At the end of her kindergarten year, we received a letter from my daughter’s school. She had missed enough days from illness that there were concerns about promoting her to first grade. Any more absences, we were warned, and she would be referred to an attendance review committee whose members would decide if she could move on to first grade. A friend who worked for a neighboring school district came over for dinner a few days later and when I told her about the letter, she assured me these were mailed to all students who missed 25% of the school days, and it was rare for the committee to decide to hold back a child.
What nagged at me for the last month of school was the confirmation of my suspicion that my daughter had missed an abnormal number of days from illness. By practical necessity, schools had a built-in buffer for absences. An absence or two or three was acceptable; those that added up to nearly 25% of the school year were not.
After that letter, I started thinking of her sick days as episodes. On the surface, they were singular events: she would run a high fever, have a raw, red throat, and sleep fitfully for three‒five days. The doctor would test for strep, the test would come back negative, and the virus would run its course.
The illness behaved episodically because it repeated at irregular intervals. Sometimes she would be sick twice in a month, sometimes she would be healthy two months in a row, but the illness always returned. When viewed over the course of a school year, her sick days did not resemble singular events at all.
My mom loved our childhood pediatrician because she said he believed moms when they said something was wrong with their child. Moms know their kids better than I do, he would say. If he were alive today, maybe he would modify this to parents, but this was suburban north Dallas in the 1980s, and it was mothers who brought their kids to the doctor.
My sister is profoundly deaf in one ear, severely deaf in the other, yet as an infant and a toddler, she passed all her hearing tests. She can’t hear me, my mom finally told our doctor. I know what the tests say, but I know my child.
Now that I’m a mother, I understand why this pediatrician meant so much to her. His acceptance of a mother’s intuition was the first step towards my sister receiving her first pair of hearing aids. I imagine my mother sitting on uncomfortable plastic chairs, saying to audiologists and ENT specialists, “I know I sound like a hysterical mother but…” Surely there were times she believed this was true.
The word hysteria derives from the Greek word for uterus, hystera. The ancient Greeks, including the famous Hippocrates, believed that a woman’s womb moved freely in her body. Lack of sex would cause it to shrivel, lighten, roam, where it would collide with other organs. Insomnia, seizures, headaches—all were attributed to the problem of a free-range womb. Wombs as out of control carriages, taking turns too fast, cutting off others in their desire to flee. Surely this appealed to women trapped by society; they might be angels in the house for propriety’s sake, but their wombs had unchaperoned freedom.
The recommended cure for a wandering womb in this time was orgasm, administered by either a husband or doctor. Women: do not attempt this at home, alone. Social history of medicine scholar and author Roy Porter points out that the diagnosis of hysteria returned with a vengeance in the nineteenth century, and that it came to be seen as the “open sesame to impenetrable riddles of existence: religious ecstasy, sexual deviation, and, above all, that mystery of mysteries, woman.” The belief that a woman’s physical and mental states were at the capricious whim of her womb and reproductive system, that if she was sick of body and mind she had no one to blame but herself, was too tantalizing a concept to lay dormant for long.
In February of 1906, the German artist Paula Modersohn-Becker left her husband Otto. The town of Worpswede where they were living had begun to feel small and provincial to her, as did her husband’s predictably safe art, all those rivers and idyllic country landscapes he was so fond of painting. Modersohn-Becker said she needed to be in Paris, where she could take risks, both in art and life.
Once in Paris, she writes in her journal, “I have left Otto Modersohn and I am standing between my old and my new life. What will it be like? And what will I be like in my new life? Now it is all about to happen.”
As soon as she leaves Worpswede, Otto writes his wife pleading letters to return home. In her letters to him, she acknowledges his feelings and thanks him for all his love. She’s sorry he is hurting. Reading between the lines, she is not sorry but… Instead, she is sorry and… She wants Otto to be okay, she wants him to take risks in his own art, she wants to share with him all the strange, wonderful things happening in Paris. She writes: “So many things about you lived in my heart, but then disappeared. I have to wait and see if they’ll return or if something else will appear instead.” In the same paragraph, she asks if he will send money. She advises him to stay close with his daughter Elsbeth and she writes how glad she is that he sold two paintings in her absence.
She’s unsure, in Paris, how to sign her own name now.
Modersohn-Becker is thrilled when she finally receives a letter from her mom. “You’re not angry with me!” she writes. “I was so afraid you’d be angry. It would have made me sad and hard.”
MB’s Self Portrait on the Sixth Wedding Day (1906), painted during her stay in Paris, is the first nude self-portrait of a woman in Western art history. To avoid paying the fees to sketch live models, MB’s sister would photograph her naked in the Parisian apartment, and these photographs were the source material for the self-portraits.
The Parisian apartment had fleas and opaque windows. At night, it would grow bright as day and sometimes MB would steal out of bed to study her paintings by moonlight. The joy of falling asleep, surrounded by her work, is something she marvels at in letters to Otto. Even the light of the moon and what it bestows on her work is different in Paris.
For Mother’s Day one year, I shared on Facebook a line from Katherine Heiny’s short story “Andorra”: “She thought that was the essence of motherhood: acting like you knew what you were talking about when you didn’t. That, and looking at people’s rashes.”
In most areas of life, expertise comes with life experience or extensive study. After my first husband and I told the kids we were getting a divorce, my son ran into his room and ripped off his sheets and upended his bookshelf. He threw books and toys around his room until he collapsed onto the bottom bunk of his bed. Even as the enormity of his feelings and their physical expression made sense to me, I also believed that maybe I could have saved him from those big feelings if I had just read one more article about divorce. Once again I felt I was failing at this job that was supposed to be so very natural for women.
When my daughter was one, I saw a mark on the small of her back while changing her diaper. The mark was irregularly shaped and had a tinge of blue. It hadn’t been there the night before. I said this several times, as I showed it to my mom and then my aunt, that the mark had suddenly appeared, that it had not been there at bath time the night before or earlier that day when I dressed her, yet there it was now, directly above the diaper line, and as we studied it, I became convinced it was not a mark, but a bruise.
It would be impossible to recreate the panic that followed, how quickly we jumped, without naming it, to the diagnosis of leukemia. This is not a normal leap to make, except we had all recently read Jodi Picoult’s novel My Sister’s Keeper about a young girl with leukemia. On my aunt’s street was a young girl who had recently been diagnosed with the disease. There is a fear that can follow a healthy pregnancy and an easy delivery, both of which I had enjoyed, as if you are only allowed so much good luck. I both believed this and found it illogically absurd, and yet that mark.
Coincidentally my daughter had her one-year check-up that day. In the parking garage of the doctor’s office, I pulled up her small shirt and showed her dad the bruise. He studied it a moment, before licking his finger and briskly rubbing at the spot.
“Ink from the diaper,” he said.
It was summertime. I burst into tears.
Some argue hysteria was a prevalent diagnosis in the nineteenth century because doctors had not named or discovered many of the diseases that largely impact women: chronic fatigue syndrome, endometriosis, most autoimmune diseases. Others claim hysteria as a feminist rebellion, a means for Victorian women to escape the unrealistic gendered expectations of the period. It’s also been hypothesized that the diagnosis of hysteria in women, largely by male doctors, was yet another a way for society to control women’s bodies while undermining their minds.
In Feminist Theory: From Margin to Center, bell hooks quotes activist Carmen Vazquez, who once lamented that “Feminism in America has come to mean anything you like, honey.” hooks wasn’t amused by this vagueness, fearing that an “anything goes” approach to feminism is ineffective as a political tool. It’s difficult to rally around abstraction, and if you fail to acknowledge how the present has been shaped by the past, the status quo remains.
And what woman hasn’t bristled when called hysterical?
Today, the word hysterical does not mean a woman has a wandering womb, or that she is sexually repressed, or that she is mentally ill. Rather it can be used to describe a funny situation, or express that something, or someone, is uncontrollably amusing. It’s also used to describe a person who behaves with excessive emotion.
In the Oxford English Dictionary, the first definition of hysteria is rooted in pathology: a functional disturbance of the nervous system, characterized by such disorders as anæsthesia, hyperæsthesia, convulsions, etc., and usually attended with emotional disturbances and enfeeblement or perversion of the moral and intellectual faculties. Women being much more liable than men to this disorder, it was originally thought to be due to a disturbance of the uterus and is functions. Former names for the disease were vapors and hysterical passion. The second definition is figurative, and defines hysteria as a morbidly excited condition or unhealthy emotion or excitement.
As a noun, hysterics can be an outpouring of uncontrolled emotions, while a hysteric is someone who embodies these extreme emotions. In the section for English-language learners, the Merriam-Webster Dictionary offers these examples:
I think his movies are hysterical.
She burst into shrieks of hysterical laughter.
By the time the police arrived, the victim had become hysterical.
My mother went into hysterics when she saw my tattoo.
He dismisses his critics as a bunch of hysterics who are always predicting disaster.
Men are still largely the makers of meaning when it comes to hysteria: they incite hysterical responses, and they can wield the label of hysteric to silence critics. In contrast, women are the bearers of meaning. They carry hysteria inside them. Hysteria can be called forth, or called out, by men, by stress, by a woman’s body. Women are cautioned to stop acting hysterical, while also being told, poor dears, you simply can’t help it.
I wanted someone to listen to me when I told this doctor and then this nurse and then this second doctor that I didn’t understand why my daughter kept running a high fever, accompanied by a raw red throat, every few months. I didn’t understand why we continued to test her for strep when it was never strep. I didn’t think she had a life-threatening disease. I don’t know how I knew this; of course I didn’t know this.
What I kept trying to relay to doctors was that no one else in our family ever caught this illness. It was unique to her body, never contagious, but no matter how I phrased this, it was routinely dismissed.
Maya Dusenbery writes in Doing Harm that these kind of dismissals can cause women to doubt themselves, to wonder if in fact they are imagining their symptoms, if the disease really is all in their heads.
Women under fifty-five years old are seven times as likely as men to be sent home from the hospital, mid-heart attack. They are advised to go home, pour a glass of wine, and unwind with a soothing bath. They are sometimes chided to better manage the stress in their lives, to keep their panic attacks under control. Women are more likely to be referred to a psychologist when suffering from a rare disease with atypical symptoms, men to a specialist. Once a woman has been labeled hysterical by the medical community, it becomes even more difficult to get a diagnosis.
A man once told me that he thinks women can take on so many responsibilities that they can make themselves sick. He looked genuinely worried about this predisposition of women.
When I asked a nurse if my three-year-old daughter’s recurring fevers were normal, she snapped, “Do you want your kid to be sick?”
It’s distressingly easy to tell a woman to shut up. Insinuating that a mother has Munchausen syndrome by proxy is one way. Calling her hysterical is another. As Mary Beard writes, “When it comes to silencing women, Western culture has had thousands of years of practice.”
French psychoanalyst Collette Soler writes in her essay “Hysteria, A Hystory” that an experience becomes history once it has been told, either to yourself or someone else. Viewed this way, the importance of history is in the storytelling, as well as the perspective of the storyteller. Freud believed the unconscious was driving the story, that the verbal expression of the story was often in conflict with the story the symptoms were telling. He was especially interested in the story a hysteric might not even know she was telling.
An acquaintance told me about the time she took her daughter to an asthma specialist. Her daughter was having trouble breathing but her asthma tests kept coming back normal. What exactly is the payoff for you, the doctor asked her, for having a sick kid, and what is the payoff for her—here he turned to her daughter—for being the sick kid?
This is the groundwork, the sturdy foundation for future misdiagnoses, how heart attacks, in a woman’s body, become panic attacks. A mother and daughter speaking together does not carry the weight of two voices. Rather, it is seen as one hysterical female instructing another, and their silencing becomes the spectacle.
A woman is in a double bind when speaking about her health. If she is too emotional, she is hysterical, and her pain is ignored. If she’s too calm, she’s told she is fine, otherwise she would be acting hysterical, and her pain is ignored. Studies show women are more likely to be given sedatives for their pain; men pain medication.
Soler writes that the three elements involved in the hysterical symptom are the hysteric, the other, and the other’s symptoms. Or as Elaine Showalter says, “hysteria is dialogic: it depends on the needs of patients as well as the decisions of doctors.” Women cannot be hysterics alone because it requires a conversation. Or, a monologue.
Medical students are told to look for the obvious diagnosis first. Hoof beats most likely signal a horse, not a zebra. In other words, don’t look to the exotic if the obvious is stampeding in your direction.
Women are simultaneously always, and never, seen as zebras; they are the other and they are the hysteric. You can’t possibly have what you say you have. The story you are telling is born of stress. It lacks a clear thesis.
For years, women were not told the side effects of their birth control pills. Dr. Elizabeth Connell once famously said that if you tell women the symptoms, they will all have them the next day. When it comes to women, better to see what crops up, than plant seeds.
One time, walking barefoot in my own driveway, I stepped in glass. All of it came out except for one piece which lodged itself in the ball of my foot. I decided, after some half-hearted excavation attempts, that the glass would surely work itself out, like a splinter.
A week later, I started limping from the hard knot of pressure in my foot. A few days after that, I broke down and visited an emergency care clinic by my house. While the perception is that women rush to the doctor at the first sign of illness, it’s much more common for women to wait, the way society believes men do, until they are feeling very poorly, so as to avoid the label of hypochondriac.
The doctor was incredulous at the reason for my appointment. You want me to cut open your foot because you think you have glass in there?
Maybe this particular doctor had to contend with countless women entering his practice, begging him to cut open their feet in order to extract imaginary pieces of glass. Maybe “I have glass in my foot” was uttered so often by women who, in fact, did not have glass in their feet that this doctor had every right to sound exasperated, disbelieving, condescending.
This is going to hurt, the doctor said when I finally convinced him to look for the glass. It’s going to hurt a lot.
We had moved past, glossed right over, the fact that I was sitting on an exam table, swollen foot in his hand, because I was already hurting a lot.
He brusquely numbed my foot and then sliced it open. I don’t see anything. He was digging around inside my heel and it did, in fact, hurt a lot. Like I said, it’s very unlikely–
He grew silent and the digging intensified before he dropped the bloodied piece of glass onto the tray.
You want to keep it? he asked.
I shook my head.
No more walking around barefoot, he chided with a wink, suddenly a paternal grandfather.
One weekend when my daughter started running a fever I drove her to the after-hours clinic near our house. I was tired from being up half the night with a sick and cranky child. I was tired of explaining myself to doctors who kept telling me all was fine. I was tired of making plans with friends and cancelling them.
Her normal fever thing? a friend had asked earlier that day when I called to say we had to postpone our weekend getaway.
I was sick of being treated like I was crazy for thinking it abnormal my child had a normal fever thing.
I explained this pattern to the new doctor as he looked in my daughter’s throat and held a stethoscope to her small chest. She gets this every few weeks and it’s never strep, I said. I was snappish, less concerned about appearing calm and rational. More likely I said, I can already tell you the strep test will be negative, and I’m tired of putting her through these tests.
Has anyone suggested she has PFAPA? the doctor asked that day. He sent us home with a printout about Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis, as well as a steroid. If she had the periodic fever syndrome he suspected, she would be fine within hours of taking a steroid. He called at nine thirty that morning to say the strep test was negative and to give her the steroid; by noon, she was running around the house, fever-free. A few months later she had her tonsils removed, the recommended treatment to resolve PFAPA, and her cyclical fevers disappeared.
Only a few months earlier, I told a doctor it seemed my daughter was catching the same illness over and over again, as if it were laying dormant in her body, and he said, Sometimes to a layperson viruses can look the same, but of course they’re not.
I recently went back and read about PFAPA on the American College of Rheumatology website:
Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis (PFAPA) is a syndrome that consists of recurrent episodes of fever, sore throat, mouth sores and swelling of the glands in the neck. The frequency of PFAPA is not known, but the disease appears to be more common than originally thought, and may be the most common recurrent fever (autoinflammatory) syndrome that does not come from an infection. Both males and females and all ethnic groups can develop PFAPA. PFAPA usually starts in early childhood, between the ages of two to five years.
Most doctors don’t receive feedback on their missed diagnoses. Women in the hospital recovering from a heart attack don’t track down the doctors who sent them home from the hospital after admonishing them to stay off WebMD. I personally did not find the doctors and nurses who told me to stop worrying about my daughter’s cyclical illnesses, mainly because for years afterwards, I suspected that the delay in her diagnosis had been my fault. If only I hadn’t undermined myself by saying, “I know it sounds crazy but…” If only I had been louder/quieter/more demanding/less demanding. I should have leaned in, I should have interrupted, I should have asked, Why—aren’t—you—listening—to—me?
Seven years later, I feel the same angry helplessness at the word “recurrent.”
In college, I took a Spanish class where we learned both the mechanics and the ethics of translation. In one video, a young boy is at the doctor’s office with his mother. Instead of translating his mother’s symptoms, he begins ad-libbing because he thinks the doctor would make a good boyfriend for his mom. He wants to know if you’re single, he thinks you look nice today, he tells his increasingly horrified mom. The doctor quickly discovers what is happening, but the damage is done.
Dusenbery notes that women who are struggling to have their symptoms taken seriously by a doctor often bring a man—father, husband, son—to appointments. If a man can back up a woman’s claim that she is not merely stressed, or tired, or hysterical, or that she is all three because she is ill and this illness is impacting her quality of life and the lives of her family members, then suddenly, she is sick enough to be believed. This is often called the yentl syndrome, that until a woman proves she is as sick as a man, she is not sick.
Educational psychologist Lori Day’s 2015 article, “If Our Sons Were Treated Like Our Daughters” asks the reader to join her in a parallel universe, one where boys are socialized to cultivate their bodies, not their minds. “Loving parents and teachers accept this strange culture as if it’s not so bad,” she writes, “or perhaps even good.” In this world, it’s the boys who are catcalled on the street, act out prince fantasies, and are told they can be anything they want, so long as they look good doing it.
Imagine how subversive, and confusing, the translation video would be had it starred a man, his child, and a female doctor.
When I got a UTI for the first time, I was in college and the campus doctor said he needed to know if I’d had anal sex recently. When I said no, he asked if I was telling the truth, that if I wanted to get better I needed to be honest and trust him. Back home in my apartment, I made myself a lunch of ramen noodles and told myself I was silly for crying, and I thought of a different doctor, the one who when I was fourteen and had a rash on my face, asked my mom to leave the exam room halfway through the appointment.
Have you been rolling around with some boy in the woods? he asked after she left.
We lived in the suburbs of Dallas.
No, I said. I think this is a reaction to a new moisturizer.
One last chance to be honest before I call your mom back in.
No, I said again, as firmly as a shy fourteen-year-old girl could.
When it comes to women, Dusenbery points to both a knowledge gap and a trust gap in medicine. The knowledge gap is easier to grasp since women were largely absent from medical trials and medical testing until the NIH Act of 1993. Even twenty-five years later, diseases that impact women are more likely to be underfunded and understudied. While not the chasm it once was, the knowledge gap is still wide and deep enough to frighten.
In 1991, Americans watched the all-male Senate judiciary committee interrogate and attempt to discredit Anita Hill, a law professor accusing then Supreme Court nominee Clarence Thomas of sexual harassment. She was accused of harboring erotic fantasies and was labeled psychologically disturbed by many. The following year, 1992, saw an influx of women into Congress, and in 1993 the NIH Act, requiring all federally funded trials to include women and minorities, was passed. The original bill had been introduced by Senator Ted Kennedy and was signed into law twenty-four years after he drove his car off a bridge on Chappaquiddick Island, where he waited ten hours to report the accident. The passenger in his car, 28-year-old campaign strategist Mary Jo Kopechne, drowned. During the Thomas-Hill hearing of ’91, Ted Kennedy was mostly silent, despite his reputation as the “liberal conscience of the Senate.” His notable muteness during the hearings was chalked up to the ghost of the Chappaquiddick incident, as well as his nephew’s impending rape charge in Florida.
Even if medical knowledge eventually catches up and closes the knowledge gap, there is still a problem with trust. There are different realities and consequences for those who have the power to choose silence, and those who are silenced.
Showalter describes in “Victorian Women and Insanity” a mental asylum where female patients sorted colored beans into neat piles every day. Before bedtime, the beans were dumped into a single container for the next day. Much of the work, Showalter notes, was meant to keep women too busy to chat or argue. Complacency, or quietly performing her Sisyphean task, signaled a woman was cured.
Women are treated as if they carry the seeds of hysteria inside them, and it’s the seeds that cause them to think they are sick, and if a woman is sick, it is because she carries seeds. I imagine sorting these seeds into piles and disposing of them. In one pile: mistrust, disbelief, condescension, superstition. In another: calm down, stop acting hysterical, and it’s just stress. Attempting to gather together and destroy all these imaginary seeds is a collective, not individual effort. The persistence of the imaginary in a lived reality can make a person sad and hard.
Women artists in the nineteenth century often painted scenes of motherhood and children. Since this was their “natural” realm, critics claimed these scenes of domesticity weren’t difficult for women. They were good, yes, but this kind of art was embedded in their constitution. Next women would be asking for praise for breathing. God.
At the Women Artists in Paris 1850-1900 exhibit where I first saw Modersohn-Becker’s work, I was struck by all her paintings of nursing mothers and pregnant women. A plaque alongside these paintings noted that MB struggled to get pregnant for many years. I was primed to see both tragedy and longing in her work, and I did.
This show did not mention she was the first Western female painter to paint herself nude nor did it mention that Modersohn-Becker was a devoted stepmother to her husband’s daughter Elsbeth, and it did not mention her stint in Paris, where she lived alone.
I wish the show had included MB’s painting Child with Goldfish Bowl painted in 1906, most likely when she was living in Paris. A shadowy naked girl holds a tray with two rounded objects below her chin. The objects are fruit, and yet, no matter how I squint, it’s her own lopped off breasts there on the tray. This painting is from the era she told a friend she wanted to be more “naïve” in her work. The risk for a woman artist living alone, whose family is hurt and baffled by this desire to be alone, who often can’t pay her own bills, is a return to simplification, to naiveté, after the mastery of complication.
After much persuasion, and a vigorous, months long letter-writing campaign, MB agrees to let her estranged husband Otto visit. Before his visit, Modersohn-Becker writes to ask where he will be staying. The implication is that he should not stay with her. A few months before his visit, in May 1906, she writes in her journal, “When Otto’s letters reach me they are like voices from the earth while I am like one who has died and is in Elysium, hearing these earthly cries.”
For Otto, the visit is a success. MB writes her family to say she will be returning to Worpswede with her husband. She is practical in her hopefulness that it will be different this time, that her time in Paris was not spent in vain: “I’ll be happy and content as long as I have a place where I can work in peace. And I’ll be grateful for whatever part of love has come my way. As long as one stays healthy and doesn’t die too young.”
By March she is pregnant, and in November 1907, she gives birth to a girl she and Otto name Mathilde, after her mother. After delivery, standard advice, she is instructed to stay in bed and rest. On November 21, she is told she can get up. MB brushes her hair, she pins roses in it, she asks to hold Mathilde. Minutes later, she drops to the floor, dead of an embolism from a blood clot which had journeyed from her legs to her lungs during her extended bedrest. She was 31.
While on bed rest, she complained of pain in her legs and was told it was neuralgia, or nerve pain, and the best thing she could do was stay in bed. Had she simply been allowed to move around freely, instead of confined to bed, it’s likely the embolism would not have occurred.
The Women Artists in Paris exhibit ended with Echo by Ellen Thesleff, of a young girl in profile, her body shapeless under her white shift. Her shoulders are flung back, and her mouth is open as she discovers the power of her own voice. A yellow sky hovers above her, but her feet are planted firmly on the green grass. Behind her are trees, and behind those trees could be anything: a flea-infested Parisian apartment, a farmhouse in Germany, a suburban neighborhood.
In Thesleff’s painting I see both my daughter and Modersohn-Becker’s daughter Tille. Maybe this is a painting of the future. There is absorption and wonder stamped on the girl’s face as she shouts across the field and her voice returns. Her echo is confirmation that she has a voice, that she has spoken and been heard.
In one of the photographs taken by her sister while in Paris, Modersohn-Becker is topless, an amber necklace circling her throat, her hair parted neatly down the middle. She holds a shadowy object between her breasts. In Self Portrait on the Sixth Wedding Day, MB gives her hair the same part, she draws the same amber necklace, but rather than cradling an object, her hands cradle her own pregnant belly.
Alongside the obvious connotations—the birth of her art and creative self, her complicated desire to be a mother—is also an interrogation and a reimagining of herself. She is studying the viewer, studying her. What are you going to do about it, about me? she asks.
Now it is all about to happen.
Cover Art by Kelsey Baker