From Hysteria to Hormones

“Koerber challenges the view of medical discovery and practice as an ever-ascendant trajectory, invoking instead the philosophical concept of topological time as a nonlinear folding and twisting of expert and popular concepts of biology and behavior. Recommended.”—S. W. Moss, Choice

“Through careful dissection of the established rhetorical history of women’s reproductive health breakthroughs in medicine, Koerber develops a rhetorical topology that rhetoricians of science and medicine will find methodologically useful as they interrogate the unique rhetorical exigences of science and medicine.”—Jillian Klean Zwilling, Women’s Studies in Communication

“Another valuable entry in the growing area of rhetorical history of medical rhetorics.”—John Lynch, The Quarterly Journal of Speech

“In situating the science of women’s ‘hormones’ in the deep history of ‘hysteria,’ Koerber refutes any reductive tales of linear scientific progress. From Hysteria to Hormones shows not only that ‘science moves in many directions all at once,’ but also how some of those movements produce novelty that reconstructs old ideas in order to keep them lively. Scholars interested in feminism, science studies, and rhetoric will find this a vivid, provocative, and creative analysis.”—Celeste M. Condit, author of Decoding Abortion Rhetoric: Communicating Social Change

“From Hysteria to Hormones offers the reader a series of close rhetorical readings of medical history, revealing turbulent and uneven transformations in perceptions of women’s bodies across centuries. Utilizing Michel Serres’s theory of time as topological, Amy Koerber interleaves rhetorical concepts in an analysis that begins with Hippocrates and ends with ‘pregnancy brain.’ Throughout, she carefully demonstrates that relying on hormonal explanations for women’s behavior is not all that different from talking about wandering wombs.”—Bernice L. Hausman, author of Viral Mothers: Breastfeeding in the Age of HIV/AIDS

“A wide-ranging and innovative book that upends the story that hormone discovery marked a break with outmoded knowledge about women’s bodies, arguing instead that hormone research required rhetorical reinvestment in old notions of hysteria. Employing Michel Serres’s concept of topology, Koerber conducts a nuanced, multimodal analysis of key moments in the historic reworking of hysteria into hormones. Eschewing a linear approach, she examines ways that the history of medical discourse about women’s bodies has looped and twisted back on itself as opposed to ‘advancing.’ Readers interested in the history of medical discourses about women or about rhetorical methods of historiography will find much to appreciate.”—Nathan Stormer, author of Sign of Pathology: U.S. Medical Rhetoric on Abortion, 1800s–1960s

“Koerber expands our knowledge of theories of women’s bodies and behaviors, while she deepens our understanding of what it means to write rhetorical history. With strong documentary evidence and brilliant ‘rhetorical-topological’ analysis, she reveals that ancient and contemporary accounts of women’s health are more alike than we might think. In the growing field of rhetoric of health and medicine, and in science and technology studies more generally, Amy Koerber is the real thing.”—Judy Z. Segal, author of Health and the Rhetoric of Medicine

“Steeped in rich primary sources and evocative analysis, Amy Koerber's From Hysteria to Hormones re-envisions the history of women's health by demonstrating how the discovery of hormones did not so much revolutionize science and medicine as it created an exigency for reinscribing long-held arguments grounded, often, in misogyny and myth. Koerber's book is at the forefront of scholarship in the rhetoric of science, technology, and medicine, and is not to be missed by students of rhetorical history.”—Robin E. Jensen, author of Infertility: Tracing the History of a Transformative Term

“By way of meticulously researched and analyzed rhetorical artifacts, From Hysteria to Hormones documents in compelling fashion how earlier ideas of biological difference and inferiority are never fully abandoned but in fact inform and animate later scientific theories, including those in circulation today. Even more, this important book theorizes these conceptual processes as thoroughly rhetorical and therefore also historical and contingent. For those interested in understanding both the limits to, and possibilities for, a non-normative, feminist language of sexual difference, this book is indispensable reading.”—Kelly E. Happe, author of The Material Gene: Gender, Race, and Heredity After the Human Genome Project

Amy Koerber is Professor in Communication Studies and Associate Dean for Faculty Success in the College of Media and Communication at Texas Tech University. Her book Breast or Bottle: Contemporary Controversies in Infant-Feeding Policy and Practice was awarded the 2015 Conference on College Composition and Communication Award in the category of Best Book in Technical or Scientific Communication.

Contents

List of Illustrations

Preface

Acknowledgments

1. Hormones and Hysteria: A Rhetorical Topology

2. Hysteria from Ancient Texts until the Nineteenth Century: The Womb as Topological Space 3. Charcot’s Circus: Nineteenth-Century Science of Hysteria as a Moment of Stasis

4. Stasis Unsettled: The Early Twentieth-Century Rise of Endocrinology

5. Topology of Sex Difference: A Long History of Men Saying Outrageous Things about Women’s Reproductive Organs

6. Illuminating Women: Metaphor and Movement after Centuries of “Groping in the Dark”

7. This Is Your [Female] Brain on Hormones: Enthymeme in Contemporary Discourse

8. From Hysteria to Hormones

Notes

Bibliography

Index

Preface

But for Adam no suitable helper was found. So the Lord God caused the man to fall into a deep sleep; and while he was sleeping, he took one of the man’s ribs and then closed up the place with flesh.

Then the Lord God made a woman from the rib he had taken out of the man, and he brought her to the man.

The man said,“this is now bone of my bones and flesh of my flesh; she shall be called ‘woman,’ for she was taken out of man.”

That is why a man leaves his father and mother and is united to his wife, and they become one flesh.

Adam and his wife were both naked, and they felt no shame.

—Genesis 2:21–25

After God so graciously created a helper for Adam, the man and woman lived together in pure bliss for a little while. Then one day, so the story goes,“when the woman saw that the fruit of the tree was good for food and pleasing to the eye, and also desirable for gaining wisdom, she took some and ate it. She also gave some to her husband, who was with her, and he ate it.” And we all know the rest of that story.

Whether through a religious tale about the first woman who could not resist a juicy piece of fruit, or through using the most sophisticated scientific tech- niques available in the twenty-first century, the effort to find language that accounts for the differences between men and women has been relentless, in the Western world and elsewhere. This quest has taken us down many different roads, some of which have turned out to be dead ends, and many of which seem pretty bizarre from today’s perspective.

For example, the predominant belief about sex difference in ancient Greece was that the reproductive organs, both male and female, were wild animals. However, there was an important difference between these animals’ behaviors in male and female bodies. The man’s “wild animal” existed in a fixed and visible location outside his body. The woman’s, by contrast, lived inside her body, where it was free to roam around unseen and cause unexpected problems. Historian Nancy Demand explains that according to one of the popular medical theories at the time, women were believed to be “weaker, moister, softer, more porous, and warmer than men,” and females were thought to be incomplete versions of males. Furthermore, it was believed that“without the moisture and weight pro- vided by semen and the fetus, the womb would wander about the body causing alarming and dangerous symptoms.” In other words, women in ancient Greece who were not pregnant were seen as subject to all manner of health problems caused by the dangerous, yet unseen, wandering womb. Recommended treat- ments for the wandering womb included “fumigations and odor therapies” that would attract the animalistic womb back to its natural location. Intercourse was also frequently prescribed as a cure for such problems as menstrual blockages.

The first use of the term hysteria to describe this condition is usually attrib- uted to Hippocrates, who used the word “hysteron” (literally, “movement of the uterus,” but derived from the Sanskrit word for belly) to explain the origins of a number of women’s health symptoms. Concerns about the numerous health problems created by the wandering womb persisted for many centuries, although as early as the thirteenth century, Western physicians started to ques- tion whether hysteria was literally caused by movement of the uterus, or whether the female brain could also possibly have been involved. Within the confines of science and technology available for studying the human body at that time, of course, such questioning of these ancient Greek beliefs could only exist in the realm of speculation, and ancient Greek ideas about the uterus as a physical cause for hysteria persisted quite explicitly in many of the medical texts and widely accepted customs of the nineteenth and early twentieth centuries. One well-known example is Victorian women’s practice of carrying smelling salts, a practice which recalled the idea that a pleasurable odor could restore the wandering uterus to its natural place.

In the twenty-first century, of course, we have achieved a more scientific understanding of the human female’s anatomy. This does not mean that science has finally discovered the truth about male-female difference, but rather that we have mechanisms such as double-blind peer review and competition for grant funding to ensure that if someone claims that women’s reproductive organs are wild animals wandering uncontrollably inside their bodies, then those claims will not go unchallenged, and such claims will not be convincing to anyone if there is no evidence to support them. As a result, today it is unlikely that a physician will attribute a female patient’s symptoms to the fact that her uterus is a wild animal that refuses to stay in place. We have ultrasounds to visualize the internal anatomy of male and female bodies and to diagnose underlying problems in a much more scientifically verifiable way than has ever been possible before in the history of medicine. We have blood tests to determine levels of various bodily substances that might explain some health conditions. And we have images produced by brain scans to provide evidence of the differences between men’s and women’s brains. We even have entirely disparate medical specialties devoted to the disorders that might afflict the brain and the uterus, and physicians in each of these specialties have access to their own array of pharmaceutical products that can be used to restore order from the outside when the body’s own internal systems (whether neurological, hormonal, or otherwise) seem to be malfunctioning.

The early twentieth-century discovery of hormones certainly has an important role to play in this transformation from mythical to scientific understandings of women’s bodies and the health problems that they experience. Shortly after Ernest Henry Starling coined the term hormone in 1905, hormones began to provide a chemical explanation for bodily phenomena that were, for many centuries prior, understood in terms of vague, unscientific notions such as wandering wombs, humors, energies, and balance. By the 1930s, endocrinology was established as a discipline, and experts could offer scientific explanations that referred to specific reproductive hormones as the causes for female symptoms that had for centuries been vaguely defined and often lumped together under the unspecific, constantly changing diagnosis of hysteria. These hormones were first identified vaguely under the umbrella term “female sex hormones,” but they later came to be known more specifically as estrogen and progesterone. In short, hormones are the scientific entity most prominent in replacing hysteria as a catch-all diagnosis for female problems.

In contrast to previous scholars’ emphasis on the profound changes that occurred after the discovery of hormones, I argue in this book that the discovery of hormones was not so much a revolution as an exigency that required old ways of thinking about women’s bodies to be twisted, reshaped, and transformed to fit the new turn-of-century expectations that medical practices and recommendations would be based in science. This revised approach to the rhetorical history of hormones takes seriously philosopher Michel Serres’s admonition to “beware of philosophies that put he who practices them in the august position of always being right, of always being the wisest, the most intelligent, and the strongest.” Modern science, Serres reminds us, is based in just such an episte- mology. We talk in terms of scientific revolution, assuming that the newest ideas represent a sharp break from the older ideas and that the newest ideas are the best. Based on many of the previous historical analyses that are available, we might be tempted to see the discovery of hormones in the early twentieth cen- tury as just such a revolutionary departure from past ways of understanding women’s health. In contrast, my main argument in this book is that hormonal explanations did not necessarily replace older notions like hysteria, at least not at a clearly discernible moment in history. Rather, the rhetorical analysis presented in this book reveals that the boundary between older, nonscientific ways of understanding women’s bodies and newer, scientific understandings is much murkier than we might expect.

The persistence of hysterical neurosis as a diagnostic category in the Diagnos- tic and Statistical Manual of Mental Disorders until 1994—when this term was removed from the publication’s fourth edition—is just one example of the murkiness of the boundary between older and newer understandings of women’s health. Furthermore, even though hysteria (and hysterical neurosis) has now been eliminated as a valid medical diagnosis, many symptoms affiliated with it remain in the current edition of the DSM. Even today, much of the scientific research about women and their hormones is not as progressive as one might expect. Hormones seem to have allowed scientists to move away from theories of the womb as the main motivator of women’s behaviors, but researchers have not abandoned the basic presumption that appears in ancient texts— namely, the idea that women are motivated by something inside themselves that they cannot control, whereas men control themselves through rationality and the male brain.

This glimpse at a complicated history helps explain why even in the most recent scientific literature, we still see studies that examine the uterus-brain relationship and how it might impact women’s behaviors and abilities. Such studies inquire, for instance, about how the volume of regional gray matter in the brain fluctuates throughout the menstrual cycle, how the “neuroplasticity” of female rodents’ brains increases after they bear offspring, or how women respond differently to challenging math problems depending on the phase of their menstrual cycles. As these examples suggest, even in the twenty-first century, scientists in various disciplines remain interested in the ways in which the female body creates complications for the female brain, and they seem to be finding endless new ways to articulate the research questions and implement the studies that will help them better understand these effects.

A quick Google search for “hormonal woman” turns up dozens of sites that use negative language to characterize the effects of hormones on women’s bodies in popular discourse. WebMD, for example, informs us that “hormonal ups and downs can wreak havoc on a woman’s life,” but the instructions that follow this comment in the article promise to help women“escape the horror hormones cause.” Another site proclaims to inform readers about“10 Things Men Should Know about Female Hormones.” Hormones are described at this site as “the reason why she snaps and bites people’s heads off for no apparent reason, but also why she cries while watching that sappy movie that she’s already seen dozens of times.” And, as suggested in figure 1, the stock photos that result from an Internet search for “hormonal woman” are far from flattering.

Thus, I argue in this book that the gradual transformation that has occurred between the early twentieth century and the present—from hysteria to hormones—can be best understood as a rearrangement of the dominant relationship among the symptoms, causes, and diagnostic categories that we use to understand the age-old phenomenon of “female problems.” Hysteria was a catchall phrase that for many centuries was used as the diagnosis for a large, diverse array of symptoms that were attributed to a wide range of causes— everything from physical symptoms like indigestion to nervous symptoms like anxiety and tension. Depending on the historical era, these symptoms had several possible etiological explanations, including the wandering womb, problems with the ovaries, a womb that is physically displaced, or something in the brain and central nervous system. When the shift to a hormonal understanding of women’s health occurred over the first few decades of the twentieth century, a shift also occurred in the rhetorical mechanisms of diagnosis. Instead of one disease (hysteria) with many different symptoms and possible causes, we see a shift toward a situation in which there are many different diseases and symptoms but only one possible cause: hormones. The symptoms are the constant in this equation. They remained remarkably similar throughout the eras—always hard to pin down, and always quite diverse. These are the symptoms that physicians throughout the eras persistently refer to as “female problems” and, quite frequently, they describe these problems with terms such as“obscure” or “mysterious.” As for the disease itself, what was consistently known as hysteria for several centuries started to fragment in the early twentieth century into a number of discrete diagnoses. Hysteria continued to exist as a psychiatric condition, but it eventually came to be known as hysterical neurosis; many of the other symptoms that used to be affiliated with hysteria are now affiliated with hormones, and they are described in terms such as “premenstrual tension” and “postpartum depression.”

(Excerpt ends here)

Communication Studies

           Rhetorical Studies

Gender Studies

History