Then vs. Now: The Decline of the “Hysteria” Diagnosis

Ever wonder how “hysterical” got such a bad rap?

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Today, referring to a woman as “hysterical” is unlikely to provoke a positive response. It’s considered a loaded term, packed with history, bias, and even trauma. Interestingly, many people have a strong reaction to the hysterical label, even if they can’t exactly pinpoint why the word is so troubling.

The truth is, the word has gone through multiple transformations: from a legit diagnosis, to a catch-all for all women’s health concerns, and finally to a dismissive label for passionate women. While each generation lost touch with the true definition of “hysterical,” the negative connotation was passed on.

The Earnest Beginnings of Hysteria

It’s hard to fathom now, but hysteria was never meant to be a snub against women. Humanity’s earliest doctors genuinely tried to help female patients with depressive symptoms. Impressively, hysteria is one of the first recognized mental health disorders.

Hysteria literally comes from the Greek word for “of the womb.” That’s because ancient civilizations believed hysteria was caused by the uterus being out of place, moving about, or generally wonky. The uterus was considered to be active and animalistic, as if it had a life of its own.

Ancient Egyptians described hysteria as early as 1900 BCE, and the symptoms mimic what we now would call depression. The Egyptians treated hysteria by having the woman sniff unpleasant substances, which would allegedly move the uterus back to its rightful place.

Things took on a slightly more judgmental tone in Greece. Although hysteria helped launch the birth of psychiatry in ancient Greece, it also started the association between hysteria and “misbehaving women.” Greek mythology tells the story of a physician named Melampus, who helped “cure” Argo’s virgins who had revolted and fled to the mountains.

According to the myth, Argo’s virgins were acting with “female madness.” Melampus claimed this was caused by their “melancholy” uteruses, due to a lack of orgasms or a normal sex life. The famous Plato, Aristotle, and Hippocrates all agreed: Uteruses became unhappy when they weren’t allowed to procreate with men.

It was Hippocrates who first coined the word hysteria, back in the 5th century BCE. He believed sex and procreation helped widen the woman’s vaginal canals, which helped cleanse out the body. Thus, Hippocrates believed widows, virgins, and sterile women were at a high risk of hysteria—a sick uterus.

Starting in the 2nd century CE, doctors took the opposite view as their ancient predecessors. The Greek physician Soranus (who is considered the original ob-gyn) stated that the burden of pregnancy and childbirth is what *causes* hysteria, and abstinence was the cure. In fact, Soranus claimed virginity was the ideal state for women.

Although ancient claims about hysteria came with bizarre ideas about the uterus, physicians’  attempts to identify and understand mental health did lay important groundwork for the school of psychiatry that would eventually help men and women alike.

Hysteria Turns Demonic

In the Middle Ages, beliefs in the demonic and supernatural were common. When physicians could not explain a symptom or disease, it was suspected to be the Devil’s work. Many diseases, including hysteria, were blamed on witchcraft, possession, or associating with the Devil.

Unfortunately, women with hysteria at this time were viewed as witches, not patients. The treatment (or punishment) was exorcism. This stemmed from the growing pains of a cultural shift: Christianity in the late Middle Ages was threatened by a more secular movement, and the response included inquisitions, witch hunts, and paranoia.

Women beared the burden of this panic. Nothing is more difficult to explain than mental health, so melancholic or depressed women were prone to accusations. Since women were prone to domestic violence, and elderly women and widows were often mourning their deceased loved ones, it made sense that women were commonly sentenced to death or torture for “sorcery” during this time.

Hysteria Passes to Men

As modern science progressed, doctors turned against the supernatural—and even the idea that only women could be hysterical. It was the physician Thomas Willis who first pitched the idea that hysteria was a disorder of the brain and nervous system, and not the uterus, in the 17th century.

It took a while for this theory to take hold. In fact, the general public in the Victorian Age—two centuries after Willis published his brain theory—still believed a wandering uterus was to blame for women’s aroused emotions. A callback to ancient treatments, Victorian women carried smelling salts with them so they could move their uterus back into place whenever they got too emotional or woozy.

But among the science community, the concept of the brain as the center of mental health disorders was becoming more commonly accepted. This creates an important shift in gendered thinking: If hysteria is caused by the brain instead of the uterus, then men can theoretically become hysterical, too. (Similarly, anorexia nervosa was almost called anorexia hysteria around this time; however, the man who named it, Sir William Gull, argued that this eating disorder could potentially affect men, so he shied away from the hysteria term.)

While "hysterical men" was mostly just a theory, it became reality just before the 20th century. The notable Sigmund Freud declared himself a hysteric in 1897, writing, “I now have a crisis of unhappiness. The chief patient I am worried about today is myself. My little hysteria, which was much enhanced by work, took a step forward.” Later, of course, he used hysteria as the basis for his theory of the Oedipus complex.

Hysteria Goes Out of Favor

The late 19th and early 20th centuries were a time that many modern diseases were identified and defined. It was during this time that hysteria was questioned.

Up until that point, hysteria had become a catch-all for a number of physical and mental ailments affecting mainly women (despite Freud’s efforts). Conditions you now know as depression, anxiety, endometriosis, eating disorders, personality disorders, or simply just boredom or rebellion could be diagnosed as hysteria.

As more diagnoses were carefully defined with distinct criteria, it became harder to identify what constituted a “hysterical fit.” In particular, mental health experts became more knowledgeable about depression and anxiety after World War II. As diagnoses of these two conditions increased, the rates of hysteria decreased.

The death of hysteria as a medical diagnosis could be set in 1980, when the diagnosis was officially removed from the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM), the go-to guide for mental health professionals.

While you won’t see “hysteria” written on your medical records these days, you might still hear it in conversation, where it tends to carry a pejorative and misogynistic tone. It’s hard to believe this word was once the start of the crucial understanding of mental illnesses.