Approaching Hysteria: Disease and its Interpretations.

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Micale, M.S., Approaching Hysteria: Disease and its once a study of hysteria, an evaluation of other such studies, and a challenge to future scholars. Micale's critique of recent medical, historical, feminist, artistic, and social interpretations of hysteria is generous and tough-minded. He is encouraged by the number and diversity of these studies, but faults them for intellectual isolationism. Scholars in medicine “either remain unfamiliar with the most significant writings of critics and historians or reject this work out of hand as faddish, uninformed, and irrelevant,” while those in the humanities, “ignorant of the basic clinical and scientific dimensions of the subject, have been content to cultivate the latest themes and methodologies of their field and to dismiss the work of doctors as uncritical, self-serving, and unsophisticated” (p. 11). Because he wishes to avoid these shortcomings, Micale approaches hysteria in a way that integrates clinical and cultural aspects of his subject.A considerable part of the book is devoted to hysteria's place in the medical, intellectual, political, and religious life of France at the close of the last century-the belle époque of hysteria as disease and metaphor. Briquet and Charcot, Flaubert and Baudelaire, the Paris Commune and the Dreyfus Affair, Lourdes and the Salpêtrière all figure in Micale's analysis of the forms hysteria took and the functions it served.Micale, a good historian, both teaches us about the past and stimulates us to think about the present: “Just as the history of hysteria reached a high point in France during the penultimate decades of the nineteenth century, so anorexia nervosa, multiple personality, and chronic fatigue syndrome are experiencing their golden ages during the 1980s and 1990s” (p. 290). Like hysteria, these illnesses are more common in females, can be induced by suggestion, and are thought to reflect contemporary cultural conditions. Moreover, therapeutic industries have developed “to cater to the specialized needs of the more financially secure victims of these disorders, not unlike the nerve doctors and nerve clinics of a century ago” (p. 291). Plus ça change, plus c'est la même chose.Among his recommendations to future historians of disease, Micale should have included a period of clinical observation. The reality of illness and its treatment is found at the bedside, not in the library. He should also have provided an index whose richness matched that of his text. And given repeated references to Brouillet's painting Une leçon clinique á la Salpêtrière and to Bourneville and Régnard's book Iconographie photographique de la Salpêtrière, reproductions would have been most welcome. But these are minor flaws in a brilliant, multifaceted work-a gem of scholarship.Phillip R. Slavney, M.D.

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