Tracey Loughran

Hysteria and neurasthenia in pre-1914 British medical discourse and in histories of shell-shock

Histories of shell-shock have argued that the diagnosis was subdivided into the categories hysteria and neurasthenia, and that the differential distribution and treatment of these diagnoses was shaped by class and gender expectations. These arguments depend on the presentation of hysteria and neurasthenia as opposed constructs in British medical discourse before 1914. An analysis of the framing of these diagnoses in British medical discourse c.1910—1914 demonstrates that hysteria and neurasthenia, although undergoing redefinition in these years, were closely connected through the designation of both as functional diseases, and the role attributed to heredity in each. Before the war these diagnoses were perceived as indicators of national decline. Continuity, as well as change, is evident in medical responses to shell-shock.

Shell-shock and medical culture in First World War Britain

© Tracey Loughran 2017. All rights reserved. Shell-Shock and Medical Culture in First World War Britain is a thought-provoking reassessment of medical responses to war-related psychological breakdown in the early twentieth century. Dr Loughran places shell-shock within the historical context of British psychological medicine to examine the intellectual resources doctors drew on as they struggled to make sense of nervous collapse. She reveals how medical approaches to shell-shock were formulated within an evolutionary framework which viewed mental breakdown as regression to a level characteristic of earlier stages of individual or racial development, but also ultimately resulted in greater understanding and acceptance of psychoanalytic approaches to human mind and behaviour. Through its demonstration of the crucial importance of concepts of mind-body relations, gender, willpower and instinct to the diagnosis of shell-shock, this book locates the disorder within a series of debates on human identity dating back to the Darwinian revolution and extending far beyond the medical sphere.

Introduction: Agency and Invisibility in Constructions of Infertility

This section introduction uses Hilary Mantel’s Giving Up the Ghost (2010), a powerful memoir detailing the author’s undiagnosed endometriosis and subsequent hysterectomy, to open up a discussion of the importance of power and agency in understandings of infertility in the modern era. In histories of infertility, the issues of agency and invisibility are deeply entwined. The power to act depends in part on social recognition of a ‘problem’, and the choices of those whose voices are not heard, or, even worse, are deliberately silenced, are narrowed – sometimes to the point of non-existence. The chapters in this section show how in past societies, as in the contemporary world, disparities of power marked and determined the experience of infertility. They demonstrate that while ideological constructions of gender, race and class have conditioned popular, legal, and medical approaches to infertility, stigmatized and neglected groups have managed to fight back and to challenge these constructions in unexpected ways.

Introduction: The Body Politic and the Infertile Body

This section introduction sets out the ways in which infertile bodies have been situated as objects of political concern. Since ancient times, the reproductive capacity of a people has been used as an indicator of political health. Even today, in many Western societies the fertile body is used as a symbol of national power. Historically, high-level machinations of power have often determined the individual experience of infertility, whether through castigation of those who fail to conceive, or policies of population control. This section examines the intersection between medical and cultural constructions of infertile bodies, political understandings of population and the health of the state, and the development and provision of techniques for investigating, managing, and curing infertility. It concludes that analysis of political influences on perceptions and experiences of infertility helps us to understand the boundaries of infertile individuals’ capacities for action, and their abilities to enact positive change.

Introduction: Situating Infertility in Medicine

This section introduction explores medical approaches to infertility in a variety of geographical contexts and chronological periods, considering how doctors have conceptualized, diagnosed, and responded to infertility as a condition. The chapters in this section examine the historical shaping of medical understandings of infertility, how access to treatment has been mediated by social, political, and scientific factors, and the medical construction and treatment of ‘deviant’ sexualities. Indeed, it has often proved impossible to separate medical and moral discourses. These chapters also lament an historical failure to record the patient’s voice, and suggest the very limited extent to which patient autonomy was compatible with medical authority. The section thereby offers rich insights into medical thinking and practice on infertility, and into the broad interface between medicine, science, and culture.

Introduction: Reproductive Technologies and Imagined Futures

This section introduction considers some of the ethical debates generated by the creation of new reproductive technologies, and places these in historical perspective. It contrasts ethical debates which have shaped the development of research science and access to new technologies with literary and philosophical imaginings of the potential implications of reproductive technologies and what these might mean for infertile women and non-fertile couples. In doing so, it underlines the extent to which debates on infertility have always been grounded not only in current concerns, but have involved imagined futures for individuals and societies. The chapters in this section show that our reproductive futures are likely to remain bound not merely by our scientific capabilities, but by our social values. The ‘right’ to reproduce will remain mediated by complex and historically contingent factors. The troubled historical relationship between (wo)man, technology, and modernity is likely to remain a dominant trope, in media representations as much as our imaginations

Introduction: Defining the ‘Problem’: Perspectives on Infertility

This section introduction considers diverse definitions of infertility in different historical and disciplinary contexts. The chapters invite readers to consider the extent to which the ‘biological’ category of infertility has always been mediated by social and cultural concerns; how changing definitions have shaped ‘patient’ experience; how definitions shape the historical object of study; and some of the methodological problems which might be associated with researching the history of infertility. These chapters reflect on issues of perennial importance to the history of infertility, controversies which have not been resolved, and methodological problems which remain constant. They show that throughout past ages, individuals brought their own understandings – shaped by manifold social, cultural, and economic resources – to the experience of living with and attempting to overcome infertility. The section therefore builds on existing research on the history of infertility, but also interrogates the assumptions of this research, and opens out new possibilities for future histories.

Introduction: Infertility in History: Approaches, Contexts and Perspectives

This Introduction argues that historical scholarship offers a vital corrective to present-minded assumptions about infertility, which often conflate the experience of infertility with the effects of reproductive technologies. Infertility is as old as recorded history, and yet for the most part its history remains unwritten. This neglect stems partly from difficulties in defining infertility. Medicalized definitions often hide political and structural issues that affect how infertility is researched. This problem is compounded by the secrecy, shame, and silence that has often surrounded infertility in past and present societies. Historians must develop creative techniques for locating and reading surviving evidence of infertility. Historicized perspectives can alter our understandings of four topics central to studies of infertility in contemporary societies: medicine and reproductive technology, kinship, stratified reproduction, and gender. Even more importantly, newly historicized understandings of infertility can help sufferers to understand and to exert increased control over the condition.

Body and Mind in “Shell-Shock”: War and Change within Psychological Medicine

In the early days of the war the medical profession, in accordance with the materialistic outlook it had inherited from the latter part of the nineteenth century, was inclined to emphasise the physical aspect of the antecedents of a war neurosis. As the war has progressed the physical conception has given way before one which regards the shell explosion or other catastrophe of warfare as, in the vast majority of cases, merely the spark which has released long pent up forces of a psychical kind.

Conditions of Illusion: Agency, Feminism, and Cultural Representations of Infertility in Britain, c. 1960-80

In the 1970s, reproductive control was perceived as essential to women’s liberation. In practice, however, feminist assertions of ‘the right to choose’ usually focused on the right not to have children. In the 1980s, a prominent strand within radical feminism critiqued new reproductive technologies as part of a technopatriarchal conspiracy, and portrayed infertile women as its passive victims. As a result of these critiques, the Women’s Liberation Movement (WLM) is often depicted as unsympathetic or even hostile to infertile women. This chapter compares representations of infertility in mass-market women’s magazines and feminist publications. It explores the extent to which these publications enabled individual women to articulate their experiences of infertility, the contexts of these articulations, and how these representations of infertility related to wider perceptions of motherhood, biological determinism, and women’s capacity for agency.