In the late nineteenth and early twentieth centuries, theories about the origins of hysteria and methods of treatment differed greatly and were constantly changing depending upon the particular physician who was observing the women diagnosed as hysterical, as well as the social context of that diagnosis. The work that Jean Martin Charcot pioneered at Salpétriêre Hospital in France was quite different than that of his former student Sigmund Freud in Vienna, Austria. Charcot’s studies of hysterical women focused on institutionalized, lower class women. Freud on the other hand studied Viennese women in the milieu of upper middle class society. The social class of these nineteenth century women created a different context for doctor-patient relationships embodying different ideals of womanhood. Although approached from different ends of the spectrum, the diagnosis of hysteria provided both upper and lower class women with a form of escape. The expectations and stigmatizations of women in the late nineteenth century were so oppressive that hysteria as a disease bequeathed women of all social classes a renewed sense of freedom and repose. By comparing the styles and techniques of Charcot, Freud, and Silas Weir Mitchell—an American—I will demonstrate how the social context of the time shaped hysteria as an ironically satisfying option for women yearning to flee from oppression.
Prior to the nineteenth century, when hysteria became a commonplace diagnosis, the earliest evidence of hysteria-like symptoms was recorded on ancient Egyptian medical papyri under the heading “melancholia”. One symptom of melancholia was “the ball in throat” dysfunction. According to myth, the dislocation of the uterus to the throat caused this malady. This ailment became known as “globus hystericus” and later “hysteria”.^[1] The root of the word hysteria is derived from the Greek word “hystera” meaning womb or uterus. For the most part, hysteria has been viewed as a disease exclusive to women who were thought to have a “wandering” womb. ^[2] Throughout history, there have been cases of male hysteria, but they were characterized as signs of epilepsy or general nervousness. In such cases, men were rarely called hysterics.

One of the pioneering physicians to work with women afflicted by this wandering womb was Jean Martin Charcot. Charcot was a renowned neurologist and neuropathologist in nineteenth century France. Born in Paris in 1825, Charcot began his pursuit of neurological work in 1862, at the Salpétriêre Hospital.^[3] Charcot is best known for the demonstrations he conducted in order to teach his students neurology. The women used in these demonstrations were patients at Salpétriêre whom Charcot diagnosed with hysteroepilepsy.^[4] The point of such demonstrations was primarily to teach his pupils and further scientific knowledge in the study of neurology. In one of his Tuesday lectures Charcot proclaims, “I do not know what will be the final outcome for this woman’s contractures, but I am glad to have been able to show you a rather typical attack.”^[5] It is clear that his primary concern was not the patient’s well being, but rather her usefulness in the demonstration.
Charcot was an avid promoter of the scientific nature of hysteria. Known often as an indefinable disease because of the immense variety of symptoms, Charcot attempted to outline a set of characteristics that could compose the disease hysteria.^[6] When, as in the demonstration described earlier, successful treatment of a hysterical woman was uncertain, Charcot used that opportunity to teach his eager students the archetype phase layout of a hysterical fit. In order to demonstrate these phases, Charcot’s intern induced hypnosis or placed pressure on one of the subject’s hysterogenic zones. A hysterogenic zone was a point on the patient’s body (e.g., the lower abdomen or ovarian region, under the breast, the leg, etc.) that if touched by the intern would induce a hysterical fit.^[7] While Charcot ardently promoted hypnosis for the treatment of hysteria, his interns were always the ones to actually hypnotize the patients. It has been assumed that Charcot’s assistants prepared the patients to perform how Charcot predicted they would perform.^[8] This supposed preparation might be one of the reasons that Charcot lost substantial credibility in the scientific community.
By 1893, upon the death of Charcot, his work with hysteria was renamed “artificial” or “cultural” hysteria.^[9] This was derived from the suspicions that Charcot created hysteria as a disease and that his interns—although it is unclear whether or not Charcot was aware of this—helped to shape the findings to suit his theories. Similar doubts had surfaced during his lifetime and he responded to such accusations publicly at his demonstrations.
It has been said that it [hysteroepilepsy] exists only at Salpétriêre, as if I have created this condition by my own willpower. What a marvel this would be if I could, in fact, fabricate illnesses according to my whims and fantasies. But in fact I am a photographer. I describe what I see.^[10]

While Charcot attempted to free himself from accusations of artificiality, the only statement he actually made is that people should trust his word because he is merely telling what he sees. This was, at best, only a partial explanation of why everything that Charcot claimed or outlined in his diagnosis of hysteria was reflected in the behavior of his female patients during demonstrations. As the “creator of hysteria” Charcot was maligned for his unscientific work in the field. This title of creator portrayed him not as the discoverer of an important neurological disease, but rather emphasized the artificial nature of his work with hysteria and hypnotism.^[11]
One of Charcot’s contemporaries, M. Regnard attempted to assist Charcot in speaking against the idea that hysteria was a disease created by physicians, and more specifically by Charcot. Regnard, drawing on his experiences working alongside Charcot, implemented some of Charcot’s techniques such as demonstration. In a lecture given to the Association Scientifique de France, Regnard supposedly hypnotized a hysterical woman. After inducing hypnosis in this woman, Regnard proclaimed to the audience:
Do you believe that a girl who can neither read nor write, and who comes from the most obscure portion of Britany could be versed in the details of this delicate physiology? For my part, I do not believe it. If she is an imposter, we shall soon discover it.^[12]

Regnard claimed that a girl with such lower-class upbringing could not possibly know how her body would behave when hypnotized. After convincing the audience of the utter feeblemindedness of this girl, he opined, “If this girl is only pretending, she is exceedingly clever.”^[13] Such a statement was designed to provide evidence that he was not merely constructing this situation. Regnard was aware that the audience would never believe that a girl of her upbringing could be so clever as to mimic the state of hypnosis. In actuality, however, the slow-witted nature of the girl was not relevant when an intern had suggested to her how to perform. In that case, she only needed to be capable of listening and following directions.
Considered the dregs of society, the women of Salpétriêre presented in these demonstrations belonged to the lowest classes of women in France.^[14] This created a different doctor-patient relationship than that expected among middle class women.^[15] Because of the differences in social status, the doctor would not associate with them in the same manner. Charcot was known for his aloof personality; he was unable to relate to the miseries of his female patients. Much of this probably had to do with the fact that there was such a discrepancy between their socio-economic statuses.^[16] Perhaps because the women were so far from his social milieu, the only way he knew to behave was distanced and detached.
Charcot’s tendency to use the women of Salpétriêre for the sake of science rather than to treat them and restore them to society was also an issue of class disparity. Depending on the socio-economic status of the woman patient, the goal of the physician differed. For Charcot, his primary goal was to gain knowledge for the sake of science. He did not have respect for his patients, nor was he interested in curing them.^[17] According to one of his students, after his appointment to Salpétriêre, Charcot
Spent the entire morning in his office, and had the patients brought to him one by one. In 1881, when he was appointed clinical professor of diseases of the nervous system, he rarely visited the wards of the hospital and did not leave his own office except to go to the autopsy room, to his laboratory of pathological anatomy, or to his ophthalmologic office.^[18]

Not only did he pay little attention to his patients, but also he essentially ignored what they had to say about their experiences. When, in the demonstration, the patient is crying out, Charcot says, “You could say it is a lot of noise over nothing.”^[19] Here he has no sympathy for the woman and her apparent distress. This kind of behavior illustrates how Charcot viewed these women and how he did not treat them respectfully as human beings. This behavior towards the poor will be discussed in more detail when considering the view of an American contemporary of Charcot.
Despite the fact that Charcot’s work was later considered unscientific because he was viewed as the creator of hysteria, he still considered his own work to be beneficial to science. In doing so, he did not try to treat these women. He focused on increasing the knowledge of the nervous system and teaching that knowledge to his pupils.^[20] This raises the ethical issue of treating an individual as a subject for scientific study compared to treating an individual for her own sake. In the case of hysteria, that distinction was drawn along lines of class.
The behavioral expectations of women in society differed depending on the woman’s socio-economic status. In a nineteenth century text written about women, by a woman, Margaret Fuller Ossoli comments on the nature of women in the lower, more unfortunate classes, from the perspective of the upper class. This is particularly relevant, because like Fuller, the physicians belong to the upper-middle classes and would probably have similar opinions about those who do not have enough money to live they way they wish to and thus are drawn to a life of crime:
I met a circle of women stamped by society as among the most degraded of their sex. “How,” it was asked of them, “did you come here?” for by the society that I saw in the former place they were shut up in a prison. The causes were not difficult to trace: love of dress, love of flattery, love of excitement. They had not dresses like the other ladies, so they stole them; they could not pay for flattery by distinctions, and the dower of the worldly marriage, so they paid by the profanation of their persons. In excitement, more and more madly sought from day to day, they drowned the voice of conscience.^[21]

This illustrates the opportunities for these lower class women outside the walls of Salpétriêre. For them, being labeled a “hysteric” and paid attention to by Charcot—a popular neurologist of the time—was infinitely better than living the life that they would have had outside of the asylum. Using these women merely as scientific subjects was as or more beneficial to these women as treating them in an effort to send them back out into society. In fact some physicians and social workers “found that the insane were largely incurable, the feebleminded proved to be untrainable, criminals returned to their lives of crime, alcoholics clung to their bottles, and the poor seemed often to prefer a life of indolence and want.”^[22] This attitude of the lazy desire among the poor seems a common thread in the views of the physicians at the time, and thus would explain why physicians made little or no effort to treat the poor hysterical women.
Even if the doctors felt as though they could treat hysteria in a poor woman, the treatments that these women of Salpétriêre might have undergone would not be likely to have helped their socio-economic position in the outside world. Thus being a hysteric was a way for these lower class women to escape the demonization of the oppressive society that existed beyond the walls of the asylum. In this way, Charcot’s lack of respect for his patients and aloof personality did not negatively affect these women, for they were given privileges at Salpétriêre that they would not have encountered on the streets.
Charcot’s principal method in observation of his patients was through photography. As he was quoted earlier, Charcot looked at his photos and describes what he saw. However, here it is important to understand what these photographs were actually like. In fact these erotic photographs taken by Charcot exhibited similarities with theatrical portraiture far more than what was considered typical photography of mental patients for medical purposes.^[23] The poses of the women in these photographs also detracted from their medical value. They are placed in very seductive poses with clothing falling off their shoulders or their eyes gazing deep into the camera lens.^[24] Here, the photos were more about expressing sexualized femaleness than medical documentation.
This opportunity to be photographed was extraordinary for these poor women. Inside the ward they could perform in front of the camera and feel as though their sexuality was appreciated and valued rather than scoffed at, as it would be on the streets or in the profession of prostitution. In fact the very sexualized characteristics of hysteria were encouraged in front of the camera for the supposed purposes of medical documentation.^[25] One of Charcot’s students commented on the jealous nature of the female patients and how they desired the attention of the great physician.^[26] This jealousy suggests that Charcot, with his theatrical photography and his subtle encouragement of sexual exposé, provided the women of Salpétriêre with a more desirable life than that which they had been living in the slums of society.
If Charcot’s assistants were in fact telling the women of Salpétriêre what to do, why were these women willing to exhibit the traits of which Charcot and his assistants spoke? These poor female patients saw no other more desirable option for them to not feel demonized. Their lower economic status was the product of disease, something that they could not control. By medicalizing their condition not only did the women lose the necessity of taking responsibility for their economic situation, but they were also given the attention of well to-do, highly respected individuals in France. To be beneficial to science was far more than they could hope to achieve in their meager lifetime. Freud however, a former student of Charcot’s, had different goals in his studies of hysteria.

Sigmund Freud, born in Moravia in 1856, was a Viennese liberal Jew. Freud’s concept of hysteria and general neuroses later developed into his theories of psychoanalysis. Beginning with “hysteria” signifying a disassociation of the womb and thus causing sexual maladies, Freud was able to trace those sexual origins to his theory of infantile sexuality in his methods of psychoanalysis.^[27] In 1905, Freud completed the written portion of his work with Dora, a hysterical woman whose real name was Ida Bauer. In this case history, he clearly states that the “causes of hysterical disorders are to be found in the intimacies of the patients’ psychosexual life, and that hysterical symptoms are the expression of their most secret and repressed wishes.”^[28] The link between sexuality and hysteria is tied up in Freud’s work from the outset, and is more fully developed in his theories of psychoanalysis.
This idea, that all neuroses have an origin that is sexual in nature may have arisen out of Freud’s work with Charcot. Freud claims that in 1885, when he was working with Charcot in France, he overheard Charcot saying, “Mais, dans des cas pareils c’est toujours la chose génitale, toujours—toujours—toujours.”^[29] Here Charcot claims that the root of such neuroses lies in the genitals. This was interesting because Charcot had often claimed that—despite the sexual nature of his photographs—his hysterical patients had nothing to do with sex at all. A more complete explication of Charcot’s views surrounding hysteria and sexuality is that he acknowledged the sexual dimension—similar to the role of heredity—but he chose to emphasize the role of emotions rather than sexuality in neuroses.^[30] Apparently Freud forgot (or repressed) the episode and only later remembered Charcot’s words on the subject.^[31]
Despite the idea of the sexual etiology of hysteria perhaps originating with Charcot, Freud and Charcot’s sentiments and main arguments concerning hysteria were dissimilar in regards to the importance of sex in neuroses. In fact, Freud replaced Charcot’s neuropathological constitution of the disease with the sexual constitution. Freud did not try to outline a list of symptoms, but rather he tried to theoretically find psychic mechanisms.^[32] The result of this approach is that symptoms are seen as the psychic defense against traumata which later turns into his idea of psychoanalysis.
By examining the case studies of hysteria on which Freud worked, it becomes evident quite quickly that he was serving a different population than Charcot. In the case of Frau Emmy Von N., which began on May 1, 1889, Freud makes note of the “unusual degree of education and intelligence,” of this forty-year old woman.^[33] In the same case, reference is made to a maidservant that her family had once had.^[34] Both of these scenarios illustrate opportunities given to Viennese women of the middle and upper classes. In the case of Miss Lucy R., he writes of the young lady living as a governess in a house in Outer Vienna.^[35] These were not the uneducated women of Salpétriêre.
The link between sexuality and hysteria might be better understood by examining what was expected of middle class women, the population which Freud was serving, in the nineteenth century. Fuller, in her Woman in the Nineteenth Century, and Kindred Papers Relating to the Sphere, Condition and Duties of Woman, comments on the expectations of women in marriage in the nineteenth century:
It has been inculcated on women, for centuries, that men have not only stronger passions than they, but of a sort that it would be shameful for them to share or even understand; that therefore, they must ‘confide in their husbands,’ that is, submit implicitly to their will; that the least appearance of coldness or withdrawal, from whatever cause, in the wife is wicked, because liable to turn her husband’s thoughts to illicit indulgence; for a man is so constituted that he must indulge his passions or die!^[36]

Although Fuller is an upper class American woman, her writings echo the Victorian themes of repressed sexuality that have been so widespread in current historical discourse. Fuller was not the only one to express such views.
Ideas about the sexlessness of women permeated the globe in the nineteenth century. August Debay, a French physician of the mid-19^th century, argued in his Hygiene et physiologie du marriage that:
men make love brutally to satisfy a need,—the women in general experience only a sensation of friction, more or less vivid according to their temperament. Most of them remain indifferent or show no sign of pleasure at all.^[37]

Many bourgeois regarded sex as an erotic behavior of low or bestial quality. This again shows a distinction between the social classes. Women enjoying sex would be considered typical and suitable for lower class women, but when it came to the bourgeois of the nineteenth century, that was not how women were expected to behave. Around the time that Freud entered the scene, psychologists and sexologists were beginning to plead that the results of sexual repression were far worse than the immoral nature of the sex drive. This view, however, was not widely accepted by the public.
Freud had very strong feelings about the inherent differences between women of higher and lower classes, which could explain his reasoning for working with middle and upper class women. In a letter to his fiancée Marthe Bernays, he claimed that there is no reason for the lower classes to try and control and shape their desires because they are, “too powerless, too exposed, to be like us.” Historian Peter Gay, in his book The Bourgeois Experience, Victoria to Freud: The Tender Passion, articulates the conflicted ideas about the role of knowledge in sexual exploits. On the one hand, many of the poor possessed knowledge about sex because it had been unavoidable in the cramped and shabby living conditions. On the other hand, however, the young children of the nineteenth century bourgeois knew more than their parents because of the increasing availability of books, pictures or other sources that were not available to the poor.^[38] In this way, it was a different kind of knowledge that each of these groups acquired. Interestingly enough, the middle class seemed both more likely—because of the availability of books and pictures—and less likely—because of the expectations of sexual repression—than the lower classes to secure sexual gratification.
If sexual interest was to be expressed by Freud’s female patients that would directly violate everything that was believed to be true about middle class women of the nineteenth century. This is why Freud claimed that the symptoms of his patients, “must be regarded as direct toxic consequences of disturbed sexual chemical processes.”^[39] In the case of “Katharina,” Freud claimed that he,
had found often enough that in girls anxiety was a consequence of the horror by which a virginal mind is overcome when it is faced for the first time with the world of sexuality.^[40]

This specific quality could only be held true for women of the upper and middle classes who had been held up to these Victorian standards of sexuality, whereas the lower classes had been exposed to sex all along. At the end of this case history he comments again:
I shall not here comment on the fact which I have found regularly present in a very large number of cases—namely that a mere suspicion of sexual relations calls up the affect of anxiety in virginal individuals.^[41]

Katharina could be considered an exemplary image of Freud’s upper-middle class, hysterical woman where sexual repression brought on by Victorian ideals caused hysterical symptoms.
Freud’s theory about female sexuality was one of many reasons that he had difficulty obtaining a professorship. Being a liberal Jew did not make life easier for him, and his sexual basis for every neurological dysfunction did not help either. So when he finally obtained a professorship, at the age of forty-five, Freud was ecstatic and felt that his theories had finally been politically endorsed.
The public enthusiasm is immense. Congratulations and bouquets keep pouring in, as if the role of sexuality had been suddenly recognized by His Majesty, the interpretation of dreams confirmed by the Council of Ministers, and the necessity of the psychoanalytic therapy of hysteria carried by a two-thirds majority in Parliament.^[42]

This represented Freud’s great need to have his ideas be accepted, especially in such a religiously frustrating and sexually repressive era.
Despite Freud’s claim that hysteria’s sexual etiology “was going back to the very beginnings of medicine and reviving a thought of Plato’s,” not everyone believed his work to be legitimate. Taking “scientific” ideas from Plato would not be considered the most valid explanation for why anything was the way it was. His determination to associate all neuroses with sexual dysfunction lost him a lot of popularity as a doctor.^[43]
Understanding Freud’s views on the how sexual knowledge should be dispersed to women helps to illustrate why his views were so difficult to accept. While it seems that Freud helped to liberate female sexuality in many ways, his idea of “normal” sex was still quite limited and very much dictated by social status. While Frenchman Jules Michelet claimed in 1846, that the governing classes had a pathetic sex life dictated by impotent husbands, frigid wives, and exhaustive indifference in both man and wife, Freud had quite a different image.^[44] To Freud, the lower class girl was not innocent and trustworthy as Michelet had deemed her. Freud used a comparison of the proletariat girl and the bourgeois girl to illustrate these inherent differences.
In this scenario, one is the caretaker’s daughter and the other is the landlord’s little girl. Because of the nature of the lower class girl, she will already—by the age of five or six—have experienced or witnessed a significant amount of sexual conduct and will thus take the initiative in these sexual relations between these two small girls. This sexual attraction for one another leads to masturbation. The proletariat girl will continue to masturbate without guilt until menstruation, at which point her life will continue without any feelings of shame and she will go on to do whatever she so desires. The landlord’s daughter, on the other hand, will toil with the guilt of masturbation and will thus grow distaste for sexual encounters. This distaste is the result of the repression of her desires. This repression will manifest itself in later years as a neurosis.^[45]
Freud is similar to Michelet in that the middle class way of life—the repression of sexuality—results in sexual dysfunction. However, where Michelet claims that the middle class is forever plagued with frigidity and impotence, Freud sees neurosis and later psychoanalysis as the way that modern bourgeois culture can compensate for its restraint and refinement.
Freud’s explanation of the landlord’s daughter and the caretaker’s daughter may have stemmed from the case of Katharina, or at least cases like hers. For “to judge by her dress and bearing, she could not be a servant, it must no doubt be a daughter or relative of the landlady’s.”^[46] This emphasis on sexuality in middle class women did not help to encourage Freud’s credibility in hysteria because people did not like Victorian women to be involved in discussions about sex.
The common ideas about sexuality in Vienna have been thought to be similar to those of the Victorian era although the expectations of both of these cultures differ greatly from the actualities. One of the problems that women of Vienna faced, in addition to attempting to comply—or at least thinking about complying—with the sexual standards set at the time, was the idea of pregnancy. Freud’s sexual etiology of neurosis gained more sway when considering reconciliation of repressed desire and the fear of unwanted pregnancy.^[47]
Freud believed that not being sexually satisfied resulted in neuroses for women. Despite Freud’s ideas that the very repression that was being expected of women was what promoted neuroses, he still, for lack of a better option, agreed with the views of the times. He was also a believer in the idea that for a woman to talk about sex meant that she must be less feminine in nature and only the “more masculine” analysts were capable of such discussions. At the same time however, Freud defended the need to discuss sexual matters with his female patients claiming that it was not corrupting them.^[48] It could be said that because these women were already diagnosed with some form of neurosis, they were no longer subjected to the subtleties of femininity and masculinity. They, in Freud’s mind, must have been outside such realms of distinction.
By examining the case of Dora, it is possible to see how middle class culture did not allow her any other escape than that of being diagnosed as a hysteric. Because of the Viennese culture of the time, women were not given a good education or a means to make a living on their own, and thus became dependent upon their families both economically and emotionally. For Dora, this was not enough, and her form of escape was through her symptoms of hysteria, which acted as a cry for help.^[49] Despite her method of escape through the diagnosis of hysteria, the medical community was not very sympathetic to the symptoms of hysteria.^[50] However, in a time when contemporary science and art denigrated femaleness, the medical community was the last of her concerns. At least Freud’s following made her feel better about herself and gave her more agency in a way that she had never experienced prior to the diagnosis.

France and Austria were not the only places where work on hysteria was being performed. The American neurologist, Silas Weir Mitchell was a contemporary of Charcot. Born in 1829, to a series of prominent male physicians in Philadelphia, Mitchell was destined to become one of the founders of American neurology and neurophysiology.^[51] His patients, like Freud’s, were of his own social milieu, which may explain why he treated them with more respect than Charcot.
In Mitchell’s Doctor and Patient, his audience is explicitly upper class. One of Mitchell’s main suggestions for the cure of hysteria or nervousness was the rest cure, in which the woman is to lie down for a few hours each day.
If she cannot get rid of her home duties, let her try at least to secure to herself despotically her times of real and true rest. To lie down is not enough. What she needs is undisturbed repose, and not to have to expect every few minutes to hear her at door the knocks and voices of servants or children.^[52]

The inclusion of servants here demonstrates that Mitchell was addressing middle or upper class women. However, despite the women’s economic status, she is still expected to fulfill certain duties in the home. Later on in his treatise, Mitchell says candidly, “I am reminded as I write that what I say applies and must apply chiefly to the leisure class.”^[53] There is no doubt who Mitchell’s hysterical women were.
Mitchell showed a great deal of respect for his patients. He commented extensively on the role of the physician and the demeanor the physician should exhibit towards his patients, particularly hysterical patients.
The position of the physician who deals with this class of ailments, with the nervous and feeble, the painworn, the hysterical, is one of utmost gravity. It demands the kindliest charity. It exacts the most temperate judgments. It requires active good temper. Patience, firmness, and discretion are among its necessities.^[54]

This good temper of which Mitchell spoke is particularly pertinent when treating poor patients. In a lecture given to the students of the University of Pennsylvania and Jefferson Medical College, Mitchell discussed the need for physicians to treat the poor or at least to have experience treating the poor.
Whether we like it or not this service is essential to the young, and valuable at all ages.... And so it is that with us the gift of our mental and moral best to the poor becomes an unquestioned necessity of our nature. These onerous claims lessen as life runs on. None altogether escape this form of charitable expenditure. But each virtue has its attendant evil. An eastern proverb says, ‘every angel has a twin devil.’ This constant unrequited service of the sick poor has its danger to character. I have felt it myself. I want you to feel it.... These early years among the poor, or the class of uncertain debtors, are apt to make some men rude and uncareful, and ill-tempered. Most honestly do I say that such work is what I may call an acute test of character.”^[55]

While Mitchell preaches from his own experience that every physician should be comfortable working with the poor, as we saw earlier, his own primary work was with women of the upper tier. Since Charcot invested his life working with lower class women, Mitchell’s explanation may well apply to his character.
Charcot was compared to a god of Mount Olympus because of his distant nature. In fact, sexologist Havelock Ellis said of Charcot, “For purely psychological investigation he had no liking and probably no aptitude.... the questions addressed to the patient were cold, distant, sometimes impatient.”^[56] Mitchell was more like Freud. Both were known for their empathy for the patient’s humanity.^[57] Mitchell, however, had come upon this profession in a different manner than the others.
After the Civil War, Mitchell began to see the importance of treating neurological diseases. After numerous casualties and being assigned to work in several army hospitals, Mitchell embraced the studies of neurology.^[58] Although Freud and Mitchell both treated the same socio-economic group of women, and gave them equal respect, they differed in their ideas about the nature of neuroses themselves. Mitchell did not agree that all neuroses had a sexual etiology or that sexual deprivation would lead to hysteria.^[59] He called Freud’s sexual implications “filthy things.”^[60] This could be for a number of reasons. A bit older than Freud, by 1890, Mitchell was already sixty-one years old and had been more ingrained with the Victorian ideals that had thrived for so many years regarding the unacceptability of feminine sexuality.
Mitchell compares the nervousness that is often found in weak and feeble women to that which is found in veterans of war,^[61] when nervousness or a form of hysteria afflicts men.^[62] If hysteria only occurs in men in the most dire circumstances, but hysteria can occur in women who are fulfilling their expected roles in society, then what does that say about the nature of women’s expected roles? The only logical conclusion would be that the usual role of women, like men’s role as soldiers, was not one to be desired.
Despite Mitchell’s rejection of Freud’s sexual etiology and thus the rejection of psychoanalysis, Mitchell was considered to be a quite attractive doctor by his patients. He was a charismatic, well-read, attractive, and entertaining man. There is one story told by A. B. Burr of a situation that supposedly occurred between Mitchell and one of his female patients who would not get out of bed. He scared her out of bed by teasing her with sexual innuendoes. Apparently Mitchell said, “If you are not out of bed in five minutes—I’ll get into you!” When the patient did not respond, Mitchell began unbuttoning his pants , and she immediately jumped out of bed and ran hastily away. Although Mitchell never told the story himself, it was quite popular during his lifetime, and he never denied the incident.^[63] Mitchell’s capability to joke with these women in this manner may imply a certain hierarchy in sexual relations, but it also lends to the comfortable nature that he exhibited with his patients.
His goal, unlike Charcot, was to rehabilitate these women such that they could be restored to their role in society. This focus on the prevention of further attacks and the need for early restoration was a main focus of Freud’s work as well.^[64] In most of these cases he worked with hysterical women who were very thin and needed to gain some extra weight. He wanted to rid these women of the notion that they had to be as thin as little boys.^[65] Because these were women of his social status it was important to treat them so that they could feel accepted by society. This contrasts to the institutionalized women of Salpétriêre where being ailed by hysteria was more socially acceptable than being returned to a discredited role in society, because at least in the institution it was not considered to be their own fault.
In an effort to restore the middle class women to what Mitchell considered their appropriate role in society, he practiced one form of treatment that allowed women to behave outside the typical female role. In fact his treatment was so extreme that it thrust hysterical women into what was considered to be the typical role of men at the time. After a period of time out in the wilderness, camping and fishing, the formerly hysterical woman was able to return to her world. She,
With two good wall-tents for sleeping-and sitting-rooms, with a log hut for her men a hundred yards away and connected by a wire telephone, she began to make her experiment. A Little stove warmed her sitting-room at need, and once a fortnight a man went to the nearest town and brought her books. Letters she avoided, and her family agreed to notify her at once of any real occasion for her presence. Even the newspapers were shut out, and thus she began her new life. Her men shot birds and deer, and the lake gave her black bass, and with those well-chosen canned vegetables and other stores she did well enough as to food. The changing seasons brought her strange varieties of flowers, and she and her friend took industriously to botany, and puzzled out their problems unaided save by books. Very soon rowing, fishing, and at last, shooting were added to her resources. Before August came she could walk for miles with a light gun, and could stand for hours in wait for a deer. Then she learned to swim, and found also refined pleasure in what I call word-sketching, as to which I shall by and by speak. Photography was a further gain, taken up at my suggestion. In a word, she led a man’s life until the snow fell in the fall and she came back to report, a thoroughly well woman.^[66]

This method of treatments that Mitchell found very successful allowed women to escape their duties within the oppressive world of womanhood in the home, experience some of the freedom that their husbands and male counterparts lived everyday, and feel free.
The need for hysteria in America at this time, if it could be called a need, is an interesting one. Because the ideals of femininity were that of the emotional, dependent, gentle, woman, a woman who broke the mold needed a medical explanation. Life for a mid-nineteenth century woman inevitably meant pain, whether it was emotional pain with the high mortality rates of infants or the physical pain and dangers of childbearing. In the 1880s Mitchell said,
We may be sure that our daughters will be more likely to have to face at some time the grim question of pain than the lads who grow up beside them...there comes a time when pain is a grim presence in their lives.^[67]

Still, women were expected to maintain the cultural ideals of femininity. The difficulties of being a woman in the mid-nineteenth century led to the basic malaise and dissatisfaction of the middle class woman years later.
The expectations of women in America were very much defined and constrained by her role in the domestic sphere. In 1855, Fuller wrote,
As a little girl she is to learn the lighter family duties, while she acquires that limited acquaintance with the realm of literature and science that will enable her to superintend the instruction of children in their earliest years. It is not generally proposed that she should be sufficiently instructed and developed to understand the pursuits or aims of her future husband; she is not to be a help-meet to him in the way of companionship and counsel, except in the care of his house and children. Her youth is to be passed partly in learning to keep house and the use of the needle, partly in the social circle, where her manners may be formed, ornamental accomplishments perfected and displayed, and the husband found who shall give her the domestic sphere for which she is exclusively to be prepared.^[68]

Given the rigid expectations of women during this time, it is understandable to think that these bourgeois women may have wanted to escape the day-to-day toils of womanhood. Hysteria provided that escape for middle class women. By defining hysteria as a disease, the women who were diagnosed with it were able to stay in bed, get personal attention from a physician, and be alleviated of their duties and responsibilities as a woman. Expressed unconsciously, this can be regarded as a manifestation of women’s discontent with their roles in society.^[69]
For hysterical women of the nineteenth century, being diagnosed as a hysteric was a way for women to escape. This was true of both lower and upper class women. For Charcot and his studies with lower class women, his main priority was to use these women to better scientific discourse in neurology. While this raises ethical issues surrounding the rights of the patient, at the time many of the women at Salpétriêre probably felt quite special to be the focus of attention of the privileged class. In this way, lower class women escaped from the demeaning outside world of the slums to a place, though not paradise, where they were exempted from the shame associated with being responsible, according to Victorian morays, for their own dismal life. In fact, under the gaze of the camera, previously stigmatized behavior was encouraged.
On the other end of the spectrum lay Freud and Mitchell who served the upper tier of hysterical women. While these women were not burdened in quite the same way that the lower class women were, they too needed escape. The constraining ideals of womanhood and femininity were oppressive. By being diagnosed as a hysteric, they were given an excuse to take a break from those traditional roles, and manifest sentiments that may have been considered sexually inappropriate. As diagnosed hysterics, they were no longer to be blamed for their behavior.
While hysteria was most certainly a constructed disease that shifted with the social conditions of the time and the people who were diagnosing it, it played a significant role in the shaping of ideals of womanhood. The mere fact that men and women were witnessing these hysteric attacks—whether legitimate or not—meant that there was clearly something wrong with the way that women were expected to behave. Freud failed to answer that question. The notions of liberation and independence for women were not yet part of the culture. But the study of hysteria as a disease exposed great disillusionment that had been buried within the repressive ideals of the Victorian era.

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