Illness as Assemblage

Demonstrating Hystero-epilepsy: Crisis and Its Simulation

In his clinical lectures on diseases of the nervous system at Salpêtrière in the 1870s and 1880s, Charcot uses the term ‘hystero-epilepsy’ to designate one of two phenomena: the first, ‘hystero-epilepsy with distinct crises’, a condition in which a person ‘is the subject of two diseases of which the outbreaks appear separately; at one time the hysterical crises are present (the attacks, as we say here), at another time the epileptic seizures (the fits)’; and the second, hystero-epilepsy with mixed crises, used for ‘those cases where hysteria alone exists, but in which also the malady is characterised, in its complete outbreaks, by four periods, one of which, the first (epileptoid or hystero-epileptiform phase), bears the likeness of epilepsy’ (1889 [1878]: 33). In one of many attempts to disaggregate hysteria from epilepsy, Charcot proposes the term ‘hysteria major [la grande hystérie]’ (1889 [1878]: 33) for the second form, which doesn’t so much eliminate the ‘clinical ambiguity’ ⁴ as demonstrate ambiguity as a key aspect of both hysterical and epileptic crises. In the present moment of the hegemony of evidence-based medicine, I find it useful to return again to Charcot’s lectures to make the rather obvious point that a medical crisis might be ‘mixed’ and/or ‘ambiguous’ rather than ‘distinct’ in character. The question becomes: how do we treat this mixed and ambiguous character of illness – both in the clinic and in narrative? I use ‘treatment’ as a kind of method for assembling together the clinical, conceptual, and discursive practices that enact illness across multiple spaces and temporalities. In my formulation of treatment as method, it isn’t just doctors who treat illness; illness is treated by a myriad of practitioners across a myriad of milieus (Diedrich, 2007).

Hustvedt’s diagnosis and treatment of the shaking woman considers these formal and methodological questions. She explores the relationship between the self and illness, and argues that many physical illnesses, like cancer, have an ‘alien quality, a feeling of invasion and loss of control that is evident in the language we use about it’ (2009: 7). Hustvedt notes, ‘No one says, “I am cancer” or even “I am cancerous,” despite the fact that there is no intruding virus or bacteria; it’s the body’s own cells that have run amok. One has cancer’ (2009: 7). She believes that ‘neurological and psychiatric illnesses are different’, leading to a shorthand that identifies a person with his or her illness: ‘he has epilepsy’ becomes ‘he is epileptic’. This difference relates to the performative quality of neuro-psychiatric illness as opposed to illnesses like cancer that are perceived as hidden, interiorized, and even secretive. ⁵ I have argued elsewhere that the diagnosis of illness in general is a performative act, ‘performative’ understood here through the lens of both social interactionist theories, which explore the constitution of the self in the practices of everyday life, ⁶ and speech act theories of performative utterances, which explore how saying can be doing, and have been utilized to discern, importantly, the how not the what of gender. ⁷ The utterance ‘you have – [choose your disease here]’ doesn’t simply name an existing biological condition; it brings that condition into being. Being diagnosed leads to becoming something new or someone else; it is an estrangement that can be both painful and productive. I argue that these diagnoses reveal not so much the or even a truth of the self, but the self as truth effect of the practice of diagnosis, and this self as truth effect can bring relief from the shame and stigma that often attaches to the experience of illness, although this is certainly not universally the case.

Returning again to Charcot, we note that he was already well aware in the 1870s and 1880s that the doctor’s ability to diagnose accurately and authoritatively is undermined both by a constantly mutating nosography and by the always present danger that the patient is simulating or exaggerating her condition, a process I call ‘lying and the performance of patienthood’ (Diedrich, 2010a). In the lecture in which he tries to tease out the differences between hystero-epilepsy with distinct crises and hystero-epilepsy with mixed crises, Charcot ends his demonstration with the case of ‘a young Jewess from St. Petersburg’, who ‘never menstruated’ and ‘has been attending the Clinique for about six weeks’ (1889 [1878]: 40). Charcot tells those in attendance at his lecture that the young Russian Jewess ‘comes to Paris in the hope of being cured, having been unable to obtain relief elsewhere’, but he also admits he has reservations about the case: the reservations are less about the possibility of cure than about the patient herself, whose facial tic non-douloureux is produced, suspiciously, only when the doctor wishes it to be, which, in an irony that Charcot does not elaborate on, suggests that a patient might use the doctor’s wishes to subvert his authority, or, put another way, the doctor’s authority rests on the patient’s production of the symptom upon demand. I will say more below about the problem of the doctor’s wishes being used by the patient when I take up Foucault’s attempt to untangle the knot of simulation, hysteria, and psychiatric power. For now I simply want to note that, at least to some extent, this dynamic is the basis of all encounters between doctors and patients: ideally the patient improves by heeding the doctor’s wishes. With simulation the reverse happens instead: the doctor’s wishes make the patient sick. ⁸

In order to demonstrate the simulation he suspects, to show simulation in action, Charcot first brings out a ‘woman who is afflicted with facial tic non-douloureux in the form generally seen’ (1889 [1878]: 40). By assembling one facial tic non-douloureux and another, Charcot displays the difference between hysteria and simulation, or true hysteria and false hysteria, asking his clinical audience ‘whether [the case of the 15-year old Jewess from St. Petersburg] is not one of those singular instances of simulation with which the history of hysteria teems’ (1889 [1878]: 41). It bears emphasizing: simulation is both singular and abundant in the history of hysteria. Yet, at the same time as he seeks to separate hysteria from its simulation, Charcot also notes, when discussing the Russian girl’s possible motives for simulation, ‘that hysterical people often simulate without any very distinct end in view, by the worship of art for its own sake’ (1889 [1878]: 42). Here, simulation – ‘art for its own sake’ – is a symptom of, or internal to, hysteria, which would seem to complicate efforts to separate true hysteria from its simulation. Charcot asks, ‘But is not the love of notoriety motive sufficient?’ And he answers his own question with another question that suggests the importance of what the patient gains from her artistry in deceiving her doctors: ‘To deceive, or think she deceives, the physicians of St. Petersburg, then those of Paris, next the Faculty of Vienna, and thus to make a tour through the whole of Europe, is not this sufficient motive?’ (1889 [1878]: 42). Through simulation, the young Russian becomes a hysteric; she both imitates and invents anew the diagnostic category ‘hysteric’. ⁹ Her becoming-hysteric is both contained within and escapes the spaces, discourses, and practices of the clinic; or, put another way, her deception takes her places, even if the master clinician Charcot professes not to be taken in by her deception. There is of course a long, fascinating conversation in feminist theory about whether hysteria is a feminist, or proto-feminist, form of resistance. ¹⁰ I will elaborate further on this debate below, but want to suggest here that the possibility of feminist resistance is already acknowledged, at least obliquely, by Charcot, who notes both the precarity of the doctor’s power to diagnose and the patient’s powerful desire to simulate an hysterical identity. The doctor and patient co-constitute the truth of illness through the artifice of its simulation in the clinic. At the same time, of course, they also co-constitute the, or a, truth of gender through the artifice of its (gender’s) simulation. In the clinic, gender itself becomes a kind of illness that is simulated.

What happens, then, when the patient herself makes up her own diagnostic category, becomes both doctor and patient in one body, as Hustvedt does with the ‘shaking woman’? Hustvedt’s ‘shaking woman’ is both more and less than other neuro-psychiatric identity categories – such as ‘epileptic’ or ‘schizophrenic’ or ‘hysteric’; it both expands and contracts who Hustvedt is; it is both a truth and lie of the self. Hustvedt herself complicates the question of identity and identification: ‘The shaking woman felt like me and not like me at the same time. From the chin up, I was my familiar self. From the neck down, I was a shuddering stranger’ (2009: 7). Her bifurcation between head – not shaking – and body – shaking – literalizes the mind/body dualism, and in doing so, reveals the shaky ground on which such distinctions are secured and maintained. The body’s symptom becomes an object of analysis, quite literally: when Hustvedt gives a talk about the shaking episode at Columbia University’s Program in Narrative Medicine six months after her shaking/talk at her father’s memorial service, she shakes again. In her talk, Hustvedt explains, ‘I described my tree-commemoration fit and used three figments – a psychiatrist, a psychoanalyst, and a neurologist – to illustrate how a single paroxysmal event might be construed differently, depending on your field of expertise’ (2009: 27–8). A doctor friend in attendance at Hustvedt’s talk tells her that, ‘it had been like watching a doctor and patient in the same body’, and she expands on the bifurcation her friend and others had witnessed: ‘Indeed, I had been two people that day – a reasonable orator and a woman in the middle of a personal quake. Entirely against my will, I had demonstrated the very pathology I was describing’ (2009: 30). The paroxysmal event at the narrative medicine clinic at Columbia becomes a 21st-century echo of the enactment of hystero-epilepsy at Salpâtriére, showing how particular clinical spaces bring about particular illness assemblages at particular times. In this later scene, doctor and patient merge into one body – doctor-patient, happily hyphenated. Hustvedt seems aware that there is no small irony in the fact that her embodied demonstration of her condition – both physically and in narrative – should happen within the context of program in narrative medicine, an emergent late 20th- and early 21st-century historico-clinical phenomenon. ¹¹ Another bifurcation and merging happens in narrative after the fact of the event of the lecture. The ‘narrating woman’ tells us that the ‘shaking woman’ acted entirely against Hustvedt’s will. Where precisely intention lies is confounding to say the least.

How to diagnose this shaking, then: where does it come from and when did it begin? To answer this question, Hustvedt tracks back through the history of the diagnosis of convulsive disorders, noting that, ‘Physicians have been puzzling over convulsions like mine for centuries’ (2009: 7). She meets a psychiatrist at a neuroscience lecture, who tells her she works mostly with ‘conversion patients’ sent to her by ‘neurologists who don’t know what to do with them’ (2009: 10). Hustvedt explains that ‘conversion disorder’ has replaced ‘hysteria’ in current nosography, ‘but lying beneath the newer term is the old one, haunting it like a ghost’ (2009: 10). The terminological shift from ‘hysteria’ to ‘conversion disorder’ seems particularly apt for a disease characterized by signs and symptoms that are confusing and confounding for doctors and iconic and imitable for patients. Again, we see the recurring and co-constituting problems of vestigiality, precarity, and simulation, as Hustvedt takes her reader on a tour of changing classifications, through the now five American Psychiatric Association’s Diagnostic and Statistical Manuals (DSM-I–V), while also noting classificatory discrepancies between the DSM and the World Health Organization’s International Classification of Diseases (ICD 1–10). ¹² Hustvedt’s journey through a classificatory thicket ends at the question with which she began and which she returns to throughout her narrative: ‘The contemporary dilemma of identification sounds a lot like the difficulties physicians have had throughout the ages separating epilepsy from hysteria. The question has always been, A woman is shaking. Why?’ (2009: 13).

Dividing Hystero-epilepsy: Convulsive Games of Truth

‘A woman is shaking. Why?’ is a question Foucault also addresses, if obliquely, in his lectures at the Collège de France on the theme of psychiatric power a century after Charcot’s lectures at Salpêtrière. In his sweeping final lecture for the course, on 6 February 1974, Foucault begins with the emergence of what he calls ‘the neurological body’ in the late 19th century, and then explores ‘the struggle between neurology and the hysteric’, in which the hysterical patient’s counter-maneuvers against psychiatric power simulate not only the hysterical attack itself but also, in Foucault’s sympathetic reading, the interlinked assemblages of illness, trauma, and sexuality. Foucault argues in his lectures that, from around 1820 to around 1870–80 (when Charcot will appear on the scene), ‘the so-called convulsive illnesses – medically, clinically, no effective difference was made between epilepsy and others – were illnesses of the mind’ (2006: 305). In these same lectures, Foucault also refers to the hyphenated term ‘“hystero-epilepsy” to designate a hybrid form (composed of hysteria and epilepsy) marked by convulsive crises’ (2006: 325, note 18). He then describes Charcot’s ‘codification of the hysterical attack (crise) on the model of epilepsy. In this way,’ Foucault continues, ‘the huge domain of what before Charcot was called “hystero-epilepsy,” the “convulsions,” is divided in two’ (2006: 310), or, at least, this is the stated diagnostic and conceptual goal at the time, according to Foucault’s reading.

One hundred years after Charcot, around 1974, when Foucault is lecturing on the emergence of the neurological body and psychoanalysis is losing its dominant position in psychiatry, the diagnostic line between these two domains is still not established conclusively, and the hybrid category remains operative conceptually and clinically. Even as the term ‘hystero-epilepsy’ is no longer favored in medical discourse, the ambiguous condition continues to haunt neurology and psychiatry, and the conceptual partition between organic and mental illness remains precarious. Hustvedt’s repeated question – ‘A woman is shaking. Why?’ – leads to further questions about divisions – between hysteria and epilepsy, between organic disease and mental disease, between ‘a shuddering person and a cool one’ (2009: 27), between doctor diagnosing and patient being diagnosed, between subject and object, between one side of the brain and the other. What Hustvedt attempts to understand through her narrative treatments of the shuddering person and the cool one is how two can be one, or one multiple in and across time and space. ‘Who are we, anyway? What do I actually know about myself?’ Hustvedt asks, and in putting these two questions side by side, she both links and separates the universal and particular, being and knowing (2009: 70). In her brief treatment of Hustvedt’s ‘neurological memoir’, Lisa Blackman notes that, on the basis of her experience of ‘extreme and visceral dividedness’, Hustvedt ‘undertakes an informed and incisive analysis of the sciences, and how they might speak to the phenomena she has repeatedly felt’ (2012: 169). As Blackman explains, this puts Hustvedt in conversation with a long line of thinkers ‘working within subliminal psychology during the nineteenth and twentieth centuries’ (2012: 170). As with Charcot’s Russian Jewess, then, Hustvedt’s shuddering takes her to new places, new experiences, new thought, and further questions:

My symptom has taken me from the Greeks to the present day, in and out of theories and thoughts that are built on various ways of seeing the world. What is body and what is mind? Is each of us a singular being or a plural one? How do we remember things and how do we forget them? Tracking my pathology turns out to be an adventure in the history of experience and perception. How do we read a symptom or an illness? How do we frame what we observe? What is inside the frame and what falls outside it? (2009: 70)

For Hustvedt, as for Foucault, the experience of illness is multiple, and tracking that multiplicity demonstrates that even as diagnostic categories seek to contain and reduce – to frame, in Hustvedt’s words – an illness experience, the experience always also falls outside the frame, overspills the container, gets messy. This is the case for Hustvedt’s diagnosis in particular and for the illness assemblage hystero-epilepsy in general. Two pathological facts stand in contradiction: the fact of the diagnostic container, which reduces, and the fact of illness itself, which always exceeds its diagnostic container.

Although a key word search in The New England Journal of Medicine reveals that the term ‘hystero-epilepsy’ has been used infrequently since Charcot’s time, the two post-1960 uses of the term, in book reviews, indicate the enduring precariousness of the categorical and conceptual separation between madness and epilepsy in the late 20th century. The first, a review of an epilepsy textbook in 1969, discusses the ever-changing nature of the diagnosis of epilepsy, and the continuing interest in the ‘psychologic and social aspects of epilepsy’ (Rosman, 1969: 966–7). Yet, one of the reviewer’s main criticisms of the textbook is that certain conditions are ‘incorrectly classified’ or ‘incorrectly categorized’ (Rosman, 1969: 966), demonstrating disagreement, even among experts, about correct classifications and categorizations. The reviewer also finds fault in the clinical discussion of the diagnosis of epilepsy, because ‘no attempt is made to help the physician differentiate seizure from syncope, breath-holding, cataplexy or hysteroepilepsy’ (Rosman, 1969: 966). The reviewer’s demand that the textbook pay closer attention to the differential diagnosis of epileptic seizures from hysterical convulsive cases is a sign, I argue, of a continuing anxiety in medicine over the possibility of hysterical convulsions being taken as real. We see yet again anxiety circulating around the doctor’s ability to distinguish real from fake diseases. Such anxiety surely contributes to the prioritization of and reliance on technologies of visualization to present disease to the patient (sometimes even before she knows she is ill) rather than relying on the patient’s own report of illness.

In his lectures on psychiatric power, Foucault explains that the hysteric adopts symptoms – ‘those, precisely, offered by the organically ill’ – in order to fool the doctor. In so doing, Foucault asserts that she ‘goes against the current of the asylum game’ and is therefore ‘the true militant of antipsychiatry’ (2006: 253–4). By taking the hysteric rather than the schizophrenic as the true militant of anti-psychiatry, Foucault both extends and challenges many of the theorists of anti-psychiatry, including Laing (1967) and Cooper (1967), but also Deleuze (2004), Guattari (2009), and Deleuze and Guattari (1983 [1972]), who tended to be preoccupied with the schizophrenic as figure of protest against normative structures – familial, psychiatric, social. Evoking what we might describe as a disciplinary convulsion, Foucault notes, in his course summary to the lectures on psychiatric power, that:

the major tremors that have shaken psychiatry since the end of the nineteenth century have all basically called the doctor’s power into question; his power and its effect on the patient, more than his knowledge and the truth he told regarding the illness. (2006: 341)

Although he then refers explicitly to several contemporary anti-psychiatrists, including Laing, Basaglia, and Cooper, by taking up the feminized figure of the hysteric and not the masculinized figure of the schizophrenic, Foucault aligns himself with the work of certain feminist theorists at the time, especially Hélène Cixous’s reading of Dora as ‘the name of a certain force, which makes the little circus [of the family, psychiatry, and the social] not work anymore’ (Cixous and Clément, 1986 [1975]: 157). In The Newly Born Woman, published just after Foucault’s lectures, Cixous argues that Dora’s resistance is a kind of proto-feminism:

Dora seemed to me to be the one who resists the system, the one who cannot stand that the family and society are founded on the body of women, on bodies despised, rejected, bodies that are humiliating once they have been used.… It is the nuclear example of women’s power to protest. It happened in 1899; it happens today where women have not been able to speak differently from Dora, but have spoken so effectively that it bursts the family into pieces. (Cixous and Clément, 1986 [1975]: 154)

Although Cixous makes a powerful case for the material effects of the hysteric’s protest, the question of whether the family is indeed burst into pieces by hysteria, and what the short- and long-term effects of this bursting are, is an important one – in 1899, in 1975, and today. In her rejoinder to Cixous in their ‘Exchange’ at the end of The Newly Born Woman, Clément argues that the hysteric cannot challenge the discourse of mastery from outside the discourse of mastery. For Clément, the hysteric’s statement can only remain, in Lacanian terms, at the level of the Imaginary, never the Symbolic, meaning its effects are limited at best and self-destroying at worst.

Around 1970, the hysteric disappears from medical discourse, and reappears in critical theory (confirming, perhaps, Charcot’s observation that she is always on the move). I am making a case here for the re-appearance in this still later clinical and critical moment of that even more vestigial category: hystero-epilepsy. After the review from 1969, the term ‘hystero-epilepsy’ makes its next appearance in The New England Journal of Medicine in 1995, in a book review of Mark S. Micale’s Approaching Hysteria: Disease and Its Interpretations (1995), a review further confirming that, even at the turn of the 21st century, the categorical and classificatory distinctions between epilepsy and hysteria are still not stable, at least not in clinical practice. Thus, in her positive review of Micale’s book, Cynthia Stonnington, now Chair of Psychiatry and Psychology at the Mayo Clinic in Minnesota, notes that ‘though official classifications no longer use the term “hysteria,” doctors still refer to patients as being “hysterical,” or diagnose “conversion hysteria,” “hysterical paralysis,” and so on’ (1995: 1796). In relation to issues of changing diagnostic categories, and persistent historical associations, Stonnington then makes a fascinating comment about epilepsy, and about what we might call, following Foucault, convulsive ‘games of truth’:

Paralleling the increase in historical studies of hysteria since the 1980s is the increase in the number of hospital epilepsy-monitoring units, whose staff are able to sort out true epilepsy from its imitators. About one third of the patients admitted to these units are ultimately given the diagnosis of ‘pseudoseizures’ – or, to give them another name, hysteria. Psychiatrists and neurologists have shown renewed interest in studying the causes and treatment of ‘hysteroepilepsy,’ which at present remains ill-defined. (1995: 1796)

Despite experts – master clinicians not unlike Charcot a century earlier – who are able to ‘sort out true epilepsy from its imitators’ and divide the convulsions into two (true convulsions from false ones), the categories hysteria and epilepsy remain precarious, always in danger of re-assembling into the hybrid, vestigial, and ill-defined category, hystero-epilepsy. The increase in the number of epilepsy-monitoring units – new clinical forms for demonstrating true from false epilepsy ¹³ – reveals both the power and anxiety of this particular performance of expertise.

Re-assembling Hystero-epilepsy: The Mechanics of Conversion

It seems important, then, to state the obvious: epilepsy, like hysteria, can be simulated. I will leave the question of how frequently this happens to the epilepsy monitors, but want instead to draw attention to the fact that the problem of simulation draws hysteria and epilepsy together again – re-assembling hystero-epilepsy, if not as a diagnostic fact, then as a clinical event, which calls into question not only the boundaries between disease categories, but also the boundaries between disciplines, medical and non-medical, as well as the continuing instability and anxiety around gender, and its persistent, if under-theorized, importance in medicine. Hustvedt tracks these changing disciplinary inclusions and exclusions, noting:

Hysteria, once within the providence of neurology, was pushed into psychiatry. Nevertheless, by all accounts, most conversion patients first present themselves to neurologists because they appear to have neurological problems. The issue here is again one of perception and its frames, disciplinary windows that narrow the view. (2009: 79)

Although Hustvedt recognizes the humanistic appeal of an analysis that explores what certain symptoms mean, she is also interested in the ‘biological root’ (2009: 93) of the conversion between the psychological and physiological, between psyche and soma. We are back to Hustvedt’s enduring question, ‘A woman is shaking. Why?’, but rather than substitute a purportedly simple biological event – shaking – for a purportedly complex psychological conversion, we might do well to follow Elizabeth Wilson’s lead and ask: how – literally – does the body do convulsion? Not only, then, ‘A woman is shaking. Why?’, but also ‘A woman is shaking. How?’

Wilson (2004) posits a strategic biological reductionism for feminist theory, as a counter-method to the hegemony of social constructionism in feminist theory. By calling Wilson’s reductionism strategic, in no way do I mean to suggest that her work is not conceptually and politically nuanced. Rather, I would argue that the precise description Wilson practices in Psychosomatic has effectively expanded and transformed the objects of and for feminist theory: from interpretations of gendered symptomology to analyses of biological processes, extending further back – ‘further chronologically and further phylogenetically’ (2004: 1), making connections between higher and lower orders and between purportedly simple biological events and complex nonbiological domains (2004: 13). Thus, Wilson returns to Freud’s hysterics, but not to discuss the hysteric as proto-feminist in particular, or even hysterical subjectivity in general. Wilson returns to Freud’s (and Breuer’s) hysterics to discuss the question of how hysterics convert (2004: 5), biologically as well as psychologically. What concerns Wilson is the fact that, ‘the most obvious aspect of hysteria – the bodily disability – has been attenuated in feminist accounts of hysterical symptomology’ (2004: 5). This connects to the concept and practices of illness as assemblage – moving from the neurological to the psychological and back again, and from the simple to the complex and back again.

Wilson’s brilliant reading of the case of Fraulein Elisabeth’s hysteria from Breuer and Freud’s Studies on Hysteria (1959 [1895]) is instructive to read along with Hustvedt’s case study of the shaking woman. In Freud’s account, Fraulein Elisabeth experiences pain in her legs, which, according to Freud’s analysis, are physical manifestations of the psychic pain caused by an affective complex of love and loss that infused her experience of caring for her dying father (according to Freud’s analysis, the pain in one leg is caused by the bodily memory of her father resting his foot on her leg while she changed his bandages), as well as the denial of her desire for her sister’s husband (even or especially after the death of her sister). In her reading of the case, Wilson emphasizes the biological aspects of Fraulein Elisabeth’s condition, explaining that ‘the physiology of her thigh muscles (their capacity to stretch and contract; their intimacy with the peripheral nervous system) cannot be separated from the illness and death of her father or from the words of her analyst. The intersubjectivity of her analysis is facilitated not just by words, ideation, and affects but also by nerves, blood vessels, and skin’ (2004: 10). Wilson helps us visualize this network of ‘intersubjective, biologically attuned complicities’ with a multiply hyphenated parenthetical diagram of a complex assemblage: ‘(… muscles-skin-legs-father-sister-hands-words-pain-analyst …)’ (2004: 10). The ellipses on either end of the (a- and de-)signifying chain point to the stretching and contracting – both spatially and temporally – of this material and immaterial process of association.

Wilson is particularly taken with Freud’s evocative term ‘somatic compliance’ to explain the process of hysterical conversion. The term, which Wilson draws from Freud’s analysis of Dora, acknowledges ‘“the participation of both sides” (i.e. the somatic and the psychic)’ (Freud, 1959 [1905]: 40, quoted in Wilson, 2004: 11), and the capacity for conversion between the two. By ending up with Wilson’s early 21st-century return to Freud’s early 20th-century hysterics, I don’t mean to suggest that her treatment finally allows us to understand once and for all the relationship between mind and matter. Rather, Wilson’s work brings me back, yet again and in a conclusion of sorts, to the vestigial category hystero-epilepsy, and to knowledge both accumulating and getting lost. In her account, Hustvedt eventually sees a sympathetic neurologist, who takes a thorough medical history, ‘dismisses conversion disorder’ (2009: 155) out of hand, and recommends two MRIs, one of the brain to check for temporal lobe epilepsy and the other of the cervical spine (C-2–C-5), both of which prove inconclusive. We learn more about Hustvedt’s long history of migraines, and, with the help of Oliver Sacks’s (1999) clinical and narrative treatment of that particular nervous condition, Hustvedt draws another line back into her own personal history and into medical history, this time linking migraine with epilepsy. Hustvedt describes Sacks as that rare medical practitioner, who ‘acknowledges not only the twists and turns of medical history but the genuine ambiguities that arise when we try to attach names to phenomena that resist clarity’ (2009: 157). Twists, turns, ambiguities: Hustvedt’s own singular story takes her and her reader places, accumulating all along the way a multiplicity of shaking women and their histories of nerves. The shaking woman is both a clinical figure and a narrative figure. She may also be political and resistant. What she is not is one thing or another, fixed once and for all in time and space. To understand illness as assemblage requires that we be ready to go places, places that are both in and beyond medicine and ourselves – much like the Russian Jewess becoming-hysteric in and beyond Charcot’s neurology clinic, and much like Hustvedt becoming-the-shaking-woman in and beyond the narrative medicine clinic.