On Hysteria: The Invention of a Medical Category between 1670 and 1820 by Sabine Arnaud (review)

This book, although entitled On Hysteria, spends much of its time discussing vapors, one of a number of maladies including uterine furors, suffocation of the womb, fits of the mother, and hysterical and hypochondriac passions that, after the French Revolution, would be placed under a single category—hysteria—in medical dictionaries like Charles-Joseph Panckoucke's Dictionnaire des sciences médicales. Focusing primarily on eighteenth-century France, Arnaud deepens our understanding of numerous conditions not yet categorized as hysteria until the nineteenth and twentieth centuries. To date, the preponderance of scholarship on this subject by Elaine Showalter, Jan Goldstein, Mark Micale, Sander Gilman, and others has been devoted primarily to the modern period. Thorough accounts of the early modern period are important in themselves and as a prehistory to the category of hysteria that would emerge later with the professionalization of medicine.

In her deeply erudite, but sometimes abstruse work, Arnaud makes a distinctive contribution to the medical humanities. Trained in philosophy, aesthetics, comparative literature, and cultural history, she is not interested in examining efforts made to cure hysteria or in tracing the progress of medical knowledge over the course of the eighteenth century. Much of medicine was, after all, "pre-scientific," falling outside the quest for objectivity. Where others have sought progress, Arnaud finds myths, metaphors, references, and repetitions that she demonstrates do not appear in orderly succession. The past did, however, have an impact on the present as ideas were constantly circulated, criticized, refined, and reconstituted into new webs of discourse based on the demands of the times.

Eighteenth-century medical texts were read by a broad public. They provided opportunities for physicians to engage with philosophers and the lettered elite on a range of issues that went beyond physicians' normal sphere of competence. Discourse on literary, philosophical, religious, anthropological, and political matters prompted queries into human nature, the relationship between mind and body, gender difference, and social class. Exchanges went in both directions, and physicians were eager to cultivate a lay audience. They experimented with multiple genres including dialogue, autobiography, correspondence, narrative and polemic—intended to inspire trust in their patients and engage them in a considerable amount of soul-searching.

References to hysteria date back to the Hippocratic corpus. Vapors were thought to be "of the uterus," causing convulsions, breathlessness, and suffocation as they circulated throughout the body. As time went on, new symptoms were recognized, including paleness, stiffness, swoons, and catalepsy. Eighteenth-century physicians like Joseph Raulin, François Boissier de Sauvages, and Pierre Pomme contributed to the publication of a profusion of medical texts on the subject.

Vapors were associated with the aristocracy. References to vapors appeared repeatedly in the intimate journals and letters of Mme de Sévigné, Mme du Deffand, Mlle de Lespinasse, Diderot, Sophie Volland and their confidants at the royal court. It was thought that sociability gave rise to vapors that were manifested by those with refined sensibilities, sometimes bordering on genius. Vaporous individuals gave expression to the turmoil of their souls. In this context, Arnaud suggests that vapors constituted an aesthetic of existence more than a pathology.

Arnaud has a keen eye and ear for rhetoric. She appears to be as interested in how physicians wrote as in what they wrote. This attention to rhetoric is displayed early in the book when she describes the changes in register of a letter from Mme Aimond de Saint Marc as turning familiar, ironic, descriptive, and even philosophical when speaking about the impossibility of defining the vapors.

A running theme of the book is the need to consider the epistemological and political stakes invested in discourse. In the 1730s, physicians turned into arbiters in a fierce public debate about the Convulsionaries who gathered around the tomb of the Jansenist deacon de Pâris at St. Médard cemetery seeking healing. Were they possessed when they experienced fits or thought...