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I am very grateful for the wealth of these reviews. It is very rewarding! To sum up briefly, On Hysteria is a study of the formation of a medical category, hysteria, in the course of the seventeenth to early nineteenth centuries. Tracing the transformations of the category during this period and asking what was at stake in the formation of the diagnosis, I aimed to make three types of contributions with this book by investigating: (1) hysteria, (2) the transformation of the status of medicine at the turn of the nineteenth century, and (3) methodologies in the history of science. With these aims in view, I would like to address the questions raised by the reviews.

(1) Hysteria

On Hysteria focuses on the eighteenth century, the period in which the word hysteria was first used (it was not used in the Hippocratic writings, as is commonly believed). It was during the eighteenth century, not the nineteenth century, as is often claimed, that the category was invented and caught on. Archives show that conceptions of convulsions in a religious context made up only a very small part of earlier writings on hysteric pathology, which was also widely discussed in medical contexts and was a common reference in literature, public political debates, and even philosophical writings. Hysteria was not viewed as a female malady in this period; it took shape as an aristocratic pathology until the French Revolution, whereupon physicians began to present it as an illness affecting women across class boundaries. As such, one of the book’s claims is that hysteria became established as a diagnosis because the category and its symptoms were cited and used in a wide range of contexts, all of which participated in creating the need for, and establishing the credibility of, the new category.

(2) The role and status of medicine

In studying the genealogy of a medical category, my goal was to enhance our understanding of how the role and status of medicine within society changed during the late eighteenth century. Unlike existing studies of this development, which have in large part focused on institutions or on the medical gaze, this work addresses the uses of narrative and writing strategies, ranging from the application of metaphors and citations to the use of literary genres. These writing practices aimed to establish the credibility of this new diagnosis, the validity of its application despite the lack of a defined list of symptoms, a complicity with the reader and potential patient, and authority among colleagues. More generally, they aimed to inscribe the category in a tradition of writings and existing theories on the body and the mind.

(3) Writing practices in the eighteenth century and the writing of history

I am very grateful to see that all of the reviewers share my interest in the analysis of writing practices. As they have pointed out, this work aims to analyze texts from a wide range of genres and contexts in order to access a category’s workings and its uses, as opposed to describing its successive definitions and interpretations. I examine political and epistemological investments in the category in relation to political environments, including the crises of Convulsionaries in France in the 1830s; during the French Revolution; and in the course of George III’s withdrawal from the throne. I also trace its use in Buffon’s anthropological works, in Voltaire’s materialistic claims, and in literary works from epistolary tales and essays to novels. My aim has been to trace the constant transformation of its connotations and implications. The attention given in On Hysteria to genres and strategies, webs of citation, and circulation aims to propose a history of science as a history of knowledge in the making.

As Caroline Warman insightfully points out, The Anatomy of Melancholy is one of several works preceding this time period that lends itself to this kind of analysis. Such writing practices can be found before the Enlightenment, and could easily be added to the inquiry. Including them would only enhance my claims of the importance of writing practices in determining a pathology and in constructing a relationship to the body and to society. At any moment in time, literary genres pervade other discourses and the perception of the body, as they are the means through which people educate themselves to see, perceive, feel, and talk about their own bodies, thereby accelerating the identification of symptoms that would have previously been disregarded or seen through another prism. Yet this book does claim that there is something specific to the mid- and late eighteenth century, a moment when narrative enhances the understanding of the pathology. In my view, the use of such writing practices at this particular point in history goes beyond the expression of a singular experience or a rhetorical form. Because these practices are shared by many, they define the sensibility of the time, a sensibility that can be found beyond the topic of hysteria, as underlined by Maria Semi. They shape the pathology, the role of the doctor, and the vision of medicine. Privileging the regularity over the first occurrence—following Foucault—I think that the increased presence made the choice of this practice even more meaningful in the eighteenth century.

Part of what is special to the eighteenth century is, then, the function of these writing practices, which disappeared with the rise of “objectivity” in the nineteenth century. As noted by Sean Quinlan, the narrative practices developed by physicians in the twentieth century differ strikingly from the ones exposed in the book, as they are fully intended to function as pieces of literature. In the eighteenth century, narrative practices are inscribed within an epistemological inquiry: they are integrated into scientific practice and the formation of knowledge. The change lies less in the emergence of novelty than in the investment made in the words available to talk about them, and in particular genres of writing. Literary genres inscribed pathology into the culture of the salon proper to the eighteenth century, as well as narratives of the building of the French nation. And it is the convergence of these interests and investments that make the emergence of a specific category at a specific point a needed and valued contribution.

To convey a sense of how hysteria’s connotations and denotations proliferate exponentially, the book advocates a double relationship to history: the use of hysteria in relation to previous sedimentation of meanings, and in reaction to contemporary issues. The structure of my book alternates several historical frames to get a sense of the function of the pathology and its displacements in context. While the first chapter aims to provide three wide historical lineages in the understanding of the category (gender, class, religion), other chapters focus on specific writing practices, in general linked to a specific context and time frame. Chapter II moves from 1575 to 1820; chapter III from 1730 to 1789; chapter IV focuses on the Republic of Letters between 1750 and 1780; chapter V covers the use of narrative between 1750 and 1820; and chapter VI extends from the late 1760s to 1820. The superposition of numerous layers aims to revisit the same time period with different lineages—and with this a type of publication and a type of use of the category. Each frame focuses on a specific configuration of the disease, which determines the types of writing practices explored in that chapter. Each chapter may therefore be read independently.

Caroline Warman questioned why the eighteenth century was particularly meaningful in the understanding of hysteria and of medical writing. One of the main reasons why the eighteenth century is crucial is that the word was coined then, thereby creating the possibility for a new understanding of the pathology. As Peter Cryle carefully underscored in his review, this does not mean that the first use of the category resulted in immediate change. Rather, it fosters the assumption that there was a need for the word, a need for certain bodily manifestations to be read as symptoms. The decision to create this diagnosis asserted the need to make sense of it, to determine a coherence for it. It makes the claim that a comprehensive explanation can be found over the several meanings and contradicting interpretations available, once the phenomena are fully understood. The selection of one word also means the disappearance of other words; just as strikingly, in 1789 the term “vapors” is used for the last time in the title of a medical treatise, creating a synchronization between a medical wording of the body and political regimes. It is just such convergences—between naming, writing practices, political and epistemological stakes, politics of health, and types of audience—that this book aims to explore.

 

Sabine Arnaud is Research Group Director at the Max Planck Institute für Wissenschaftsgeschichte, Berlin, Germany.

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  1. Pingback: Book Forum––Sabine Arnaud’s On Hysteria by Todd Meyers - Bioethics Research Library

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