The Many Meanings of ‘Hysterical’

CLINICAL CONVERSATIONS

—Editor Howard Forman, MD

In Hysterical: A Memoir, Elissa Bassist describes a medical mystery and her healing journey to claim her voice in a society that often silences women. She questions our knowledge of diseases in women, calls out pop-culture tropes, and gives a scathing indictment of The Little Mermaid.

Susan Hatters Friedman, MD, caught up with Bassist to discuss Hysterical and the many meanings of the word. Excerpts from the discussion are below.

Susan Hatters Friedman, MD: The title of your book is brilliant. How does the title capture the work?

Elissa Bassist: “What is the one word that encapsulates my book?” I thought to myself during a nap. And then: Hysterical. The book encompasses all 8 to 15 meanings of the word. It is about uncontrolled extreme emotion, which is the dictionary definition of hysteria. It is about the medical condition hysteria. It is about using the label “hysterical” to dismiss women. It is funny. It is about mass hysteria in terms of reacting to a traumatic environment and making ourselves sick by repressing, and repressing because there is no template to deal with this kind of trauma. So I think I nailed it. I got all the meanings of the word.

Hatters Friedman: Absolutely agree! One of the big points you make is about reducing women to “crazy” or “hysterical” to keep women quiet. And you use lots of examples, including Vice President Kamala Harris. Can you say a bit about that?

Bassist: Those words are used as weapons to make women feel ashamed of what we say, of what we think, of what we feel, of who we are. When I was younger, when anyone labeled me, I wanted to prove to them that I was not hysterical, so I silenced myself. It is a very effective word. And thank G-d we have role models like Harris who recognize the word is being used against her and that it is an empty, ridiculous word. The definition has been expanded such that it is meaningless. Yet we still react to it, even if we know that it is being used against us, because of how long it has been used against us. I started writing Hysterical 12 years ago, and it is still hyper relevant; most recently we were called hysterical for thinking that our right to abortion might go away. “Hysterical” is as buzzy a word as “gaslighting” and as relevant.

Hatters Friedman: One of my favorite lines in the book is when you ask your therapist, “Is there a therapy for women with patriarchy?” How do you think that psychiatrists and therapists can help?

Bassist: Everyone needs to work on listening to women and believing women and all marginalized genders and identities. We give the benefit of the doubt to the white cisgender man; we believe what he says. We believe in his pain. We want to help him, and we want to help him quickly. The same is not true for literally anyone else. It is the opposite. There is a long-held bias and stereotyping of individuals who are not white cisgender men and of their problems, which do not seem to count.

I wish my doctors had said to me, “You’re in pain. Let’s change that. Let’s discuss all the options available. I want you to be involved in the decision-making. And I want you to feel safe and unafraid.” My psychopharmacologist told me, in contrast to my therapist at the time, “I hate that you’re in this amount of pain. This pain is not normal, and you should not live with it. We have many treatment options. And you’re stronger than you think you are.” She was reassuring and helpful and resourceful. It was also game-changing for me, that what I believed about myself and my pain was not true, that I could be so wrong about myself.

Hatters Friedman: What you are saying is so valuable—about you having agency in the relationship with your doctor versus being told what is going to happen to you.

Bassist: Yes, agency. And my therapist seemed clinical, whereas my psychopharmacologist was caring about my emotional life and my concerns and my fears, and she did not dismiss any of it. And she believed everything I said. She believed in my pain as much as I did.

Hatters Friedman: It seems like a lot of your recovery, from the psychodynamic standpoint, was about finding room for your own voice.

Bassist: When I was out of treatment options, I tried obsessive-compulsive disorder therapy, where I did exposure and response prevention therapy (ERP). Based on my obsessive fear of saying the wrong thing and receiving retribution for it, my clinician offered talking cures, and they worked for my emotional and physical pain.

I never thought I would be out of pain. I thought I would die before I was not in pain. But after 3 months of ERP, my unending pain had ended. And not from pills or surgery, but from expressing myself. Although ERP felt more painful than surgery because my brain had learned silence as protection, and so I had to rewire my brain and my fear system.

Now I feel like I can trust myself and advocate for myself. I can ask for what I need. I can get angry. And I feel more confident saying “no” and “I’m mad” instead of “please” and “thank you.” I had not considered expression as important as breath or a heartbeat.

Hatters Friedman: You write about labeling sexual violence. Why is it so tricky to define violent experiences?

Bassist: Individuals who live as women try to take up as little space as possible. We do not want to make a scene. We do not want to make a big deal. We do not want to worry or upset others. And so we diminish our experiences. Meanwhile, society diminishes our experience for us in the limited language they give us to describe abuse and our own lives. I have talked to so many women who did not realize they were abused until years later when they saw some movie or had some conversation or read some book that offered wider definitions of violence. And the next realization is that we have been repressing our experiences and downplaying them, and we have been suffering from that repression.

Hatters Friedman: Another topic in the book that struck me as a Veronica Mars fan and a Law & Order: Special Victims Unit fan, is that a lot of female protagonists’ backstories involve rape. And you point out that even in The Little Mermaid—a movie many of us loved growing up—the premise is unsettling.

Bassist: We have been so duped by our favorite TV shows and films. “Patriarchal propaganda” is in everything we love, and we do not know because we love it. My favorite female protagonists have been raped. Why? It is like they need to have been brutalized to be strong. That is the story that male storytellers want to tell, that violence galvanizes women.

With The Little Mermaid, it is bizarre that a 16-year-old mermaid gives up her voice for skinny legs to get an 18-year-old prince to marry her. In the original version by Hans Christian Andersen, her tongue is cut out, and she had to get married to a mortal because that is how mermaids get a soul. In thinking about everything I loved as a girl and then how I turned out as a woman, it is no coincidence I have a hard time speaking up for myself.

Hatters Friedman: You are a highly sought-after writing teacher. What have you learned as a patient dealing with doctors that you tell students as their teacher?

Bassist: A lot of my students who are women must be coaxed or reminded that it is OK to ask a question because asking questions is a call back to being “hysterical.” Like when former presidential aide Jason Miller called then-Senator Harris “hysterical” during a hearing over Jeff Sessions’ collusion with Russia during the 2016 election. “I mean, she was asking some tough questions,” Miller offered as proof.

I wish doctors would say, “What are your questions? What are your stupid questions?” instead of “Do you have any questions?” With the latter, I will say no because I want to be a “good patient.”

Hatters Friedman: You talk a lot about therapy in creative writing classes. How does therapy influence your teaching?

Bassist: Part of teaching is getting students to express what they are thinking and feeling but are too polite to say out loud. Ditto therapy. We are all too worried about being imperfect and embarrassing ourselves, and I try to lower the stakes and to trade high expectations for low ones, to get over ourselves in order to do our work, because you cannot get any work done if you expect it to be a masterpiece. I also try to create a safe, nurturing environment conducive to sharing and normalizing our darkness. In my class, we are allowed to have bodies that hurt and talk about it and turn it into art.

People are too afraid of writing something bad or saying something wrong or stupid or dark. That is the goal. Write something bad; say something wrong or stupid or dark. Another way to put it is to just write, just speak up. I learned about risk in exposure and response prevention therapy. Risk uncertainty, risk failure, risk humiliation. Writing is risk. Writing is also a psychological game with winners and losers, and you have to change the voice in your head to write, from critic to fan. You need to be so on top of your mental health to write since writing can bring out every negative thought you have ever had about yourself and life itself. Writing is therapy, but you also need to go to therapy.

Hatters Friedman: Thank you!

Ms Bassist is an essayist who writes cultural and personal criticism, a humor writer, a writing teacher, and editor of the Funny Women column on The Rumpus. Dr Hatters Friedman serves as the Phillip Resnick Professor of Forensic Psychiatry at Case Western Reserve University in Cleveland, Ohio. She is editor of Family Murder: Pathologies of Love and Hate, which was written by the Group for the Advancement of Psychiatry’s Committee on Psychiatry and the Law. She was awarded the 2020 Manfred S. Guttmacher Award by the American Psychiatric Association. She is a coeditor of Malpractice and Liability in Psychiatry.