| Book Review | Health and History, 11.1

Book Reviews

Mark Micale, Hysterical Men: The Hidden History of Male Nervous Illness (Cambridge, MA: Harvard University Press, 2008). ISBN 978-0674-03166-1. 366 pp.

Hysteria has always been an intriguing medical entity, both for the doctors who studied the afflicted then and for the historians who study the doctors now. But apart from hysterical reactions to warfare, there has been little attention paid to male hysteria by either physicians or historians. Mark Micale presents a welcome account of this neglected field.

This book begins with an ancient Egyptian papyrus (from around 1900 BCE) and ends with the publication of Freud's Three Essays on the Theory of Sexuality in 1905—a history covering a little less than four thousand years. The nineteenth and early–twentieth centuries receive the most attention, covering some 226 pages of the book, but this does not detract from the overall picture. Indeed, the fundamental questions Micale wishes to address—doctor-patient relationships, sexuality, gender ideals and relations, and medical aetiology—were fiercely debated during this period, serving the purposes of the book well.

Micale also compares the attitudes of the medical establishment with those of the literary elite, a nod towards C.P. Snow's notion of the 'two cultures.' This approach is interesting, creating a sense of hostility between conservative doctors and liberal writers, and is perhaps best illustrated in the relationship between Marcel Proust and his father-physician, with 'the major dichotomies of the age—Victorian/Modern, science/art, positivism/subjectivism, straight/gay, healthy/hysteric—all map directly onto Proust and his father' (pp. 214–15). According to Micale, this distinction was (and one could argue that this relationship varied from the complimentary to the adversarial) then blurred in the work of Freud (pp. 257–8).

But perhaps the most interesting contribution to the study of male hysteria Micale makes derives from two pieces of evidence. The first is a series of photographs taken at the Salpêtrière showing a male patient displaying the same hysterical stigmata normally found in Charcot's female patients (pp. 220–3). As this only known set of prints once belonged to the artist Francis Bacon, Micale makes the curious suggestion that we owe their existence to the fact that they show 'a young, good-looking naked man in vulnerable, quasi-coital positions, characteristics that the homosexual Bacon would have appreciated' (p. 225). I leave the reader to judge what this statement may imply.

The second piece of evidence is taken from the Freud-Fliess correspondence. These documents suggest that psychoanalysis did not receive its intellectual impetus from the treatment of female hysterics, but from the conversations of three men—Freud, Fliess, and a male patient, Herr E. This patient, 'alone among Freud's patients in the 1890s, had the power not only to verify, revise, and invalidate Freud's developing psychological ideas but also to elucidate Freud's own neurotic symptoms.' (p. 264) Like the photographs, these documents survived only by chance, adding weight to Micale's argument that male hysteria has been systematically ignored at various points in history.

A peculiar feature of this book, however, is that it drifts across nationalities as time progresses. From the Middle Ages to the Enlightenment, the English experience of neurosis is what concerns Micale—until the mid–nineteenth century when France (in general) and Charcot (in particular) take centre-stage. But once Freud leaves the Salpêtrière, Vienna becomes the focus of attention. These changes obviously reflect Micale's areas of interest and expertise, and admittedly, this criticism has little effect on many of the important cultural points he wishes to make. But since this work is a history of a disease concept as well, this point needs to be elaborated.

In studying hysteria as a disease concept, Micale makes his purpose explicit: 'It is physicians and their diagnostic behaviour, rather than patients and what ailed them, that remain center stage in my account' (p. xiv). However, this isn't absolutely true. The demons that faced Richard Burton, Samuel Johnson, and John Stuart Mill are mentioned here in the text, but neurasthenia, only in footnotes. In the former instance, 'hysteria' has been broadened to include 'melancholy,' yet for the late–nineteenth century 'hysteria' refers only to Charcot's narrowed usage. Micale's statement is true in the second instance, but not in the first. Moreover, the sense of an eighteenth-century international community of doctors that is created in this work does not quite survive into the nineteenth century.

These criticisms are, however, relatively minor and they do not detract from an otherwise fine piece of scholarship. The book is well-written, and Micale, unquestionably a leading expert in the study of hysteria, takes care to explain the many theoretical nuances that may have been lost on the unfamiliar reader. The appeal of this book is not limited to students of medical history and its mixture of social and literary analysis will entice many other readers.

SEAN DYDE

UNIVERSITY OF SYDNEY

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