The ‘secret’ source of ‘female hysteria’: the role that syphilis played in the construction of female sexuality and psychoanalysis in the late nineteenth and early twentieth centuries

Introduction

The verse in the Bible … about the sins of the fathers being visited upon the children unto the third and fourth generation has worried me all my life. At the beginning I wondered if my father’s sins were visited upon me and if I must die from his wages of sin, the wages of sin being Death! …

 When I was a child I never heard the words syphilis or gonorrhea. I had been made aware of the grown up people whispering sometimes with their heads together, about disasters in our town of Buffalo. When a young man that everyone knew hung himself in his bedroom, naked save for a pair of white gloves, I heard my mother and a neighbor mumbling about it, sitting in the shaded drawing room in their summer silks: ‘He had … you know!’ my mother said and drew down the corners of her mouth … So later when I was old enough to be curious about what people ‘did’ when they were married, whatever it was, it was all tied up with sin and forbidden acts and having ‘that awful thing’. (Luhan, 1947/2012: 130–1)

In the nineteenth and early twentieth centuries, venereal disease was a secret disease. It was not yet clear that there were several venereal diseases; this fact would not be uncovered until the early 1900s when different causative microorganisms were identified and reliable diagnostic tests developed. Effective treatments with sulfa drugs and penicillin were not introduced until the 1930s and 1940s. As Mabel Dodge Luhan described, venereal disease was intimated obliquely, by facial expression, a nod or a whisper, indicating that, he had ‘you know …’.

The secrecy and fear surrounding venereal disease influenced many social attitudes, reinforced the division between races and social classes, and significantly impacted the construction of female sexuality. Women were divided into good/chaste/white and upper or middle class versus bad/infected/promiscuous lower class and coloured. To have syphilis was to be an outcast from respectable society. In a patriarchal society, which offered few options for women, having a secure place in society was a matter of survival for women of all races and classes.

Freud and his colleagues acknowledged the damage of the prevailing sociocultural construct of female sexuality by codifying women’s neurosis, or hysteria, as resulting from repression of sexuality. However, by failing to recognize that, for many, the avoidance of sex with men was based on their fear of contracting venereal disease and, for married women, their fear of passing the disease on to their children, the early psychoanalysts embarked on a description of women that was flawed and reductive at its core.

This article begins with a brief history of venereal disease (VD), in order to illustrate how legitimate were the fears associated with these incurable diseases. A close reading of several sources, primarily the memoirs of Mabel Dodge Luhan (1933, 1935, 1936, 1937, 1947/2012), along with a range of literary, biographical, polemical, medical, psychoanalytical and artistic sources, reveals both the personal impact of the fear of syphilis and its horrific impact on the society and culture of the late nineteenth and early twentieth centuries. The article describes how the fear of VD was present in the women treated by Freud and his colleagues, and concentrates on the cases of Dora and Mabel. A brief discussion of Anna O is included, as her treatment by Breuer was foundational in Freud’s theory of female sexuality. The implication for psychiatry is that a model of psychological development originates within its sociocultural milieu and cannot escape suppressed aspects of that culture.

A brief history of venereal disease

Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance. First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease becomes a metaphor. Then, in the name of the disease … that horror is imposed on other things. (Sontag, 1978: 58–9)

Mabel Dodge Luhan was not being melodramatic when she wrote that her life was held hostage by the ‘sins of the fathers’. If the Judeo-Christian God had wanted to develop a disease that would punish men and women for sex, in the most frightful ways imaginable, he would have had to invent syphilis. It is not only a disease whose symptoms mimic many other known infectious diseases, but it has been – since Columbus purportedly brought it home as the curse of the Americas he had conquered – the single most shame- and guilt-ridden disease on the planet, until AIDS, whose aetiology and cultural manifestations resemble it strikingly (Brandt, 1987: 202; Wilford, 2008).

Since the Renaissance, syphilis has been blamed on the marginal and despised – prostitutes, immigrants, Jews, and homosexuals – and identified as the source of society’s pollution. In a similar way, when AIDS came to public awareness in the 1980s, Christian fundamentalists proclaimed it God’s just punishment for homosexuality. Venereal disease affected women of all classes and races, but prostitutes received the brunt of society’s wrath. ‘If I were a judge’, roared Martin Luther, ‘I would have such venomous syphilitic whores broken on the wheel and flayed because one cannot estimate the harm such filthy whores do to young men’ (Crosby, 1972: 158). In 1826, Pope Leo XII banned rubber condoms because they protected the infected from the suffering they deserved (Nelkin and Gilman, 1991: 47).

Syphilis is the disease that ‘has most terrorized western culture’, not only because of its virulence, but also because of its vicious irony: ‘Eros and Thanatos fiendishly reunited’, as ‘One is punished by the very means by which one has transgressed’ (Quétel, 1990: 196). Alfred Crosby has noted its most significant ramifications in terms of its impact on heterosexual intimacy:

The fear of infection tended to erode the bonds of respect and trust that bound men and women together . . . . Add to the normal emotional difficulties of the sex relationship not just the possibility of the pains of gonorrhea, but the danger of a horrible and often fatal disease, syphilis. Where there must be trust, there must also be suspicion. Where there must be a surrender of the self, there must now also be a shrewd consideration of future health. (Crosby, 1972: 158–60)

‘He who knows syphilis knows medicine’, said the father of modern medicine, Sir William Osler (Silverman, Murray and Bryan, 2008: 145). So common and serious was infection with syphilis, that all physicians were attuned to its myriad clinical presentations. In the nineteenth century, an entire medical subspecialty, syphilology, was devoted to the study of the great imitator Treponema pallidum, the spirochete that causes syphilis. The pathophysiology of syphilis is well documented in medical textbooks; the following is a brief review.

In the primary phase of infection, syphilis typically has a three-week gestation, when a sore or chancre develops on the genitalia. In women, these sores are easily missed because they are internal. After two to four weeks, a secondary phase occurs with symptoms of varying severity. The patient can have a slight fever and mild headache or be more affected with lymphadenopathy, severe headache, myalgia, arthralgia, mouth sores, atrophy of the optic nerve, and extensive body rash. Untreated patients can remain infectious for up to four years. After a latency period that can last from four years to lifelong, 30–40% enter the tertiary phase. Symptoms can again be relatively mild such as reduced eyesight, hearing, rashes, etc., or, in 5%, catastrophic with cardiovascular disease, and neurosyphilis such as tabes dorsalis, meningitis or general paralysis of the insane (GPI).

Syphilis can be transmitted to children by infected mothers. Depending on the variety of syphilitic infection in the mother, congenital syphilis can result in stillbirths, saddle nose (an ulcerated bridge of the nose), incisor teeth that curve inward, deafness and cardiovascular lesions. Women with gonorrhea develop symptoms in 7 to 21 days. Infection can occur in the uterus, ovaries and fallopian tubes, resulting in frequent and painful urination, vaginal discharge and reduced fertility. It was considered a minor disease, like the cold, until the end of the nineteenth century, when it was discovered to cause arthritis, meningitis, pericarditis and peritonitis. ¹

In the late nineteenth and early twentieth centuries, the most influential venereologist in Europe and the USA was the Frenchman Alfred Fournier, who made the study of venereal diseases ‘a respectable branch of medicine’. As founder of the French Society for Sanitary and Moral Prophylaxis in 1901, he published a pamphlet warning young men of ‘feminine provocation’, which could destroy families and children and ruin the human species (Quétel, 1990: 134–6). Prince Morrow, Fournier’s counterpart in the USA, was the first to describe syphilis as a ‘social disease’, and as one of a ‘triad of contemporary plagues’ that included alcoholism and tuberculosis (Brandt, 1987: 9–15). Doctors, nurses and those in the general public who were aware of the disease believed that syphilis was inheritable through the third generation. Thus the mantra that ‘the sins of the fathers will be visited upon the children’, a thesis that was powerfully and controversially brought to the stage in Henrik Ibsen’s 1881 play, Ghosts (Spongeberg, 1997: 155).

At the turn of the twentieth century, the prevalence of syphilis was reported to be as high as 10% (Howles, 1943: 59), but it is likely that the incidence was about 2–5% of the general population (Baughn and Musher, 2005). Such an incidence would be consistent with the rate estimated by Fournier and others in the late 1800s. Hazen’s analysis in 1928 estimated that there were about 8×10⁶ syphilitics in the USA, and Parran estimated that there were approximately 681,000 new cases each year in the USA (Parran, 1938). In 1905, Schaudinn and Hoffmann successfully identified Spirochaeta pallida as the aetiologic agent of syphilis (Baughn and Musher, 2005), but despite numerous attempts, fulfilment of Koch’s postulates, except for cultivation of the organism on artificial media, was delayed until Noguchi achieved it in 1911.

Epidemiological evidence suggests that ‘perhaps 50% of contacts sexually exposed to early infectious syphilis actually escape infection’. ² Mercury vapour baths or the ingestion of mercury and iodides of potassium, which could lead to loss of teeth and bowel haemorrhaging, were the most common treatments for syphilis through the early twentieth century, until the discovery of Salvarsan, an arsenical compound created by Dr Paul Ehrlich, in 1909 (Brandt, 1987: 40–1).

European and American doctors disagreed on how long a man should refrain from sexual intercourse after contracting syphilis, and they used different dosages, regimens and prognostications about the efficacy of Salvarsan and its somewhat less toxic successor, NeoSalvarsan. Some doctors believed a few intravenous injections would help to keep the patient non-contagious, while others recommended injections for months or years (Parascandola, 2008: 78). Some doctors believed Salvarsan ‘cured’ syphilis, and others that it did not. While it did not eliminate the disease, the treatment made most patients non-infectious and helped them to avoid the tertiary stage (Brandt, 1987: 40–1).

Penicillin was identified as effective treatment for syphilis but did not become generally available to the public until 1946. It was not until the middle of the twentieth century that syphilis ceased to be common in mental institutions. In the early twentieth century GPI was noted at rates as high as 25%, and in the second decade of the century 20% of male and 7% of female patients in the admissions to New York State mental hospitals had GPI (Grob, 1994: 125).

The social impact of syphilis

In his excellent study of the social construction of VD in the USA, No Magic Bullet, Allan Brandt explored the moral panic over venereal disease that was foundational to a number of Progressive era social control reforms, such as social hygiene, eugenics and women’s suffrage (Brandt, 1987: 7–51). It occurred within the context of increasing divorce rates, a rising militant women’s rights movement, and fears of race suicide stirred up by nativists opposed to the ‘degenerate races’ who made up mass immigration. (Some 20 million immigrants arrived in the USA, mostly from Central, Southern and Eastern Europe, between 1880 and 1924.) Venereal disease ‘provided a palpable sign of degeneration, as well as a symbol of a more general cultural crisis’. Brandt estimates that the infection rate for VD in the USA in the late nineteenth and early twentieth centuries could have ranged between 10 and 50%. ³

Among moral reformers in Europe and the USA, a ‘just say no’ policy to conjugal infidelity became the favoured protocol. Doctors advised patients to abstain from sex after infection for six months to three years; and they typically told men not to tell their wives, in order not to threaten the stability of white middle- and upper-class marriages. Women of ‘good breeding’ were not expected to have any knowledge of the disease, while working-class women and women of colour, who were ‘destined by virtue of their origins to be of “low sexual morality’”, were expected to avoid ‘contaminating the bourgeoisie’. In Anglo-Saxon countries, the disease was usually referred to as ‘a rare blood disease’ (Brandt, 1987: 23–4). One of the many reasons it is so difficult to document the number of cases, until recent times, is because doctors and medical examiners often disguised the diagnosis.

A widespread granting of credentials in the professions of law, medicine and teaching began in the late nineteenth century, and doctors wanted more control of the ‘moral order’, which they achieved by gaining credibility from political leaders and the public for their ‘technical expertise’. The discovery of ‘venereal insontium’ – infections of the innocent – in the last decade of the nineteenth century generated the social purity crusade. There followed a virtual redefinition of VD from the classic ‘carnal scourge’ to a ‘family poison’ (Brandt, 1987: 9–15).

In 1901, Prince Morrow chaired a VD study committee of the New York County Medical Society. His statistics helped to create a venereal panic when he claimed that 80% of men in New York City had been infected with gonorrhea and that 5–18% had contracted syphilis. In Social Diseases and Marriage, Morrow (1904) claimed that gonorrhea made 50% of women sterile, while another doctor attributed 60–80% of pelvic inflammations that required hysterectomies, or removal of ovaries, to gonorrhea. Morrow wrote of VD as ‘treasonous’ in its threat to destroy the foundations ‘of the Victorian, child-centered family’. One in seven marriages, he claimed, was sterile because of VD (Brandt, 1987: 16).

Until the second decade of the twentieth century, public debate on these issues in the USA was rare and controversial. When Edward Bok, the editor of the Ladies Home Journal, published a series of articles about VD in 1906, he lost 75,000 subscribers. When Margaret Sanger’s infamous article ‘What Every Girl Should Know’ was published in 1913 in the Socialist journal The Call, it was confiscated and labelled obscene by the US Post Office because she referred to syphilis and gonorrhea by name. Sanger claimed that the majority of women in New York who married were in danger of venereal infection, warning that for women who contracted syphilis there was a 60–80% chance that their offspring would die (Brandt, 1987: 24).

While some doctors wanted sex education to be available to parents, and particularly to men, their chief strategy was to argue for chastity and moral purity as a means of protecting the social order. The attempt to keep women ignorant of VD’s potential and very real damage to their bodies drove some feminist activists and writers in England and the USA to make the claim that women needed political and civic rights in order to end ‘the conspiracy of silence’. Christabel Pankhurst’s polemic The Great Scourge and How to End It (1913), and Charlotte Perkins Gilman’s novel The Crux (1911/2003), are just two of many works by women’s rights activists in the era that boldly took on the topic.

In Microbes and Morals, Theodor Rosebury speculates about the influence that the spirochete and the gonococcus have had throughout the ages on ‘philosophy, art, and literature’ (Rosebury, 1971: 146). It is hardly surprising to find that syphilis served as a powerful trope in European and American literature and art. Often thinly disguised in Romantic and Victorian literature and the arts, VD also served as a constitutive factor in the creation of modern literature and art. Mabel Dodge Luhan was not alone in imagining and experiencing the pervasiveness of VD. In her seemingly contradictory embrace and loathing of sexuality, she also encompassed the range of attitudes that marked the lives and works of several of her fellow writers and artists who shaped the gender of modernity.

The influence of syphilis on modern literature and art

In European and American short stories, novels, plays, illustrations and paintings from the mid-nineteenth century through the mid-twentieth century, syphilis was deployed to describe the disintegration of borders – of gender, race, ethnicity and class. The disease – often allegorized, masked, or portrayed as a hideous double – infiltrated and infected the individual bodies of the privileged, and poisoned the body politic. Among the European artistic avant-garde, venereal disease appeared in and influenced works by the Symbolists, Expressionists, Cubists and Surrealists, perhaps most powerfully in the urtext of modern art, Picasso’s Demoiselles d’Avignon (1907), with its bold distortions of form and colour and the confrontational depiction of women prostitutes.

French Symbolist writers such as Charles Baudelaire were venomous towards women because they ‘engineered the fall of man’, while French anti-feminist writers, like Émile Zola, ‘linked what was seen as the insidious power of New Women with social degeneracy’ (Williams, 1980: 19). In late British Victorian literature, the syphilitic double went underground and became the ‘dual personality’ of Robert Louis Stevenson’s Dr. Jekyll and Mr. Hyde (1886), and the doppelgänger of Oscar Wilde’s The Picture of Dorian Gray (1890), which Wilde’s biographer, Richard Ellmann, has interpreted it as a ‘parable for [Wilde’s] secret syphilis’ (Ellmann, 1988: 95). Gaston Leroux describes Erik, the ghost who haunts the opera house in his play The Phantom of the Opera (1910), as having a skeletal frame, big black holes for eyes, and the collapsed nose that marked syphilitics, thus his famous white mask. Bram Stoker’s Dracula (1897) has been discussed in terms of coded references to syphilis, made explicit in its most recent adaptation by the BBC in 2006, where the vampire is brought to England in order to give a blood transfusion to Lord Arthur Holmwood, the syphilitic aristocrat who is about to wed the innocent Lucy Westenra (Davison, 1997: 34–5; Hayden, 2003: 219; Showalter, 1985: 109–15).

Other writers were more concerned with the impact of public hysteria on the free expression of sexuality than they were with the disease itself. As Elaine Showalter (1985: 199) has explained: ‘For the male literary avant-garde, … syphilis was the excrescence of a sexually diseased society, one that systematically suppressed desire and so produced anxious fathers and divided and disfigured sons.’ This was certainly true for D.H. Lawrence, who published a screed about the ways in which the fear of VD had poisoned European and American art and literature. The pox ‘entered the blood of the nation, particularly of the upper classes’, he wrote, and ‘after it had entered the blood, it entered the consciousness and hit the vital imagination’, striking a ‘fearful blow to our sexual life’. Lawrence attributed the terror of syphilis to the upper classes’ ‘dread of anything but ideas, which can’t contain bacteria’ (Lawrence, 1936: 555–8).

T.S. Eliot may have found one of the sources of the misogyny and sexual loathing that inhabits his poetry in his Calvinist father’s stern warning that, because syphilis was ‘God’s punishment’, he hoped that a cure for it would never be found: ‘Otherwise … it might be necessary to emasculate our children to keep them clean’ (Henry Ware Eliot, T.S. Eliot’s father, quoted in Showalter, 1985: 188). In the ‘apocalyptic vision’ of T.S. Eliot’s The Waste Land (1922), ‘the poet’s sexual phobias result in the disintegration of not only the modern cultural apparatus, including social, political, and gender roles, but of the very landscape’ (MacDiarmid, 2003: 338). Eliot’s masterpiece is permeated with fears of Anglo-Saxon race degeneration, brought and passed on through venereal diseases that have increased the sterility of the upper classes, while the masses breed in frightening numbers. The form and imagery of Eliot’s poetry are, of course, modern. But his sentiments about the working class’s contribution to the decline of the Anglo-Saxon race and nations are as invidious and old-fashioned as those of his Victorian forebears.

Modernist artists, like modern writers, responded to the disease in both coded and open ways in their experimentation with form. There is perhaps no more iconographic painting of the advent of Modernism than Pablo Picasso’s Les Demoiselles d’Avignon (1907), a painting in which art history scholars have uncovered the trace – and erasure – of VD. Most agree that Picasso used prostitutes (and African art) to mask his own aggressively bold confrontation with the canons of art history. He frequented bordellos in Barcelona and may have contracted VD in 1902. In the winter before he painted ‘Demoiselles’ he visited a Parisian venereologist, ‘ostensibly to paint the syphilitic prostitutes in his care’, but perhaps for more personal reasons as well (Richardson and McCully, 1996: 11–18). Picasso wanted to entitle his painting Le Bordel d’Avignon, but his dealer insisted on the euphemism. Whether interpreted ‘as an allegory or charade on the wages of sin’, or as a rendering of his terror at the reality of women ‘coming to power’ at the expense of the patriarchy, Picasso’s calling it ‘My first exorcism-painting’ is certainly suggestive (Chave, 1994: 605; Steinberg, 1988: 10).

Salvador Dalí, one of the founders of the Surrealist movement in post-World War I Europe, rendered his fears of women’s diseased bodies in the coded language of dreams, which erupted from the irrational depths of the unconscious to paint themselves on canvas. Dalí’s father, a wealthy notary and a regular client of prostitutes, believed that he had transmitted some type of VD to his son. Like Eliot’s father, he wanted ‘to warn the adolescent Salvador of the dangers involved, and so he gave him books containing pictures of the lesions caused by syphilis’. Dalí ‘remembered these illustrations as being frightening and repulsive and came to associate them with sexuality as a whole’, which ‘led him … to rely on onanism as his source for pleasure’ (Martinez-Herrera, Alcántara and García-Fernández, 2003: 855). One of his first contributions to Surrealism was entitled Le Visage du Grand Masturbateur (1929), a sardonic commentary, perhaps, on the medical community’s fears that if masturbation replaced sexual intercourse it would lead to debilitating physical and social ailments.

Psychoanalysis, sexology and sexual identity

Mabel Dodge Luhan’s life and writings are revelatory of the interconnections among psychoanalysis, sexology and Spiritualism in the late nineteenth and early twentieth centuries. At the time when she was engaged with Freudian psychoanalysis and sexology, she supplemented these with various New Thought and occult doctrines and practices. Her eclecticism was very much in tune with her times. When Mabel embraced both Freud and Havelock Ellis, it was their notion of women’s sexuality as their (modern) identity that she understood as linking them.

All the mental hygiene movements have complex origins in Western society and culture. One factor that shaped their emergence was the increasingly biological and hereditary model of human nature and behaviour that drove scientific and medical theorizing, investigation and reform, and became entrenched during the last quarter of the nineteenth century. Gender differences were examined scientifically, in such a way that women were seen as the sum of their reproductive roles.

‘Her whole soul, conscious and unconscious’, as American psychologist G. Stanley Hall put it, ‘is best conceived as a magnificent organ of heredity’ (Russett, 1989: 61). Charles Rosenberg has noted: ‘Even the educated were convinced that most chronic and constitutional ills were rooted irrevocably in “the blood”’, such that ‘Americans found in heredity a plausible mechanism with which to restate in appropriately secular form a lingering commitment to “original sin”’ (1974: 200).

Damnation by blood, the condemnation to suffer the punishments of the ‘fathers’, made the various manifestations of mind-cure movements in the early twentieth century salvifically appealing to millions of Americans and Western Europeans. Nathan Hale has documented the many ways in which early psychotherapy borrowed from hypnotism, suggestion and psychic research. This was especially true in Boston, where these sympathies were fostered by a ‘lingering Unitarian and Transcendentalist tradition’, and where ‘Christian Science and New Thought Practitioners flourished, taking patients from neurologists and, what was more galling, curing them’ (Hale, 1971: 121). When Mabel first decided to undergo psychotherapy in 1914, she wrote a letter about her family ‘inheritance’ of sin and suffering to the leading Boston psychotherapist, Dr Morton Prince, although she never worked with him.

It is hardly surprising that those suffering from depression and other psychological ailments would turn to mentalist therapies that promised an escape from ‘hereditary degeneracy’. Relying on the passive goodness of a divine godhead that offered infinite reserves of love and support was one route; the active unlearning of destructive feelings and behaviours through talk therapy was another. Mabel was ‘manic-depressive’, as she informed the psychiatrist A.A. Brill, when she first visited him (Luhan, 1936: 506). Whatever the accuracy of the label, there is no doubt that she was subject to severe cycles of highs and lows throughout her adult life that at times left her despairing and suicidal. Thus all routes that promised a cure were attractive, as there were no effective medications for bipolar disorder until lithium became available in the 1960s.

Historians of modern women have noted: ‘Promiscuity and extra-marital sex posed many more risks for them than for their male lovers, who believed in women’s sexual freedom in theory but in practice were often alarmed by it’ (Ellen Kay Trimberger, quoted in Snitow, Stansell and Thompson, 1983: 9). The risks were also, as we know, medical. A Boston gynaecologist was not alone is asserting that birth control (condoms) reduced venereal diseases, which were, in any case, ‘just punishment for sin’ (Snitow et al., 1983: 9). Thus, radical sexologists, who condemned contraception for inhibiting women’s ‘natural’ purpose in life, made common cause with the very conservatives they were purportedly undermining.

During the first decade of the twentieth century, psychotherapy increased in ‘national medical and popular interest’ in the USA because its ‘environmentalism and optimism’ were consonant with the Progressive era spirit of reform (although hereditarianism continued to underlie the ‘science’ of the eugenics movement). Since the mid-nineteenth century, women had flocked to Spiritualist beliefs and practices, as founders, leaders and adherents. In the twentieth century, they responded as well to the new talking cures, which treated their ‘neurasthenic’ complaints with dignity rather than with ridicule and rest cures: ‘No longer were neurotics “vampires” or “silly exaggerators”, chiefly upper-class females. Most psychotherapists argued that neurosis was intensely serious and painful and could attack the happiness of individuals and families more cruelly than many organic illnesses’ (Hale, 1971: 138–40).

At the same historic moment that British sexologists were discussing free love, Sigmund Freud was discussing the ways in which the ‘civilized code’ of sexual morality made women its chief (neurotic) victims – unable to ‘repress, sublimate, or fulfill their powerful sexual drives’. He found Americans ‘very contemptible’ for having what he described as the ‘most extreme’ sexual morality. Freud was hardly advocating ‘free love’ (Hale, 1971: 13), but there were radical feminists, like Mabel’s friend Emma Goldman, who took away from his lectures on sexual repression the ‘truth’ that sexual suppression was one of the primary factors in women’s lack of intellectual and personal achievement (Gifford, 1991: 132–3).

Freud’s theory of psychoanalysis emerged from his own dark forebodings of the ways in which a ‘sexual climate of gloom, frustration, fear, mutual despair, and moral uncertainty’ was damaging the sexual lives and marriages of the European middle-classes (Marcus, 1987: 9). Many of his first cases involved men and women who were both syphilitic and ‘hysterical’. He was aware of the similar symptoms that both hysteria and tertiary syphilis produced: blindness, lameness, spasms, paralysis, tics, etc. Freud’s commitment to a predominantly mentalist view of human nature and development may have grown partly out of his disgust with the ways in which Jews had been associated for centuries with theories of hereditary degeneracy, including the spread of syphilis. His mentalist view was also connected to the marginalization of Jewish doctors to the low status specialties of dermatology (a euphemism for syphilology), neurology and psychiatry, in which they were expected to work as clinicians, not theorists (Marcus, 1987: 7–8). ⁴

Freud insisted that psychoanalysts should not have to be medical practitioners because of ‘the racism of medicine’ (Gilman, 1988: 192). In the USA where psychiatric practice required a medical degree for certification by the 1920s, syphilis was ‘the making’ of the field, when the medical discovery of ‘syphilis of the insane’ provided psychiatrists with scientific credibility. American psychiatrists cast modernity – science, frankness, pragmatism – ‘as the enlightened antithesis to Victorianism’, a platform they used ‘to launch their more general attack on propriety and privacy as outmoded remnants from the pre-scientific past’. Syphilis provided a ‘perfectly legitimate entrée into the domestic realm, and, as such, underwrote their conviction that in the future science would exempt no human activity, however intimate, from expert scrutiny’ (Lunbeck, 1994: 50–2). All these interrelated concerns were embodied in Freud’s first and most studied case, Dora (Freud, 1905/1997).

The case of Dora

Most contemporary scholars read Freud’s Dora as a narrative of the emerging field of psycho-analysis. It opens a revealing window into the Victorian patriarchal biases that made their way into modern culture, most particularly in terms of the personal and cultural dread that the ‘New Woman’ aroused. Freud began to see Dora in October 1900, when she was 18; the therapy lasted for three months, terminated by Dora apparently because of her dissatisfaction with the interpretive road Freud was taking with her.

Dora believed that she had inherited syphilis from her father, whom Freud had treated for it. She was suicidal and despairing for many good reasons, not the least of which was her father’s attempt to pawn her off on his lover’s husband. Dora’s ‘mental’ illness, as many scholars have noted, was rooted in her milieu and the sexual double standard that locked women into individualized explanations for neuroses that had profoundly social causes. Dora believed that her father had infected her mother with VD, and she may have been right, given the symptoms from which her mother suffered. When Dora told this to Freud, along with her fear that she had inherited syphilis from her father, he interpreted her fears as part of her pathology rather than as a precipitating cause, although he admitted ‘that the offsprings of luetics were very specially predisposed to severe psycho-neuroses’. Dora, Freud also noted, attended lectures on women’s rights, was widely read, and was ambivalent about her sexual identity, which Freud diagnosed as ‘repressed’ homosexuality (Freud, 1905/1997: 67).

As he moved toward his conclusion of the case, Freud speculated on its larger cultural ramifications in a way that suggests a source for his move (around 1907) from a belief in father–child incest to the Oedipal ‘wish’ that became the hallmark of his mature theory of psychosexual development. Freud notes that Dora’s governess (who was in love with Dora’s father) taught her:

all men were frivolous and untrustworthy. To Dora that must mean that all men were like her father. But she thought her father suffered from venereal disease – for had he not handed it on to her and her mother? She might therefore have imagined to herself that all men suffered from venereal disease … (Freud, 1905/1997: 76)

Freud was shaken by the horrified public and medical response to his theory that incestuous sexual abuse was part of the hidden life of the bourgeoisie. Perhaps he could also not accept the links he discovered among the venereal diseases of men and some women’s rejection of heterosexuality as a life-threatening disease.

Mabel Dodge Luhan

Mabel’s fear of sexuality began with her father, Charles Ganson, who seems to have been responsible for her first associations of sexuality with syphilis, madness and punishment. Her earliest childhood memory is of visiting her father in a sanitorium, where, she was later told, he was incarcerated for ‘self-abuse’. He had been banned from having intercourse with her mother after Mabel was born because it ‘made him insane’, but he had apparently failed to heed the advice. In the notes made by her psychiatrist Smith Ely Jelliffe, Ganson’s outbursts of rage and violent behaviour are twice juxtaposed to the suicide of the Buffalo man, mentioned in the opening quote of this paper (Rudnick, 2012: 30–1).

We cannot know why this man is mentioned alongside Ganson in Jelliffe’s 1916 case notes. Was Mabel’s father syphilitic or homosexual or both? Why did sexual intercourse ‘make him insane’? Was he suffering from paresis, syphilitic insanity, in his last years? Why does Mabel write in her memoir about her first love affair that she had to make love to John Parmenter to ‘get the taste of my father out of my mouth’? (Rudnick, 2012: 50). Did her father sexually abuse her or just transmit to her his revulsion towards female flesh, at once menacing her burgeoning sexuality with his frightening prohibitions not to ‘kiss boys’, easing her into the gentle and unthreatening arms of young women, and sending her on her ultimate journey towards what the poet Adrienne Rich has named ‘compulsory heterosexuality’, as a means of restoring the family circle she never had (Rich, 1993: 227).

Mabel turned to lesbian relationships in her girl- and young womanhood at least partly out of terror of the consequences of heterosexuality. During her boarding schools years she had brief relationships with several young women, one of whom, Violet Shillito, became the most important love of her life, until Mabel met her fourth husband, a Taos Pueblo Indian, Antonio Lujan. Violet was the first person in Mabel’s milieu to introduce her to modern philosophy, art and literature and to inspire her to cultivate her mind and spirit. Mabel continued her lesbian affairs throughout her second marriage to Edwin Dodge, when she lived at the Villa Curonia in Florence with him between 1905 and 1912. She was hardly the only Victorian woman of her generation to do so. Vita Sackville-West, a member of the famous London Bloomsbury circle, turned away from her husband Sir Harold Nicolson, and to the woman who would become her life partner, after he informed her that he had contracted syphilis from a prostitute (Glendinning, 1992: 88–9). Even among that unconventional crowd, marriage was an important facade to maintain, and so most remained married. The Freudian and sexological regimes that Luhan adopted led anywhere but to her liberation. Of undoubtedly greater efficacy was the memoir writing that she engaged in for 40 years (Luhan, 1933, 1935, 1936, 1937, 1947/2012).

Freud’s theory of female sexual identity

Freud became interested in hysteria when he visited Jean-Martin Charcot at the Salpêtrière Hospital in Paris. He stayed with Charcot for four months in 1885–6 and was present at many of the demonstrations when Charcot used hypnosis to ‘cure’ the patients who had unexplained physical symptoms. Freud developed a method called ‘free association’ to understand why patients presented with somatic symptoms that did not appear to have any underlying physical cause. He called this method, and subsequent treatment, psychoanalysis. Psychoanalysis is predicated on the belief that repressed fears and unacknowledged psychological conflicts produce physical symptoms. It describes repression as the primary psychological defence mechanism, followed by secondary defence mechanisms such as projection, rationalization, displacement, undoing and somatization. If repression alone is not effective, then the anxiety surrounding the conflict is expressed through a variety of behaviours such as somatization and somatic symptoms, in the condition formally known as hysteria. In his treatment of young women, Freud identified physical symptoms that he believed were caused by the repression of sexual desire.

Functional neurological disorder (FND) is the current psychiatric term for the disorder formerly known as hysteria (American Psychiatric Association (APA), 2013). FND is ‘characterized by neurological symptoms (e.g. weakness, abnormal movements, or non-epileptic seizures) that are inconsistent with a neurological disease, but nevertheless cause distress and/or psychosocial impairment’ (APA, 2013). FND has a high degree of co-morbid psychiatric illnesses such as depression, anxiety and post-traumatic stress disorder (O’Brien et al., 2015). Present-day treatment is highly individualized and based upon the patient’s psychiatric co-morbidities, but in the early twentieth century this disorder was treated with hypnosis.

At first, hypnosis was used to treat Anna O, the patient who helped Freud to develop free association. Anna O was the pseudonym of a patient of Josef Breuer, who, in collaboration with Freud, published her case study in Studies on Hysteria (Breuer and Freud, 1955: 21–47). The description of her treatment is regarded as the beginning of psychoanalysis. Under Breuer’s guidance, Anna O identified a psychological stress that preceded the appearance of each of her physical symptoms. She decided, with Breuer’s input, to end her hypnosis sessions and just talk about whatever came to her mind. She called this the ‘talking cure’, which became officially known as free association, the first step in psychoanalytic treatment.

In making women the foundation of his ‘sexual etiology for hysteria’, Freud ‘gave early-twentieth-century psychiatrists license to further eroticize this female malady’ and to reinforce Victorian notions of ‘womanliness’. Modern sexual identity was first inscribed on the bodies of women, and it soon became ‘the omnipotent cause, the hidden meaning’ of their being (Lunbeck, 1994: 209). At the same time that psychoanalysis mandated sexual freedom for women, it ‘paradoxically tightened the grip of the system’ (Buhle, 1998: 38).

Implications

The social suppression of the fear of syphilis was not uncovered by psychoanalysis and escaped examination as an important underpinning to the psychoanalytic beliefs and theories about the psychosexual development of women. From the evidence we have reported here, it is clear that the fear of syphilis was an important driving force in ‘good’ women’s reluctance or refusal to engage in sexual relations with men. The lesson for psychiatry is to be cognizant of the impact of mental models on the development of theories about human nature and human motivation. Mental models of the mind are developed within specific sociocultural milieus, but we cannot avoid creating flawed models if there are hidden cultural influences. The sociocultural beliefs about syphilis shaped the early psychoanalytic theory of women; and its secrecy made it the hidden bedrock on which early psychoanalysis was based. Thus, it is important to examine the historical origins of our beliefs and practices, not only to correct the record, but, one hopes, to correct our current mental models and practice.

Ways forward

Psychoanalytic feminism has attempted to rewrite and correct the Freudian view of women and feminine identity. Jacques Lacan, Luce Irigaray and Julia Kristeva have shown how women have been a large projective canvas for the disavowed aspects of male identity (Zakin, 2011). Feminist theorists have attempted to describe the multiple factors, internal and external, that construct female identity, and to provide a description untainted by traditional male projections. This is a difficult task as we all (men and women) are raised in a patriarchal culture that shapes our thoughts, beliefs and behaviours. However, we can continue to shine a light on hitherto unknown areas of patriarchal influence. This article demonstrates one way that female identity has been misconceptualized by showing how the ‘secret sin’ that was syphilis, and its suppression, played a pivotal role in the evolution of psychoanalysis.