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Stuck in Era of Hysteria

kkazan's picture

             For all that Alice James knew she was crazy. At least that’s what her doctors, and the society at the time, told her. In the Victorian era, hysteria was a common diagnosis for women who had chronic pain that had many variables. As can be seen through her diary, Alice spent most of the second half of her life in bed, a common treatment for women with hysteria. At her time, hysteria was a disorder that only women had, as it was considered a womb disorder, with the common symptom of causing trouble; almost any disease could fit the symptoms of hysteria, there being no definite list of symptoms. It’s no wonder that Alice James had such a diagnosis.

            It is visible throughout her diary: Alice did not conform to society’s expectations of women of the time. She was a witty, ironic, satirical, and intelligent; things that women in the Victorian era were allowed to be. One can tell from her writing that she was not the average subservient woman of the times. In Alice’s entry on June 2, 1890, she writes, “How extraordinary it is to see that wittiest and most infinitely perceptive of races, individually surrendering itself to a Colossal Vanity, that quality from which springs all the grotesque in life!” Alice was of course jesting, criticizing the comments of on of Henry’s friends. Not only did she degrade he human race and criticized a respected man’s opinion, but Alice, a woman, claimed herself smarter than Henry’s friend, Bourget. For this act alone, Alice could have been deemed a hysteric, yet this is no isolated state of mind for Alice, nor is it her only ‘symptom’.

            It was thought that the modern life lived in such modern times created hysteria in women. It was the pace of life that caused women such anxiety, a key symptom of hysteria. From Alice’s own pen we see that Alice, from the age of 19, often “had violent turns of hysteria” or what we would call anxiety attacks. (Oct. 26, 1890) One the same day, Alice states that she had “physical weakness, excess of nervous susceptibility….” In other words, as reiterated by her physician on the date of her fatal diagnosis, “the most distressing case of nervous hyperesthesia.” So, along with being too intelligent to fit into her role of a woman, Alice was also a nervous being. No wonder she thought her herself hysterical. She had two very telling symptoms that could only lead to one diagnosis.

            Alice also, more than once mentions her gout. She would have had intense stomach pain, swelling and discoloration of the joints, and a fever. (WebMD) While Alice rarely wrote of her physical symptoms or chronic illness, she does mention her “usual attacks of rheumatic gout.” (July 18, 1890) Though it seems that her doctors correctly diagnosed her gout, they may not have fully understood why she had it and had no treatment for it. It was known that gout was a result of a previous illness. Though Alice writes of her gout, and her physician is aware of it, the symptoms of gout coincide nicely with the symptoms of hysteria. Many women were diagnosed with hysteria if they had pelvic or stomach pain.

             Interestingly enough, Alice only wrote about treating hysteria in one way: bed rest. While this was a common practice, it was not the most popular way to treat hysteria (although it was not treatable at all as it was a chronic illness). Thought a womb illness, it was thought that hysteria resulted from a woman having pent up fluids inside her body; in other words women were thought to have hysteria as a result of not having sex often enough. Because of this belief, the most common treatment was to give a woman an orgasm, by either pelvic massages, or earlier prototypes of a vibrator. As Alice was in a Boston marriage with Katherine Peabody Loring, and hence was considered a virgin, it is surprising that she never underwent any other treatment than bed rest.

            While hysteria was the go to diagnosis for women’s illnesses in the 19th century, the diagnosis fell out of popularity and it is no longer considered an illness. Freud reclassified the illness as conversion disorder, anxiety attacks and schizophrenia. If Alice were to be examined today by a physician, her diagnosis and treatment would be quite different.

            Looking at Alice’s diary, there are hints as to what Alice’s symptoms were. Although she admitted to not wanting “to rehearse herein her physical collapses in detail,” (July 18, 1890) some of her symptoms are evident from the text. To start with, Alice had the physical symptoms of gout, as can be inferred from her stating that she had gout, still a respectable diagnosis today. It can then be known that Alice suffered from intense stomachaches and joint pains that would be most prevalent at night. While these are symptoms of gout, they are also symptoms of rheumatoid arthritis and osteoarthritis, although doctors in the Victorian era would have a hard time discerning which illness Alice had, and, as Alice’s diary is the only catalogue of her symptoms, she cannot receive a better diagnosis today.

            If we step back from the gout, we know that some of Alice’s symptoms of her so called hysteria were “physical weakness, excess of nervous susceptibility.” She also wrote that her muscles “refused to maintain muscular sanity,” and that “violent inclinations suddenly” invaded her muscles. (Oct. 26, 1890) Alice was “a victim to many pains.” (May 31, 1891) It is known now that these symptoms are the result of many diseases today. For one, it seems clear that Alice suffered from panic attacks and muscular spasms. Also, it was probably true that Alice was depressed for most of her life, as can be ensued by her thoughts of suicide, lack of life, and her weakness. Depression can even cause horrible stomachaches.

            One option, which was not known about in Alice’s days, is endometriosis. A gynecological disease, endometriosis causes abdominal and back pain, irregular menstruation, and gastrointestinal distress. These overlap with an underlying mental illness like depression or schizophrenia. Dr. Nancy Hendrick, says that women who have an early onset, such as Alice had, have more severe cases than those that develop endometriosis later on in life. She also believes that endometriosis can bring on autoimmune disorders that could describe Alice’s joint pains and swelling. Dr. Hendrick’s diagnosis seems to fit perfectly with Alice’s symptoms, and even explains the fact that she had episodes, as the symptoms become worse around the menstruation cycle.

It is also possible that Alice suffered from musculoskeletal pain, which would cause fatigue, pain, and sleep disturbances. Like Alice, it is said that Henry suffered episode of pain that sent him to his bed. Dr. Hendrick believes that he too might have had musculoskeletal pain, which can run in families.  

Unfortunately Alice’s physicians knew none of this, so she was labeled a hysteric.



            On behalf of Alice James, I used the all-amazing WebMD to find all of the diagnosis that I suggested Alice might have had. I took the symptoms mentioned in her diary and plugged them into the online self-diagnosis, which in turn gave me all the possible diseases that fit the symptoms. I also used WebMD to find all the symptoms associated with such illnesses.

            Other Sources: “Alice James and Endometriosis” by Nancy Hedrick, M.S.W., L.C.S.W. Found at:


Maines, Rachel P. (1998). The Technology of Orgasm: "Hysteria", the Vibrator, and Women's Sexual Satisfaction. Baltimore: The Johns Hopkins University Press.


Morantz, Regina M.; Zschoche, Sue (1980). "Professionalism, Feminism, and Gender Roles: A Comparative Study of Nineteenth-Century Medical Therapeutics". The Journal of American History 67 (3): 568–88.


Anne Dalke's picture

"Too intelligent to be a woman"

Let me flag, first, some of the technical bits you need to attend to more carefully, if you are going to be writing on the internet. Look first @ formatting (the size and consistency of the font you choose). If you cut and past from Word, you'll need to correct for formatting instructions that might show up in your posts (can you fix those that appear there now?). And what about using a strong image to draw in your reader, to make her want to know what she is looking @..?  "Hysteria" lends itself easily to such depictions:

You are certainly taking full advantage of some of the opportunities offered on the internet, however, in your decision to use "the all-amazing WebMD to find all of the diagnosis that Alice might have had." It's fascinating to me to imagine how different her life might have been, had her doctors been able to identify her symptoms, as you do, as those of  rheumatoid arthritis, osteoarthritis, endometriosis, autoimmune disorders, musculoskeletal pain...

But! -- when you say that it's "unfortunate" that, since Alice’s physicians knew none of this, she was labeled a hysteric, I wonder. One of the effects of your essay, for me, has been the way it has highlighted the context and era-specific nature of the diseases we recognize (ask Marina to tell you, for example, what she's learning in her cultural psychology course about area-specific diseases). when you say, for example, that Freud reclassified hysteria as "conversion disorder, anxiety attacks and schizophrenia," I can only shudder, and want to her those classifications unpacked in detail!

Your historical facts also need some checking. Although, as you say, she rarely writes of her own physical symptoms, Alice James actually underwent quite a range of treatments, and her diary is not the only catalogue of her symptoms available to us today. And I would not say that "For all that Alice James knew she was crazy."I think she knew that she was not, knew quite well what was going on, though her doctors may not have. 

You have woven a number of other very striking passages in and out of your essay: especially vivid is James's own claim that her muscles “refused to maintain muscular sanity " (what a conflation of mental and physical!). But no more striking than your notion that Alice James may have simply been "too intelligent to be a woman" in 19th century America. Whoosh!

P.S. Don't miss the interestingly related essay in today's NYTimes re: Revising Book on Disorders of the Mind.