By Michal Shapira
Jan Goldstein’s new book Hysteria Complicated by Ecstasy: The Case of Nanette Leroux is a compelling and intriguing demonstration of what can be gained by close study and analysis of one archival manuscript of a medical case history. The case in point tells the story of eighteen-year-old Nanette Leroux, a village girl from Savoy who fell ill in 1822 with diverse nervous symptoms (among them convulsions, lethargy, sleepwalking , and what her physicians called catalepsy, that is a muscular contraction that fixed her limbs and other body parts in their positions when the symptom took hold). Nanette’s doctors believed the girl to be suffering from “hysteria complicated by ecstasy” following repeated “frights” caused by a rural policeman said to have tried to “offend her modesty.” Goldstein discovered the lengthy (200 page) manuscript at the Institut de France in Paris, and she uses this archival find as a window into a wide-range of historical contexts and methodological questions. The book is divided into two parts which in themselves serve as an interesting model for a historical critical edition: the first half of the book is a meticulous exercise in micro-history providing context for and interpretation of the archival text, and the second half includes the translated and transcribed manuscript itself. Indeed, despite the manuscript’s obscurity, Goldstein is able to successfully “milk it for what it’s worth” and to demonstrate why it is noteworthy. Her ability to reveal and discuss early nineteenth century rural and small-town life in the Alpine region of Savoy and some of the medical debates and conceptualizations of the time is inspiring.
While the psychiatric case as a genre grew in length over the course of the nineteenth century, here we have a detailed, and therefore significant, archival example from early on in the century. Through the text, we learn about the patient herself. Described as a somewhat passive, simple village girl, she also had also her moments of wit, creative use of self-expression to assert some control over her situation, and even rebellion against medical practice. We also learn about her two French physicians, Alexandre Bertrand and Charles-Humbert-Antoine Despine, and their conflicting views as they produced the medical edition. The two men came from different backgrounds. Despine was a materially comfortable man of the provinces working for the medical administration of the state-run thermal baths at Aix-les-Bains. Bertrand, on the other hand, was a young and struggling Parisian but a scientist of the big city. What brought these two physicians together was their mutual interest in animal magnetism and Despine’s search for a worldly colleague to help him in the writing of the case. Their relationship allows Goldstein to explore the production of science in the provinces and ties with metropolitan expertise. Despine first meets Nanette after she had already been examined by a local physician and was also helped by a supportive layman. Despine’s advice was that she should be bought to Aix-les-Bains for therapies such as baths, showers, and electro-magnetism. He approached her both as a doctor trying to cure her and as a scientist aiming to experiment with the case in order to produce scientific knowledge.
True to her goal of getting as much as possible out of the text, Goldstein uses this micro-history to artfully explore larger macro-historical trends. Indeed her thorough approach leads her to wonder when the historian needs to stop contextualizing or when is ever “enough context.” Her method is an exhaustive one. Like a true detective, she restores the different backgrounds to the manuscript, from the immediate textual contexts of the scientific debates at the time to the larger social, cultural, political, and economic circumstances in which Nanette, her doctors, and others mentioned throughout the case lived. The result is dazzling, demonstrating how with imaginative scholarly work a broader picture can be pieced together. For example, Goldstein offers fascinating facts about the Savoy region itself under the Old Regime, the Revolution and the Piedmontese restoration. She also reveals the spa at Aix-les-Bains as an interesting and unique setting where urbane, cosmopolitan, tourist crowds meet the provincial misfortunate in a new age of travel and consumerism.
The context Goldstein provides is so rich that at times it seems that she drifts too far away from the medical case itself. Yet, again and again she is able to demonstrate how seeing the whole setting is important to understanding the particular episode. For instance, she shows how the tension between the traditional ways of Nanette’s native life and the burgeoning modernity and consumer market culture that the girl experienced in the spa town in fact played out in her illness. Without studying the rich background of place and time, Goldstein argues, the case’s details would have remained unclear. For historians of science and medicine, the scientific debates of the time and the different diagnostic labels of catalepsy, hysteria, and ecstasy assigned to the case are of special interest. Goldstein points out that the concept of hysteria emerged in the 1820 but that at the time it was not necessarily a uterine malady and could still be considered gender-neutral and devoid of erotic connotations. She also reveals the complex and conflicting gender dynamics at the time both between Nannette and her caretakers and impressively also inside Despine’s household.
But beyond contextualizing the manuscript, Goldstein is also interested in analyzing and making sense of the case. It is here that the more theoretical and methodological questions of the book emerge. A key issue is trying to answer how contemporaries conceptualized Nanette’s illness. While for post-Freudian twenty-first century readers of the text it might seem as if Nanette is suffering from sexual trauma due to the assault of the policeman, Goldstein emphasizes how the concept of psychological trauma was not yet available to contemporaries, as it would only develop from the 1870s onwards. What the participants in the manuscript did believe was that Nanette’s experience of fright served as a trigger to her illness. This early nineteenth century belief, Goldstein insists, was manifested in a manner that was utterly different than in the fin de siècle. Nanette’s doctors, for example, were not interested in a more all-embracing psychological explanation of her illness as key to self-understanding, or in memory-recovery of the violent episodes. They only aimed to eradicate her symptoms and restore her health and to find out whether animal magnetism could accomplish such goals. While the two doctors shared interest in magnetism, they favored different explanations for it. Despine subscribed to the late 18th century tradition of Mesmer, believing that the cure is of a physicalist nature, while Bertrand preferred a mentalist view of magnetism, and at times was willing to look at the illness from a psychological point of view, seeing it as stemming from Nanette’s “ideas” or “imagination.”
Goldstein takes her work a step further when she proposes a twenty-first-century interpretation of the case, using both Michel Foucault and Sigmund Freud to reread it in a more theoretical fashion. She defends this approach in an appendix that one wishes was more developed, especially given the theoretical tensions between these two writers. Her rationale for advancing in such a direction is that Nanette’s physicians shared certain limitations in understanding her illness that Goldstein believes invite the historian to try to improve on their work. In trying to explain why the two doctors ignored the sexual elements in the case—so obvious to a twentieth-first century reader— Goldstein uses Foucault to claim that Despine and Bertrand lived in a transitional moment in the early nineteenth century, just on the threshold of “sexuality” as it was later understood. For them, sexuality was not yet turned into an object of scientific knowledge
and was not yet part of a causal scientific explanation of a wide array of human behaviors. Despine and Bertrand functioned in the era “before sexuality” as they did not automatically connect their patient’s pathology to sex and did not locate sex at the center of her being and of her illness. Their sensitivity to sexual matters was different than ours and their concept of hysteria therefore was not so closely tied to sexuality. Hence they saw no point in analyzing in depth what seemed to be attempted rape.
Goldstein then uses a Freudian approach to try to conceptualize Nanette’s own subjective understanding of her situation and the causes of her illness. In a sense here Goldstein brings the case “back to sexuality” – a reverse move from the Foucauldian reading she utilizes thus far and one that could have been elaborated upon further. Goldstein is guided by the psychoanalytic assumption that Nanette possessed an unconscious mind that enabled her to manipulate cultural symbols and discursive possibilities available to her for her own means. In this manner, for Goldstein, the fact that Nannette demanded a watch of her own “surely speaks of her wish—probably unconscious and hence articulated symbolically through the medium of symptom—for some freedom from society’s relentless demands on her biological performance [as a woman], some measure of self-regulation.” (p. 118) Such a hypothesis may not appeal to all historians and may raise the question of whether it is the role of the historian to explain the described illness by twentieth-first century standards. Yet such creative reading does enable a certain interesting interpretation of the case, according to which Nanette’s illness was an expression of an unconscious psychic conflict that centered on questions of rebellion, autonomy, and traditional patterns of behaviors and dependence for a woman in her era. Goldstein argues that Nannette’s taking refuge in illness had to do with the historical change of the post-revolutionary era that exposed her to alternative, and more egalitarian, visions of the future. Located between traditional and modern lifestyles, Nannette literally embodied the contradictions of her historical moment. As this elegantly written book combines an erudite survey of multiple historical contexts, a micro-history of early nineteenth-century French and Savoyard medicine, gender and politics, and an imaginative conceptualization of a medical case, it should be of interest to any serious historian.
Michal Shapira is a Thomas Arthur Arnold Research Fellow at the Department of History, Tel Aviv University. She is a modern European historian focusing on the impact of total war and the development of expert culture in the twentieth century. She is the author of the book The War Inside: Child Psychoanalysis, Total War and the Making of the Democratic Self in Postwar Britain (Cambridge University Press, 2013).