As he began to lose his wits for the first time in 1788, George III announced to all who would listen that “I’m nervous, I’m not ill, but I’m nervous; if you would know what is the matter with me, I am nervous.”1 Sadly for him, the court and his physicians did not agree. Mad they called him, and soon he was being bled, blistered, starved, vomited, and purged, tied to his chair, menaced, placed in a strait waistcoat, whipped, and cut off from all contact with the outside world. Modern historians have broadly embraced the idea that his hallucinations, delusions, and delirious ravings were in all probability the side effects of an inherited metabolic disorder, porphyria, a disease that, appropriately enough, turned his urine purple. And certainly the king was far too disturbed ever to have been considered merely hysterical. But his embrace of the language of nervousness mirrored that of his subjects, among whom disordered nerves were now the maladie à la mode. A way of conceptualizing disease that would have made no sense even to most of the learned a century earlier had become common currency, embraced enthusiastically by the polite and hoi polloi alike. And occupying a central place among these “nervous disorders” was a complex of disturbances variously referred to as hysteria, hypochondria, the vapors, and the spleen.
2. George III taking the waters at Cheltenham. Water cures were long a fashionable remedy for “nervous” complaints. (Wellcome Library, London)
Hysteria’s migration from the uterine origins accorded it in Hippocratic and Galenic medicine to its new incarnation as a nervous complaint had begun to take place in the last third of the seventeenth century. The changed view of its etiology owed much, in the first instance, to the researches and writings of the royalist Sedleian Professor of Natural Philosophy at Oxford University, Thomas Willis, and to the subsequent pronouncements of his Puritan contemporary and rival Thomas Sydenham—famous for his emphasis on bedside observation rather than on books, and the physician often called the “English Hippocrates.” Alongside, and to some extent instead of, the ancient Hippocratic notions of disease as a systemic disturbance of the four humors—blood, phlegm, black and yellow bile—these pre-eminent physicians began to explore an alternative system of bodily regulation, the nervous system, as a new source of disequilibrium and debility. In some respects, these ideas were obviously at odds with tradition, and yet the nerves were, like the circulation of the blood, something that could be incorporated into the more broadly based model of illness that was almost universally embraced at the time.
Disease of all sorts, for seventeenth- and eighteenth-century Englishmen, was constitutional, a symptom of an underlying disorder of the body that was systemic in nature. What surfaced locally as symptoms was often just the manifestation of the deep-seated disturbance of the body’s equilibrium, and just how that disturbance manifested itself was in turn dependent upon one’s inheritance and circumstances. Hence the notion of disease specificity was discounted. It followed as well that not just hysteria but other diseases were malleable and mobile, capable of migrating to different parts of the body as they developed, and mutating into different (and potentially more dangerous) disorders. Treatment in consequence was often a matter of getting disease out of the body, via purges and vomits and bleedings, through measures designed to sweat it out, or through counter-irritation designed to draw the disease away from the most dangerous areas of the human frame, and provide a route out of the system—blisters, issues, setons, and so forth.
In the years after Charles II’s restoration to the throne in 1660, Thomas Willis undertook a sustained effort to understand the anatomy of the brain and the central nervous system. Though a technician, Richard Lower, did much of the actual work of dissection, Willis’s theorizing based on these observations formed the foundation of a thoroughgoing reassessment of the nature and role of the nervous system in animating the human body.
The anatomy of the nerves [nervous system], [he proclaimed in 1664], provides more pleasant and profitable speculations than the theory concerning any other part of the animal body: for by means of it, are revealed the true and genuine reasons for very many of the actions and passions that take place in our body, which otherwise seem most difficult to explain: and from this fountain, no less than the hidden cases of diseases and symptoms, which are commonly ascribed to the incantations of witches, may be discovered and satisfactorily explained.2
Mind and body met and somehow interacted in and through the brain and the nervous system, and the “animal spirits” that Willis viewed as commanding and controlling the body were powerful agents whose derangement could be invoked to explain all manner of illness and pathology. Here was a new arena for medicine that he dubbed “neurologie,” one concerned with what many came to see as “the first” or the most “noble” of the body’s organs.
A man of modest origins, Willis was plain in appearance and manner, and afflicted with a stammer, but he was, in seventeenth-century parlance, a skilled natural philosopher. He had been marginalized by his royalist sympathies during the time of Cromwell, and his initial forays into clinical practice brought him only a modicum of success. The sort of moneyed and titled clientele who patronized the most prominent gentlemanly physicians largely eluded him, and as a practitioner he had to make do with an itinerant practice in the market towns in the Oxford area. For several years, even following the Restoration, he occupied much of his time with the experimental examination of the brain and the nerves, and their presumed connections to sensation, motivation, thought, and behavior, topics on which he began to publish extensively in Latin in the 1660s, shortly before he moved to London. His anatomical drawings were concrete illustrations of his radically different conception of the brain, for his use of preservatives allowed him to see the organ as no one had before him. Folds and fissures, the distinction between a variety of distinct regions and features of the brain—the brain stem, the pons, the medulla, and the circle of arteries at the base of the brain (still known as the circle of Willis)—the visualization of the infolding of the cerebellum and cerebral cortex, the structures of the mid-brain, all these marked a dramatic reconceptualization of the physical reality of the brain, and of its role as the organ of thought.
Willis’s relocation to the metropolis in 1667 proved to be a great success. The erudite if unprepossessing medical man rather belatedly acquired an enviable practice among the fashionable and socially prominent, and, following his death, his writings were soon translated into the vernacular, accelerating the circulation of his somewhat radical ideas about the sources of diseases in general, and of convulsive disorders in particular. Among these Willis numbered, not just epilepsy or the falling sickness, but a cluster of disorders involving the hysterical passions and the hypochondriacal affections.
The pathologies that produced hysteria and analogous disorders were, he asserted, firmly rooted in “the Brain and the Nervous Stock.” They involved disturbances of sensation, motion, and consciousness that fell short of the “universal Convulsions” that marked true epilepsy, but were a closely related family of diseases. (The eminent nineteenth-century French neurologist Jean-Martin Charcot was of similar mind, often referring to “hystero-epilepsy.”) It was “some taint” of the animal spirits “possessing the beginning of the Nerves within the head” that was productive of the disorder, “and whatever inordination, or irregularity from thence happens … is only secondary.”3
3. Thomas Willis (1621–75), coiner of the term “neurologie,” and Sedleian Professor of Natural Philosophy at Oxford University. (Wellcome Library, London)
Willis was well aware that, in making these claims, he was taking issue with the received wisdom about hysteria that had lasted for millennia. This “half damn’d” disorder was, he acknowledged, one of
so ill fame, among the Diseases belonging to women, that … it bears the faults of many other Distempers: For when at any time, a sickness happens in a woman’s body, of an unusual manner, or more occult original, so that its Cause lyes hid, and the Curatory Indication is altogether uncertain, presently we accuse the evill influence of the womb … and in every unusual Symptom, we declare it to be something hysterical.
Wide was the range of symptoms attributed to this distemper:
A motion in the bottom of the belly, and an ascention of the same, as it were a certain round thing, then a belching, or a striving to vomit, a distention, and murmur of the hypochondria, with a breaking forth of blasts of winde, an unequall breathing and very much hindered, a choaking in the throat, a vertigo, an inversion, or rolling about of the eyes, oftentimes laughing, or weeping, absurd talking, sometimes want of speech, and motionless, with an obscure or no pulse, and deadish aspect, sometimes Convulsive motions, in the face and Limbs, and sometimes in the whole body, are excited: but universal Convulsions rarely happen, and not unless this disease be in the very worst state … I have observed these Symptoms in maids before ripe age [puberty], also in old women after their flowers have left them; yea, sometimes the same kinde of Passions infest men …4
Here were a number of further departures from tradition. Hippocratic and Galenic texts had placed the uterus at the heart of many disorders suffered by the female half of humanity, unambiguously so in those labelled hysterical. “Most ancient, and indeed Modern Physitians,” Willis acknowledged dryly, “refer them to the ascent of the womb, and vapours elevated from it.” Not a quarter century before, in 1651, the great William Harvey, renowned for discovering the circulation of the blood, had given new voice to the ancient consensus. Hysteria was a female malady, perhaps the quintessential female malady.
For the uterus is a most important organ, and brings the whole body to sympathize with it … When the uterus either rises up or falls down, or is in any way put out of place or is seized with spasm—how dreadful, then, are the mental aberrations, the delirium, the melancholy, the paroxysms of frenzy, as if the affected person were under the domination of spells, and all arising from unnatural states of the uterus.5
Willis would have none of it.
The former opinion, although it plead antiquity, seems the less probable, for that the body of the womb is of so small a bulk, in virgins, and widdows, and is so strictly tyed by the neighbouring parts round about, that it cannot of it self be moved, or ascend from its place, nor could its motion be felt, if there were any: as to that vulgar opinion, or Reason taken from the vapours, we have often rejected it as wholly vain, and light …6
That the wandering womb of Antiquity was an anatomical impossibility would be confirmed by the great eighteenth-century Italian physician Giovanni Battista Morgagni (1682–1771), author of the classic The Seats and Causes of Diseases Investigated by Anatomy (1761). Morgagni’s published work was the fruit of six decades of labor, and he lent his considerable authority in support of Willis’s conclusion that in cases of hysteria and hypochondria “the chief disorder is in the nervous system, as it is called.”7 By the middle of the eighteenth century, though, the once heretical idea had become a commonplace.
That shift had occurred in part because Willis’s views on nervous disorders were broadly shared by his great Puritan contemporary and rival, Thomas Sydenham (though the latter was neither interested himself in brain anatomy, nor saw it as having any clinical relevance). Sydenham was convinced that “no chronic disease occurs so frequently as this.” As much as a sixth of his clientele, he announced, were of the hysterical persuasion, victims of “a farrago of disorderly and irregular phenomena.” For him, this occasioned no surprise, “for few women (which sex [as he slyly noted] makes one half of the grown persons), excepting such as work and fare hardly, are quite free from every species of this disorder.” And not just women deserved the diagnosis: “several men also, who lead a sedentary life and study hard, are afflicted with the same.” To be sure, the men’s complaints not infrequently acquired a different label: “yet upon comparing the hypochondriac complaints, which we judge to rise from obstructions of the spleen and other viscera, with these symptoms, which seize hysteric women, we find a great similitude between them.” Indeed, “hypochondriasis (which we impute to some obstruction of the spleen or viscera) is as like [hysteria] as one egg is to another.” Wild and unintelligible talk, terrible convulsions, vomiting, a sensation of choking, violent pain and palpitations of the heart, and an “even more disordered” state of the mind merely hinted at the diversity of shapes and forms hysteria might take. For “this disease is not more remarkable for its frequency, than for the numerous forms under which it appears, resembling most of the distempers wherewith mankind are afflicted.” It might manifest itself in any region of the body, and, wherever it surfaced, “it immediately produces such symptoms as are peculiar thereto; so that unless the physician be a person of judgment and penetration he will be mistaken, and suppose such symptoms to arise from some essential disease of this or that particular part, and not from the hysterical passion.”8
Sydenham’s conception of hysteria differed from Willis’s in some important respects. It was not fits as such that were central to his view of the disorder (though he acknowledged that “sometimes it causes terrible convulsions”), but rather that the symptoms these patients presented “cannot be accounted for on the common principle of investigating diseases …” and surfaced in those who had a prior history of “disturbances of the mind, which are the usual causes of this disease.” Willis had distanced himself from the psychological, employing a reductionist physiology to explain disorders of the nerves. Sydenham, by contrast, noted the frequent complication of depressive symptoms in patients presenting with “hysterical [or] hypochondriacal complaints.” He insisted that
their misfortune does not only proceed from a great indisposition of the body, for the mind is still more disordered, it being in the nature of this disease to be attended with an incurable despair; so that they cannot bear with patience to be told that there is hope of their recovery, easily imagining that they are liable to all the miseries that can befall mankind; and presaging the worst evils to themselves.
The passions—“grief … terror, anger, distrust, and other hateful passions”—were both crucial to the genesis of hysteria, and central elements in its course. And many of its sufferers exhibited an extraordinary emotional lability: “All is caprice. They love without measure those whom they will soon hate without reason.”9 Yet none of these characteristics should come as a surprise, since, in crucial ways (ways that remained opaque and hard to specify), the nervous system was coming to be seen as the interface between the material and the psychic realms.
Seventeenth- and eighteenth-century physicians rarely laid hands on their patients, relying on head, not hand, as the basis of their diagnostic acumen, and leaving the stigmatizing manual tasks that were a necessary part of any direct examination of the patient’s body to the lower-status surgeons. Inevitably, this neglect of the physical examination led to all manner of diagnostic errors. Most famously, a whole array of fashionable physicians in the spa town of Bath misdiagnosed David Hume’s illness, assuring the eminent philosopher that his “bilious” complaints were eminently curable, and would lend themselves to cure by changed diet and regimen, and by drinking the foul, sulfurous, waters. And they were not the least discombobulated when the pre-eminent British surgeon John Hunter did venture to palpate Hume’s abdomen and distinctly felt the cancerous liver tumor that would rapidly kill its possessor. In any event, all practitioners in the Augustan Age obviously lacked access to the sorts of diagnostic technology critical to the differentiation of diseases today. Thus such labels as “hysteria” and “hypochondria,” which admittedly were protean categories embracing disorders that mimicked other forms of disease, must necessarily have caught in their net numerous afflictions that today would be assigned to a wholly different realm of neurological pathology—a fact that should remind us of the dangers and difficulties of retrospective diagnosis, and of the foolishness of assuming that, just because the label “hysteria” has survived across the centuries, its content has remained similarly unchanged. Undoubtedly, some of the people whom seventeenth- and eighteenth-century physicians diagnosed as hysterical would today be seen as suffering from some form of epilepsy, from multiple sclerosis or the effects of tertiary syphilis, or from malignant tumors that manifested themselves in mysterious bodily ailments. But the issue of “mistakes” in the diagnostic process cuts both ways. Still other seventeenth- and eighteenth-century patients, as Sydenham reminds us, were not diagnosed as cases of hysteria, when, in the hands of a different doctor, or at a different time, they most certainly would have been.
In its new “nervous” guise, hysteria (along with the vapors, hypochondria, and the spleen—labels that came to be used more or less interchangeably) incorporated the milder forms of another traditional mental disorder, melancholy. In humoral medicine, the origins of hypochondria had lain in an excess of black bile, which was thought to originate in the spleen. Hence the equivalence of those two terms. The fumes from the excessive bile were thought to ascend to the head, thereby creating cognitive and emotional disarray. More and more, however, these congeries of diseases were set apart from the various forms of Bedlam madness. Whether one looks to the social location of the sufferers, the treatment to be meted out to them, or their prospects of cure, in all these respects “nervous” patients were increasingly regarded very differently from those suffering from other forms of alienation.
Mania, dementia, and the darker forms of melancholia—those disturbances of the psyche that were often collectively referred to as lunacy or insanity—were not just signs of a far more serious complex of disorders, but occupied a different ontological status. Deprived of “the sovereign power of the soul” and the central defining characteristic of the human, Reason, the victims of out-and-out madness were dragged down into a state of brutish insensibility and incapacity. The veneer of civilization was stripped away, replaced by extravagance, incoherence, incomprehensibility, menace, rage, and unpredictable outbreaks of violence that revealed the beast within. In the words of the early eighteenth-century physician Nicholas Robinson, they were “the most gloomy Scene of Nature, that Mankind can possibly encounter … almost debas’d below the brutal Species of the animated Creation.”10 Their ferocity, as Thomas Willis had urged a half century earlier, could be tamed only by a mixture of discipline and depletion, measures designed to put down “the raging of the Spirits and the lifting up of the Soul.” Even still, such creatures were scarcely within the reach of orthodox medical remedies, and instead required forceful, even violent, interventions, measures designed to induce “their reverence or standing in awe of such as they think their Tormentors.” For in truth, “Furious Mad-men are sooner and more certainly cured by punishments and hard usage, in a strait-room, than by Physick or Medicines.”11
Hysteria was different, persistent, but treatable with the standard remedies of antiphlogistic medicine: attention to diet and regimen, regulation of the body’s evacuations, bleedings, purges, and vomits. Its victims, Willis acknowledged, “are healed more often with flatteries, and with more gentle Physick.”12 His efforts, and those of Sydenham, to link the disorder to the nerves had not at first drawn universal approbation or even much attention beyond the ranks of a handful of elite physicians. Katherine Williams’s study of seventeenth-century manuscripts—doctors’ private notebooks as well as the recipes for treating disease put together by womenfolk—has documented the persistence of traditional notions of hysteria’s gynecological origins even as these high-status metropolitan physicians dismissed them as nonsensical. But, in the first third of the new century, among an increasing number of medical men and, at least as significantly, among the affluent classes to whom they sought to minister, the notion of hysteria’s nervous etiology made major inroads.
In professional circles, the appeal of theories of nervousness derived in part from the more general rise in the popularity of applying mechanistic explanations to medical phenomena. Most obviously, this move towards what is often termed “iatromechanical” medicine derived from the general cultural prestige of the new Newtonian science. Accounts pitched in mechanistic terms, and invoking physical laws and processes (or sometimes chemical principles and knowledge), proliferated in the early eighteenth century and became a touchstone for the explanation of all sorts of bodily disorders. Through the efforts of Willis’s and Sydenham’s students and successors, enthusiastically taken up by a lay audience, the new notions of “animal spirits” moving speedily or slowly through the delicate network of tubes or fibres that made up the brain and nervous system soon achieved a wide currency.
Certainly, nerves were not the only possible physical culprit in cases of hysteria and hypochondria. The London physician John Purcell (1674–1730) thought that the underlying problem lay, not in the nervous system, but “in the Stomach and Guts; whereof the Grumbling of the one and the Heaviness and uneasiness of the other generally preceding the Paroxysm, in no small Proofs.” “Vapours” from these regions, rising “up to the Head” produced the characteristic “Hysterick Fits … a Disease which more generally afflicts Humane Kind, than any other whatsoever; and Proteus-like, transforms it self into the shape and representation of almost all distempers …”13 But many of his colleagues preferred to follow their eminent seventeenth-century predecessors and implicate the nervous system. John Pechey’s General Treatise of the Diseases of Maids, Big-Bellied Women, Childbed Women and Widows appeared in 1698, and largely contented itself with paraphrasing Sydenham. Just over a decade later, Bernard Mandeville put related ideas into general circulation, couching his discussion of “the Hypochondriack and Hysterick Passions vulgarly call’d the Hypo in Men and the Vapours in Women” in the form of a dialogue between Philopirio, the doctor, and Misombedon, the father of the patient, a literary device he selfconsciously deployed “by way of [providing] Information to Patients” rather than “to teach other Practitioners.”14 And both the prominent metropolitan physician Sir Richard Blackmore and Nicholas Robinson, one of the governors of London’s oldest madhouse, Bedlam, lent their authority to the cause.
Robinson, probably the most crudely reductionist of the lot, sought to account “mechanically” for all sorts of “Alterations of the Mind.” Whether simple “Lownesses of the Spirits” or outright “Madness, and Lunacy,” the origins of the mental disturbance was to be sought in “Changes in the Motion of the [nervous] Fibres.” Others, he observed scornfully, were “ready to resolve all into Whim, or a wrong Turn of the Fancy.” He emphatically did not share their erroneous views. “I deny,” he insisted, with characteristic truculence,
that all the Thoughts themselves can ever start from a regular Way of Thinking, without inferring, at the same Time, a Change in the Motions of the Animal Fibres … it’s impossible that the Mind can suffer and the Body be unaffected at the same Time … Every Change of the Mind, therefore, indicates a Change in the bodily Organs; nor is it possible for the Wit of Man to conceive how the Mind can, from a chearful, gay Disposition, fall into a sad and disconsolate State, without some Alterations in the Fibres, at the same Time.15
Like others who seek to render mental faculties epiphenomenal (whether in the eighteenth century or now), Robinson was oblivious to the contradiction implicit in his decision to try to persuade others of the rightness of his views, whether by constant reiteration of his position, or by reasoned argument. “It clearly appears,” he kept insisting,
that whenever the Mind perceives itself uneasy, low-spirited, or dejected, it is as full a Demonstration, as the Nature of the Thing will admit, that the Instruments, by which the Mind directs the Powers of its Operations, are affected … While the Nerves … are in good Plight, the Ideas they convey through any of the Senses will be regular, just, and clear; upon which the Understanding will judge and determine of Objects, as they are, but the Laws of Nature … But if the Structure or Mechanism of these Organs happen to be disorder’d, and the Springs of the Machine out of Tune; no Wonder the Mind perceives the Alteration, and is affected with the Change.16
If hysteria was a symptom of a “machine out of tune,” and, more ominously, a disorder that in Robinson’s view differed in degree but not in kind from madness itself, it nonetheless (like its twin hypochondria) was emphatically a genuine disease. All these forms of mental alienation, “from the slightest Symptoms of the Spleen and Vapours, to the most confirm’d Affections of Melancholy Madness and Lunacy … are no imaginary Whims or Fancies, but real Affections of the Mind, arising from the real, mechanical Affections of Matter and Motion, whenever the Constitution of the Brain warps from its natural Standard.” Hence, “compleating a successful Cure” depended upon employing medical remedies, even “Medicines of the Brain, necessary to procure a Freedom from those Affections, the Mind labours under during the Continuance of this Disease.”17 On the central claim that hysteria was a real disease, Robinson was as one with other leading society physicians, even those who adopted a more nuanced view of mind–body interactions and who embraced milder modes of treatment.
Sir Richard Blackmore, for example, who had served as William III’s and Queen Anne’s personal physician, was equally emphatic that hysteria belonged in the medical man’s province, and that it shaded imperceptibly into “Melancholy, Lunacy, and Phrenzy.” Like Sydenham and Willis before him, Blackmore insisted that, though others tried to distinguish them, in essence hysteria and hypochondria were
the same malady … It is true that the convulsive Disorders and Agitations in the various Parts of the Body, as well as the Confusion and Dissipation of the animal Spirits, are more conspicuous and violent in the Female Sex, than in Men; the Reason of which is, a more volatile, dissipable, and weak Constitution of the Spirits, and a more soft, tender, and delicate Texture of the Nerves [among women]; but this proves no Difference in their Nature and essential Properties, but only a higher or lower degree of the symptoms common to both.18
Blackmore acknowledged, however, that “This Disease, called Vapours in Women, and the Spleen in Men, is what neither Sex are pleased to own.” Speaking one suspects from personal experience, he lamented that a physician “cannot ordinarily make his Court [his chances of obtaining fees from a moneyed patient] worse, than by suggesting to such Patients the true Nature and Name of their Distemper.”19 A major reason for the patients’ reluctance to accept the diagnosis was, he was convinced, that those who had never suffered from it dismissed it as a purely imaginary disorder, and hysterics thus felt themselves subject to derision and contempt. But, even if the disease was the product of “fancy” and imagination, the pains they suffered were real and unfeigned. Terrible ideas, all by themselves, could produce pain in both brain and body.
With respect to therapeutics, Sir Richard was one of those who took strong issue with Robinson’s advocacy of “the most violent Vomits, the strongest purging Medicines, and large Bleeding … often repeated” as the appropriate treatment for hysteria.20 Patients suffering from the disease, Blackmore insisted, were often afflicted with great despondency and anxiety, for which the best response was calming prescriptions. It did no good to assault the patient with fearsome and painful remedies. On the contrary, strong purges and the like would only enfeeble the system and ultimately undermine and “demolish” the patient. He should rather be composed and strengthened, and perhaps calmed with opium, thus strengthening his system and restoring him to health.
Save for masochists, and those sad souls convinced that, unless treatments were painful and unpleasant they were unlikely to do much good, such milder prescriptions were probably the more popular among prospective patients, and the need to attract patients was, of course, of paramount importance to all these practitioners. Physicians’ books and treatises, though ostensibly aimed to some extent at their professional brethren, were simultaneously a way of raising their profile among an affluent and educated lay audience, who, for much of the eighteenth century, shared a common set of cultural assumptions about illness and its treatment with their doctors, and expected to play an active role in the encounter with those they regarded (quite correctly by the standards of their time) as their social inferiors. In a period of growing affluence, one that saw the birth of what historians have dubbed the first consumer society, the market for all sorts of consumer goods and services was expanding apace, and, like other entrepreneurs, those who portrayed themselves as the purveyors of health and long life sought every opportunity to expand their customer base. Expanding public awareness of hysteria and related disorders, and laying claim to expertise in managing these illnesses, were obvious strategies for physicians to pursue, promising access to a far more fashionable and desirable clientele than the Bedlam mad. Here, indeed, was an extraordinarily attractive patient population, blessed with excessively refined sensibilities and exquisitely civilized temperaments (not to mention money).
What these medical men may not have fully realized, however, was just how attractive their assertions that hysteria was a physical disease like any other, a genuine disorder of the nerves, would prove to be among the moneyed and the fashionable crowd. Not for the last time in hysteria’s history, it turned out that prospective patients were hungry for reassurance that their pain and suffering were real, just like other forms of illness, and that they deserved the dignity of the sick role, not the opprobrium that accrues to counterfeiters and frauds. (When John Radcliffe had ventured to suggest that his royal patient Queen Anne was suffering from the vapors, which she regarded as suggesting her pains were imaginary or doubtful, she promptly fired him.) So the notion that the rise of “nervous” disorders was simply the invention of the self-interested professionals requires some balance. If the profession was eager, whole segments of the population they sought to serve turned out to be every bit as willing to embrace their new-fangled ideas.
