Rethinking the Intimacy of Voice and Ear: Psychoanalysis and Genital Massage as Treatments for Hysteria

Psychoanalysis developed as a treatment for hysteria, that mysterious illness ubiquitously associated with femininity.¹ In the last decades of the nineteenth century, Sigmund Freud and his colleague Josef Breuer began treating hysteria through talk, replacing former methods that involved somatic manipulation of the female body, often the reproductive organs themselves. In this article, I will consider the changing role of touch in the treatment of hysteria, specifically from the practice of genital massage to the so-called talking cure, developed by Breuer and his patient Bertha Pappenheim, aka “Anna O.” My analysis of the changes in the site of treatment for hysteria, from bodies to voices, supports an argument that the sonic exchange of voices that constituted the talking cure functioned as a form of touch for the doctors and patients who practiced this therapy.

The theory and practice of psychoanalysis lie at the core of a familiar story about the intimate relationship between voice and ear that has become prized in the twentieth century. Psychoanalytic theory is often considered to depend on a separation between a material voice that is spoken and an inner, personal voice that is tied absolutely to each unique subject.² In this narrative, the talking cure forged an impossible linkage between two manifestations of voice. This story has been useful to critique the separation between material voice and identity voice, both psychoanalytically oriented and not. In this article, I argue that the distinction between material and immaterial voice was not cut-and-dried for the developers of the talking cure, Bertha Pappenheim, Josef Breuer, and Sigmund Freud. Rather, the theory of hysterical conversion and the practice of its cure through talk were reconfigurations of preexisting somatic treatments.

Recent historical work in the field of sound studies seeks out epistemological change through the category of listening.³ This essay argues that psychoanalytic practice should be considered a transformation in practices of speaking and listening. The notion that speaking one’s traumas could cure hysteria radically reconfigured the ways in which hysteria was believed to inhabit and exit the body. The movement of the imagined cure for hysteria from the patient’s body to her psyche and her voice renders psychoanalysis into an aural technology. The cathartic method as practiced by Freud, Breuer, and their patients rendered the voice in psychotherapy into a site of intimate touch.

The Touching Cure

The treatment of hysteria through genital manipulation has been thoroughly documented in feminist scholarship, the history of women in medicine, the history of sexuality, the history of electrotherapy, and the history of female orgasm and the electromechanical vibrator. In her book The Technology of Orgasm: “Hysteria,” the Vibrator, and Female Sexual Satisfaction, Rachel Maines shows that this practice was a standard treatment for the illness going back as far as the Hippocratic School.⁴ The justification for treating hysteria at the site of the sex organs often stemmed from the notion that the womb was either sick or ill positioned. Indeed, the name given to the disease was a variation of the term ὑστέέρα, meaning “uterus.” A common treatment in the first half of the century, known as the “local treatment,” included manual investigation of the uterus, bloodletting by leeches on the uterus, injections, and cauterization of the womb. Other approaches included hydrotherapy, electrotherapy, massage, and the Weir Mitchell rest cure.⁵ In the rest cure, the patient was made to lie flat on her back for six weeks, with plenty to eat from her bed, and often not even allowed to rise in order to urinate. Electrotherapy, hydrotherapy, and massage were different means of genital stimulation. Maines documents in painstaking detail the wide range of treatments endured by nineteenth-century women with these symptoms.

In the local treatment and the rest cure, the female body was physically manipulated either by direct action on the body or by demanding a state of inaction. Genital stimulation manipulated the body in yet another way by literally bringing the patient to orgasm through manual stimulation of the patient’s genitals by the doctor with...