The History of Hysteria: Sexism in Diagnosis

Published on: 18 May 2017
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The female body has long been misunderstood. Women are often misdiagnosed by doctors, either due to the belief that they are over-dramatizing symptoms or because of a lack of adequate research on illnesses predominantly faced by women. As frustrating as this is, it’s no new phenomenon.

Dating back to 1900 BC Egypt, an ancient medical document known as the Eber Papyrus contained references to hysterical disorders thought to be caused by abnormal movements of the uterus. In the 5th Century BC, Hippocrates was the first to coin the term “hysteria” and agreed with his predecessors that this so-called condition — attributable only to women — was due to a “wandering womb,” believed to be caused by sexual inactivity. Recommended cures were, naturally, that women should increase sexual activity within the bounds of marriage. This diagnosis was not founded in science or medical research (though that may seem obvious now), but in gender bias against women and their experience of emotions and the perceived lack of sexual interest.

As currently defined by Merriam-Webster Dictionary, hysteria is, “behavior exhibiting overwhelming or unmanageable fear or emotional excess.” An alternate, psychiatric definition is, “a psychoneurosis marked by emotional excitability and disturbances of the psychogenic, sensory, vasomotor, and visceral functions.” While the definition of hysteria might seem broad, it has also altered over time. While medicine and mental health have changed a great deal over the centuries, hysteria is a historically gendered diagnosis that often served as a catch-all when doctors couldn’t identify another illness. It was extremely common to find women labelled as “hysterical” defined more by their stature as women than by their symptoms.

Around 200 AD, the belief remained that sexual abstinence was the cause of hysteria, classified by symptoms of insomnia, irritability, anxiety, erotic fantasies, and excessive vaginal lubrication. Roman physician Galen prescribed one of two things: sex within marriage or pelvic massage performed by physicians or, better yet, midwives (as it turns out, physicians were reluctant to deliver this form of relief themselves).

As the centuries went on, many different causes of, and solutions for, hysteria were presented, ranging from medical afflictions caused by the uterus’ lack of satisfaction through sexual intercourse or childbearing, to the spiritual possession of demons that caused a woman to act erratically. Everything from sex, to manual stimulation of the clitoris, to smelling pungent fragrances (originated by Hippocrates) were thought to aid in the treatment of hysteria. In the 16th century, English surgeon Nathaniel Highmore publically claimed that the “hysterical paroxysm” (the result of genital stimulation of women) could also be called an orgasm. The first vibrator came courtesy of Dr. J. Mortimer Granville, as a way to bring women to orgasm — and relieve them of their hysteria — more quickly.

Eventually, hysteria came fully to be thought of as a mental illness and not necessarily to be associated with the sexual and reproductive well-being of a woman. The term itself, however, didn’t disappear from doctors’ lexicons until the 1950s when the American Psychiatric Association removed it from the Diagnostic and Statistical Manual of Mental Disorders, the bible of modern psychiatry.

The most common condition currently associated with classical “hysteria” is Borderline Personality Disorder (BPD). Even now there is a prevailing stigma against people who suffer from BPD. Not only is BPD hard to diagnose due to overlapping symptoms that can be associated with other mental illnesses, but many therapists find it hard to treat because the symptoms of BPD include emotional volatility and instability. The manifestation of symptoms can arise, change, or disappear as fast as they are diagnosed.

Women diagnosed with BPD are often said to be “hysterical.” According to an article from Mad in America, women are diagnosed with BPD 75% more often than men and many of the common symptoms resemble those of hysteria throughout history. Is it sexism that perpetuates this gender disparity? Possibly. While women are more likely to get a diagnosis of mental illness overall, doctors are still less likely to take their symptoms — physical or mental — as seriously.

In her book “Women and Borderline Personality Disorder: Symptoms and Stories,” author Janet Wirth-Cauchon wrote, “the label ‘borderline’ may function in the same way that ‘hysteria’ did in the late 19th and early 20th century as a label for women.” While the discussion of women and mental illness may have become less blatantly sexist in recent years, it is clear that there is still an unfortunate yet commonly held belief that women are more prone to mental illness and to “abnormal” behavior (“normal behavior” often being a proxy for male behavior).

When it comes to other women’s health issues like endometriosis (the presence and growth of functioning endometrial tissue in places other than the uterus), women are often discredited or their symptoms are thought to be exaggerated. This can lead to a period of up to 10 years before a diagnosis is made and treatment received. One study, originally published in the Journal of Fertility and Sterility, claims that, “this centuries-old notion linking chronic pelvic pain to mental illness exerted tremendous influence on attitudes about women with endometriosis in modern times, contributing to diagnostic delays and chronic indifference to their pain for most of the 20th century.” Again, we see how the “catch-all” diagnosis of hysteria, and discrediting women’s mental stability, has crept into other health issues women face.

The history of hysteria flows directly into current women’s health challenges — both physical and mental. Women were, and still are, often assumed to be less competent and less in control of their bodies and minds. Alleviating the stigma surrounding mental illness requires awareness of how diagnoses are gendered by doctors and patients alike.

The history of hysteria shows just how deeply sexism can affect science and psychology. Because of this, women are put into a unique position of needing to advocate strongly for their own health. Women must continuously insist that their health concerns be taken seriously to get not only a diagnosis, but an accurate one. Women advocating for themselves will help alter the landscape of medicine and mental health and, hopefully, create a safer place for women to receive treatment.

Talkspace articles are written by experienced mental health-wellness contributors; they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts (therapists and psychiatrists of various specialties) to ensure content is accurate and on par with current industry standards.

Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.

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