Sabine Arnaud’s book is the translation of L’invention de l’hystérie au temps des Lumières (1670–1820), the product of a PhD dissertation that she published in French in 2014. As the title suggests, it is an attempt to trace the history of a medical category, but it is not written from the perspective of a historian, as what interests Arnaud is the role played by this category in western culture, especially in France in the modern period. Drawing on previous research that highlighted the closeness in eighteenth-century medical treatises of hysteria and vapours, which was a disease affecting men also, the book aims at understanding how hysteria became a women’s disease in the nineteenth century. It also intends to fill a gap in the history of hysteria by focusing on the period between the end of the witch-hunting era and the rise of modern psychiatry with Charcot and Freud.
Arnaud states firmly in the Preface that her interest resides in the language used to report and describe hysteria rather than in a history of the cures or an analysis of medical knowledge. A characteristic of the book is the author’s constant attempt to diversify the sources she studies and her focus is not only on writing techniques but also on the collective imaginary of hysteria. Alongside well-known theoretical medical treatises, she is keen to draw the reader’s attention to lesser known or forgotten theoretical texts, as well as brochures, letters and engravings.
She thus gives great importance to the works of Pierre Pomme (1735–1812), less famous today than his contemporaries Barthez or Pinel, but a very respected physician of his time. ‘Médecin-consultant’ of King Louis XV, Pomme was the author of a best-seller, Traité des affections vaporeuses des deux sexes (1763), in which he highlighted the fact that vapours affected both sexes and he linked the disease to the activities (or lack of activity) of the idle classes. Arnaud gives great importance to this social theory of hysteria and cites many texts stressing the aristocratic dimension, so to speak, of the disease. The very fact that hysterical fits were still diagnosed during the Revolution and seemed to affect less privileged groups leads her to propose a double interpretation. First, she says, hysteria was instrumentalised to explain the violence of the Revolution and, secondly, the aristocracy having disappeared, it allowed the Republican doctors to attach the affliction to the female body and more specifically to the womb.
This transition of hysteria from an ‘unsexed’ disease to a condition affecting only women is also what explains, according to Arnaud, the many changes that she identifies in the way hysteria was described. Working on a large corpus of medical texts and philosophical treatises, she was struck by the lack of proper definition and the difficulty for the physicians in associating the illness with an established set of symptoms. For Arnaud, the impossibility of diagnosing or identifying hysteria with any certainty led physicians to use and create metaphors expressing the constant transformation of the malady. In this ‘catalog of images’, the most successful ones were an ever-changing god, Proteus, a reptilian animal able to transform the colour of its skin, the chameleon and a mythological creature, the many-headed hydra. At the end of Chapter 2, where most of these metaphors are studied, it appears that although they expressed a lack of knowledge, these images were, however, used by the physicians to try to understand the suffering of their patients and build a scientific theory. Interestingly, Arnaud sees here a pattern very close to the one she describes when working on Pomme: the mythology helped to identify women with hysteria by associating the womb with the figure of a capricious and insatiable animal.
From figures of speech, Arnaud moves to genres both in scientific and literary writings. This analysis from a literary perspective of texts on hysteria forms the core of the book (four of the six chapters). One chapter is thus devoted to the uses of dialogue, autobiography and correspondence to discuss and share medical knowledge and focuses on a few examples: Hunauld’s Dissertation sur les vapeurs et les pertes de sang (Dissertation on the Vapors and Loss of Blood), Cheyne’s English Malady, Révillon’s Recherches sur les causes des affections hypocondriaques and the well-known epistolary consultation cases of Tissot. Enlarging the scope of her study to other medical works and to several novels (Lennox’s The Female Quixote, Godwin’s Caleb Williams and Diderot’s The Nun), Arnaud comes to two main conclusions: first, physicians used literary genres to build an empathy with their patients which highlighted the individual aspects of the disease; secondly, as she writes herself at the end of the fourth chapter, novelists and medical doctors shared the same objective, as they both aimed to describe as precisely as possible the diversity of hysteria: ‘[they] shared a desire to move away from abstract systems and obscure metaphysics, and joined in giving accounts of the constant variations of the body’ (p. 205). Clearly, history here is evacuated and medical knowledge is described as a collection of observations that give no new insight into the nature of the disease. In a way, with critical knowledge being presented so negatively as ‘abstract systems and obscure metaphysics’, one might even believe that physicians of the seventeenth and eighteenth centuries had turned their backs on the very idea of scientific theories.
Arnaud’s methodological choices have prevented her from understanding that the stress on empathy and the individual aspects of a disease was intrinsically linked to strong theoretical choices and a reflection on the very nature of sensibility. Although she cites the names of Barthez, Cabanis and Broussais, she seems to know little about vitalism and the debates that agitated French medical schools in the second half of the eighteenth century. It is equally surprising that the eagerness to give ‘accounts of the constant variations of the body’ is never explained as a consequence of the ‘return to Hippocrates’ and the rise of the clinic. This is partly due to the fact that, distancing herself from the traditional historical method, Arnaud obviously did not want to study any of her cases in a historical context and is happy to introduce her authors with generalisations. But there is also a lack of language analysis leading to several misunderstandings or actual errors that is more surprising from an author claiming a background in literary studies. From the very beginning of her book, Arnaud identifies hysteria with vapours and convulsions and moves to analyse texts where these terms are present without ever questioning the links between the symptoms or set of symptoms they refer to. It is not surprising, then, that she confuses the convulsions that can affect postpartum women, which were expressly linked to ‘true illnesses’ by the famous Petit to a symptom of hysteria, and the proof that, for modern physicians, ‘hysteria is now seen as posing a threat to generations’ (p. 244). Another consequence of both the a-historical approach and the systematic identification of hysteria with vapours and convulsions is that the reader is presented with several interpretations that all seem to be valid for the same period. For example, in the passage previously quoted on Petit, Arnaud was emphasising the negative image of women given by the revolutionary physicians and their identification of hysteria with womanhood. However, a few pages before this, she explained that physicians sympathetic to the Revolution ‘read the revolutionary years as a form of hysteria: the pathology explained all the revolutionary excesses whose negative effects were to be corrected by the new republic’ (p. 237). Obviously, here hysteria was a disease affecting both men and women. These deficiencies are highlighted by the over-abundance of repetition due to the fact that the book is in great part made up of a collection of articles.
Beyond this criticism, it is clear that the subject of On Hysteria remains a fascinating one as it brings to light the difficulty of conceptualising a disease and identifying it with a definite set of symptoms. The many forgotten texts that Arnaud has dug up are a clear indication of the rich bibliography that is waiting to be discovered and studied.
