenomenon, and that it is closely linked, for better or worse, with femininity. For a long time I thought I was a counterexample to both of these points: a bona fide male hysteric of the twenty-first century.

§ 11

In fact, hysteria’s apotheosis came out of its masculinisation. Long associated with women—“hysteria” comes from the Greek for womb—as it exited the realm of possession and witchcraft and entered the domain of medicine, hysteria started to be found among men. Most of Charcot’s patients were women, but he became famous for his insistence on male hysteria. A muscular railway worker with hysterical paralysis following a train accident makes for a satisfying image: the masculine ideal suffering from the ultimate female complaint.

§ 12

Part of Freud’s self-mythologising was that he had been rejected by the Viennese medical establishment because of anti-Semitism and his insistence on the reality of male hysteria in the 1880s. The problem is that male hysteria turns out to be a slippery thing.

§ 13

Nothing, in hysteria, is what it seems. Hysteria is often said to take on whatever guise the sufferer’s culture will recognise as a “real” affliction so that they can gain some secondary benefit, however tenuous and, in the long term, harmful. So, the wandering wombs become witches become enraptured saints become epileptics become neurasthenics become borderline-sufferers become chronic fatigue become fibromyalgia become eating disorders become your symptom of choice. This is the story that gets repeated in any study of hysteria written in the last fifty years.

§ 14

The suggestion that physical symptoms are of an ultimately mental origin often provokes indignation in sufferers who understand it as dismissal of their pain. The outraged reaction, in 1997, to Elaine Showalter’s book Hystories is not atypical. Showalter suggested not only that eating disorders, but also diffuse and intractable conditions like chronic fatigue and fibromyalgia are essentially hysterical, which is not to say not real, although that qualification is always contentious.

§ 15

Whether because of my age or some fluke of sensibility, I was fiercely loyal to my diagnosis. (“An older and more beautiful diagnosis, the kind you could bring home to mamma” as the Trish Salah puts it.) The satisfaction of being taken seriously meant keeping absolutely silent about the fact that I choose to lie down on the floor at the very beginning. This unsurprisingly caused a lot of guilt. I was obsessed with the fact that my illness began voluntarily, which meant being, again unsurprisingly, very harsh on myself. In the aftermath of my hospitalisation someone proposed hypno-therapy, which terrified me. Under hypnosis I might reveal this shameful secret.

§ 16

The irony, of course, is that there was a secret there. The fact that my symptoms were of partially voluntary origin—or, more accurately, seemed that way to me—would have come as no surprise to anyone following my case. Anything that could have been revealed to others would also have come as a revelation to myself.

§ 17

Freud describes conversion in quantitative terms. An idea with a certain degree of force or intensity is so unbearable that the thinker finds a strategy to get rid of it. It seems like goes away but it’s still there, not just a secret from others but from oneself, until it surges back. Except it does not return as an idea, but as the same degree of force or intensity manifested in bodily symptoms.

§ 18

The metaphysics are worth pausing over. Psychoanalysis, going back to Freud, likes to think of itself as an anti-Cartesian discipline, denying the strict duality of mind and body. One wouldn’t know it, however, from the account of hysteria, which was the initial birth-moment of Freud’s edifice and, despite its early date, was never really abandoned. Descartes, after all, thought the mind and body were fundamentally different kinds of things, duae substantiae realiter distinctae, though this didn’t prevent them from interacting. Why should translation from the mental into the physical be compelling, unless there were some fundamental chasm that were being bridged?

§ 19

The idea that the body can “speak,” that it is a source of wisdom surpassing what is known to one’s mind, clearly has some appeal, but I can’t help but find it profoundly alienating in the way dualism can be: this body is something mysterious, separate from me; it knows things I don’t. Calls to get “back in touch” with our bodies and unearth their knowledge assume that they’re the sort of things from which one can be separated in the first place.

§ 20

Here is a better way of thinking about hysterical symptoms: start from more mundane instances where the body is obviously implicated. Crying for example. The way the body and mind are working together is fairly obvious, even if the mechanism—or the reason tears accompany emotional release—remains a bit mysterious. There is nothing metaphysically suspect, no elaborate account of mental causation or interaction (conscious or otherwise) needed. Hysterical symptoms need not be different. It’s not a matter of the body speaking in place of the “mind,” but that where they would usually go together, the mind has tricked itself into repression. The physical pain and symptoms are neither representation or expressions, they are simply the bodily side of a common process whose mental analogue has gone missing.

§ 21

The signature flourish in accounts of hysteria is the notion that bodily symptoms are not just expressive but representational. Freud describes the experience of rejection as feeling like a “slap in the face” which results in facial paralysis, the feeling of “not having a leg to stand on” ends up producing a sore left leg.

§ 22

What has been left out until now is that Freud, breaking with his mentors Charcot and Breuer, finds a sexual germ at the core of every case of hysteria: hence the account of infantile sexuality that would go on to be a definitive feature of psychoanalysis.

§ 23

In my own case, hysteria and transsexuality seem like too good a conjunction to ignore and an impossible comparison to make without being crass.

§ 24

Such a story would go something like: some sort of trauma has burrowed its way deep into the transsexual’s soul and, incapable of finding expression and release in the usual way, manifests itself as an intense, ineluctable urge for perhaps the most radical form of bodily transformation available. Hence the putatively empathic response that the best course of action surely would be to try to change the mental side of the equation rather than the bodily one.

§ 25

A friend and I have taken to referring, perhaps less jokingly than either of us intend, to the fact of transitioning as my “condition.”

§ 26

One can dilute—or “expand”—the concept of hysteria such that, no longer strictly speaking of an illness, it comes to signify a congeries of tensions between mind and body, a generic way of gesturing at the breakdown of the apparently harmonious relation between them. To say that there is some affinity, if not identity, between the hysteric and the transsexual, then, just becomes a fancy way of pointing to the overdetermination of the body. Everyone is careful to write sentences like: “I am not meaning to imply that transitioning is best understood as a hysterical conversion.”

§ 27

Why not take the comparison at face value? If so, perhaps the nineteenth century physicians who tried to cure hysteria using various bodily techniques weren’t so far off the mark. Electro-stimulation, and hydrotheraphy most commonly, although Joseph Granville’s prescription of vibrators to his female patients gets more attention (including a mediocre movie with Hugh Dancy and Maggie Gyllenhaal). It goes without saying that these weren’t effective, but the question is whether their failure should indict the whole idea of manipulating the body. Hydrotherapy may have been a bust—or appears so in retrospect—but hormone replacement therapy seems to work quite well.

§ 28

One of the higher-brow critiques of “transgenderism” I have read recently compares it—unfavourably—with Gnosticism, the late ancient, dualist competitor of Christianity as we know it, which supposedly denied the fundamental unity of mind and body, treating the body as a mere hunk of matter that can be manipulated and modified to its owner’s taste. (For what it’s worth, I think the Gnostics have gotten a bad rap for the last two millennia, but their defense will have to wait.) But what could be a more unified view of soma and psyche than one which treats them as so intertwined that you can’t change one without changing the other? That is: the point isn’t to make the body match the mind, whatever that might mean, but to change them both at the same time.

Elena Comay del Junco is a writer and academic.

First published in 3:AM Magazine: Wednesday, July 8th, 2020.