1 EARLY THEORIES Freud’s earliest patients were drawn from Viennese middle-class and upper-class women (and some men as well) suffering from diseases of the nerves. These difficult-to-diagnose diseases, prevalent in both Europe and America at the time, were often connected with, on the one hand, the female sex and, on the other, the stresses of modern urban life. As one British commentator noted of the apparent rise in the level of neurosis, ‘the stir in neurotic problems first began with the womankind’; by the 1890s ‘daily we see neurotics, neurasthenics, hysterics and the like … every large city [is] filled with nerve-specialists and their chambers with patients’ (Showalter 1985:121). Neurosis was a slippery category throughout the nineteenth century. Labelling an illness a disease of the nerves often simply meant that a physical cause was not forthcoming. In 1885 Freud went to study for a short period with the famous French neurologist Jean-Martin Charcot (1825–93) at the Salpêtrière asylum in Paris. By the nineteenth century the Salpêtrière was an asylum for women patients with mental illnesses – mostly hysterics. Interestingly, when the Salpêtrière was originally founded in the late seventeenth century it was a prison for confining prostitutes, ‘debauched’ girls and female adulterers. An unruly, out-of-control sexuality, and the need to confine or punish that sexuality, link the women prisoners of the seventeenth century with the hysterical women patients of the nineteenth century, as we shall see when we examine the changes brought about by Freud’s ideas of the causes of hysteria.
THE QUESTION OF HYSTERIA Freud’s development of psychoanalysis’s founding concepts, such as the unconscious (see p. 4) and repression (see p. 21), are intimately connected with his experiences of treating his first hysterical female patients. But what precisely is hysteria? HYSTERIA Hysteria’s symptoms vary: they can include amnesia, paralysis, unexplained pains, nervous tics, loss of speech, loss of feeling in the limbs, sleepwalking, hallucinations and convulsions. Its diagnoses have changed over the centuries, but some beliefs about hysteria remained firmly lodged in place until the late nineteenth/early twentieth century. The word hysteria comes etymologically from the Greek word for ‘womb’, hysteron. Hysteria was initially known as the disease of the wandering womb, and it was believed that only women suffered from it. References to hysterical illness date as far back as an Egyptian medical papyrus from 1900 BC. From the ancient Egyptians onwards, female anatomy was considered an important factor in hysteria: one cause of hysterical behaviour was believed to be women’s mobile uteruses that wandered up their bodies away from their proper resting point. Freud’s work helped sever the definition of hysteria from its attachment to female anatomy and redefine it as a psychological disease. Most late nineteenth-century medical practitioners subscribed to one of two conflicting ideas about the causes of hysteria. Some doctors believed that all hysterics were really just attentionseeking fakers. Other, more sympathetic medical commentators assumed that hysteria did exist but that it was a disease suffered only by women. It was no longer believed to be caused by the unlikely wanderings of the womb, but it was still connected with disturbances in the female reproductive organs. With his work at the Salpêtrière, Jean-Martin Charcot discarded both of these beliefs about hysteria: through his hypnotic experiments he showed that hysterics were not malingering (faking their illnesses); neither was hysteria specifically related to female biology, since some men also manifested symptoms of hysteria. Yet Charcot finally subscribed to strictly physical explanations for hysteria. He maintained the long-standing belief that hysteria could develop only when there was inherited degeneration of the brain. Freud found these explanations for hysteria unsatisfactory, suggesting that, rather than physical causes, the disease might have psychological origins in sexual disturbances from early childhood. Thus, when compared with earlier theorisers of neurotic illnesses, Freud made a significant change: he moved from biological explanations to narrative explanations, from diseased bodies to diseased memories. In the 1880s and 1890s, when Freud began practising medicine, hysterical illnesses were seen as inherited degenerative diseases caused by a weak constitution – diseased, alcoholic or syphilitic parents, bad blood. One of the key changes that psychoanalysis made in thinking about mental illness was to shift it from a physical to a psychological model. Freud suggested that people could fall ill because of their past history – a traumatic event which happened under stressful circumstances would then be strategically forgotten because it was too painful to recall. Freud and his colleague Joseph Breuer compiled a series of case histories called Studies on