Ask Me About My Uterus

by Abby Norman

  As anyone who has ever attempted to disprove the leading theory of anything will tell you, this did not go over well. He conceded that although the uterus may not be the seat of hysteria, the ovaries could be push-buttons for whatever neurological malfunction occurred. In an attempt to prove this theory, he devised a machine called an “ovary compressor,” which was just as horrific as it sounds. Demonstrating on patients at the Salpêtrière, the mental asylum in Paris where he worked and did the bulk of his research, he would use the apparatus essentially to squash the ovaries of women in his care. They, of course, reacted in grandiose ways—in part because they were, no doubt, in great physical pain (which would not surprise anyone who has ever had a particularly rough pelvic exam). Some women, aware that hysterics were expected to behave according to a particular narrative, may have (consciously or unconsciously) felt the need to live up to (or even outdo) the behavioral precedent other patients had set.

  Charcot’s device was certainly encouraging the symptoms of hysteria to manifest—but it didn’t explicitly prove that the ovaries were the impetus for them, or that there was even an organic neurological basis for the disease. Throughout his life—and evermore after his death—Charcot was frequently undermined by the rest of the medical establishment. His students took his research and reworked it after he died, claiming it as their own, and often used it to invalidate the theories he had presented.

  Nor did patients remember Charcot very fondly: although he had come the closest of anyone, perhaps, to taking them “seriously,” by suggesting that their symptoms and disease states were real, he hadn’t hesitated to exploit the women in his care. They were an integral component of his famed, if not rather dramatic, series of lectures. Delivered from something of a pulpit adorned with footlights, his demonstrations, which were greatly admired by Freud, featured well-known patients at the Salpêtrière. They could go on for several hours, often drawing the attention of the public, who could come to gape as though they were taking in a circus side show.

  Charcot’s lectures and flagrant exposés may have been among the most entertaining of such demonstrations, but they weren’t the only ones. Social mores of the era almost assured that the patient-physician dynamic be without boundary, and that meant women were vulnerable to exploitation—including sexual—regardless of whether they were “true hysterics” or not. It’s not uncommon to read old patient charts in which sexual relations—consensual or not—between patients and physicians were noted simply as a matter of fact, implying that such a relationship was not thought to violate ethical standards. It helped that, during the mid-nineteenth century, sedation was becoming increasingly popular as a first line of treatment for women for just about anything—particularly ether, which was highly addictive. Women who were in a semiconscious state were obviously particularly vulnerable to physicians who wanted to exploit them.

  The treatment of women by the medical establishment in the early twentieth century is further illuminated by the description of male hysteria, or neurasthenia. Neurasthenia was the kind of diagnosis a doctor might give a man he had known for years when he came in for a bad headache, before offering him a snifter of brandy. Hysteria was the diagnosis that same doctor would give a woman in the village who hadn’t been able to walk for three weeks.

  Male physicians were not the only ones carrying this narrative. The patriarchal structure of medicine informed how female physicians practiced, too—as much, if not more than, it did their male colleagues. At the expense, yet again, of female patients.

  One physician of the era, Mary Putnam Jacobi of New York, bluntly compared male versus female hysteria, saying: “If this be a female, and notably selfish, the case is pronounced hysteria. If a man, or though a woman, amiable and unselfish, the case is called neurasthenia.” Delving further into Jacobi’s writing, one finds that she saw hysteria as a natural consequence of affluent white-lady boredom. Certainly in some cases this was true, just as it is today. There have always been, and there will always be, malingerers. But it’s curious that throughout history, a woman in pain was presumed to be lying. Guilty until proven innocent, as it were.

  Perhaps it was easier for a male doctor—who did not understand the intricacies of the female reproductive system, who could not fathom the feeling of a deep and unrelenting weight in one’s pelvis, threatening to split the person in two—to call the woman a liar than admit he did not know what was wrong. That he did not know how to help her. Perhaps it was that women, who were so severely unchallenged, who were sequestered away with little or nothing in the way of intellectual opportunity, grew so bored that they devised a devilish scheme by which they could bring constant fascination into their lives, drawing attention to themselves. Perhaps they found identity in illness. If so, I’m tempted to applaud them for their creativity, but also find myself angry at their short-sightedness—at what Jacobi called selfishness.

  It was more than likely a combination of these and other psychosocial, cultural factors that created the essence of hysteria, from which not even the most modern of modern women have completely broken free. It lives in all of us, a little cough that makes us question our perceptions of ourselves, the innermost truth of our bodies, our very minds.

  We’ve all done it. We’ve all gone to work with a fever and said, “It’s nothing, just a cold,” when we knew deep down we had the flu. We’ve rationalized having “food poisoning” for weeks as the real culprit digs its heels deeper into our guts. We’ve fainted, vomited, bled, laughed, screamed, and cried—and said, “I’m sorry, I don’t know what came over me,” when we know damn well, deep down, exactly what came over us: a wave of nausea, crushing fatigue, disorienting dizziness. If only we’d listen.

  If only someone on the outside knew the language we speak inside ourselves to keep our pain a secret, to silence our suffering, to find one hundred reasons why we’re fine instead of the one reason that we’re sick.

  WHEN I WAS SEVENTEEN, ONE morning I noticed that I was having a hard time getting my feet to firmly hit the stairs. I grabbed the bannister and laughed it off, thinking I must either not quite be awake or had slept weird and irritated a nerve in my leg. I brushed it off and carried on with my day assuming it would resolve. But the next morning, the same thing happened. Then I started having difficulty using the stairs at school in between classes. Most unnerving, a short time later I began to have trouble feeling my foot on the pedals when I drove. Pretty soon I was hobbling around like an infirm ninety-year-old woman.

  At first I wasn’t that concerned, because it wasn’t unusual for me to experience joint pain when I would get my period. It could get so bad that I wasn’t able to play the piano for a few days, something I did regularly when my metacarpals weren’t on fire. I came in an hour early to school each day just to play in the music room, since moving around as a kid, I didn’t have regular access to a piano. I remember my disappointment at sitting down and discovering that my hands had become a clumsy mess against the keys.

  I continued to ignore my symptoms, assuming I was overtired, or stressed, or perhaps anemic from my heavy periods. It wasn’t until my friends started commenting on the way I was walking that I started to worry—clearly I wasn’t compensating as well as I’d thought. I started having to walk the long way through the halls to class in order to use the accessible ramp, because I couldn’t get up the stairs. The first few times, my friends thought it was funny. After about a week, they began to suggest that I should see a doctor.

  Clearly, I should have been a lot more unsettled by the fact that, over the course of a few months, I had gradually been losing the use of my legs. I found it curious, but not disturbing. I was certain that there was a logical explanation for it; therefore, it caused me no real anxiety. If I didn’t give it the power to frighten me, then it wouldn’t. That’s what I told myself, anyway.

  My regular doctor referred me to a neurologist, and that’s why I dutifully reported to patient registration at the hospital that morning after signing myself
out of school (a privilege that I could have abused as an emancipated minor, but never did). The woman behind the desk eyed me uncertainly and asked where my parent or guardian was, since I was still a minor.

  “I’m legally emancipated,” I mumbled, pulling the tattered copy of my emancipation papers from my bag. “And I have Mainecare,” I added, sliding the card across her desk. This was the state’s Medicaid program, which I’d qualified for after a few rousing trips to the Department of Health and Human Services. I was quickly learning that no one likes Medicaid. Health-care professionals hate it because they get stiffed on payments. Many of them won’t accept it, because they know they’ll be underpaid for their services. Beneficiaries know that they’ll inevitably be denied treatment, shamed for their “reliance on government benefits,” and forced to jump through hoops to get, and keep, their coverage.

  The registrar looked down the bridge of her nose at me, and I wondered if she knew what emancipation even meant.

  “Really,” she said—in the way an adult might feign interest in a child’s nonsensical story when what they really want is a stiff drink—“Well, I still need to call your parents.”

  “No, um. Actually—you don’t,” I sputtered, feeling my face warm at the prospect of being perceived as talking back. “I don’t live with them. I haven’t lived with them for five years. If you call the probate court they’ll fax you a fresh copy of this paperwork if you don’t believe me—”

  She reached for the phone, “You’re a minor, so, we need your parents to—”

  “My birthday is in a week,” I pleaded, attempting to stare her down, “I’ll be eighteen. Please. Don’t call my parents. It’s not legally necessary. I’m not lying.” I felt tears burning my eyes, my heart strangling my throat. I willed myself not to cry, but the panic had set in, and I knew that the torrent would come.

  “Don’t you want your parents to know you’re here?” she asked, completely indifferent to the fact that I’d just told her I hadn’t lived with them in five years.

  “No, you don’t understand—”

  “You’re not a foster kid, are you? Do you have foster parents?”

  “No, I’m emancipated, I’m on my own. I mean, I have someone who kind of looks after me, I guess? Her name is Estelle. She lives a few blocks away. I can give you her number—”

  “Is she your guardian?”

  “No! I’m my own guardian!” I snapped, finally beginning to cry. I was humiliated, and I watched powerlessly as she dialed my parents’ home phone number, which must have been in my record from when I had been brought in for a strep test as a child.

  “We have your daughter Abigail here and we need your consent to treat her,” I heard the woman say, having presumably gotten my mother on the line. It was midmorning, so my dad would have been at work.

  Hot tears ran down my face and I felt my legs begin to shake. It was strangely reassuring, because I hadn’t exactly been feeling them for a few days. Now I could at least feel the sensation of my knee hitting the underside of the registration desk.

  “I see,” the woman said, eyeing me, “Well, thank you.” She hung up the phone, grabbed my emancipation papers, and stood up. “I’ll be right back, I need to make a copy of these.”

  I pulled myself together while she was back at the copier, straightening my spine and drying my eyes on the sleeve of my sweater. My legs continued to quake, and I pressed the palms of my hands hard against my upper thighs to try to stop them.

  The woman returned a few minutes later with my hospital ID bracelet and pointed me toward the lab as though nothing had happened. I thanked her, struggled to stand up, and limped out of the office down the hall.

  The neurologist was completely unfazed by the specifics of my history or my alleged physical condition. I half expected myself that it was all psychological. If I’d learned anything from taking Advanced Placement Psychology the year before as a junior, it was that hysteria often manifested itself with dramatic bouts of paralysis. Maybe the stress of my weird childhood was trying to figure out which part of my body it wanted to live in. I didn’t exactly give this theory to the neurologist, but I prepared myself to hear that it was all in my head.

  He did a brief neurological exam, which was unremarkable except that he found it curious that I struggled to get up from a squatted position. I didn’t disagree; it did feel like a struggle. He harrumphed through the rest of the exam and, doing his due diligence, I suppose, ordered more blood tests and a full-body MRI. Humoring me with a more thorough investigation in no way reassured me that he didn’t think I was hysteric, but I suppose it was a step up from the historical approach of attributing such a diagnosis to a woman willy-nilly. Something I’d been enlightened about in my psych class the previous year, via the usual literature, starting with notable cases like that of Anna O.

  THE CASE OF ANNA O., by Sigmund Freud and his colleague Josef Breuer, is one of the most famous psychological case studies, period—hysteria notwithstanding. While she’s most often associated with Freud’s body of work, she was seen by Breuer, who only conferred with Freud once he found himself unable to help her. “She was deranged,” Breuer said, adding that he hoped she would die to end her suffering. The young woman they’d call Anna when they wrote up her case was twenty-one years old when she met Breuer in 1880. In Studies on Hysteria, on which the two psychiatrists collaborated, Anna is described as being remarkably intelligent, if not gifted, as well as kind and highly empathetic. She was, they said, capable of rational thought, and not suggestible in the least—although she did have an “astonishingly underdeveloped” sexuality. Anna, the men wrote, was “bubbling over with intellectual vitality,” but leading an extremely boring life, one that was primarily devoted to caring for her ill father. Anna’s own illness was presumed to be a manifestation of her anxieties, thwarted potential, and stifled sexuality. She told stories of her life—which were really stories of herself—to Breuer in the form of talk therapy, which at the time was dubbed the “talking cure.”

  Despite the initial grim prognosis, Anna O.—whose real name was Bertha Pappenheim—made a full recovery, having committed to this kind of emotional work. Whether she was working through past traumas or current anxieties, her physical and mental symptoms resolved once attention was paid to them. She went on to have a very successful career as a social worker, becoming the founder of the Jewish Women’s Association.

  It’s no wonder that she became a textbook case: her diagnosis was fairly straightforward and responded to treatment. She either didn’t have any underlying comorbidities, or if she did, they weren’t significant enough to complicate her course. The use of psychodynamic therapy, such as the talking cure, would be complex enough, given every patient’s unique emotional experiences and perspectives; add in physical pathologies (known and unknown), and it becomes a much more complex task. And that initial focus on the emotional state, or the preference for ascribing a psychiatric explanation to a physical presentation, may well lead to a misdiagnosis.

  In 1962, when she was seventeen years old, two notable things happened to Karen Armstrong: she joined a convent, and she began having fainting spells. In her book The Spiral Staircase, she eloquently discusses her emotional and spiritual journey, but also gives vital weight to the concurrent physical maladies that plagued her. The spells that she had were not just peculiar and alarming, but embarrassing. The nuns in the convent often told her she needed to pull herself together, or accused her of being melodramatic. She even recalled entertaining the assumption herself as she attempted to come up with an explanation for the bizarre symptoms: “I assumed that even though I might not be feeling especially upset, I was displaying some subconscious need for notice, love, or intimacy. The blackouts, I concluded, must be a bid for attention.”

  No one so much as suggested she visit the infirmary, let alone see a doctor. She was assumed, by others, even eventually by herself, to be weak-willed—or malevolently manipulative—for years before anyone gave credence to the
idea that she might be ill. She eventually left the convent. Had she—like Anna O. before her—been experiencing her “fits” as a result of feeling stifled by her environment, you’d think her spells would have ended. They did not, and in fact, they had been progressively worsening. Her doctor suggested that her anxiety, as he perceived her condition, needed to be treated through psychoanalysis, which she diligently undertook, although she had doubts: “I would be overtaken by a queasy sense of déjà vu. This was exactly the sort of reasoning that I had used in the convent, and look where it had got me.”

  It had been nearly a decade since she’d joined the convent and begun experiencing the fainting spells, the progressively worsening blackouts, and lost time. And she had, in fact, lost a lot of time. Years of her young life, nearly her entire twenties, were marred by the symptoms and the fruitless quest to explain them, let alone cure them. Then, one day nearly fifteen years after that quest had begun, she ended up in the emergency room after a particularly bad spell. When she woke up, she was told she’d had a grand mal seizure, and was referred to a neurologist at once.

  She regaled the neurologist with the story of her years of symptoms, and he asked her why she had not gone to a doctor about them, when they were clearly so troubling and serious. Oh, but she had, she said. She explained to him that she’d been seeing doctors for years. The doctor was stunned into what she called a “devastating quiet” before asking her if any of them, when she had told them of these symptoms (which he felt were demonstrative of a “textbook case” of temporal lobe epilepsy), had ever suggested she have an electroencephalogram (EEG) of her brain.