The medical myth that still shapes misunderstandings of women’s health

Hysteria was long attributed to a wandering uterus. The earliest text blaming women’s reproduction for illness was the Kahun Gynaecological Papyrus, an Egyptian medical scroll from 1900 BC. Women’s wombs were blamed for things like choking, cognitive deficits and the inability to speak, and paralysis. Treatments for women were always nonsurgical: swallowing medicine or rubbing it on the body; fumigating the womb with oils or incense. 

Hippocrates, the father of medicine, birthed the concept of hysteria. Translating to “uterus,” hysteria was used to theorize women’s ailments — something that few male doctors of the time understood or studied. In fact, the Greeks often linked women’s health and sexuality with madness: emotional volatility, hallucination, dissociative states, tics, convulsions. The obsession with the womb by male scholars has been a central curiosity in part because they perceived it as the source of women’s undoing, physically and emotionally. Hysteria itself, according to Hippocrates, was a result of a wandering uterus that couldn’t adjust to societal expectations and therefore was the source of women’s social discontent. This idea of the wandering uterus held throughout the Middle Ages and was one reason men were not commonly perceived as hysteric. The womb was considered a “master switch” of all women’s health and disease.

Most somatic complaints women expressed at the time were relegated to “hysteric passions”; “heart and breathing troubles, liver complaints, muscle weakness, and pregnancy complications to dizziness, weeping, laughing, absurd speech, and even eye rolling had been lumped together with the customary chokings, fainting, convulsions and contortions in the diagnostic behemoth that was hysteria.” This medical framing conceived women as weak, sensitive, and impressionable to control them. When women acted out, they were considered anxious and easily distressed; when they expressed any physical complaint, it was attributed to an emotional liability. These myths were juxtaposed to the “rational” men who exhibited reason and strength that enabled them to protect their physical bodies and minds from life’s more emotional events.

The hysteria diagnosis has long been attributed to covering up biological problems in women’s health. For instance, Thomas Willis — a physician in Oxfordshire during the English Civil Wars (1642) who coined the term neurology — began thinking about what symptoms of hysteria could be mapped in the brain. Through the course of his research — mostly through autopsy — he discovered that, in fact, symptoms like “convulsive passions” or “fits” may be closely linked to inflammation of the brain. One patient, for instance, died from what appears by description to have been encephalitis. Although little was known about what this swelling of the brain might have been in the 1600s, today we know that encephalitis can be triggered by viruses, bacterial infections, or an immune reaction. What Willis did contribute to the study of hysteria, however, was a severing of the connection between hysteria and the uterus.

Misfiring of the nervous system has long been a focus of medicine, although much of the focus has been on the motor side of the nervous system. For instance, paralysis of the foot, facial neuralgias, loss of vision and voice, tics, deep and disabling physical pain, and chronic muscular contractions were typical symptoms of what was once called “conversion hysteria” and is often referred to now as “functional neurological disorder.” Since antiquity, problems with the motor side of the nervous system — from loss of speech (hysterical aphonia) to the inability to open eyelids — have been considered physical symptoms driven by psychological problems. These symptoms manifest in many cases in fits or fainting and writhing. These physical symptoms are often perceived to be “pseudoepileptic.” For example, many young women with the disabling disease multiple sclerosis were diagnosed with “hysteria” before a biological test was discovered.

Most of these types of hysteria were based on an explosion of empirical research on neurophysiology in the middle of the 18th century that transformed how clinicians perceived and diagnosed hysteria. At this point, “physicians would be asking not whether the humors were out of balance but whether the nervous system has become too ‘excited’ … because excited is close to irritable or irritated, they may also ask whether nervous disease was not a result of irritation.” It was at this time that thinking of hysteria focused on constructs of inflammation and irritation, and the terms were often used interchangeably — although, inflammation was often associated with clear pathological changes at work, and irritation was used as a global term for disorder (when the disordered physical site or association was unclear).

During the Victorian era, menstruation and sex became closely intertwined with women’s mental and physical health. Many theorized that ovulation was triggered by intercourse and that menstrual blood was a release of nutrients that had been saved up for pregnancy. Most of these theories were based on a minority of patients, and since “they had little understanding of what was ‘normal,’ the myth that menstruation [was] linked to sex crystallized into medical and cultural lore.” Yet, menstruation was rarely studied, and clinicians misunderstood what it was.

By the late 1850s, the ovaries were identified as the true link to menstruation, and illnesses were therefore a reflection of what English physician Edward Tilt called “ovaritis” — often caused by the frequency or infrequency of sex. During this time the lack of sex (as opposed to lack of food, money, or medical care) was often said to be the cause of sickness. In many cases, hysteria was linked to wealth, society, and privilege. In Tilt’s view, women’s ovaries might become overexcited when women would read, look at pictures, have conversations, listen to music, and socialize. These views were what linked hysteria to the suppression of women’s education and power. From this time, new links between ovaries and the nervous system promoted old theories of the link between women’s reproductive organs and hysteria. 

Cartesian dualisms

Current popular usages and histories of the term hysteria have misconstrued women’s illness that can sometimes be attributed to biological origins. Often traced to French neurologist Jean-Martin Charcot, such potted narratives simplify a much more complicated situation. At the famous Salpêtrière Hospital in Paris in the late 19th century, Charcot made careful distinctions between those women he classed as hysterics and those suffering from other mental illnesses. The hysterics’ symptoms were physical, including involuntary contortions, tremors, tics, paralysis, and what we might now call oversensitive histamine responses. Charcot always believed there were real neurological problems underlying hysterical symptoms — although, he did not know yet what to call them.

But medical times and trends change. Early in his career Charcot viewed hysteria as an organic disease that was measured in what he called “dynamic lesions.” Charcot and his fellow doctors were making strides diagnosing things like amyotrophic lateral sclerosis (ALS) and multiple sclerosis, finding physiological causes. Charcot was well known for saying that there is a neurological basis for hysteria, making a distinction between hysteria and schizophrenia that was significantly different from a generation prior. 

In the last twenty years of his career, however, Charcot shifted to arguing that hysteria is also psychological or, as he is widely quoted as saying, “Hysteria must be taken for what it is: a psychic disease par excellence.” Attributing hysteria to both men and women, Charcot linked male hysteria with traumatic shock, such as from war, which was distinct from female hysteria that was associated with repressed sexual desire or trauma. Later Charcot emphasized how paralysis and tremors, convulsions, and delusions were not faked but rather were somatic manifestations of psychological distress. 

This work had a profound influence on Austrian neurologist Sigmund Freud, whose incredible rise of intellectual dominance in psychiatry and promotion of psychoanalysis at the end of the 19th century would transform the field. Freud’s influence was not only in how people thought about psychiatric illness, but also in how it was treated. After Freud left his training under Charcot in Paris, he returned to Vienna and became famous for arguing that everything is repressed trauma. At the time, Charcot’s prominence dissipated in the medical community, and Freud’s voice became prominent.

Freud believed that in most cases women’s pain reflected suppressed trauma expressed symbolically through their bodies. Talking about and through these experiences, he argued, would serve as cathartic release and provide opportunities for healing. “Frau Emmy von N” (Fanny Moser) was a classic case of hysteria in the landmark book Freud published with his colleague Josef Breuer in 1895. Frau Emmy suffered from chronic stomach pain, depression, insomnia, and hallucination. Freud connected these symptoms to traumatic episodes from her childhood when she was shamed, scared, and isolated. Through an eight-week treatment using primarily hypnosis, Freud argued, he was able to remove the imprint of these “episodes of fright.” When some women denied having experienced any trauma, however, Freud perceived them to be in denial and to be test cases for discovering what traumas were hidden within the psyche. Yet, it was later discovered that Freud exaggerated the effects of his treatments — and that none of his subjects were “cured” by his hypnotherapy.

In American Breakdown, American writer Jennifer Lunden contends that “his pseudoscience still lives, predisposing an entire medical system to distrust women’s reports of their own bodily experiences.” 

In this vein, medical historians argue that such interpretations of hysteria tell us more about contemporary culture than they do about the past. Cora Salkovskis, a medical historian who spent years studying archives from asylums in the United Kingdom, found that few clinicians used the diagnosis of hysteria at that time, in part because it was such a broad catch-all diagnosis. This is largely because the idea of diagnostics was significantly different in the 18th and 19th centuries. In the 18th century, the primary diagnostics (at least in psychiatry) were mania and melancholia. These branched out significantly in the 19th century, when constructs like hysteria were used in clinical settings to describe behavior as opposed to psychology. However, at the time diagnoses were not perceived to be the rigid systems they are today, when they are traced through illness identities as well as insurance claims. Instead, diagnoses were much more malleable, leaving space for diverse patient experiences.

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