Ragalika Veeranala
The word ‘hysteria’ originates from the Latin word hystericus, which means “of the womb” (Merriam-Webster, n.d). Owing to the obvious female origin of the word, Hysteria is regarded to be the first female-exclusive mental disorder (Tasca et.al, 2012). The evidence of which can be found in two papyri discovered in ancient Egypt, around 1900-1600 BC. They addressed what seem to be the symptoms of hysteria such as nervousness, agitation, depressive syndromes etc. and assign its cause to the movement of the uterus in the female body. The Greek physician Melampus said that women had gone mad because of an absence of orgasms, leading to a condition called “uterine melancholy” (Tasca et.al, 2012). Plato and Hippocrates proposed that the uterus became sad and sick if it didn’t enjoy the advantages of having sex and procreation (Tasca et.al, 2012). While some treatments prescribed sexual activity, others preached eternal celibacy, indicating that women were simply considered to be reproductive organisms; everything seemingly wrong with them was deducible to their sexual activity, or lack thereof.
In the middle ages, the view that “the woman is a failed man,” as stated by Aristotle, became wildly popular (Tasca et.al, 2012). The church considered women to be full of sin and were deemed inferior to men (Tasca et.al, 2012). This propagated the notion of demonic possession as a causal factor for hysteria, and exorcism, to treat it, gained prevalence. Physically or mentally-ill women were viewed as witches, and were subject to severe maltreatment, often leading to persecution. In the modern ages, the development of scientific inquiry didn’t result in a better or more humane understanding of hysteria. In fact, the earlier misogynistic theories intensified.
During the mid 18th-century, physicians such as Raulin and Roussel viewed the advent of industrialization as a causal factor of hysteria; they mentioned that it made women lethargic, ill-tempered, and narcissistic (Tasca et.al, 2012; Ussher, 2013). Based on a severe misinterpretation of the Theory of Natural Determinism, enclosing women within the limits of fixed social roles and reminding them of their responsibilities as caregivers was seen as a treatment for hysteria (Tasca et.al, 2012). By the late 18th century, the etiology of hysteria had begun to evolve. It saw associations with the nervous system, implying that men could be diagnosed with the disease as well. Despite this obvious conclusion, hysteria continued to be a disease of women and was inextricably connected with the feminine nature (Ussher, 2013). Around the latter half of the 19th-century, the diagnosis of hysteria became so extensive that it ranged from symptoms of laziness, deceit, paralysis, chronic pain, ambitiousness, speech and eating disorders, difficulty in breathing, stomach pain to loud laughter (Ussher, 2013). Evidently, anything and everything that challenged or defied the patriarchal norms of the society was pathologized (Cohut, 2020).
From ‘emotionally unstable personality disorder' in Diagnostic Statistical Manual-I (DSM) to hysterical personality disorder in DSM-II to histrionic personality disorder (HPD) in DSM-III, to other cluster-B personality disorders in DSM IV & V (Novais, 2015), hysteria continues to inspire diagnoses for expressions deemed feminine by the society (Ussher, 2013). For example, “attention-seeking behavior, seductive behavior, sensitivity, switching emotions rapidly and theatrical speech” (Simsek et.al, 2020) are some indicators of HPD mentioned in DSM-V. Another disorder which retained the diagnostic criteria of Hysteria is the Borderline Personality disorder (BPD), exhibiting “substance-abuse, distorted self-image, unstable relationships, intense anger etc.” (National Institute of Mental Health, 2017). It was found that almost 50% of the women who had BPD were comorbid for HPD (Becker, 2000; Ussher, 2013). While the label associated with a hysterical woman was ‘damaged’, that of a borderline woman was ‘dangerous’ (Jimmenz, 1997; Ussher, 2013).
The DSM, although regarded as the source of all information concerning the descriptions and symptoms required to diagnose mental disorders (Hooley et.al, 2021), is a handbook inspired by political opinions, and thus has a patriarchal undertone (Simsek et.al, 2020). Although the DSM doesn’t mention HPD and BPD to be sex-exclusive disorders, statistics say otherwise. The rate of incidence of HPD was noted to be 1.84% and was mostly diagnosed in women (Simsek et.al, 2020). Similarly, BPD is diagnosed 75% more frequently in women than in men (Skodol et.al, 2003). These numbers allow us to hold DSM responsible for formalizing biased diagnostic constructs based on biased sampling (Skodol et.al, 2003).
If such diagnoses have been based on faulty assessments, then one can say that those women were often misdiagnosed. This is extremely detrimental to women’s healthcare systems. For example, due to the symptom-similarity between endometriosis and hysteria (like chronic abdominal pain), women experience a delay in being correctly diagnosed (Nezhat et.al, in press), with doctors assuming that women are exaggerating their symptoms. It has also been found that there is a wide gender divide present in the treatment of women with chronic pain as their plight is sidelined due to the notion that women are innately sensitive or ‘hysteric’ (Samulowitz et.al, 2018). This divide is a direct consequence of the gender gap found in medical research and senior leadership positions in hospitals and public health universities (Clague, 2019; Khan et.al, 2019). According to a study, sex specific results concerning the efficacy of treatments were reported in only three out of 1.5 million medical research papers, and that only female authors would do so (Sugimoto et.al, 2019). These facts attest that because of the men in power, hysteria persists in medicinal practices even today.
Not much has changed except that the 16th-century woman was a witch and the 21st-century woman is a borderline slut (Ussher, 2013). Their laughs and ambition still remain ‘hysterical’, and their bodies and minds a mystery to medical science. Thus, it is imperative to scientifically inquire the basis of diagnostic labels of clinical psychology and reduce the gender biases in medicinal research and practices to create more gender-inclusive healthcare systems.
References
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