When Sigismund Schlomo Freud, the father of the psychoanalytic school of thought, diagnosed Ida Bauer, pseudonymously known as Dora, in his written account of her case, he diagnosed her with hysteria. It was a common diagnose in his time. But in 2023, the suggestion that someone is experiencing hysteria would make any sensible person scoff. But what even is hysteria? Where did it come from? And what changed from then to now to create so stark a contrast?

The term is normally attributed to a humble physician living in the 5th century B.C.E. who went by the name of Hippocrates. Hippocrates, however, was not the one to create the idea of hysteria. He inherited it from Egyptian medicine, which had a rather odd theory of female anatomy. Egyptians saw the uterus, known as the hystera in Greek, as an entity within women’s body’s. The uterus was, in their eyes, full of ever-accumulating toxins, and if not expelled through sexual activities, “takes to wandering around the body, causing various kinds of disorders,” (Tasca, et al.) which would be identified as symptoms of hysteria. Those affected were subject to a recommendation to engage in sexual acts and additionally were subject to exposure to terrible smells that supposedly would force the uterus back into its intended position. These “wandering womb” theories were adopted over the years by many, from Plato and Hippocrates to Galen and the scores of medieval physicians who still based their practice upon his work.

Visual depiction of antiquated ideas of female anatomy. Screenshot from PBS’s Mysteries of Mental Illness documentary.

As time went on, and Christianity saw a meteoric rise in Europe, the theory of hysteria was warped further. Now, it wasn’t just the uterus that was responsible, but also unfaithfulness. According to a PBS documentary series entitled Mysteries of Mental Illness, “mental illness was related to the morality and the worthwhileness and the sinfulness of the person who was suffering.” Thus, those who were experiencing symptoms of ‘hysteria’ were seen as people who had fallen victim to sin and the devil. Persecution for supposed witchcraft also began to occur in conjunction with these diagnoses, most famously with the Salem witch trials.

Entering the end of the 17th century and the beginning of the Renaissance, though, these sorts of viewpoints began to be replaced. A movement towards scientific thinking resulted in a bit of a reversion to the humoral techniques of treatment developed by Hippocrates and Galen. Some thinkers in the medical community began to associate hysteria with the brain, rather than the womb, and at this point hypnosis and hypnotic suggestion began to be recommended by some practitioners. It wasn’t all progress, though. It is commonly cited that, whether it be the restrictiveness of their corsets or their penchant to swoon, Victorian women would faint often, and would require smelling salts to be revived. Whether it was recognized or not at the time, this certainly seems to mirror the ancient Greek and Roman practice of using malodorous scents to return the wandering womb to its intended position.

A smelling salts container from the Victorian Era.

The most significant shift in perception of hysteria almost certainly came into the world with the work of Freud. For all the flaws he exhibits, it is difficult to deny that Freud’s theory of psychosexual development shifted the paradigm on how hysteria was viewed. Replacing the understanding of hysteria being a sickness caused by a lack of sexual activity or by infertility, the book Studies on Hysteria, written by Freud and Josef Breuer, “led to the psychoanalytic concept of hysteria,” which presented it as a “purely psychological disorder,” according to the International Encyclopedia for the Social and Behavioral Studies. The Encyclopedia also cites the psychoanalytic concept as becoming “the dominant explanatory theory for the next 60 years.” So, though Freud changed the trajectory of treatment of the condition from being founded on millenia-old biological assumptions to a more scientific psychologically-based techniques, it means that the oversights that he made would be exacerbated by over a half century of practice based on his work. To anyone who has read his case study for Ida Bauer, it is obvious where he went wrong. He failed to address the aspect of what made the hysteria diagnosis as harmful to women as it was: its usage to enforce patriarchal control in society. For centuries prior to his work ever being published, hysteria was being used as an excuse to silence or kill women who did not conform to the image of woman that was shaped by the powers that be: a homemaker, dutifully and silently attending to her roles as wife and mother, and not doing much else.

In the modern era, hysteria is no longer a valid diagnosis. Now, the symptoms once associated with it could be classified any number of ways. The Encyclopedia lists many, from “neurological conversion symptoms” and “dissociative symptoms, fugues, and amnesic episodes” to “phobic anxiety” and “somatization disorder.” Many of them remain mysterious, with little that can be proven about their causes and the specific situations of their appearance. In a way, the 20th century conception of hysteria remains, with unexplainable phenomena just being chalked up to one of the subcategories.

As with any concept that has existed in society for a long time, hysteria can be seen rearing its head in the arts. In some places, like Kate Novak’s “Hysterical Girl,” it is direct in its confrontation of such a messy and complicated history. In others, it is not the focus, but an important part of the story. One such piece is John Cassavetes’s opus A Woman Under the Influence, starring Cassavetes’s wife Gena Rowlands and friend John Falk.

Mabel Longhetti, played by Gena Rowlands in A Woman Under the Influence.

The film centers around a woman named Mabel and her husband Nick as the two of them attempt to navigate the balancing act of raising their kids and maintaining their relationship while Nick works long hours in a construction job with the city and Mabel struggles with constant anxieties. Mabel’s behavior is a central conflict of the film. In Nick’s own words, she’s “not crazy. She’s unusual. She’s not crazy, so don’t say she’s crazy.” Mabel is shown to depend on substances to soothe herself, and after passing out at a bar, she is sexually assaulted. Over the course of the next few scenes, a clear pattern begins to emerge in Mabel’s behavior. She cares a very significant amount about how Nick sees her, and is also very loving towards her kids, to the point of being overbearing. A turning point occurs when Nick comes back to the house with his mother and Mabel has set their kids and the neighbors’ kids loose to play dress up. Nick calls a doctor to determine whether or not Mabel should be institutionalized. After an extremely stressful back and forth, he determines that she should be. Without Mabel present, it is demonstrated that Nick is a greater harm to his kids than Mabel ever was: he takes them out of school to go to the beach and allows them to drink beer, and he is verbally and physically abusive at times, causing the kids turn against him. At the end of the movie, Mabel returns home extremely subdued and quiet, nothing like the boisterous self she was earlier in the movie. At the dinner table, she lets slip that she was treated with electro-shock therapy. Later, after guests leave and Nick appears to threaten her, Mabel cuts her hand open with a razor blade. After the kids show concern for her health, she puts them to bed, and her and Nick clean up the house and set up the bed as the credits roll.

Mabel looks on as Nick turns out the lights.

So what does that have to do with anything I just mentioned? I chose to discuss A Woman Under the Influence because I believe the movie perfectly demonstrates the intersection between gender and mental health. The connection between Mabel and the concept of hysteria is clear: she is a woman who acts erratically and often contrary to the way that her husband wants her to behave. Even though Nick does seem to love her, worries about how Mabel acts around others and how well she can take care of the kids causes him to get her institutionalized. This is very much analogous to the way women’s mental health has historically been treated. The most important determiner of how women should act is always men. It’s patriarchy, If they are acting ‘wrong,’ it’s because they aren’t fulfilling the role that the male-dominated society expects from them in the way they are supposed to. At no point does anybody care to ask Mabel how she feels and why. Her sexual assault  at the beginning of the film, which can be assumed to influence her actions throughout, goes entirely unaddressed. Even when Nick is shown to be emotionally unstable and erratic, often lashing out or making poor decisions, he sees no consequence, for he is a man, and is acting as men are expected to. All the while his wife is in a mental institution, being shocked with electricity and made to follow the same dull routine day after day, living a miserable life forced upon her by the man who vowed to love her eternally, in sickness and health.

All in all, the history of the diagnosis and cultural representations of what was once known as “hysteria” all come together and demonstrate one very clear point: a continued refusal to believe women and to treat them with the dignity that they deserve as human beings has allowed for the justification of centuries of mistreatment at the hands of the medical establishment, mistreatment that is still ongoing in many locations in the world and that must end by any means necessary. Because women don’t have wandering wombs. They shouldn’t feel sexually compelled by forced sexual advances. And they might just be a lot less crazy than they seem. So they should be believed, not blamed, and maybe then cures for the plethora of conditions that ‘hysteria’ represents can be found and distributed, soothing thousands of peoples’ suffering.