Women's Health in Victorian America

Hysteria

History of Hysteria

Some of the earliest writing on hysteria is traced back to Egypt in 1600 BCE, in the Ebers Papyrus, which is considered the oldest medical document. The document describes a treatment for women who felt depressed, experienced seizures, felt like they were suffocating, or felt as if death was imminent. The treatment involved returning the uterus to the correct place, which could be done by “placing malodorous and acrid substances near the woman’s mouth and nostrils, while scented ones were placed near her vagina” if the uterus needed to be moved down, or reversed if it needed to be move up (Tasca et al.). So, very early on, hysteria-like diseases were categorized as an issue with the uterus. However, the term hysteria wasn’t really used until Hippocrates used it in 5th century BCE Greece. His theories about hysteria also centered around the uterus, and he argued that a woman who did not have a satisfactory sex-life would have a uterus that “not only produces toxic fumes but also takes to wandering around the body, causing various kinds of disorders such as anxiety, sense of suffocation, tremors, sometimes even convulsions and paralysis” (Tasca et al). The cure Hippocrates offered was more marital sex, but other Greek cures include exercise, massages, and hot baths.  Plato also talked about this sort of disease of the uterus, describing it as “an animal inside an animal” (Maines). This is not the first time that hysteria is described by men in a way that dehumanizes women. 

As the ideas of Hippocrates started to spread into Europe during the Middle Ages, the word hysteria was not often used, but a disease that suffocated the uterus was described (Maines). Also during this time, hysteria was connected to concepts of the devil and witchcraft, as some of the symptoms were similar to the believed signs of possession, as well as the idea that “if a physician cannot identify the cause of a disease, it means that it is procured by the Devil” (Tasca et al.). The society at this time, being strongly Christian, preached chastity and celibacy that limited a woman’s role and again, labeled them as inferior, hysterical, and even as witches, if they did not conform to the expectations. 

During the Renaissance, the emphasis on the Devil being responsible for such diseases faded out, but still the uterus was the organ that doctors used to explain the  “vulnerable physiology and psychology of women: the concept of inferiority towards men is still not outdated” (Tasca et al.) During the 17th and 18th centuries, the emphasis on the uterus slowly began to be replaced by the concept that hysteria could be a mental disease, involving the brain instead of the uterus. Physicians like Thomas Willis (1621-1675) introduced this idea, and others emphasized the connection of hysteria to femininity arguing that the disruption of the natural feminine nature is what causes the disease. As the 18th century continued, the idea that hysteria is a mental illness also led to the implication that perhaps it was not just a disease that could be found in women. Still, the ideas put forth by Hippocrates continued into the Victorian Era, which will be talked about in more detail in the next section. During this time period, Sigmund Freud also argued that hysteria was not limited to women, and that men could also be affected, because the cause was rooted in development and not sexual deviation. Hysteria being thought of as a legitimate disease carried on into the 20th century, and wasn’t removed from the Diagnostic and Statistical Manual of Mental Disorders until 1980. 

Do you still see any traces of this history in today’s society? What has changed, and what hasn’t with women’s health, mental health, and sexuality?

Victorian Era Hysteria

The hysterical female thus emerged from the essentially male medical literature of the nineteenth century as a “child-woman” highly impressionable, labile, superficially sexual, exhibitionistic, given to dramatic body language and grand gestures, with strong dependency needs and decided ego weaknesses […] Society has indeed structured this regression by consistently reinforcing those very emotional traits characterized in the stereotype of the female—and caricatured in the symptomatology of the hysteric.

“THE HYSTERICAL WOMAN: SEX ROLES AND ROLE CONFLICT IN 19TH-CENTURY AMERICA” BY CARROLL SMITH-ROSENBERG, PG. 677

By the time of the play, physicians had largley agreed that hysteria could affect anyone, regardless of gender, class, or age. Still, they also agreed that the disease was most common among middle and upper middle class women, aged 15 to 40 years. Some symptoms Victorian physicians noted included nervousness, depression, the tendency to tears and chronic fatigue, or of disabling pain, and even seizures (Smith-Rosenberg 660-661). Rachel P. Maines also provides a long list of symptom that signified hysteria, which includes fainting, edema, nervousness, insomnia, muscle spasms, heaviness in the abdomen, shortness of breath, depression, headaches, mental & physical weariness, forgetfulness, mental confusion, constant worry, loss of appetite for food or sex with the approved male partner, tendency to cause trouble for others. Maines emphasizes that the lack of desire for sex or an inability to enjoy sex with her husband is one sign of hysteria in doctors’ eyes. However, doctors noted a contradiction seen in their patients: “the hysterical woman might appear to physicians and relatives as quite sexually aroused or attractive, she was, doctors cautioned, essentially asexual and not uncommonly frigid” (Smith-Rosenberg 663).

By diagnosing [the patient] as ill, [the physician] had in effect created or permitted the hysterical woman to create a bond between himself and her. Within the family configuration he had sided with her against her husband or other male family members—men with whom he would normally have identified.

“THE HYSTERICAL WOMAN: SEX ROLES AND ROLE CONFLICT IN 19th-CENTURY AMERIca” by Carroll Smith-RosenberG, pg. 673

Those affected by hysteria, and women in general, were thought of as weak-minded, and so the idea that a hysterical woman was like a child was not unheard of. Going back to Hippocrates’s theories of the uterus, hysteria was still thought to be linked to a woman’s reproductive health, and an irregular menstrual cycle could be another sign of hysteria. Some physicians also believed that female masturbation or sex in excess could be the cause of hysteria, a contradiction to the idea that too little sex could lead to hysteria (668-669).

During the late Victorian era, physicians were trying to treat hysteria as an organic disease, or a disease that would show up in the physical bodies and tissues of the patients, but much of the pain and other symptoms patients reported were found to not effect the health of any individual body parts. Therefore, there was the worry that women with hysteria could just be “clever frauds and sensation-seekers—morally delinquent and, for the physicians, professionally embarrassing” (666). Whether the disease was “real” or not, physicians at the time tended to think negatively toward the women who came to them for help. When trying to find causes for hysteria, physicians generally hypothesized that it was caused either by the “indolent, vapid and unconstructive life of the fashionable middle and upper class woman, or by the ignorant, exhausting and sensual life of the lower or working class woman” (667).

While hysterical patients were often made to feel inferior, the truth was that once a patient was diagnosed with hysteria, she completely changed the dynamic of the typical Victorian household:  

With this almost role-reversing power, hysteria brought with it a slew of unfriendly connotations with it. Read more in the Physicians and Patients section on the power struggle that occurred between hysterical women and the men who were charged with treating them.

More on Maines’s Technology of Orgasm

Sarah Ruhl used Rachel P. Maines’s book Technology of Orgasm: “Hysteria,” the Vibrator, and Women’s Sexual Satisfaction to provide a lot of the background information that frames the play. Her most bold and even controversial claim is that the invention of the vibrator by British doctor Joseph Mortimer Granville came from the need of doctors to be able to create the “paroxysms,” or orgasms, in women in order to cure them of hysteria. This claim has become pretty well known, but it is refuted by Hallie Lieberman in an opinion article for the New York Times and in a scholarly article she co-wrote.

Lieberman argues that Granville invented the vibrator not specifically to make women orgasm more easily, but to instead “as a medical device for men, to be used on a variety of body parts, mainly to treat pain, spinal disease and deafness.”

The following except shows more of Lieberman’s argument:

Attempts to control women’s sexuality are based in part on the same beliefs that undergird the vibrator myth: that because women don’t understand their own sexuality they should not be the ones in control of it. It makes women seem ignorant, passive and easily duped by manipulative men. In other words, it perpetuates the myth that women lack sexual agency […]

If you swap the genders you can recognize how much the widespread acceptance of this story is based on gender bias. Imagine arguing that at the turn of the 20th century, female nurses were giving hand jobs to male patients to treat them for psychological problems; that men didn’t realize anything sexual was going on; that because female nurses’ wrists got tired from all the hand jobs, they invented a device called a penis pump to help speed up the process. Then imagine claiming nobody thought any of this was sexual, because it was a century ago […]

Women have historically been seen as ignorant about their own bodies, and female sexuality has been controlled and constrained by men throughout history. In contrast, men are viewed as knowledgeable about their bodies — at least knowledgeable enough to know when they’ve had an orgasm.

“(Almost) Everything You Know About the Invention of the Vibrator Is Wrong” by Hallie Lieberman

How does historical accuracy affect a play? If the vibrator method is inaccurate, how does this affect your reading of In the Next Room?

Further Reading:

“Victorian-Era Orgasms and the Crisis of Peer Review” by Robinson Meyer and Ashley Fetters

Physicians and Patients

According to John S. Haller and Robin M. Haller in The Physician and Sexuality in Victorian America, people living in the Victorian era “turned to advice columns in newspapers, etiquette books, philanthropic organizations, marriage manuals, and an assortment of ‘private’ counselors who dealt with personal problems. Increasingly, too, Victorians turned to the physician, who, through the professional distance his office imposed, assumed a neutrality in which they felt secure. Like the priests confessional, the minister’s study, or the lawyer’s office, the doctor’s consultation and examination rooms became a sacred setting in which confidential conversation might take place, and the Victorians could give vent to feelings, emotions, fear, and anxieties that afflicted them.”

One way this is seen is in the relationship between hysteria patient and doctor. As mentioned earlier, the doctor, by recognizing the patient’s hysteria, has taken her side as opposed to her husbands side, and so there is a bond there that implies an understanding. However, Smith-Rosenberg’s article also depicts this relationship as borderline abusive in some cases.

Physicians were concerned with—and condemned—the power which chronic illness such as hysteria gave a woman over her family […] It is evident from their writings that many doctors felt themselves to be locked in a power struggle with their hysterical patients.

Smith-Rosenberg, pg. 674

Smith-Rosenberg describes this unhealthy relations as a sort of child-parent role, with the doctor as an oedipal father, and the patient as a “child-woman.” In this way, “doctors had become part of a domestic triangle—a husband’s rival, the fatherly attendant of a daughterIn a number of cases” (674). Trying to be the dominant one in the relationships, doctor’s would recommend a series of humiliating and painful treatments for hysterical, uncooperative women, including suffocation, beating them with wet towels, showering them with ice water, and public exposure and humiliation. When the patient become cooperative, the doctor would be able to then respond as a loving father-figure. Some medical literature, like a treatise by S. Weir Mitchell, explicitly said that doctors would make the best husbands because they “know and understood all women’s petty weaknesses, [and] could govern and forgive them” (676). Therefore, even if using a vibrator as a cure for hysteria was not a common practice or something that occurred at all, the image of that practice aligns with the power-dynamics that were present in the treatment of a hysterical patient.

Breastfeeding and Wet Nurses

“We’ll find a nice nurse for you, won’t we? A nice wet nurse with lots of healthy milk. Your father put an advertisement in the paper and we’ll get lots of replies today.”

Mrs. Givings

According to data from this decade, an estimated around 12-15% of women experience “disrupted lactation” or an inability to produce or sustain the production of breast milk (Harmanci). The most common reason for this is insufficient glandular tissue or hypoplasia, where there is not enough mammary tissue to support consistent breastfeeding. While this is contemporary data, it can give an idea of the percentage of those effected. However, it may also be drastically different, because studies have shown that external stressors can affect the ability to produce milk.

The use of a wet nurse was not uncommon up until the early 20^th century. In an interview, Jacqueline H Wolf, a historian who wrote on the history of breast feeding, calls wet nursing a “visible occupation,” meaning there were ads in newspapers, wet nurses working in hospitals, as well as privately for individual families. However, it was the occupation of desperate women, as it was not pleasant. Wolf puts it this way, for those working privately: “Really, what it meant was that a wealthy baby lived and a poor baby died” (Rothman). Although wet nurses were more common than they are today, it was also a common belief that the mother’s milk was the healthiest thing for the baby. This was contrasted by what the middle and upper class thought of wet nurses. According to Wolf in her essay on the perception of wet nurses, “wet nurses had such dismal reputations that when a doctor suggested a family hire one, the recommendation almost always was met with dismay. The consternation was due largely to class differences–physicians and the families who hired wet nurses were well-off, while wet nurses tended to be poor women in unusually desperate circumstances” (Wolf 97). Wolf also discusses physicians’ conflicting ideas about the characteristics of the best wet nurses with the most milk. Some physicians argued that American women were not as milk-abundant as Irish or German women, and some physicians argued that women of color had the most breast milk. Other physicians vehemently opposed this, and many families held their own prejudices. Wolf gives one instance: “One of these doctors, after a lengthy
search, found an African-American woman willing to breastfeed a very sick white baby. The baby’s shocked mother objected strenuously to the doctor’s choice of a wet nurse. The angry doctor promptly offered to find a cow in lieu of the unsuitable wet nurse. What kind of a cow would you prefer, he asked sarcastically, ‘a black, a white or red one?'”( Wolf 101)

Other alternatives, such as formula, bottle feeding, and breast pumps, were just starting to come about at the end of the 19th century, but many of these methods didn’t become popular until even later.

There’s evidence of wealthy women who were just heartbroken that for whatever reason they weren’t able to breastfeed. And there’s other evidence of women who were just as happy to hand over their children to a wet nurse. There’s no one answer.

“Desperate Women, Desperate Doctors and the Surprising History Behind the Breastfeeding Debate”
Jacqueline H. Wolf

Further reading: