American Journal of Clinical Hypnosis

ISSN: 0002-9157 (Print) 2160-0562 (Online) Journal homepage: http://www.tandfonline.com/loi/ujhy20

Micale, Mark S. (1995). Approaching Hysteria:

Disease and its Interpretations. Princeton, NJ:
Princeton University Press, xii + 327 Pages, $29.95
(Cloth)

John F. Kihlstrom PhD

To cite this article: John F. Kihlstrom PhD (1999) Micale, Mark S. (1995). Approaching
Hysteria: Disease and its Interpretations. Princeton, NJ: Princeton University Press, xii
+ 327 Pages, $29.95 (Cloth), American Journal of Clinical Hypnosis, 41:4, 336-338, DOI:
10.1080/00029157.1999.10404234

To link to this article: http://dx.doi.org/10.1080/00029157.1999.10404234

Published online: 21 Sep 2011.

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 American Journal of Clinical Hypnosis Copyright 1999 by the American Society of Clinical Hypnosis
41:4. April 1999

Book Reviews
Associate Editor:
Etzel Cardeiia

Micale, Mark S. (Ed.). (1993). Beyond the unconscious: Essays ofHenri

F. Ellenberger in the history of psychiatry. Princeton, NJ: Princeton
University Press, 416 pages, $49.50 (cloth)
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Micale, Mark S. (1995). Approaching hysteria: Disease and its

interpretations. Princeton, NJ: Princeton University Press, xii + 327
pages, $29.95 (cloth)
Reviewed by: John F. Kihlstrom, PhD, University of California, Berkeley
Henri F. Ellenberger's monumental treatise, The Discovery ofthe Unconscious: The History
and Evolution of Dynamic Psychiatry changed forever our understanding of the origins of
psychogenic theories of psychopathology and of psychological, as opposed to physical and
biological, treatments for mental illness. For clinicians and researchers interested in hypnosis,
Ellenberger's book holds a special place because, in his view, the discovery of the
unconscious, the notion of psychogenesis and the development of the talking cure all began
with Franz Anton Mesmer. Then, they continued with the Marquis de Puysegur, the Abbe
Faria, and, later, with Elliotson, Braid, and Bramwell, and culminated in the studies of
hypnosis and hysteria of Charcot, Janet, and Freud, and the rival program of suggestive
therapeutics promoted by Liebeault and Bernheim. Ellenberger makes clear that the
mesmerists, magnetizers, and hypnotists of the late 18th to late 19th centuries were not
charlatans, as was commonly supposed (and remains commonly supposed today). Rather,
this body of practice, research, and teaching represented the first school of dynamic
psychiatry, a point of view that argued for a psychogenic view of mental illness emphasizing
the interplay between conscious and unconscious mental processes. The first dynamic
psychiatry, in turn, laid the foundation for a new dynamic psychiatry, and the rival therapeutic
schools of Janet, Freud, Adler, and Jung. Ellenberger makes clear that without hypnosis,
our understanding and treatment of mental illness would have developed very differently.

Most hypnosis researchers and practitioners know of Ellenberger's book, but they will be
unfamiliar with the rest of his scholarly output. In Beyond the Unconscious, Mark Micale,
a professor of history at the University of Suffolk (UK) and a student of Ellenberger's, has
collected more than a dozen essays by him on various aspects of the history of mental
science. Part One, on Freud and early psychoanalysis, contains papers on Gustav Fechner,
Moritz Benedikt, and a critical study of Freud's groundbreaking lecture on male hysteria.
Part Two has accounts of Charcot, Janet, Rorschach, and the development of dynamic
psychiatry in Switzerland. Part Three, on "The Great Patients," reflects on Freud's seminal
cases of Anna O. and Emmy von N., and Jung's case of Helene Preiswerk. There is also a
discussion of how the preference of early theorists' both for self-analysis and the treatment
of hysterical women (Freud comes to mind here) led to distortions in clinical theories of

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psychopathology. Part Four, on "Themes in the History of Psychiatric Ideas," has essays
on the fallacies of psychiatric classification, the notion of the creative illness, and the concept
of pathogenic secret and healing by confession. This last essay is especially pertinent in
light of the contemporary debate over recovered memory therapy. These essays are bracketed
by a precis and analysis, by Micale, of The Discovery of the Unconscious, and a complete
bibliography of Ellenberger's writings on the history of psychiatry.

Hypnosis was a major player in the development of dynamic psychiatry, but, as The Discovery
of the Unconscious makes clear, it was not the sole player. Hysteria played an equal role:
the chameleon-like nature of the condition, and the marked suggestibility of hysterical
patients, underscored the importance of such psychological factors as perception, memory,
imagination, and belief. In Approaching Hysteria, Micale provides a historiography of
hysteria: not a history of the syndrome, but rather an analysis of how hysteria has been
understood by past and present historians of science, medicine, and intellectual history,
scholars of the arts and humanities, neurologists and neuroscientists, and mental-health
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professionals. He also discusses the "cultures" of hysteria - how hysteria has been used as
a metaphor and figure of speech in non-medical contexts, including the arts, literature and
politics.

There are amazing discoveries in what Micale calls the "new hysteria studies" conducted in
the quarter century since the appearance of lise Veith's Hysteria: The History ofa Disease.
To begin with, and contrary to widespread belief, hysteria does not, in fact, occur as a
disease category in ancient Hippocratic texts, and the syndrome as it was known to Charcot,
Janet and Freud was first described in the 17th century. Moreover, in these earliest
descriptions, hysteria was not a disease of the middle class, nor was it even a disease of
women. One of the major contributions of Micale's work is to help us to understand the
role that social construction plays in the determination of disease entities, from the beginning
of Enlightenment medicine right up to the most recent revision of the Diagnostic and
Statistical Manualfor Mental Disorders (DSM-IV).

Inthe second part of his book, Micale turns from medical history to cultural history, discussing
the ways in which hysteria has served as a metaphor for something else. Inspired by Susan
Sontag's Illness as Metaphor, Micale shows how the idea of hysteria has attained a place in
popular imagination and culture, from King Lear (who complains of globus hystericus) to
Camile Paglia. Interestingly, Micale shows that cultural portrayals of hysteria are not just
an importation from medicine. For example, Flaubert's literary depiction of mental illness
in Madame Bovary, coupled with Baudelaire's review of the novel, influenced the way
hysteria was characterized by 19th century French medical authorities.

Just as Ellenberger completely revamped the history of psychiatry that previous generations
learned from Gregory Zilboorg and George Henry's History of Medical Psychiatry, so
Micale has completely revamped the history of hysteria that we all learned from Vieth.
Approaching Hysteria changes what we know about hysteria by summarizing the results of
the most recent scholarship, but it also changes how we think about hysteria. And we need
to continue thinking about hysteria despite the unease the word creates because it is still
with us today, not just in the conversion and dissociative disorders, but also in somatization,
personality and post-traumatic stress disorders, and probably lots of other places. To those
who object to the term, Pierre Janet offered an appropriate response more than a century
ago:

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 Book Reviews

The word "hysteria" should be preserved, although its primitive meaning

has much changed. It would be very difficult to modify it nowadays, and,
truly, it has so grand and so beautiful a history that it would be painful to
give it up. However, since every epoch has given to it a different meaning,
let us try to find out what meaning it has today.

Micale offers this quote as the epigram for his book. As we seek to understand what meaning
hysteria will have for us in the 21st century, Approaching Hysteria is essential reading.

References

Ellenberger, H. F. (1970). The discovery of the unconscious: The history and evolution of
dynamic psychiatry. New York: Basic Books.

Sontag, S. (1978). Illness as metaphor. New York: Penguin.

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Veith, I. (1965). Hysteria: The history ofa disease. Chicago: University of Chicago Press.

Zilboorg, G., & Henry, G. (1941). History of medical psychiatry. New York: Norton

Spiegel, David (Ed.). (1997). Repressed memories. (Section II of American

Psychiatric Press Review of Psychiatry, Volume 16) . Washington, DC:
American Psychiatric Press, 173 pages, $25.00 (paper), no index
Reviewed by: Chris Courtois, PhD, The Psychiatric Institute of
Washington, Washington, DC
David Spiegel, editor of Repressed Memories, is to be commended for his even-handed
approach to this section of the Review ofPsychiatry. This approach is evident in the choice
of authors for the five chapters that make up this section and in his comments in the
introduction and afterword. All of the authors, whatever their background, acknowledge
and decry the contentiousness of the recovered/false memory controversy and each, in his
or her own way, argues for a more tempered position and collaboration on the part of
researchers and clinicians, whatever their perspective or orientation. To this end, although
the different traditions and epistemologies between clinical and experimental/cognitive
researchers are explicitly acknowledged throughout this volume, an effort is made in each
chapter to find or suggest some common ground between the most divergent of the positions
and politics in the controversy. Data derived from the consulting room and the laboratory
are reviewed and efforts made to show where they cross-reference and might cross-fertilize
in future research efforts. They are also discussed as they relate to reasoned clinical practice.

Throughout this volume, researchers and clinicians alike are reminded that the study of
repressed traumatic memories is relatively new. They are cautioned about overextending
and over-generalizing their data, and are encouraged to maintain a flexible enough position
to allow for new research findings and new interpretations. Each of the chapters is described
below to provide the reader with an overview of the diverse material covered in this volume
but also to highlight areas of commonality and shared perspective among the authors.

In the first chapter, "Trauma and Memory," Butler and Spiegel address two broad areas: the
effects of traumatic experience on memory and the use of laboratory findings of memory
alteration and implantation as a model to explain recovered memories. They first point out
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