The American Psychiatry Association recently released the DSM-5, and the latest incarnation has come under a great deal of criticism since the early stages of development. The DSM-5’s new diagnosis criteria, definitions, and disorders have raised concerns about over-diagnosing and over-medicating what used to be considered normal. I thought this would be a good time to examine the history of mental illness, particularly the hysteria “epidemic” of 19th century Europe and America. In many ways, the history of psychiatry can be traced through the history of hysteria; interpretations of the hysteric evolved as conceptions of the causes of mental disorders changed. As the name suggests, the earliest conceptions of hysteria centered on the uterus as the cause of the overwrought emotions and nervous delusions that defined the disease.
By the mid-19th century, however, psychiatry experienced a shift due to developments in medical technology and changing conceptions of consciousness. Rather than hysteria being a purely physical disorder, focus shifted to the “nerves” as psychiatry centered in the brain as the cause of mental disorders. Treatment for mental illness shifted away from the family and toward institutionalization at this time as well; prior to the late 18th century, mental illness was dealt with primarily within the family unit, but in the search for the origins of madness, the asylum system insisted on the patient’s separation from the family for treatment.
Women were more susceptible to being institutionalized in the 19th century; their economic dependence on men made them easy targets for institutionalization if they were unmarried or failed to perform their duties as wives, daughters, sisters, etc. These women were often classified as hysterical.
Michel Foucault interpreted the hysteric as a rebel against psychiatric (and therefore patriarchal) power. Foucault notes that hysteria and other nervous syndromes, or neuroses, could be simulated quite easily. Foucault calls hysteria “epistemologically bad” and “morally bad due to the ease with which [neurotic disorders] could be simulated and the fact that, in addition to this possibility, there was a constant sexual component of behavior” (Foucault, p. 307). The hysteric’s speech is vulgar, obscene, embarrassing, and her actions are deliberately scandalous. Throughout the 19th century, the cure for mental illness required an autobiography, a recounting of the patient’s history in order to reveal the origins of the illness. This autobiography had to be a complete confession of all of the mad and unacceptable thoughts the individual has had over the course of a lifetime. It had to be cohesive and orderly.
Resistance to the demand for confession requires “undoing the synthetic work of rhetoric and its tropes” (Tell, p. 114). One must subvert the dominant discourse, perhaps with a mad or hysterical discourse that refuses synthesis and stable identities. Feminist critic Luce Irigaray insists on the hysteric’s revolutionary potential: “Even in her paralysis, the hysteric exhibits a potential for gestures and desires… A movement of revolt and refusal, a desire for/of the living mother who would be more than a reproductive body in the pay of the polis, a living, loving woman” (Irigaray, p. 47-48). Hysteria does not speak in language, but in gestures and symptoms; it dramatizes woman’s relation to the mother, the self, and other women, and the desires that patriarchal systems force into silence, paralysis, and enclosure within the body.
The hysteric is a performer, an actress, and, perhaps, an artist of resistance. She is not, however, an author. Resistant discourse cannot adhere to the accepted forms, and especially not to psychiatric power’s demand for a cohesive autobiography, an author of madness. Obliterating the narrative voice, the “I” capable of relating an autobiography, renders confession impossible, and is therefore potentially liberating. Psychiatric power exerts its force by pinning individuals to identities through confession. Confession locates the origins and allows the disciplines, including the psychiatric system, to identify abnormal, mad, and delinquent individuals more efficiently, before the abnormal conditions even manifest.
The case of Catherine X, however, is a fascinating study of mental illness, gender, and the power structures that define madness and sanity, and the problems I have with Foucault’s interpretation of hysteria as meaningful resistance.
Catherine X was an inmate of Salpêtrière and patient of Leuret, “a woman whom he said he would never be able to cure… [because of] her inability to own to this biographical schema that carries her identity” (Foucault, p. 160). In interviews with the hospital staff, Catherine X did not use the pronoun “I,” but “the person of myself” instead. She lost touch with outer reality, claiming that invisible people conduct “physical and metaphysical experiments” on her, but more significantly, she had no sense of inner reality. Her identity completely dissolved and she became alienated from herself, thus making her incurable and any escape from the asylum impossible. A similar exile occurs for the disciplined subject in Foucault as it does for women’s lack of place in the symbolic order. The woman, the subaltern, and the madman are all exiled in language and exist on the outside of the symbolic order. In his notes, Leuret implies that the individual who does not take up the “I” is incurably mad and, resultantly, imprisoned in the asylum system. Within psychiatric power, the autobiography is a coercive tool of domination; the patient must accept the mad identity and confess his or her madness in the terms established by psychiatric discourse. An individual like Catherine X, however, did not admit to anything; she refused to fix her identity and thus did not participate in the power game of interview and confession. Catherine X is the absolute limit of psychiatric power and an assertion of the omnipotence of madness because she refuses to provide a self for the psychiatrist to examine.
Is this resistance? Or is Catherine X an example of the most oppressed, the most radical outsider and subaltern whose voice has been stripped away by the asylum?
I do see how the hysteric’s morphing symptoms out-maneuver the doctor’s treatments and possibly open new creative and linguistic avenues for self-expression, but it is problematic to view pathologization as true resistance. The hysteric in the asylum does not have true autonomy; she has to resort to self-obliteration to escape the analysis and control over her body and mind. Valorizing madness as a form of resistance has problematic implications of romanticizing it and inscribing it within a restrictive narrative of politics. Madness may only be a symbolic form of resistance and, according to Gilbert and Gubar, madness as a metaphor must be distinguished from clinical mental illness. Yet the use of these metaphors is still problematic; the metaphorical madness threatens to replace the lived experience of madness in the same way the confession in psychiatric power. Aestheticizing experience through representation is inevitably reductive; madness cannot be contained in a metaphor any more than it can be adequately explained by the metonymical replacement of symptoms. Treating madness or illness as a metaphor effaces the reality of madness itself. The experience of madness is often one of degradation and exploitation. Foucault describes the use of the hysteric as a “kind of functional mannequin” in the asylum (Foucault, p. 315). A mannequin is not even a human being; it is a prop, a speechless and powerless doll. This is not an adequate model for any real resistance to the psychiatric power structure.
The DSM is suppoesd to be free of all of these past issues of pathologizing otherness; homosexuality used to be considered a psychological disorder, after all, and the DSM removed that in an attempt to eliminate the cultural biases and arrive at a scientific understanding of psychological disorders. I am not well-versed in the DSM or psychopathology, so I will not offer any direct criticism of the latest edition. However, it is important to note that definitions of mental illness are always inscribed in a complex cultural context, so cultural biases and power dynamics are inevitable. Although we may believe we have escaped one power structure, as the hysteric who out-maneuvers and escapes the system of the asylum, we may find ourselves immediately incorporated into yet another power structure; for the hysteric, it is the concept of sexuality, and some critics of the DSM suggest that for contemporary patients, the pharmaceutical industry has replaced the asylum as the means of exerting control over the individual.
Foucault, Michel. Psychiatric Power: Lectures at the College de France 1973-1974. Ed. Jacques Lagrange, tr. Graham Burchell. New York: Picador, 2006.
Irigaray, Luce. “The Bodily Encounter with the Mother.” Tr. David Macey. The Luce Irigaray Reader. Ed. Margaret Whitford. Cambridge, MA: Basil Blackwell Ltd., 1991.
Tell, Dave. “Rhetoric and Power: An Inquiry into Foucault’s Critique of Confession.” Philosophy and Rhetoric 43.2 (2010): 95-117.