This essay argues that mainstream psychiatrists and physicians between 1860 to 1900 conceptualised Black women (both those inside and outside psychiatric asylums) as too culturally and physiologically deficient to become hysterical.[1] It examines the racialisation of hysteria, and interrogates how psychiatric theory shaped unequal and segregated care in psychiatric institutions. Hysteria was a term used predominantly by psychiatrists (but also gynecologists, general physicians, and journalists) to describe a form of psychoneurosis defined by symptoms of emotional excitability, irrationally and an “excessive display” of emotions.[2] Over the course of the nineteenth century the usage of hysteria sharply increased coinciding with the medicalisation, and institutionalisation of nervous and hysterical disorders, and the crisis of middle- and upper-class women’s role in the home.[3] As a diagnostic category hysteria did not have strict regulations and contours; George Beard wrote a seventy-five-page entry listing symptoms and displays of hysteria, only to describe it as incomplete.[4] Despite the expansiveness of its associated symptoms, hysteria’s exclusivity resided in the racialisation and gender of the bodies who were seen as “capable” of experiencing the neurosis.[5]
Indeed, physicians in psychiatric institutions rarely diagnosed Black women with hysteria. Diana Louis’s work on the Georgia Lunatic asylum observes that its most frequent diagnoses of Black women were “lunatic,” “idiot” or “epileptic,” not hysterical.[6] Significantly, the few ledger entries that did record Black women as hysterical were always accompanied with the modifier ‘violent.’[7] Whilst psychiatrists increasingly broadened the concept of insanity in the 1860s, proposing new definitions that included diseases of the emotions,[8] these developments exclusively served White patients. Indeed, the psychiatric language of diagnosis around Black patients’ neuroses became a re-iteration of the same causal assessment —that freedom was making Black people insane.[9] This narrative had a double function— firstly, it justified the increasing psychiatric incarceration of Black patients as a paternalistic instinct.[10] Secondly, it provided a justification of segregation—the inference being that different mental diseases required varying psychiatric solutions. Superintendents in southern asylums profited off the racialisation of hysteria, presenting unequal distributions of labour and care as a matter of medical strategy.[11]
The psychiatric narrative that associated Whiteness with hysteria converged with the claim that African Americans had become increasingly susceptible to insanity after slavery.[12] Psychiatrists oriented their discussion of African American insanity around its etiology, rather than the particularities of its symptoms. Indeed, Kristi Simon understands this as a residual after-effect of the antebellum period were ‘physicians rarely diagnosed slaves with a specific mental disease.’[13]Samuel Cartwright’s 1851 diagnosis of African Americans with two new mental disorders, “Drapetomania”[14] and “Dysaethesia Ethiopica” remained popular until the turn of the century.[15] Drapetomonia was understood as a “disease of the mind”[16] that encouraged enslaved people to run away. He described “Dysaethesia Ethiopica” as harder to cure, and attributed the disease to free Black people who he asserted were unable to function without enslavers.[17] Cartwright argued that this disease was caused by the absence of White enslavers. He suggested they should return to hard labour as a remedy. Whilst hysteria was presented as a complex, multi-casual neuroses, insanity amongst African Americans was understood as embedded in the subject of their freedom.[18]
Current historiographical framing has not systematically accounted for, or attempted to understand the moments when Black women were diagnosed as hysterical. For example, Laura Brigg’s essay ‘The Race of Hysteria’ (2000) predominantly focuses on the way in which the concept of overcivilisation constructed Black women as ontologically separate from hysteria.[19] Whilst Briggs account persuasively connects the physiological and psychological understanding of Black women as more robust than White women, she does not attend to the ways in which Black women were diagnosed in psychiatric settings.[20] This essays attempts to extend Briggs argument by considering how psychiatric theory shaped the implementation of psychiatric care. This methodological decision attempts to reconcile two things—that psychiatric theory justified and influenced the racialisation of care, and that the archives become more fragmented as we attempt to focus, and understand the implementation of care. Indeed, African Americans’ presence in psychiatric institutions and private practices is difficult to trace. Peter McCandless argues that in the case of the South Carolina Lunatic Asylum ‘as the population became more numerous, poorer, and blacker […] case records generally became far more perfunctory.’[21] The archive provides us with glimpses into how racialized psychiatric diagnoses mapped onto differences in psychiatric care, and consequently African American’s experience of their own neuroses.[22]
Whiteness as a prerequisite for Hysteria
This section argues that psychiatric disciplines reproduced, and borrowed from anthropological narratives of overcivilisation in order to conflate hysteria and Whiteness. In Manliness and Civilisation (1995) Gail Bederman offers a useful description of the racial claims that were at stake in the nineteenth century concept of civilisation. She succinctly argues that:
Civilization denoted a precise stage in human racial evolution—the one following the more primitive stages of “savagery” and “barbarism.” Human races were assumed to evolve from simple savagery, through violent barbarism, to advanced and valuable civilization. But only white races had, as yet evolved to the civilized stage. In fact, people sometimes spoke of civilization as if it were itself a racial trait.[23]
Although civilisation was an exclusive social category, it also presented a crisis. Physicians frequently cited the conditions of civilisation as making civilised women susceptible to hysterical outbreaks.[24] Indeed, the gynecologist Henry W. Streeter neatly distilled this belief when he wrote ‘from the cradle to the grave, every habit of the civilised woman as a class tends to debility.’[25] By contrast, these physicians typically represented Black women as physically strong, aggressive, and too under-civilised to experience hysteria.[26] Relevant here is Hortense Spillers seminal essay ‘Mama's Baby, Papa's Maybe: An American Grammar Book’ (1987) which argues that under transatlantic chattel slavery Black women were ‘Essentially ejected from “The Female Body in Western Culture.’[27] This ejection persisted in the concept of overcivilisation and the highly-gendered and racilised psychiatric category of hysteria.
Interestingly, the line between culture and female anatomy was not a particularly neat one, with physicians arguing that evidence of the former could be observed in the latter. For example, physician Robert T. Morris’ ‘Is Evolution Trying to do away with the Clitoris?’ (1892) insisted that the trajectories of biological evolution were compatible with the discourse on cultural evolution. He argued that ‘This condition [the apparent loss of the clitoris] very evidently represents a degenerative process that goes with higher civilisation.’[28] His work was in dialogue with narratives of biological racial difference supplemented by anatomical measurements.[29] In explaining the loss of White women’s sexual impulses as a product of overcivilisation and as a symptom of their evolving genitalia, he mapped the coordinates of cultural evolution onto the anatomical logic of White women’s bodies.[30] Morris then argued that the “savage” women’s capacity for physical labour differentiated them, both physically and psychologically, from their White counterparts. Introducing the example of a typical native Irish woman’s workday, he argued the work would have ‘sent a fragile girl into a madhouse.’[31] Through rendering the category of un-civilised women as better able to withstand physical and mental pressure, he presented them as the ideal labouring class.
Morris’ concerns about biological evolution and overcivilisation were thoroughly embedded in the major psychiatric debates of the last quarter of the nineteenth century. Theophilus Powell, who became superintendent of the Georgia Lunatic Asylum in 1879 published prolific amounts of work which repeatedly framed African American emancipation as a potential health epidemic.[32] In ‘The Increase of Insanity and Tuberculosis in the Southern Negro since 1860, and its alliance, and some supposed causes’ (1861) Powell claimed that in 1860 there were only forty-four insane African Americans in the entirety of Georgia.[33] Using anecdotal evidence of conversations with doctors Powell attempted to create the impression that his opinion was part of a broader consensus. Additionally, he drew on ethnology to argue that although rates of insanity were increasing amongst Black people, their place in the human racial evolutionary category prevented them from more complex conditions of ‘brain tension or mental anxiety.’[34] Segregation was framed by Powell as a matter of both mental hygiene, and White paternalism. Indeed, Powell’s conclusion asserted that “civilisation” and its associated illnesses were dangerous to African Americans.
Archival evidence from medical journals, and newspapers in the period demonstrate that there was more debate about civilisation and hysteria, than Morris and Powell were willing to engage in, or accommodate. In 1893, two almost identical critiques of the connection between nervous disease and civilisation appeared in The Daily Picuyane (January) and The Phrenological Journal and Science of Health (April). They are so similar that we can assume that they were written by the same author. Both argue that there was actually no evidence that “savages” were not hysterical, and indeed that there were ‘reliable travellers who say that violent and even epidemic nervous disorders are very common among uncivilised people.’[35] These physicians who included Black people in the category of hysteria were not performing an ideologically liberal move to affirm the complexity of Black patients’ interior lives. Rather, they were attempting to preserve the structural and moral integrity of civilisation through citing “savage” displays of hysteria.
Psychiatrists diagnosing hysteria appear to have required much more evidence, and more extreme cases, to justify diagnosing a Black woman with hysteria. Crucially, when psychiatrists diagnosed Black patients with hysteria, they almost always framed their diagnoses in comparative terms and described them as more violent, religious, ritualistic, and less feminine.[36] In The Detroit Free Press an article on ‘Negro Shouting’ in 1883 described the scene of a Black woman’s ‘genuine hysteria.’[37] The extremity of the scene here confirms the authenticity of her hysteria. The journalist wrote that ‘by a series of convulsions, leaps, [and] raising [herself] high upward and [then] pulling herself down with a movement so swift she actually seemed a shadow in the air.’[38] They believed that her ‘awful energy’[39] showed greater physical strength than any man, and was generated by a ‘real morbid ecstasy.’[40] Frailty and femininity associated with White women’s symptoms of hysteria, were replaced with physical strength akin to masculinity, and religious perversion. Even when “inside” the category of hysteria, Black women were outside the category of femininity and civilisation.[41] As will be argued in the second part of this essay, this contributed to the arguments for, and distribution of, racialised division of cares within psychiatric institutions.
Segregating Diagnoses and Care
This section argues that psychiatrists’ attitudes towards both the definition and treatment of hysteria was always mediated by race. Indeed, the administration of treatment and moral therapy in Southern asylums and private practices was structured around race as much as, and sometimes more than, actual psychological diagnoses.[42] This section investigates the resultant dialectic of segregation—that improving the quality of care for White patients was often contingent on worsening conditions for Black patients.[43] In the case of the South Carolina Lunatic Asylum, it is highly evident that the expectations of care Black women could expect to receive— and the length of time they would be psychiatrically incarcerated for—were vastly different from their White counterparts. Dr. James Babcock, the superintendent from 1891 to 1914, retrospectively declared that:
I honestly admit that I have paid more attention to the white women here than to any other department, but at the same time I do not mean to apologize for it . . . I think they were entitled to the best we had.[44]
The belief that mentally ill White women were inherently worthy of attention, care, and resources shaped the distribution of resources in southern asylums.[45] Babcock’s sentiment here hinges on the word ‘entitled,’ Whiteness itself ensured an approved standard of care and empathy.
Psychiatrists, both inside and outside asylums, were consistently resistant to diagnosing Black women with hysteria, even when symptoms constructed a persuasive case for hysteria. In S. Weir Mitchell’s clinical lecture ‘The True and Falsie Palsies of Hysteria’ (1880) Mitchell wrestled with an irrefutable and debilitating case of hysteria, which troubled the neuroses prerequisite of whiteness. Mitchell’s lecture detailed three cases of hysteria in his private practice— Mrs B, (a twenty-year-old “dark skinned rosy looking girl without the least turn to tears or undue emotions”[46]) Mrs L and Mrs C (who were both White). Mitchell presented Mrs B’s severe physical symptoms as disproportionate to her emotional regulation. Weir described Mrs B as being physically disabled by her hysteria— she was both unable to walk (Weir has to teach her to “creep”) and mute for twelve months. Yet, Weir presented the psychological manifestations of her hysteria as manageable, making her case exceptional by clearly demarcating the somatic and the psychological. He wrote ‘I should only have said that her manner was quick and excitable. She certainly had none of the usual furtive look and small defectiveness of a hysterical girl.’[47] His framing of ‘I should only have said’ sets up her physiological condition as so normal that it is hardly worth mentioning. Although Mrs B was diagnosed with hysteria, Mitchell made every effort to present it as a rare case, that was not psychologically complex. He did not offer Mrs B the same treatment he offered Mrs L and Mrs C— a detailed examination of their history and trauma.[48] Rather than refusing to diagnose her with hysteria at all, Mitchell diagnosed her, but continually modified his description in order to stress that Mrs B was physically, rather than mentally inhibited by the neurosis.
Whilst specialised care was being developed for White women in asylums, Black women were seen as belonging to another psychiatric category, and were relegated to alternative space. The racialisation of care in Southern asylums can be clearly discerned in viewing photographs from the ‘Annual Report of the Georgia Lunatic Asylum’ between 1895-1896. Whilst superintendent Powell claimed that treatment for White and Black patients were identical, these photographs provide an immediate rebuttal to this claim.[49] Indeed, Figure Three captures a private alcove that was designed for the exclusive use of White women. The image shows a partially filled space that was decorated with paintings, curtains, and centred around a table with flowers. This is particularly striking because as Diana Louis argues, Black women at the GLA were forced to inhabit overcrowded spaces that replicated antebellum quarters for the enslaved.[50] Furthermore, the White women photographed were not dressed in patient uniform, or work clothes. The space they inhabited, and the clothes they wore allowed the asylum to frame them as temporarily outside of respectable society. By contrast, Black women at the GLA did not even have consistent access to sanitary products, or feminine wear. From the outset, the space of the asylum was rendered an exclusively custodial institution for African Americas. As Louis puts it:
The conditions of the asylum, including familial separation, excessive labor, white hostility, poor provisions, health risks, and racial hostility, simultaneously echoed the horrors of enslavement and exacerbated post-emancipation challenges to Black health and citizenship.[51]
Black female patients had the highest mortality rates in asylums at the turn of the century[52]—and this was a direct result of inadequate facilities, hygienic care, and likely, over exhaustion from extensive work.
Treatment and moral therapy were entirely structured by race: White women were encouraged to conduct gentle tasks ranging from gardening, sewing, and socialising. They had access to segregated spaces that attempted to replicate the ambiance and familiarity of their own homes. However, the asylum was not a refuge for African American women who were sent there; it was a custodial institution. The asylum was structured in way that made the possibility of Black women resting impossible. Black patients’ labour was productive for the asylums, and their increasing presence and illness became ideologically useful to physicians asserting the perpetual dependency of Black people.
Scarlett Croft has recently completed an MA in African American Studies at Columbia University.
Notes:
[1] Laura Briggs, “The Race of Hysteria: ‘Overcivilization’ and the ‘Savage’ Woman in Late Nineteenth-Century Obstetrics and Gynecology”, American Quarterly, Vol. 52, No. 2 (2000), pp. 246–73; George Beard, A Practical Treatise on Nervous Exhaustion (New York: William Wood and Company, 1880).
[2]Carol S. North, 'The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations', Behavioural Sciences, Vol. 5, No. 4, (2015), pp. 496-517.
[3] Lois P. Rudnick and Alison M. Heru. ‘The “Secret” Source of “Female Hysteria”: The Role That Syphilis Played in the Construction of Female Sexuality and Psychoanalysis in the Late Nineteenth and Early Twentieth Centuries’, History of Psychiatry, Vol. 28, No. 2 (2017), p. 17. Books often described it in terms of endemic spreading between women, and suggested that people likely to suffer from the psychoneurosis should be separated.
[4] Beard, A Practical Treatise, pp. 11-85. (Overcivilisation)
[5] As will be discussed at the end of the first section, in exceptional cases Black women were described as hysterical. More robust and extreme symptoms were usually needed to gesture towards such a diagnosis
[6] Diana Martha Louis, 'Black Women’s Psychiatric Incarceration at Georgia Lunatic Asylum in the Nineteenth Century', Journal of Women's History, Vol. 34, No. 1 (2022), p. 28.
[7] Louis, 'Black Women's', p. 34.
[8] Andreas De Block and Pieter R. Adriaens, 'Pathologizing Sexual Deviance: A History', Journal of Sex Research, Vol. 50, No. 3-4, (2013), pp. 276-298. Indeed, hysteria was frequently described as a ‘disease of the mind’ and thought of in terms of endemic spreading between groups of women.
[9] Theophilus Powell, 'The Increase of Insanity and Tuberculosis in the Southern Negro since 1860, and its alliance, and some supposed causes', JAMA, Vol. XXVII, No. 23 (1986), pp. 1185; Kristi M. Simon, 'The Controversy Surrounding Slave Insanity: The Diagnosis, Treatment and Lived Experience of Mentally Ill Slaves in the Antebellum South', Master of Arts thesis, (The Florida State University, 2018); Wendy Gonaver, The Peculiar Institution and the Making of Modern Psychiatry, 1840-1880 (Chapel Hill: University of North Carolina Press, 2018), p. 181.
[10] Peter McCandless, 'A Female Malady? Women at the South Carolina Lunatic Asylum, 1828–1915', Journal of the History of Medicine and Allied Sciences, Vol. 54, no. 4 (1999), p. 553.
[11] Gonaver, The Peculiar Institution, p. 112.
[12] See footnote 6.
[13] Simon, 'The Controversy Surrounding Slave Insanity'.
[14] Cartwright derived the word from the Greek— “drapeto” meaning runaway, and “mania” meaning slave.
[15] Samuel Cartwright, 'On the Diseases and Peculiarities of the Negro Race,' DeBow's Review of the Southern and Western States (1851), pp. 331-333. Cartwright became a tenured “Professor of Negro Diseases" at the University of Louisiana.
[16] Ibid., p. 333.
[17] Christopher D. E. Willobough, 'Running Away from Drapetomania: Samuel A. Cartwright, Medicine, and Race in the Antebellum South', Journal of Southern History, Vol. 84, No. 3 (2018), pp. 579-614; Benjamin Rush, Medical Inquiries and Observations Upon the Diseases of the Mind, Vol. 1, (Philadelphia: Thomas Dobson, 1794), p. 277.
[18] Robert Myers, ‘“Drapetomania": Rebellion, Defiance and Free Black Insanity in the Antebellum United States’ (UCLA, 2014.) Retrieved from <https://escholarship.org/uc/item/9dc055h5.>
[19] George Stocking, Victorian Anthropology (New York: Free Press, 1987), p. 312.
Stocking offers a discussion of the range of ways cultural evolution was understood in the Victorian period. Cultural evolutionist expanded from classical evolutionist in order to explain the existence of “primitive culture” as fitting into a rational framework of cultural progress. Stocking argues that ‘between 1837-1871 discussions of savages become institutionalised first in ethnology and then anthropology,’ (xxii) coinciding with discourse on cultural evolution, that understood ‘individual atoms of modern society had not yet differentiated out of larger familiar or tribal entities.’ (311).
[20] Briggs, 'The Race of Hysteria', p. 246.
[21] McCandless, 'A Female Malady?', p. 553.
[22] Ian Hacking, “Making Up People,” in Thomas C. Heller, Morton Sosna and David E. Wellbery (eds.), Reconstructing Individualism: Autonomy, Individuality, and the Self in Western Thought (San Jose: Stanford University Press, 1986), pp. 222-236. Relevant here is the Hacking’s idea of “dynamic nominalism,” in which the discursive categories to describe someone actually determines the type of experience they have.
[23] Gail Bederman, Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880-1917 (Chicago: University of Chicago Press, 1995), p. 25. Between 1870 and 1890 physicians reported much higher rates of hysteria and nervous diseases.
[24] See for example: Edward B. Tylor, Early History of Mankind and the Development of Civilization (1865), Primitive Culture (1871), and The Origin of Civilization and the Primitive Condition of Man (1870).
[25] Henry W. Streeter, 'Some Deductions from Gynaecological Experience', Medical Press of Western New York (January 1886), pp. 104-17.
[26] Bederman, Manliness and Civilisation, p. 25.
[27] Hortense J. Spillers, 'Mama’s Baby, Papa’s Maybe: An American Grammar Book', Diacritics, Vol. 17, No. 2 (1987), p. 72.
[28] Robert T Morris, 'Is Evolution trying to do away with the clitoris?', The American Journal of Obstetrics and Diseases of Women and Children, Vol. 26, No. 180 (1892).
[29] Henry William Flower, 'Account of the Dissection of a Bushwomen', Journal of Anatomy and Physiology, Volume 1 (Cambridge University Press, 1867), pp. 189-208; Ellis Havelock, 'Sexual inversion in women', Alienist and Neurologist, Vol. 16, No. 2 (1895); Stephen Jay Gould, The Mismeasure of Man (New York: Norton, 1981); Joseph William Howe, Excessive venery, masturbation, and continence: The etiology, pathology and treatment of the diseases resulting from venereal excesses, masturbation, and continence, New York: C.H Kerr, 108, Archives of Sexuality and Gender. In this article Howe argues that Black women are inherently more libidinous than their white counterparts.
[30] Also, significant here is the fact that he observes that civilised people eyesight was generally less affective and responsive. Eyesight often became a way of trying to discriminate if a patient was malingering symptoms of hysteria, or being authentic.
[31] Morris, 'Is Evolution trying to do away with the clitoris?', p. 847. Morris argues that signs of degeneration were evident in both sexes, but insists they were more pronounced and easily discernible in the case of women
[32] Hecht, D'Orsay, 'Tabes in the Negro', The American Journal of the Medical Sciences, Vol. 126, No. 4 (1903), pp. 705-720.
[33] Theophilus Powell, 'The Increase of Insanity and Tuberculosis in the Southern Negro since 1860, and its alliance, and some supposed causes', JAMA, (1986), Vol. XXVII, No. 23, p. 1185—1188.
[34] Powell, 'The Increase in Insanity', p. 1187; D'Orsay, 'Tabes in the Negro', pp. 705-720.
This work parallels Hecht D’Orsay’s argument that the “induction of civilised vices into uncivilised communities anew,” made uncivilised people insane.
[35] 'Hysteria among Savages', Daily Picayune (11th January 1893), p. 4; Lucien Warner, A Popular Treatise on the Functions and Diseases of Women (New York: Manhattan Publishing, 1874), p. 88. This argument is almost identical in structure and phrasing to Lucien Warner’s definition of hysteria.
[36] 'Social Hysteria', Portland Oregonian (13th May 1894), p. 4. Nineteenth Century U.S. Newspapers.
[37] Ibid.
[38] 'Negro Shouting', Detroit Free Press (18 Feb 1883).
[39] Ibid.
[40] Ibid.
[41] Warner, A Popular Treatise, p. 88. Although Warner begins his entry on hysteria by acknowledging the role of conjecture in his account due to the ‘the absence of any statics’[41] on Black women with hysteria, he asserts with finality there can be no doubt that hysteria is more common than it was in the earlier history of our civilisation.
[42] McCandless, 'A Female Malady', p. 549.
[43] Ibid.
[44] Ibid., p. 556.
[45] Ibid., p. 543. For example, the wealth, whiteness, and social prestige of Mary Allston, who was committed to the South Carolina Lunatic Asylum in 1848, meant she had access to a private nurse, a special diet, and her own apartment.
[46] S. Weir Mitchell, 'The True and False Palsies of Hysteria,' Medical News and Abstract, Clinical Lectures (Mar 1880), p. 38, 3.
[47] Ibid., p. 129.
[48] Ibid. Mitchell writes that he told Mrs C ‘it is absurd for a women of intellect to let one organ disorder the whole body.’
[49] Powell, 'The Increase of Insanity', p. 1186.
[50] Louis, 'Black Women's', p. 41.
[51] Ibid.
[52] McCandless, 'A Female Malady', p. 554. Around the turn of the century, the average mortality rate for black patients (about 20 percent) was more than double the rate for Whites (around 9 percent).
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