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.

Works Cited

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.

Theatrical Adaptions of Uncle Tom’s Cabin

Two of the most popular forms of 19th century entertainment were reading novels and attending the theater, so it is no surprise that best-selling novels were often adapted to stage plays. In an earlier post on domestic dramas, I mentioned the theater’s bad reputation in the early 19th century, but the stigma attached to the playhouse dissipated over time. Theater attendance gradually became more socially acceptable and even fashionable among the middle class by the 1840s and ’50s, partly due to  theater managers and playwrights’s deliberate efforts to appeal to middle class values and moral standards, and partly due to the Victorian era reverence for Shakespeare, which resulted in higher regard for the theater. By the 1850s, theaters were central to the developing culture of American cities.

Harriet Beecher Stowe’s Uncle Tom’s Cabin was one of the best-selling novels of the century and spawned many stage adaptations. As popular as the novel was, many Americans were first exposed to the story at the playhouse. Copyright laws did not prevent dramatizations of novels and other printed fiction, so the first stage production of Uncle Tom’s Cabin actually debuted before the final installation of the novel was published. Uncle Tom’s Cabin is remembered as an important text in turning northern sentiments more toward abolitionism, and one would expect that the theatrical productions would have served the same purpose, moving audiences to oppose slavery as immoral and inhuman. However, the dramatizations differed significantly from each other and from the original novel, often resulting in completely divergent political messages and tones. Some productions made their own additions to “finish the story”; manager G.C. Howard and actor George Aiken’s 6-act production ended with Uncle Tom’s death and ascension to heaven (Frick). Other adaptations changed the tone of Stowe’s text, undermined Stowe’s overtly abolitionist politics to promote compromise between the North and South, and, worst of all, some of the most popular adaptations reinforced racial stereotypes and the dehumanization of slaves.

Uncle Tom’s Cabin is notable as an instigating force in tensions between the North and South over slavery; Abraham Lincoln referred to Stowe as the “little woman who started this war.” Stowe’s story moved some sympathetic viewers and readers to support the abolitionist movement and view slavery as an immoral instution. However, the theatrical productions were deeply problematic with regard to representing race on the stage. It was relatively easy for white readers to sympathize with the Black characters; Stowe heavily emphasized the morality of Eliza and Tom as humans and Christians in spite of their race, and there is the fact of Eliza’s light skin and her ability to “pass” as white. Scholarship on the problems of racial stereotypes and representation in Stowe’s novel is extensive, so I will not analyze that here. On the stage, audiences were confronted with the characters’ physicality in a more direct way, and many productions fell back on the established stereotypes of Black characters. This was especially true of the “Tom Show” adaptations of Uncle Tom’s Cabin, short comedic pieces that were loosely based on the novel, but which often resembled blackface minstrels. For example, C.W. Taylor’s production was presented as an afterpiece, so he cut several key episodes, two major characters, and added several musical numbers; the result was a play mocking the South and side-stepping many of the controversial and overtly abolitionist material in Stowe’s novel. Other Tom Shows were sensationalized melodramas that greatly expanded the roles of white characters and eliminated secondary Black characters like Topsy. Tom Shows often reduced the characters to racist caricatures and often turned the text into slapstick comedy.  Unfortunately, the Tom Shows were exceedingly popular throughout the 19th century and into the early 20th century (with most references to slavery erased from the text after the Civil War), and perpetuated the racist genre of the minstrel show.

Even among the dramatizations that stayed close to the original novel’s text, racial representation on stage was still a problem. Nineteenth century productions typically had all-white casts, so there is the significant issue of the erasure of Black characters by virtue of their representation by white actors. As mentioned earlier, Eliza’s race is ambiguous, and Stowe emphasizes the lightness of her skin, the fact that she didn’t “look like a slave,” so one may expect a white actress to fill this role. However, Tom and his family are clearly described with dark skin, a fact that no production could avoid. Although the theater often attracted individuals from more marginalized sectors of society, including immigrants from southern and eastern Europe and individuals with Gypsy and Jewish heritage, the vast majority of actors in major theaters were white. Resultantly, actors used make-up to play characters of different races. Acting manuals from the era include detailed instructions for playing characters of different races, especially Native Americans and African Americans, because these were popular stock characters in American plays. These instructions are rife with racial stereotypes that were typical in dehumanizing minstrel shows, and likely informed the way actors played the minor characters in Uncle Tom’s Cabin, even in the more faithful adaptations of Stowe’s text. The audience expected particular portrayals of minority characters and theater managers and star actors were all too willing to cater to those expectations.

Works Cited

Frick, John. “Uncle Tom’s Cabin on the Antebellum Stage.” http://utc.iath.virginia.edu/interpret/exhibits/frick/frick.html