Book Review: Hysterical men: the hidden history of male nervous illness.

To his previous extensive scholarship on the history of psychiatry, and in particular on the work of the late-nineteenth-century French neurologist Jean-Martin Charcot on male hysteria, Mark Micale has now added a new book that traces the “hidden history” of this disorder back to its origins in the early modern period. The term hysteria, as is well known, derives from the Greek work for uterus, and for centuries denoted the illness’s imagined origins in what medical men saw as the unruly properties of that female organ. Hysteria was, as Elaine Showalter long ago noted, the “female malady” par excellence. But there were always other possibilities within the discourse about hysteria. For readers conditioned to the belief, in part as a result of Micale’s earlier work, that it was Charcot who discovered male hysteria, the main virtue of his new study is to uncover the rich literature of male hysteria of the seventeenth and eighteenth centuries. This body of work, which began with Richard Burton in the 1620s, culminated during the high point of the Enlightenment. It produced a new, entirely neurological—and therefore non-uterine—model of hysteria, the precondition for its presence in men. Micale also traces the rise during this period of a “shared medico-literary culture” of nerves: the productive exchanges between the professional medical and the literary/ autobiographical discourse of hysteria. The Age of Enlightenment was also an age of heightened sensibility; yet the nervous disorders that often accompanied this self-conscious and sometimes exaggerated sensibility were not stigmatized but seen as a “sign of refinement”. In the “nervous self-reportage” of David Hume, Samuel Johnson and others, Micale invites us to see a kind of alternative narrative of the western intellectual tradition. A major turning point in Micale’s account comes with the period following the upheavals of the French Revolution. Attentive throughout to the political contexts of the discourse about hysteria, he writes that: “The ebb and flow of the discourse … clearly mirrors a larger cycle of gender polarization and liberalization” (p. 278). Partly in response to revolutionary-era demands by women for new rights, the post-revolutionary political reaction also became a period of “gender counter-revolution”. Older conceptions of gender difference reasserted themselves and hysteria was re-inscribed in the uterine model. One aspect of this was the parting of the ways between hysteria’s “two cultures”. As alienists assumed an increasingly significant role in policing the post-revolutionary gender order, male hysteria all but disappeared from view outside the memoirs or correspondence of exceptional figures like John Stuart Mill. In the final part of his book Micale returns to familiar territory, charting how Charcot—working in the liberal, militantly secular political environment of the Third Republic—resurrected the neurological paradigm and in so doing made it once again possible to train the medical gaze on the male variant of hysteria. This turn away from the uterine model, which in Charcot’s case meant downplaying the role of sex in the aetiology of the disorder, was not without its ironies, as Micale’s final discussion of Sigmund Freud makes clear. Whereas Freud uncoupled hysteria from any anatomical moorings and thus created a purely psychogenic model, he also restored sex to a central place in the disease picture surrounding hysteria. At the same time Freud rejoined the two cultures of hysteria, drawing on laboratory science and clinical experience as well as literature, mythology, and biography, including, not least, his own—the numerous nervous ailments of the 1890s that plagued him and that he referred to in his correspondence as his “little hysteria”. But even in Freud’s case, a certain reticence remained surrounding the topic of male hysteria. Despite his significant contribution to the fin-de-siecle questioning of gender and sexual identity, none of his published case histories of hysterics includes a male patient. Arguably it was not until the Great War that male hysteria, in the form of shell shock, found widespread entry into the psychiatric literature. Missing from Micale’s narrative is any discussion of the epidemic of wartime male hysteria, a crucial chapter in the history of this shape-shifting ailment and one that has been the focus of much recent scholarship. Micale is exemplary in his weaving together of intellectual, medical and cultural history; a concluding foray into social history would have provided a welcome coda to this otherwise highly illuminating account.