By Rob Boddice
Louise Bourgeois’ The Arch of Hysteria (1993) is well known for its subversion of the typical gendering of the hysteric, placing the curved, taut frame associated with Charcot’s Salpêtrière female patients into an unmistakeably male form.
Even in the 1990s, the explicit association of the hysterical and the masculine jarred with normative expectations. Bourgeois pointedly smoothes away any sign of genitalia, emasculating the form, and removes the head, indicating the absence of reason. But if this hanging form – a literal and figurative suspension of a normative historical discourse of madness – serves to question how emotional disturbance or mental illness is read, it nevertheless does so through the physical presence of a pained body. Hysteria, however subsumed in the language of the unreal or the imaginary, has an embodied sign. The cause of ‘illness’ may be in the head (wherever that may have gone), but that notwithstanding, the pain is real.
What to make of this pain? Bourgeois asks us to take seriously the pain experience of the hysteric’s wracked body, even though the cause of the pain is invisible, a phantom. Against the combined historical voices of medical history, which proclaim ‘There is no injury and no infection! Lest the body snap, hadn’t the hysteric better snap out of it?’, we are challenged not to ignore this anguish. Bourgeois is undoubtedly tapping into Freudian analyses of the hysteric, heavily overwritten by notions of dysfunctional female sexuality. The emasculated male form here both questions and ridicules this tradition. But Bourgeois is also referencing a longer-standing confusion concerning the hysterical arch and the reading of pain signs. The arch of hysteria was diagnostically indistinguishable in the eighteenth and nineteenth centuries from that of tetanus. Whether or not a pain was taken seriously by the medical profession might come down to whether that pain was ascribed to an emotional imbalance or a physical disease.
Charles Bell, in his famous treatise on the anatomy and philosophy of emotional expression in the fine arts, placed his illustration of tetanus in a section on the pain of demoniacs (he originally painted the tetanus arch in 1809, but the engraving here is from his 1824 work) 
He marks the similarities of Domenichino’s (1608-10) representation of ‘a lad possessed’ – seized by convulsions, ‘rigidly bent back; the lower limbs spasmodically extended, so that his toes only rest on the ground’ – with that of ‘true Opisthotonos’ (i.e. arising from tetanus).
If the Renaissance saw in these wracked figures the work of the devil, modern Western medicine was at pains to show a continuity of hysteria, to distinguish the woman possessed by nerves from the veritable pain of the diseased. Working out what was ‘real’ pain became a diagnostic challenge. The Boston Medical and Surgical Journal noted in 1831 that ‘hysteria clothes herself in the garb of so many diseases’, and John Forbes’ Cyclopaedia of Practical Medicine (1833) tried carefully to distinguish between tetanus and hysteria under the singular heading of ‘convulsions’.
As long as the cases being reported conformed to modernity’s gendered notion of hysteria, so the presentation of the arch could be diagnosed. The Lancet in 1886 documented the recovery process of a young woman who had been shot in the face at close range, her jaw filled with hundreds of pieces of lead shot. The doctor, having cleaned the wound to his satisfaction, noted the daily convulsions, stiffenings, and contortions of the afflicted woman, who presented a classic case of tetanus. But the doctor wondered if this was really tetanus or only hysteria. Plumping for the latter, he repeatedly dosed the patient with chloroform, bromide of potash and chloral hydrate, and watched her slowly fully recover. Irrespective of the fact that an anaesthetic was applied (as well as the fact that the woman had been shot in the head!) the ‘good deal of pain about the jaw’ was ascribed only to neuritis in a ‘girl’ who was both ‘fanciful and obstinate’.
The case stands as representative of many in which female emotional pain was reduced to a quantity of suffering, which was qualitatively different to – less than – real pain. But as both Mark Micale and Sander Gilman have pointed out, the appearance at the fin de siècle and during and after the First World War of a large number of apparently ‘hysterical men’ rapidly overturned the dominant gendered interpretation of the hysterical arch, especially when it turned out that most of these men did not, in fact, have tetanus. As the language of emotional trauma developed in the twentieth century, from hysteria to shell shock to PTSD, the medical establishment increasingly acknowledged the validity of emotional pain as real pain (although the process is by no means complete). Along the way, modernity’s apparent tendency primarily to affect the ‘emotional chariot’ of women, to locate in them the ‘nervous’ disorders of neurasthenia or the wandering womb, gave way to new appraisals of the painful embodiment of psychological trauma. By the time Bourgeois presented her Arch, its disruptive power was becalmed by a medical reality in which ‘hysteria’ no longer existed.
Rob Boddice is Assistant Professor at the Friedrich-Meinecke-Institut, department of History and Cultural Studies, Freie Universität Berlin and a Research Fellow at the Center for History of Emotions, Max Planck Institute for Human Development. He is the editor of Pain and Emotion in Modern History, published in July 2014 by Palgrave Macmillan.
 Charles Bell, Essays on the Anatomy and Philosophy of Expression (London: John Murray, 1824).
 T.N. Smith, ‘Observations on Hysteria’, Boston Medical and Surgical Journal, 3 (1831), 541; Adair Crawford, ‘Convulsions’, The Cyclopaedia of Practical Medicine: ComprisingTreatises on the Nature and Treatment of Disease, Materia Medica and Therapeutics, Medical Jurisprudence, vol. 1, ed.John Forbes (London: Sherwood, Gilbert, and Piper, and Baldwin and Craddock), 466.
 James Laffan, ‘Hysteria or Tetanus?’, The Lancet, 128 (3287), 28 August, 1886, 397-8.
 Sander L. Gilman, ‘The Image of the Hysteric’, Hysteria Beyond Freud, eds. Sander L. Gilman, Helen King, Roy Porter, G.S. Rousseau, Elaine Showalter (Berkeley and Los Angeles: University of California Press, 1993): 345-452 at 367; Mark S. Micale, Hysterical Men: The Hidden History of Male Nervous Illness (Cambridge, MA.: Harvard University Press, 2008), 117-227.