Medical historian Roy Porter* draws attention to what he calls a 'patient-shaped gap' in the history of the case study, with accounts of illness being written invariably by doctors rather than patients. In discussing a research agenda to remedy this imbalance, he claims that ‘its real challenges lie in reconstructing patterns of consciousness and action’. For the historical novelist, this involves trying to think oneself into the mindset of the character. 

One of the cultural sources I turned to in trying to 'reconstruct the consciousness' of Bertha Pappenheim was The Girl's Own Paper, a magazine first published in 1880, the year in which Bertha's story began. Reading it brings one to the inescapable conclusion that the past is indeed a foreign country. I feel that I could more easily understand a present-day Zulu or Maori than any young 19th-century woman whose mind was formed by the principles governing those moralising texts.


Feminism was still only a speck on a distant horizon, at least as far the GOP was concerned. An article titled The Girls of Today, written by 'One of Them', while advocating a degree of working activity for women, concluded: '…. there is plenty of work to do, not only for our fathers and brothers but for us girls also. Out of this work we will select that which we can do best, whether it be nursing, teaching, book-keeping, mending, lamp-cleaning, dressmaking, or anything else. At the same time we will endeavour to hold fast by those attributes of modesty, gentleness and patience which belong to good women, and while we enrich the home with our earnings, we will try to be its sunlight and its ornament.' As for a career in journalism, anyone considering it was advised that the job might require her to be out and about late at night, which would not be seemly, and that she would need 'a bold mien' to work with male reporters 'on whose province she is encroaching'. As a final word of warning GOP cautioned that 'it is not an occupation that tends to the development of feminine graces.' On a more positive note, the newly invented typewriter was promoted as a solution to the problem of finding employment for ladies, it being 'peculiarly fitted for their nimble fingers'. 

Beauty, just as much as health, was considered to be a matter of mens sana in corpore sano. 'Health can make the plainest girl pleasant to behold, if her mind be pure and innocent,' exhorted Medicus in 1884. Readers were encouraged to believe that a good head of hair could be obtained by cultivating 'a calm and unruffled frame of mind'. A daily bath, 'as cold as can be borne', and exercise were judged ideal beauty aids. Powder and 'paint' were anathema, a sign of loose morals. 

Overall the texts were saturated with religiosity. An article titled What Shall We Do With Our Sundays? was accompanied by a poem by Yeats suggesting that the answer was church attendance: 'She prays for father, mother dear, To Him with thunder shod. She prays for every falling tear, In the holy church of God. 'Middle-class girls were encouraged to procure copies of 'the Holy Gospels' and other 'nice little books' and to leave them in appropriate places, such as under the seat cushion in a hired vehicle, where they could be found by 'the lower orders'. Acting was disapproved of. 'Once on the stage, those wishing to leave it and live religious lives find much prejudice from prospective employers.' The writer wasn't thinking of women wanting to enter a convent, but simply leading a life that wasn't immoral. 

Replies to readers' letters were tart and bracing. A reader with academic aspirations was advised: 'The subjects to be avoided, save in an elementary manner, are mathematics, and possibly science - certainly, however, the former.' A young woman enquiring about a career as a governess in 1884 was told: 'You seem to think that we keep a registry office. You are not sufficiently educated to take a place as nursery governess. You cannot write; and do not express yourself properly.' But this was nothing to the scolding doled out to a correspondent from Canada: 'This is the last notice that we shall take of your silly letters. Learn your lessons, read your Bible, and make and mend your own clothes and waste no more time in writing such rubbish.'

It's difficult to believe that only 130 years separates this kind of thing from the tweets of Paris Brown, the seventeen-year-old who has just had to resign from her police job after it was discovered that she had posted homophobic and racist rants and boasted about her binge drinking, drug taking and sex life on Twitter.  But then, much as I said at the beginning, I might find it easier to understand a Zulu or a Maori than Paris Brown. 

*Porter, Roy, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 14 (March, 1985), 175-198

"Hysterical a[phasia]…. is characterized by its completeness or, rather, by its absolute character. It is not that the patients are restricted to the use of individual words, but that they are completely speechless, indeed voiceless; not a sound, not a cry comes about."
        Sigmund Freud, Aphasie 1888

In my post of 5 March I quoted Josef Breuer's description of Bertha's aphasia. It was of a complex nature and varied over the course of her illness, ranging from the typical telegrammatic speech of Broca's aphasia to the complete loss of her mother tongue, at which stage she could only express herself in other languages, mainly English. How then, in view of Freud's already published view about hysterical aphasia, could he and Breuer be subscribing to the idea that her aphasia was hysterically induced?

Freud was clearly enchanted by his own theories about hysteria, so much so that it seems almost to have constituted a default diagnosis for him. Once convinced that a patient suffered from hysteria nothing would budge him from that conclusion.

In the case of Frau Emmy von N (the second of the cases reported in Studies on Hysteria) the patient displayed, in addition to depression and insomnia, a set of symptoms which would nowadays be recognised as associated with Tourette's syndrome: random interjections and clacking sounds, agitated finger movements, convulsive facial tics and neck spasms. Freud, treating her with the cathartic method developed in discussion with Breuer, elicited from his patient a number of traumatic childhood memories, after which, he claimed, her vocal tics 'were strikingly improved' although they 'were not completely relieved'. This limited success turned out to be 'not a lasting one'.

There is nothing surprising in this. Tourette's symptoms are known to wax and wane, quite independently of any treatment.What is surprising is that Freud didn't even consider the possibility of a neurological cause as he had known Gilles de Tourette while working with Charcot in Paris, at the very time when de la Tourette first published a paper on the disorder which was to bear his name.

A later, and much more serious, misdiagnosis was made in the case of a fourteen-year-old girl, known only as M-l, who suffered from abdominal pains. Freud diagnosed her as an 'unmistakable' case of hysteria, which he claimed cleared up 'quickly and radically' under his care. The girl died two months later of sarcoma of the abdominal glands.

Freud was still loath to relinquish the hysteria diagnosis. The girl had indeed been a hysteric, he maintained. The hysteria, instead of creating its own symptoms, had simply appropriated for itself the existing pains produced by the sarcoma.

This 'mixed aetiology' explanation has served on other occasions as a get-out clause in the history of hysteria. We see it too in the above case of Frau Emmy von N. Finding that the neck spasms were continuing unabated Freud declared that they did not form part of the hysterical picture but were a form of migraine, therefore of organic origin and not susceptible to the cathartic treatment.

It's difficult to see how the mixed-aetiology explanation could be applied to solve the question I started this post with but given Freud's belief in his ability to wriggle Houdini-like out of any diagnostic bind he found himself in he would surely have come up with some rationale.