Hysterical Again: The Gastrointestinal Woman in Medical Discourse

Abstract

This article suggests increased attention to how medical discourses of gastrointestinal (GI) disorder and distress are fraught with social assumptions and consequences by examining nineteenth-century and contemporary medical texts focused on chronic constipation and Irritable Bowel Syndrome (IBS). I suggest that these medical discourses present what I call the “gastrointestinal woman,” who is characterized as having unjustified anxiety and is to blame for her condition. My approach to understanding, and ultimately revising, the representation of the gastrointestinal woman is shaped by disability studies scholarship, which encourages intervention in problematic medical discourses and more active shaping of discourses of chronic pain and illness by those who have these conditions.

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Notes

  1. 1.

    I use “disorder and distress” to broadly include GI symptoms, particularly in the nineteenth century. IBS is technically a syndrome.

  2. 2.

    That said, medical education can do more to incorporate disability studies perspectives; see Couser (2011); Campbell (2009).

  3. 3.

    My thanks to an anonymous JOMH reader who helped me articulate these issues of medical “truth” and neutrality.

  4. 4.

    Tobin Siebers (2008) makes a similar argument for a minority-based model that has the qualities of identifiability, differential power (to a majority power), differential and pejorative treatment, and group awareness (17).

  5. 5.

    Interestingly, Wendell notes the presence of GI issues as particularly silenced in a parenthetical: “Consider how rarely anyone admits in public that s/he is depressed, having intestinal cramps, or even just desperate for a toilet, compared to how often you feel that way” (89).

  6. 6.

    I use “psychosocial disability” to indicate what might otherwise be called “mental illness” or “psychiatric disorder.” My use of the term “psychosocial disability” does not quite match Margaret Price’s (2011) use of “mental disability” (which includes autism, learning disabilities, and the like), though like Price, I treat psychosocial disability as a rhetorical, historical, social, and political phenomenon.

  7. 7.

    I had to eliminate diarrhea (also a feature of IBS) as a search term because it elicited overwhelming materials on diseases still common in the nineteenth century, such as cholera.

  8. 8.

    My analysis does not include medical self-help literature that was popular in the nineteenth century, see Connor (1994).

  9. 9.

    Clark and Halloran (1993) describe the increasingly professional rhetoric of the nineteenth century, which moved from an aim for public consensus to “an emerging individualistic spirit” that emphasized “the authority of the expert” over consensus-based rhetorics (4). This might also explain the maintenance of a first-person narrative style in Donaldson.

  10. 10.

    Such anatomical confusion was typical, as evidenced by Chapman (1838): “The connection of the rectum with uterine system, and its dependencies, is, indeed, of such an intimate nature, that we are told, in some instances, from the mere irritation of this portion of the bowels, by habitual constipation, the womb enlarges, the mamme swell as in gestation, and finally secrete milk.”

  11. 11.

    Reading and books are variously connected to GI troubles in the nineteenth century. Donaldson describes constipation in “literary men” (26), and Illoway and Byford (1864) warn against reading at the toilet.

  12. 12.

    This fixation on autointoxication was part of larger nineteenth-century concerns that civilization caused bodily ills. Whorton notes that constipation was thought to “stem from misordered priorities,” where “[c]ivilized folks felt great reluctance to withdraw, however briefly, from business or social activities for fear of missing a big sale or juicy gossip” (36). Similarly, in Nerves and Narratives, Peter Logan argues that many considered hysteria to be “the consequence of a class-specific form of social life,” caused by such “middle-class conditions as year-round urban residency” (1). Thus, concerns with middle- and upper-class city life, constipation, and “nerves” may all be related, as I suggest later.

  13. 13.

    There is an interesting pattern of nineteenth-century study on constipation in people incarcerated in insane asylums, see MacDonald (1841); Dixon (1857).

  14. 14.

    In these chapters and other nineteenth-century sources, opium is also frequently mentioned as a treatment for constipation, though it is constipating. An 1830 article in the Boston Medical and Surgical Journal (later the New England Journal of Medicine) notes that opium can cause “constipation and dryness of the throat” (“Effect” 1830), indicating that using opium to treat constipation was more squarely aimed at the “cause” of constipation: hysteria.

  15. 15.

    Somewhat similarly, Dewees (1840) discusses a condition called “Irritable Uterus,” which lists constipation and diarrhea among its symptoms (291, 301).

  16. 16.

    A possible, if dubious, exception is a nineteenth-century publication that contains a “testimonial” by a woman “cured” of constipation (Morgan 1854).

  17. 17.

    He further notes, “All light household occupations are advantageous; dusting ornaments, picture-frames, etc., with the long light feather-brushes in common use, is a good exercise, and has a beneficial influence on the abdominal walls and the contained viscera” (80). While the conflation of a clean home and a properly functioning female body is almost humorous, this again sketches the constipated woman as middle or upper class, as she doesn’t work (apparently) and spends her time dusting “ornaments.”

  18. 18.

    Compared to the nineteenth-century treatises, the contemporary articles do not as consistently paint GI disorder and distress as middle and upper class, though nearly all of the research participants in the contemporary studies I analyze were recruited from gastroenterological or psychological/psychiatric clinics, which at least in the U.S., excludes those without (good) health care.

  19. 19.

    As Stephen Loftus (2011) notes in his study of pain metaphors, the pervasive metaphor of the body as a machine tends to lead to ideas that it can be “fixed,” and in his study, doctors “felt it was their duty to pursue a clinicopathological diagnosis just in case an organic cause was found” (8–9).

  20. 20.

    They explain pain catastrophizing as “a specific psychological variable that is associated with an exaggeration of negative beliefs and attitudes toward pain,” and is “related to significant psychologic distress, pain intensity, and depression [citations removed]” (1788).

  21. 21.

    The researchers are interested in how comorbid disorders might contribute to the “etiology of IBS” (1140), and they focus on a range of disorders more common in women, including fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, TMJ, and interstitial cystitis (1143–45), as well as psychiatric disorders (1146).

References

  1. Ålander, Ture, Gun Heimer, Kurt Svärdsudd, and Lars Agréus. 2008. “Abuse in Women and Men with and without Functional Gastrointestinal Disorders.” Digestive Diseases and Sciences 53 (7): 1856–1864.

    Article  Google Scholar 

  2. Ali, A., B.B. Toner, N. Stuckless, R. Gallop, N.E. Diamant, M.I. Gould, and E.I. Vidins. 2000. “Emotional Abuse, Self-Blame, and Self-Silencing in Women with Irritable Bowel Syndrome.” Psychosomatic Medicine 62 (1): 76–82.

    Google Scholar 

  3. Asbring, Pia. 2011. “Chronic Illness—a Disruption in Life: Identity-Transformation Among Women with Chronic Fatigue Syndrome and Fibromyalgia.” Journal of Advanced Nursing 34 (3): 312–9.

    Article  Google Scholar 

  4. Atkinson, Dwight. 1998. Scientific Discourse in Sociohistorical Context: The Philosophical Transactions of the Royal Society of London, 1675–1975. UK: Lawrence Erlbaum Associates, Inc.

    Google Scholar 

  5. Beard, Georges Miller, and A. D. Rockwell. 1905. A Practical Treatise on Nervous Exhaustion (Neurasthenia). New York: Treat.

    Google Scholar 

  6. Becker, Dana. 2010. “Women’s Work and the Societal Discourse of Stress.” Feminism & Psychology 20 (1): 36–52.

    Article  Google Scholar 

  7. Beizer, Janet L. 1994. Ventriloquized Bodies: Narratives of Hysteria in Nineteenth-Century France. Ithaca: Cornell University Press.

    Google Scholar 

  8. Berkenkotter, Carol, and Thomas N. Huckin. 1995. Genre Knowledge in Disciplinary Communication: Cognition, Culture, Power. Hillsdale, N.J.: L. Erlbaum Associates.

    Google Scholar 

  9. Blanchard, E.B., L. Keefer, J.M. Lackner, T.E. Galovski, S. Krasner, and M.A. Sykes. 2004. “The Role of Childhood Abuse in Axis I and Axis II Psychiatric Disorders and Medical Disorders of Unknown Origin Among Irritable Bowel Syndrome Patients.” Journal of Psychosomatic Research 56 (4): 431–6.

    Article  Google Scholar 

  10. Blankstein, Udi, Jerry Chen, Nicholas E. Diamant, and Karen D. Davis. 2010. “Altered Brain Structure in Irritable Bowel Syndrome: Potential Contributions of Pre-Existing and Disease-Driven Factors.” Gastroenterology 138 (5): 1783–1789.

    Article  Google Scholar 

  11. Blomhoff, S., S. Spetalen, M.B. Jacobsen, M. Vatn, and U.F. Malt. 2000. “Intestinal Reactivity to Words with Emotional Content and Brain Information Processing in Irritable Bowel Syndrome.” Digestive Diseases and Sciences 45 (6): 1160–5.

    Article  Google Scholar 

  12. Byford, William Heath. 1864. A Treatise on the Chronic Inflammation and Displacements of the Unimpregnated Uterus. Philadelphia: Lindsay & Blakiston.

    Google Scholar 

  13. Camilleri, Michael and Lin Chang. 2008. “Challenges to the Therapeutic Pipeline for Irritable Bowel Syndrome: Endpoints and Regulatory Hurdles.” Gastroenterology 135 (6): 1877–91.

    Article  Google Scholar 

  14. Campbell, Fiona K. 2009. “Medical Education and Disability Studies.” Journal of Medical Humanities 30 (4): 221–235.

    Article  Google Scholar 

  15. Chang, L., B.B. Toner, S. Fukudo, E. Guthrie, G.R. Locke, N.J. Norton, and A.D. Sperber. 2006. “Gender, Age, Society, Culture, and the Patient’s Perspective in the Functional Gastrointestinal Disorders.” Gastroenterology 130 (5): 1435–46.

    Article  Google Scholar 

  16. Chapman, N. 1838. “Article XII. On Constipation.” The American Journal of the Medical Sciences 21 (45): 99–108.

    Article  Google Scholar 

  17. Clark, Gregory, and S. Michael Halloran. 1993. Oratorical Culture in Nineteenth-Century America: Transformations in the Theory and Practice of Rhetoric. Carbondale: Southern Illinois University Press.

    Google Scholar 

  18. Connor, Jennifer J. 1994. “Self-Help Medical Literature in 19th-Century Canada and the Rhetorical Convention of Plain Language.” Journal of Technical Writing and Communication 24 (3): 265–83.

    Google Scholar 

  19. Couser, G. Thomas. 2011. “What Disability Studies Has to Offer Medical Education.” Journal of Medical Humanities 32 (1): 21–30.

    Article  Google Scholar 

  20. Creed, Francis, Elspeth Guthrie, Joy Ratcliffe, Lakshmi Fernandes, Christine Rigby, Barbara Tomenson, Nicholas Read, and David G. Thompson. 2005. “Does Psychological Treatment Help Only Those Patients with Severe Irritable Bowel Syndrome Who Also Have a Concurrent Psychiatric Disorder?” Australian and New Zealand Journal of Psychiatry 39 (9): 807–815.

    Article  Google Scholar 

  21. Devroede, G., G. Girard, M. Bouchoucha, T. Roy, R. Black, M. Camerlain, G. Pinard, J.C. Schang, and P. Arhan. 1989. “Idiopathic Constipation by Colonic Dysfunction. Relationship with Personality and Anxiety.” Digestive Diseases and Sciences 34 (9): 1428–1433.

    Article  Google Scholar 

  22. Dewees, William Potts. 1840. A Treatise on the Diseases of Females, seventh edition. Philadelphia: Lea and Blanchard.

    Google Scholar 

  23. Dixon, Edward H. 1857. Woman and Her Diseases, From the Cradle to the Grave Adapted Exclusively to Her Instruction in the Physiology of Her System, and All the Diseases of Her Critical Periods. New York: A. Ranney.

    Google Scholar 

  24. Donaldson, Samuel J. 1882. Contributions to Practical Gynecology. New-York: Trow.

    Google Scholar 

  25. ———. 1885. An Essay on Habitual Constipation. New York: E.P. Coby & Co.

    Google Scholar 

  26. ———. 1883. A Treatise on Uterine Displacements. Boston: Otis Clapp & Son.

    Google Scholar 

  27. “Effect of Opium.” 1830. The Boston Medical and Surgical Journal. 17 August. 453.

  28. Enck, P., U. Martens, and S. Klosterhalfen. 2007. “The Psyche and the Gut.” World Journal of Gastroenterology: WJG 13 (25): 3405–8.

    Google Scholar 

  29. Ender, Evelyne. 1995. Sexing the Mind: Nineteenth-Century Fictions of Hysteria. Ithaca: Cornell University Press.

    Google Scholar 

  30. Epps, Richard. 1874. Constipation, Hypochondriasis, and Hysteria: Their Modern Treatment, second edition. London: James Epps and Co.

    Google Scholar 

  31. Fuller-Thomson E., J. Sulman, S. Brennenstuhl, and M. Merchant. 2011. “Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data from a Representative Community-Based Sample.” Journal of Aggression, Maltreatment and Trauma 20 (4): 445–469.

    Article  Google Scholar 

  32. Garland-Thomson, Rosemarie. 2005. “Feminist Disability Studies.” Signs 30 (2): 1557–1587.

    Article  Google Scholar 

  33. Heitkemper, Margaret, and Monica Jarrett. 2001. “‘It’s Not All in Your Head’: Irritable Bowel Syndrome.” The American Journal of Nursing 101 (1): 26–34.

    Article  Google Scholar 

  34. Herndon, April. 2002. “Disparate but Disabled: Fat Embodiment and Disability Studies.” NWSA Journal 14 (3): 120–137.

    Article  Google Scholar 

  35. Hobbis, I.C.A., G. Turpin, and N.W. Read. 2002. “A Re-Examination of the Relationship between Abuse Experience and Functional Bowel Disorders.” Scandinavian Journal of Gastroenterology 37 (4): 423–430.

    Article  Google Scholar 

  36. Illoway, Henry. 1897. Constipation in Adults and Children. New York: Macmillan & Co.

    Google Scholar 

  37. ———. 1904. The Summer Diarrhoeas of Infants: Their Etiology, Pathology, and Treatment. New York: E. R. Pelton.

    Google Scholar 

  38. Johnson, Nan. 2002. Gender and Rhetorical Space in American Life, 1866–1910. Carbondale: Southern Illinois University Press.

    Google Scholar 

  39. Keefer, L., K. Sanders, M. A. Sykes, E. B. Blanchard, J. M. Lackner, and S. Krasner. 2005. “Towards a Better Understanding of Anxiety in Irritable Bowel Syndrome: A Preliminary Look at Worry and Intolerance of Uncertainty.” Journal of Cognitive Psychotherapy 19 (2): 163–172.

    Article  Google Scholar 

  40. Kirsner, Joseph B. 2004. “Blossoming of Gastroenterology During the Twentieth Century.” World Journal of Gastroenterology: WJG 10 (11): 1541–2.

    Google Scholar 

  41. Lackner, J.M., G.D. Gudleski, and E.B. Blanchard. 2004. “Beyond Abuse: The Association Among Parenting Style, Abdominal Pain, and Somatization in IBS Patients.” Behaviour Research and Therapy 42 (1): 41–56.

    Article  Google Scholar 

  42. LaCom, Cindy. 2007. “Filthy Bodies, Porous Boundaries: The Politics of Shit in Disability Studies.” Disability Studies Quarterly 27 (1–2).

  43. Landman, Isaac, Louis Rittenberg, and Simon Cohen. 1939. The Universal Jewish Encyclopedia in Ten Volumes; An Authoritative and Popular Presentation of Jews and Judaism Since the Earliest Times. New York: The Universal Jewish Encyclopedia, Inc.

    Google Scholar 

  44. Loftus, Stephen. 2011. “Pain and Its Metaphors: A Dialogical Approach.” Journal of Medical Humanities 32 (3): 213–230.

    Article  Google Scholar 

  45. Logan, P.M., and Roy Porter. 1997. Nerves and Narratives: A Cultural History of Hysteria in Nineteenth-Century British Prose. California: University of California Press.

    Google Scholar 

  46. Longmore, Paul K. 2003. Why I Burned My Book and Other Essays on Disability. Philadelphia: Temple University Press.

    Google Scholar 

  47. Macdonald, James. 1841. “Cases of Monomania.” The Boston Medical and Surgical Journal 23 (24): 23.

    Article  Google Scholar 

  48. Myers, Kimberly R. 2004. “Coming Out: Considering the Closet of Illness.” Journal of Medical Humanities 25 (4): 255–270.

    Article  Google Scholar 

  49. Micale, Mark S. 1995. Approaching Hysteria: Disease and Its Interpretations. Princeton, N.J: Princeton University Press.

    Google Scholar 

  50. Miller, Georgianna Oakley. 2009. “The Rhetoric of Hysteria in the U.S., 1830–1930: Suffragists, Sirens, Psychoses.” PhD diss, University of Arizona.

  51. Muscatello, M.R.A., A. Bruno, G. Pandolfo, U. Mico, S. Stilo, et al. 2010. “Depression, Anxiety and Anger in Subtypes of Irritable Bowel Syndrome Patients.” Journal of Clinical Psychology in Medical Settings 17 (1): 64–70.

    Article  Google Scholar 

  52. Naliboff, B.D., S.E. Kim, R. Bolus, C.N. Bernstein, E.A. Mayer, and L. Chang. 2012. “Gastrointestinal and Psychological Mediators of Health-Related Quality of Life in IBS and IBD: A Structural Equation Modeling Analysis.” The American Journal of Gastroenterology 107 (3): 451–9.

    Article  Google Scholar 

  53. National Institutes of Health (U.S.). 1995. Recruitment and Retention of Women in Clinical Studies. U.S. Dept. of Health and Human Services, Public Health Service. http://purl.access.gpo.gov/GPO/LPS66055.

  54. Ouyang, Ann, and Helena F. Wrzos. 2006. “Contribution of Gender to Pathophysiology and Clinical Presentation of IBS: Should Management Be Different in Women?” American Journal of Gastroenterology 101 (Supplement): S602–S609.

    Article  Google Scholar 

  55. Price, Margaret. 2011. Mad at School: Rhetorics of Mental Disability and Academic Life. Ann Arbor: University of Michigan Press.

    Google Scholar 

  56. Progressive Americans of the Twentieth Century, Containing Biographical Sketches of Distinguished Americans. 1910. Chicago: Progressive Publishing Company.

  57. PubMedHealth. 2010. “Irritable Bowel Syndrome.” Last modified July 7. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001292/

  58. Riedl, A, A. Stengel, M. Goebel, A.-S. Wisser, B.F. Klapp, M. Schmidtmann, and H. Monnikes. 2008. “Somatic Comorbidities of Irritable Bowel Syndrome: a Systematic Analysis.” Journal of Psychosomatic Research 64 (6): 573–582.

    Article  Google Scholar 

  59. Salager-Meyer, Francoise. 2000. “Debate-Creating vs. Accounting References in French Medical Journals.” Technical Communication Quarterly 9 (3): 291–310.

    Article  Google Scholar 

  60. Salmon, P., K. Skaife, and J. Rhodes. 2003. “Abuse, Dissociation, and Somatization in Irritable Bowel Syndrome: Towards an Explanatory Model.” Journal of Behavioral Medicine 26 (1): 1–18.

    Article  Google Scholar 

  61. Savill, Thomas Dixon. 1909. Lectures on Hysteria and Allied Vaso-Motor Conditions. New York: W. Wood.

    Google Scholar 

  62. Segal, Judy. 2009. “Rhetoric of Health and Medicine.” In The Sage Handbook of Rhetorical Studies, edited by Andrea Lunsford. Los Angeles: Sage. 227–245.

    Google Scholar 

  63. Sheehan, Tanya. 2011. Doctored: The Medicine of Photography in Nineteenth-Century America. University Park, PA: Pennsylvania State University Press.

    Google Scholar 

  64. Siebers, Tobin. 2008. Disability Theory. Ann Arbor: University of Michigan Press.

    Google Scholar 

  65. Sullivan, Michael J.L., Scott R. Bishop, and Jayne Pivik. 1995. “The Pain Catastrophizing Scale: Development and Validation.” Psychological Assessment 7 (4): 524–532.

  66. Swain, John, and Sally French. 2008. Disability on Equal Terms. Los Angeles: Sage.

    Google Scholar 

  67. Swan, Jim. 2002. “Disabilities, Bodies, Voices.” In Disability Studies: Enabling the Humanities, edited by Sharon Snyder, Brenda Jo Brueggemann, Rosemarie Garland-Thomson. New York: MLA. 283–295.

    Google Scholar 

  68. Veith, Ilza. 1965. Hysteria: The History of a Disease. Chicago: University of Chicago Press.

    Google Scholar 

  69. Wendell, Susan. 1996. The Rejected Body: Feminist Philosophical Reflections on Disability. New York: Routledge.

    Google Scholar 

  70. Whitehead, W.E., O. Palsson, and K.R. Jones. 2002. “Systematic Review of the Comorbidity of Irritable Bowel Syndrome With Other Disorders: What Are the Causes and Implications?” Gastroenterology 122 (4): 1140–1156.

    Article  Google Scholar 

  71. Whorton, James C. 2000. Inner Hygiene: Constipation and the Pursuit of Health in Modern Society. New York: Oxford University Press.

    Google Scholar 

  72. Wood, Ann Douglas. 1973. “‘The Fashionable Diseases’: Women’s Complaints and Their Treatment in Nineteenth-Century America.” Journal of Interdisciplinary History 4 (1): 25–52.

    Article  Google Scholar 

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Acknowledgement

I am thankful to the anonymous JOMH reviewers for their valuable feedback. A previous version of this paper was presented at the Rhetoric Society of America (RSA) conference in 2010.

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Correspondence to Amy Vidali.

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Vidali, A. Hysterical Again: The Gastrointestinal Woman in Medical Discourse. J Med Humanit 34, 33–57 (2013). https://doi.org/10.1007/s10912-012-9196-2

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Keywords

  • Medical discourse
  • IBS
  • Constipation
  • Nineteenth century
  • Hysteria
  • Disability