Hysteria and the Court Physician in Enlightenment France

Of the many reasons why hysteria exerts such great fascination over historians, none is more compelling than the fact that hysteria seems to come and go with changing cultural tempers. Although hysteria was once thought to be one of the most stable of disease entities, recent historical work has made clear that attention to, or even recognition of, hysteria has been far from constant. Michael Micale devoted a good section of his 1995 survey of the vast literature of hysteria to a construct he entitled "New Hysteria Studies"--the outpouring of work on hysteria by historians, psychotherapists, and cultural commentators of the last twenty-five to thirty years. ¹ A similar construct might have been devised by a historian writing circa 1800, for between 1756 and the outbreak of the French Revolution in 1789, a cluster of works appeared that constituted a kind of "New Hysteria Studies" of Enlightenment medicine. ² Some of these works focused directly on hysterical maladies, while others--nosologies and treatises on the physiology of sensibility--were more general in nature yet offered important discussions of the subject.

The medical texts devoted to hysteria all exhibited certain common patterns; all sought to define the disease, identify its victims, classify its varieties, enumerate symptoms, analyze causes, and offer remedies. Yet within each of these categories--definition, classification, symptomatology, and the rest--there is bewildering diversity. The greatest variety appears in respect to symptoms, which included disruptions of virtually every bodily function, as well as a harrowing array of emotional and mental states. ³ Scarcely less wide-ranging is the subject of "related ills," for hysteria was linked, by different observers at different times, to syncope, varieties of poisoning, hypochondria, melancholy, epilepsy, catalepsy, somnambulism, chlorosis, apoplexy, and a great range of menstrual disorders. Finally, a similarly gothic list could be devised for remedies. Eighteenth-century physicians classified therapies into the three broad categories of "physical" remedies--baths, compresses, setons, bleeding, and surgical operations; "medicinal" remedies, an array of vegetable, animal, mineral, and metal substances and preparations; and, finally, "moral" remedies, which aimed to restore health by altering regimen and, above all, by gaining ascendancy over the "passions of the soul." All of these were used in the treatment of hysteria. ⁴

Although the other themes broached by physicians in respect to hysteria do not offer this same luxuriant variety, there is variety to be found in all of them. Of continuing interest was the question of what this kind of affliction should be called. The titles of these treatises most often used the labels "vapors" or "vaporous affections," although many other terms--including hysteria as such, nervous maladies, and others--appeared between their covers. Hystérie as a noun in the singular was used. Boissier de Sauvages's Nosologie méthodique, for example, presents hystérie, so called, as a "genus" of disease having eight distinct "species." ⁵ But the problem of nomenclature remained vexed and, indeed, indicated profound ambiguities in medical representations of hysteria.

The issue of what to call this malady (or these maladies) was directly tied to the much discussed matter of whether it (or they) constituted one disease afflicting both sexes, or whether there were two different diseases--usually differentiated as "hysteria" and "hypocondria"--that afflicted the two sexes while sharing certain superficial similarities. The gendering of hysteria was also closely related to the issue of whether hysteria was attributed to somatic or psychological causes. The literature on hysteria in the Enlightenment presents conflicting claims on these questions, some historians insisting that eighteenth-century physicians "clung . . . firmly to the somatic etiology" and others that hysteria was "re-eroticized" or removed to the psychodynamic domain. ⁶ These overgeneralized assertions obscure the central feature of late eighteenth-century discourse of hysteria as it developed in France, which is its refusal of rigorous dichotomies of male / female, hypochondria / hysteria, and somatic / psychological. ⁷ A...