‘This is a book about something that did not happen in history, a thought experiment resisted over the generations, a reality of human behavior that was rarely observed by the observational science par excellence’ (p. 7). With this intriguing declaration, historian of psychiatry Mark Micale launches his book Hysterical Men.

His title, of course, explains all: over the centuries, medicine has defined hysteria as a disease of women, not men. Some years ago, feminist historians like Elaine Showalter pursued a project that lay bare the various patriarchal assumptions and projects that had made hysteria a ‘female malady.’ It took two world wars, an epidemic of shell-shocked young soldiers, the rise of new feminist critical psychologies, and the emergence in the 1970s and 1980s of PTSD (post-traumatic stress disorder) before hysteria ceased to be seen by medicine as a ‘female malady’, and men were finally given equal time and space for their experiences of emotional suffering expressed in the language of bodily distress.

All this is well established in the literature. But, for Micale, it raises a question: if we assume that in fact hysteria was never really a female malady, and that in fact European culture always really had its fair share of hysterical men as well as hysterical women, then how was the experience of such men recorded, denied and otherwise managed during the long years before space was created to give expression to such suffering? This is the question that drives Micale's study – a study, as he sees it, of a history of silence, resistance, evasion and sidelong glances.

How does one write such a history? In a prefatory note, Micale insists that his strategy is a textual one – that he is actually not interested in what such male patients really suffered from: ‘It is physicians and their diagnostic behavior, rather than patients and what ailed them, that remain center stage in my account’ (p. xiv). But if that were really all he was doing, then his whole project would make little sense. What clearly drives Micale in this book is his belief that, over and over, the physicians he is studying failed to acknowledge the objective reality of experiences that could have been and should have been – but generally were not – recognized as examples of male hysteria.

And there is a great deal at stake for Micale because he believes that the denial of male hysteria has functioned as part and parcel of a larger historical tendency to deny and stigmatize the emotional experience of men, and especially male ‘psychological travails’ (p. 47). His sense of grievance over this situation makes for a historical narrative that is marked by a strong normative sensibility – certain historical actors are commended for their more or less forward-looking ideas, and others are criticized for their inflexibility, contemptuous attitude to patients, or reactionary tendencies.

But Micale does not just want to criticize the past for not meeting the standards of the present. He also wants to understand. In particular, he points out that the late eighteenth century – with its cults of sensibility – in fact saw a brief flowering of engaged attention in both medical and literary culture to the reality of male hysteria and related syndromes (especially in Georgian Britain). Around 1800, however, everything changed, against a background of larger political and patriarchal counterrevolutionary movements unfolding across Europe. In this context, doctors were ‘aggressively pressed into the service of discovering and maintaining a regime of difference between the sexes’; the result was that, across much of the nineteenth century, ‘female hysteria thrived as never before’, while male hysteria became a ‘story of evasions, resistances, and silences’ (p. 49).

The arrival on the scene of the French neurologist Jean-Martin Charcot did change the game somewhat, to be sure. Charcot, more than anyone else in the second half of the nineteenth century, believed in the reality of male hysteria and worked hard to press that fact on his medical colleagues. Nevertheless, as Micale sees it, even his effort fell short in the end. Charcot and his colleagues, Micale notes, were happy to acknowledge the prevalence of hysteria in working-class men, in men with effeminate habits and in Jews and other alien exotics. They were unwilling, however, to contemplate it as a diagnosis appropriate to themselves and others of their social class. For this reason, Micale concludes, the male hysteric remained during the era of Charcot an individual apart – a creature of stigma. He wants more.

Then, of course, Freud arrived on the scene. But did he finally clear things up and set things right? No. In fact, Freud is actually the final and perhaps the most poignant of all Micale's flawed heroes. Like Charcot before him, Freud acknowledged the reality of male hysteria. In fact, Micale shows that Freud's early psychoanalytic theory was deeply informed by what he learned from male patients such as ‘Herr E.’, as well as by what he learned from his better-known female patients. Not only that, but through self-analysis Freud came to acknowledge his own vulnerability to hysterical symptoms, relating to his struggle to overcome or deny strong homoerotic feelings towards his friend Wilhelm Fliess.

Yet, in the end, he too – and, in a sense, the psychoanalytic movement that he inspired – recoiled from the implications of what he knew and had seen, both in others and in himself. The case of Herr E. never saw publication. All the patients discussed in Freud and Breuer's 1893 Studies in Hysteria were female. And as soon as he reasonably could, Freud turned his attention away from hysteria towards less personally destabilizing domains of mental distress.

And what was true of Freud was true, Micale believes, of the other male doctors in his story as well. I have already suggested that Hysterical Men seeks to make contextual sense, and not just to condemn what Micale nevertheless frankly identifies as disappointing developments. For him, however, the relevant explanations are not just political and cultural – they are also psycho-biographical, and quasi-psychoanalytic. Individual male doctors – Freud, Charcot, and others – repeatedly resisted or in one way or another avoided embracing the full evidence for male hysteria because confronting it would have meant confronting the vulnerable and ‘feminine’ parts of their own psyches. In this sense, Hysterical Men mingles intellectual and cultural history with a commitment to a certain kind of psychohistory that I felt needed fuller discussion. Put another way, this is a deeply researched and fluidly written text that still needs to say more than it does about the complex analytic frameworks that actually inform the story it tells.