Mcdonald 2018

Hysterical Girls: Combat Trauma
${protocol}://utpjournals.press/doi/pdf/10.3138/ijfab.11.1.3 - Monday, June 04, 2018 7:57:54 AM - IP Address:80.82.77.83
as a Feminist Issue
MaryCatherine McDonald
Abstract: The cluster of symptoms now called post-traumatic stress disorder (PTSD)
had its beginning in ‘‘hysteria,’’ a syndrome that affected only women. This paper
explores the way that the perniciously essentialist beginnings of trauma research have
bled into our understanding and treatment of trauma today. I use the work of Sandra
Lee Bartky, who argues that psychological fragmentation forms the basis of the oppres-
sion of women, to show the way that the psychological landscape has been shaped in
parallel ways for the traumatized veteran. Understanding trauma in nongendered ways
illustrates that the trauma response is an adaptive mechanism born of resilience.
Keywords: history of post-traumatic stress disorder, masculinity and combat trauma,

PTSD as a feminist issue, Sandra Bartky on feminism and combat
1. Introduction
In the United States, combat veterans are overwhelmingly male. It was not
until 2013 that the ban preventing women from serving in combat was removed
by then-Secretary of Defense Leon Panetta, and not until 2016 that women
could choose to enlist in Army Ranger School or become a Navy SEAL. Cur-
rently, only 6 percent of the veteran population in the United States is female
(up from 2 percent in 1994) (U.S. Veterans Administration 2000). Why, then,
choose combat trauma to show the ways in which our understanding of PTSD
is problematically sexist? Why argue that combat trauma is a feminist issue
when there are types of trauma that impact women more directly?
Combat trauma has proven to be difficult to understand and to treat. We
need look no further than veteran suicide data to reveal this. There are many
possible reasons for the intractable nature of combat-related trauma.1 It is my
contention that we are not doing a good job treating combat-related PTSD in
part because we have inherited a way of understanding and treating trauma
that is oppressive. It stereotypes the veteran, objectifies and fragments the
veteran, and alienates the veteran, making recovery more difficult. This oppres-
sive way of understanding trauma comes directly from its inception. In its
6 IJFAB: International Journal of Feminist Approaches to Bioethics 2018

Vol. 11, No. 1 DOI: 10.3138/ijfab.11.1.3
4 Hysterical Girls
origin, trauma was considered a weakness: in particular, a feminine kind of

failure to pull oneself together and cope, a gendered kind of madness afflicting
only ‘‘the fairer sex.’’ I do not think we have shaken the idea that to be trau-
matized is to be weak. We may not call trauma ‘‘hysteria’’ anymore, but we
still locate it in a dark and shameful place. It is not ‘‘manly’’ to suffer from
mental illness, or to struggle to cope with fear, panic, and sadness. If we
can peel back the layers of the past 140 years of trauma studies and reveal the
oppressive and sexist beginnings of trauma, and also reveal the way those
beginnings have stamped our current understanding, then we will have room
to rethink the traumatic response.
I will begin by briefly detailing the birth of hysteria in nineteenth-century
Europe, and how it came to be transformed into what we now call PTSD.
Then, following Sandra Lee Bartky’s (1990) ‘‘On Psychological Oppression,’’ I
will examine the ways in which the sexist and perniciously essentialist begin-
nings of trauma have bled into the way that we understand and treat trauma
and PTSD today. Finally, having divested ourselves of the misunderstandings
of the past, I will conclude by suggesting that if we shake off the origins of
trauma, we will have room to rethink the traumatic response as one that is
borne of resilience and not of weakness.
2. The birth of trauma

Hysteria finds its origins in Ancient Egypt, where depressive symptoms and
seizures in women were believed to be the result of a wandering uterus. Thera-
peutic methods depended on where the uterus was believed to have moved in
the body. The term hysteria is often credited to Hippocrates in Ancient
Greece.2 He believed that the uteruses of sexually inactive women were the
source of hysterical symptoms such as anxiety, tremors, convulsions, and
paralysis. The cure was sexual activity, which would restore women to their
rightful selves. Throughout the Middle Ages and the Renaissance, there were
arguments about whether abstinence or sexual activity was the better cure,
but the symptoms (depression, anxiety, paralysis, seizure) and the idea that
the ailment originated in the female reproductive organs remained unchanged
(Tasca et al. 2012).
The idea of this kind of strictly female madness that was tied directly to
the uterus and had something to do with sexuality and/or sexual activity, per-
sisted until Pierre Janet and Jean-Martin Charcot. While studying hysteria and
hypnosis, the two became interested in the most intractable cases of mental ill-
ness, hysterical women, and came to the conclusion that the origin of hysteria
was more complicated, and could not be assumed to be caused by a lack of
sexual activity (Van der Hart and Horst 1989).
The late 1800s in Europe saw an intense fascination with hysteria, Over
20 percent of all psychiatric dissertations in the late nineteenth century focused
on hysteria in one sense or another; a percentage this high has not since been
replicated on any other subject (Micale 1993). Janet and Charcot had taken
MaryCatherine McDonald 5
the hysterical patient from the annals of the insane asylums and given them
legitimacy. Charcot’s research became well known to the public, as he held
frequent Tuesday night lectures in which he would bring the hysterical patient
to the stage to display her symptoms for scrutiny and discussion.3 Charcot
brought hysterical patients into the psychiatric landscape and helped redefine
them as treatable and legitimate. Though Janet and Charcot eventually jettisoned
the idea that the symptoms originated in the uterus, hysteria was still considered
an illness that befell women only.
Charcot was primarily interested in documenting hysteria and cataloguing
its symptoms, but Janet, Sigmund Freud, and Josef Breuer (along with other
followers) were determined to discover the cause of the disorder. In 1895,
Freud and Breuer published Studies on Hysteria in which they theorized that
the cause of hysteria was past trauma. The first example they refer to is a
hypothetical one in which an upsetting emotion experienced during dinner
leads to persistent stomach upset: ‘‘We may take as a very commonplace instance
a painful emotion arising during a meal but suppressed at the time, and then
producing nausea and vomiting which persists for months in the form of
hysterical vomiting’’ (Freud and Breuer [1895] 2004, 4). Breuer and Freud dis-
covered that in conversations with their patients, the patients always seemed
naturally to trace the symptoms back to precipitating traumatic events or series
of events that were too emotionally overwhelming to process. This evidence
led them to their etiological theory: an inability to process cognitively an event
because an excess of emotions can lead to chronic somatic symptoms. This
theory led to the hypothesis that if one could process the original trauma and
give voice to the initially suppressed emotions, the symptoms would then cease.
Working separately, Pierre Janet came to the same conclusion that hysterical
symptoms could be associated with past traumas. He was the first to connect
the theory of dissociation to traumatic memories, which explained the altered
state of consciousness that hysterical patients were often found to experience
(Van der Hart and Horst 1989). He also noticed that patients who had experi-
enced trauma bring their past emotional responses into the present. A loud
banging noise might regularly elicit severe and disproportionate anxiety or
anger in a hysterical patient, whereas the nonhysterical individual would find
the noise unremarkable. His resulting theory was very similar to Freud and
Breuer’s. Janet speculated that intense emotions have an effect on the mind’s
ability to process an event and lead to a different kind of memory, one that is
somatic rather than cognitive, and is manifested in dreams, hyperaroused
states, and flashbacks.
Though Charcot, Janet, Freud, and Breuer made incredible advancements
in the understanding of hysteria, they remained inherently essentialist about
the gender of this illness. They came to understand that hysteria may not
originate in the uterus or be related to a lack of or an excess of sexual activity,
but it was still seen as a disorder that exclusively afflicted women.
6 Hysterical Girls
Had the history of trauma continued to proceed as fruitfully as it began

in the 1890s, there is no telling how far the study might have progressed.
However, the promising study of trauma came to a screeching halt for all three
theorists almost as soon as it had begun. Charcot’s work faced scrutiny when
it was suggested that the subjects of his Tuesday night lectures were acting
rather than experiencing true symptoms. Freud rejected his own work in 1897,
and Breuer fled from the study of hysteria after a patient became intensely
attached to him. Freud and Breuer abandoned their patients midtreatment and
repudiated their own work, and the study of trauma fell out of favor (Herman
1992, 15–20).
The reasons Freud and Breuer turned away from their initial research and
findings remain a subject of some controversy. It has been suggested by historians
of psychology that this turning away could be credited to personal concerns
rather than clinical ones. Judith Herman (1992) argues that Freud and Breuer
did not turn away from hysteria because they had progressed beyond it, but
because they had concerns that were more personal and political in nature.
She notes that most of hysterical patients had sexual trauma in common. In
Trauma and Recovery, Herman explains just what this meant to Freud in
particular: ‘‘To hold fast to his theory would have been to recognize the depths
of sexual oppression of women and children. . . . To ally himself with such a
movement was unthinkable for a man of Freud’s political beliefs and profes-
sional ambitions’’ (19). That is, it was not that Freud felt himself to be incorrect
in his theory but precisely the opposite. It was what being correct meant to
Freud (and Breuer) that was so problematic. The theory that Freud and Breuer
abandoned their patients because of personal and political conflict rather than
theoretical advancement seems to be borne out empirically. Though they
abandoned their patients, they did not abandon their method. Some of the
central ideas contained within Studies on Hysteria (the ‘‘talking cure’’ being
the most notable example) remain mainstays both of their later work and of
psychoanalytic theory today.
This intense fascination with trauma, followed by an abrupt turning away,
is a pattern that has repeated itself throughout the history of the study of
trauma. This pattern has not gone unnoticed. Abram Kardiner, a pioneer
in trauma theory, lamented that trauma is ‘‘not subject to continuous study,
but only to periodic efforts which cannot be characterized as very diligent’’
(Kardiner and Speigel 1947, 1). Herman (1992) calls the study of trauma one
of ‘‘episodic amnesia’’ (7). Veteran and war journalist David Morris (2016)
calls the world of trauma studies ‘‘remarkably chaotic,’’ one resembling ‘‘an
arcade at a state fair . . . with little overlap between various groups, let alone
coherence’’ (13). It is not that the study of trauma falls out of favor due to
a lack of interest, or that there are periods in time in which trauma does not
occur (though there are certainly times when more people face trauma) but
that, as Herman says, ‘‘the subject provokes such intense controversy that it
periodically becomes anathema’’ (7).
In trauma’s beginnings, the way in which the controversy and anathema

are deeply gendered is often overlooked. Perhaps the symptoms of hysteria were
not taken seriously because women, who were easier to dismiss, were presenting
them. It was not until Charcot brought these women to the stage that they
were thought to be legitimately suffering. Even then, the psychiatric power-
houses that were Charcot, Janet, Freud, and Breuer could not stand up against
the deep misogyny that sought to silence the voices of sexually assaulted women.
History is quick to blame Freud and Breuer for abandoning their patients (as it
should), but we forget, in this blame game, that suspicion had already begun to
surround the hysterical patient on Charcot’s stage. Hysteria was always doomed,
not because of Freud, but because it was an illness that afflicted women.
This seems to be bolstered by the fact that the study of hysteria was quieted
until men started suffering from it. After World War I, soldiers worldwide
began returning home curiously displaying symptoms of hysteria (Van der
Hart et al. 1999). Plagued by bouts of altered consciousness, emotional out-
bursts, paralysis, amnesia, and muteness, soldiers forced the discussion of
these symptoms back into the psychological landscape. At first, it was thought
that their symptoms were physiologically based, a result of physical rather
than psychological trauma. One such theory gave way to the popular term
‘‘shell shock,’’ the theory that repetitive exposure to exploding shells caused
minor concussions resulting in the symptoms. Though the theory itself was
quickly abandoned due to the presence of soldiers who exhibited the relevant
symptoms but were not exposed to concussive blasts, the term shell shock
continues to be used colloquially.4 Without a clear physiologic cause of the
symptoms that plagued soldiers, and without any way of understanding why
some came back from war altered and some did not, blame was shifted onto
the character of the soldier himself.
Though the illness would have a new name, its origins remained mired
in conceptions of hysteria as a certain kind of feminine weakness. Along with
the idea of weakness, the diagnosis carried a great deal of skepticism, as it was
suggested that those who ‘‘suffered’’ might develop hysteria on purpose as a
way to avoid combat in the absence of a ‘‘real’’ injury (Leff 1981). In 1922,
the British Medical Journal summarized then-recent findings relating to shell
shock. Their research found that ‘‘a large number of shell shock cases in a
battalion was a sign of poor morale. . . . [A] poor morale and a defective train-
ing are one of the most important, if not the most important etiological factors:
also that shell-shock was a ‘catching’ complaint’’ (322–23). The suggestion
here is that much like the women on Charcot’s stage, soldiers with shell shock
were acting. The bias is clear: shell shock was unseemly, a result of human
failure, a failure on behalf of certain military leaders to train and control their
troops correctly, and a failure of certain soldiers to uphold their heroic and
manly nature. Those who suffered were assumed to be lazy malingerers, exag-
gerating their symptoms for sympathy.
8 Hysterical Girls
To suffer from shell shock was to fail, and this failure was gendered. To
have an emotional response to combat meant that you had failed as a man. It
meant that you were frail, broken, weak, guilty, inadequate, lesser than—all
things that were associated with being female and hysterical. To succeed as
a soldier was either to evade this fate altogether (the best option), or to heal
by ridding oneself of these feminine evils, returning to one’s original and true
masculine strength. This bias led to treatments that used humiliation and
violence to snap soldiers out of their altered ‘‘feminine’’ states and to turn
them back into heroic men.
Lewis Yealland (1918), a Canadian psychiatrist, was a proponent of such
treatment. He believed that patients could be brought out of their symptoms
through aggressive countersuggestion. Mutism, for example, was treated in
three different ways. The clinician would either utter provocative statements
to the patient, which would elicit an angry response, or surprise him with
loud noises, which would shock him out of his silence. It is worth noting that
the provocative statements were often themselves gendered: ‘‘[A] mute patient,
when told ‘Your mother wears a wig,’ blurted out indignantly, ‘She does not!’
(4)’’ is the first example of this kind of treatment in Yealland’s Hysterical Dis-
orders of Warfare. If provocative statements and loud noises did not work, a
spatula would be pushed into the back of his throat. The most severe cases
were treated by the application of strong electric shocks directly to the throat
(3–5). Yealland’s treatments were a mix of humiliation, shame, and physical
violence.
In yet another example, Yealland described patient A1 as someone whose
mutism did not succumb to several types of treatment (1–30). After nine
months of treatment that included electric shocks applied to his throat,
cigarettes extinguished on his tongue, and hot plates placed at the back of his
throat, patient A1 remained mute. Yealland reported that, determined to heal
the patient, he told him, ‘‘You will not leave this room until you are talking as
well as you ever did; no, not before. . . . [Y]ou must behave as the hero I expect
you to be’’ (9; emphasis added). There are gender norms at play here. The hero
that Yealland expects A1 to be is a ‘‘man.’’
Yealland then applied to the patient’s throat an electric shock so strong
that it sent the patient reeling backward, unhooking the battery from the
machine. Yealland strapped the patient down and continued to apply shock
for an hour, at which point patient A1 finally whispered, ‘‘Ah.’’ After another
hour, the patient began to cry and whispered, ‘‘I want a drink of water’’
(1–15). Yealland interpreted this breakthrough as confirmation that the soldier
was suffering from weakness rather than a true psychological injury or disorder.
Patients who could not be cured were classified as chronic malingerers, attempt-
ing to garner sympathy or evade service (237–48). In a list differentiating
between epilepsy and hysteria (biologically based illness versus self-created
illness), Yealland’s bias revealed itself again and again. Any patient who failed
to be treated successfully was dismissed, and Yealland would go to great lengths
to find proof of the patient’s insincerity (165–76). Even in the cases of legiti-
mate illness (i.e., the patients who were ill and then healed through these
methods), there is the implicit idea that shell shock was a disease of manhood
rather than an illness that came from witnessing, being subjected to, and partic-
ipating in violence.
Yealland’s method of treatment was replicated in hospitals and on battle-
fields. They were well-known enough to be represented in film and literature.

For example, in the opening scene of Stanley Kubrick ’s Paths of Glory (1957),
an antiwar film about World War I, a general approaches a dazed soldier and
asks him, ‘‘Are you ready to kill more Germans?’’ When the soldier stumbles
over his answer, another soldier tries to explain that he’s a bit shell shocked.
The general responds, ‘‘I beg your pardon, Sergeant, there is no such thing as
shell shock!’’ Turning to the first soldier, he exhorted, ‘‘Get a grip on yourself,
you’re acting like a coward. Snap out of it coward! Sergeant, I want you to
arrange for the immediate transfer of this baby out of my regiment. I won’t
have our brave men contaminated by him!’’
It is worth noting the way that gender norms from our original under-
standing of hysteria have mapped on to the combat soldier. To be manly is to
be courageous, to be great, to be unwavering. To admit to anything less than
that is to be unmanly, cowardly; it is to be weak, to be a baby, to be hysterical.
Today, when we say that someone is being hysterical or histrionic, we mean
that they are being overly emotional, melodramatic. Though we no longer
attribute these symptoms to a wandering uterus, this does not mean that we
have separated them from gender entirely. And we certainly have retained the
idea that the hysteric is not suffering in a serious way and is to be dismissed.
3. An oppressive trauma
We are nearly one hundred years away from Yealland’s terrifying and torturous
treatment of veterans, and we’d like to think that this distance is not just tem-
poral. We would never be as blind as he was; we would never treat the tortured
so torturously. And yet, the threads of misogyny that founded our understand-
ing of trauma still underlie our treatment of veterans. Why is this the case?
We tend to speak of psychological disorders as if they were natural—
relatively static and unified categories that naturally occur, waiting for science
to discover them over time. It is just as likely (some argue more likely) that
these disorders, and certainly the ways in which we treat them, are in some
important sense socially constructed. The symptoms that comprise PTSD arise
from the way that society thinks of and understands memory, distress, and
normalcy. So, just what PTSD is as an ontological category is something that
changes over time as these conceptions change. As anthropologist Allan Young
(1995) avers, ‘‘PTSD is not timeless, nor does it possess an intrinsic unity.
Rather, it is glued together by the practices, technologies, and narratives with
which it is diagnosed, studied, treated, and represented and by the various
10 Hysterical Girls
interests, institutions and moral arguments that mobilized these efforts and
resources’’ (5).
This is not at all to say that PTSD is not real. Rather, what it is, how it
manifests, and how it is treated are shaped by the social structures in which
it appears. This means that when PTSD is constructed as a distinct mental
disorder, it is cocreated alongside certain social realities that come to comprise
it in important ways. For our purposes, this is most relevant in the way that
ideas of heroism and masculinity get tied up with combat and homecoming.
Going to war is seen as manly and heroic; coming home and not being shaken
by war is correspondingly manly and heroic. The reverse is also true. Not
wanting to go to war is seen as cowardly and feminine; coming home and
suffering from PTSD is also perceived as weak, unseemly, and feminine. If
PTSD was constructed in a culture that valued masculinity and viewed suffer-
ing in any emotional way as feminine and weak, these ideas are still embedded
in our understanding of PTSD today. We have not yet shaken off the founda-
tional sexism on which the history of trauma and PTSD rests. It is one that is
insidious and difficult to see, and it is psychologically oppressive. It bleeds into
our understanding of war trauma and into our methods for treating it.
Sandra Lee Bartky (1990) describes what it means to be psychologically
oppressed. It is
to be weighed down in your mind: it is to have harsh dominion exercised over
your self-esteem. The psychologically oppressed become their own oppressors;
they come to exercise harsh dominion over their own self-esteem. Differently
put, psychological oppression can be regarded as the ‘‘internalization of intima-
tions of inferiority.’’ (22)
Following Frantz Fanon, Bartky describes the ways in which women are psycho-
logically oppressed through stereotyping, fragmentation, and objectification.
What is especially important to understand is that these modes of oppression
become implied, inherited, and self-oppressing.
Bartky is not talking about combat veterans in her article. However, just
as she applies Fanon’s framework to the oppression of women, we can apply
her framework to the oppression of those suffering from PTSD. Further, there
are important ways in which the oppression of combat veterans is a kind of
exercise in the oppression of women. There are parallels between the ways
in which women and veterans are psychologically oppressed by beliefs about
their weaknesses or femininity. This serves to reify biased ideas about women
being weak, lesser than, or more emotional. To show these parallels, I will look
at Bartky’s work alongside examples from qualitative interviews of veterans
that I have completed in my own research.5
a. Stereotyping
Bartky (1990) points out that stereotyping, though so ubiquitous that it can
sometimes seem almost harmless, is problematic for two reasons. First, it makes
it impossible for other people really to understand the needs of the individual
being stereotyped or to respect their rights. When someone is stereotyped,
they are immediately dismissed and their rights subsequently almost entirely
dismissed as being relevant. Second, the longer the stereotype persists, the
more likely the individual is to internalize it (24).
The most common stereotype of the veteran is the hypervigilant, paranoid
one who hits the floor anytime he hears a loud noise. He is fragile and scared
and needs to be treated with kid gloves. We do not use this stereotype to
empathize with this person, to anticipate his needs, or to ensure that his right
to mental health care is protected. We talk about it because we are fascinated
by it—and a little bit scared. Is this person our neighbor? A co-worker? Is he
pacing again? Does he have a gun? Should we call the police? We stereotype
those who are traumatized as weak, broken, and overcome by fear and their
emotions (distinctly feminine properties) if not directly, then certainly by sug-
gestion. Those who come home from war without PTSD are heroic—stronger
and more capable—than those who come home from war traumatized. One
can almost hear the echoes of Yealland here: ‘‘You didn’t behave like the hero
I expected you to be.’’
I will now turn to qualitative interviews with veterans that I completed
over the past year during research on the complexities of veteran reintegration.
Participants were recruited from across the United States, and were largely
veterans of the conflicts in Iraq and Afghanistan. They were interviewed via
telephone during the fall and spring of 2016 and 2017. Similar issues relating
to stereotyping, objectification, and fragmentation came up repeatedly.
Participant A was hoping to have a long career in the military when he
was discharged after seeking help between deployments. After receiving treat-
ment, he attempted to redeploy and was denied. He reports: ‘‘They offered me
a desk, and that’s not why I got in. That’s not what I signed up for. So they
just threw me away, I can go back, I want to go back, but now I can’t. All I
gave, and they just threw me away. I know that I can do it. I know that I can
go back. I want to go back.’’ No matter the interview question, he kept circling
back to ‘‘they just threw me away.’’ The message that he got from the military
was clear—he was broken, and they were finished with him. What seemed so
baffling to him was that he clearly wasn’t broken. He compared himself with
those who had suffered bodily injuries and physically could not deploy again.
He could not understand why something psychological could keep him away
from doing something of which he was physically capable. However, PTSD
is associated with weakness and instability, two traits that cannot be tolerated
on the front lines. Participant A felt that his diagnosis had ruined his life. It
certainly ruined his career.
Stereotyping also plays a part in diagnostics, as clinicians sometimes fail
to see normal combat experience as anything other than precursors to PTSD.
Participant B touches on the insidiousness of this:
12 Hysterical Girls
It took me a long, long time to realize that what is normal in combat isn’t
what is normal here. I wasn’t suicidal. But in general a psychologist will look
at you and say, ‘‘That’s a suicidal tendency.’’ And it absolutely is not. That
was the first reaction that I got the first time I talked about it. It was an
example where a turret gunner got shot through the eye socket. . . . And I
was really, really angry, not because the turret gunner got shot but because
I was standing behind him and intentionally fully exposed myself so that if
anybody got shot it would be me. And it wasn’t me. It was the gunner. Why
the hell did he shoot him and not me? But I shut up about that [for] a long
time because the first person told me I was suicidal, and I thought maybe I
was. But that’s not it. That’s absolutely not it. I didn’t want my guys to die.
Though it may be a normal part of combat behavior to risk your life for a
comrade, in civilian life any behavior in which you actively and intentionally
put yourself in mortal danger counts as suicidal. Since we are already inclined
to see the veteran as somehow disingenuous, it is tempting to believe that
Participant B is hiding something. Even reading this account, we might wonder
if the veteran is explaining away his suicidality.
Why are we already inclined to see the veteran as somehow disingenuous?
Because he is seeking help for a type of psychological suffering that we know
to be a weakness or failing, and therefore we assume that he is weaker and less
capable of determining the truth about his own psychological states.
Bartky (1990) points out that the subordination of women appears natural,
and that this is what enables it to continue. This is the same with the veteran.
The subordination of the ‘‘mentally ill’’ seems natural. After all, they are the
ones who need help; they are the ones who are ‘‘broken.’’ Those of us who
are intact, who have not been exposed to the evils of war (or who have but
who are ‘‘heroic’’ enough to return without psychological scars), are stable
and can fix those who are broken.
This paradigm that the clinician is whole while the patient is broken sets
up a power dynamic that allows the experience of the patient to be completely
eclipsed. Participant B was immediately diagnosed with and treated for PTSD
to his own peril. The treatment did not work, and he spent years engaged in
risky, life-threatening, self-destructive behavior before seeking treatment again.
After a month-long stint in jail, he returned once again to treatment. He
describes a ‘‘light bulb’’ moment in it:
I did the first six weeks—and the head psychiatrist was saying, ‘‘This isn’t
working on you yet,’’ and he started doing prolonged exposure stuff on me,
and I was talking about the most violent, horrific things that I had gone
through, and it really clicked with me in the process of that, and he kept
saying,‘‘Why aren’t you showing any emotion? You’re not crying. You’re not
getting choked up.’’ And I’m like, ‘‘Greg, this isn’t what’s screwing me up.’’
And that was the light bulb. That was like the—this is focused on the wrong
thing—this entire treatment process is focused on the wrong thing. So, as
soon as I wrapped my head around that, it was like, ok, if that’s not what it
is, then what is it?’’ And then we start thinking about what causes me the
most internal strife, anxiety, problems. What causes me to drink. What causes
me to seek out crazy behavior or anything else. And again, it wasn’t memories
of violence or anything like that—it was a need to prove myself; it was a need
to accomplish a mission.
While we could speculate about whether or not Participant B was suffering
from PTSD, what we should notice from his account is the realization that
the treatment is misfocused comes from the patient, not the clinician. The
classic treatment models for combat stress were not working, and because he
so neatly fit the stereotype of the traumatized veteran, no other treatment was
ever considered. As Bartky claims, stereotyping is so problematic because it
makes it impossible for people to understand the individual being stereotyped
or respect their rights.
The problem, then, is that the widespread refusal to given any epistemic
value to the accounts of the veterans is detrimental for treatment. Those who
suffer deserve to have a say in their treatments. However, the voices of those
who have been diagnosed with mental illness are too easily swept aside pre-
cisely because they have been mentally ill, but it is paradoxically these voices
that have the innermost understanding of what this is like, and which treat-
ments are most helpful.
b. Objectification
Bartky (1990) explains that sexual objectification can happen when a woman’s
‘‘sexual parts or sexual functions are separated out from the rest of her
personality and reduced to the status of mere instruments or else regarded as
if they were capable of representing her’’ (26). If one can be sexually objectified,
one can be psychologically objectified too. If your mental illness or trauma
is seen as the only relevant thing about you—when it is separated out from
the rest of you and seen as representative—it is a harmful and reductionist
objectification.
The unwanted psychological objectification of the veteran is unfortunately
incredibly common. Nearly every veteran I spoke with mentioned something
about people’s willingness to ask intrusive questions about their deployments.
‘‘Did you ever kill anyone?’’ or ‘‘How many people did you kill?’’ are the most
commonly asked questions of veterans. Strangers are just as willing to ask
veterans these intrusive questions as they are to touch a pregnant woman’s
belly and ask them how far along they are.
Participant C began work postdeployment at a large factory with hundreds
of employees. He began his orientation and was looking forward to a sense of
normalcy and also to an opportunity to put his technical skills to good use. He
had sustained substantial injuries on deployment, and had disclosed to his boss
in confidence that he had PTSD. He describes the way that he was introduced
to the other employees:
14 Hysterical Girls
So we get out to the floor, and the boss calls everyone over. And there’s a lot
of people, like maybe a hundred. And it’s the first time I’m meeting everyone.
And I already feel under the spotlight because of my scars and things, so I’m
sort of looking down and just waiting for it to be over, and then my boss
goes, ‘‘So yeah, make sure you watch out for ____. Be sure to tiptoe around
him. He’s got PTSD. You never know when he’s going to blow!’’ I was totally
stunned. I think maybe it was supposed to be a joke, but how am I supposed
to face those people?

Regardless of whether or not the comment was meant as a joke (certainly not
a good one), the message is very clear: the most relevant fact about Participant
C is that he has PTSD. He is different from us, and though his injury might
not have a scar that we can see, it is one worth monitoring, and one that
we will not be able to forget. Participant C’s PTSD is relevant to his employer
because it signifies a weakness, a deficiency, and, in particular, a feminine kind
of deficiency or weakness—a kind of hysteria or madness. Though we are far
from Charcot, Participant C might as well have been on stage.
Moreover, Participant C’s boss isn’t actually asking people to take care.
With the statement ‘‘Be sure to tiptoe around him, he’s got PTSD,’’ the boss
is inviting his employees to gaze with morbid fascination into Participant C’s
past. Again, as Bartky points out, what is especially dangerous about objectifi-
cation is the way that it can become internalized. That is, the veteran comes to
think the fact that she has PTSD is the only relevant thing about her. How is
she expected to believe anything else? What we haven’t taken notice of are the
ways in which this kind of oppression might make PTSD harder to treat.
When psychological oppression becomes internalized and the veteran is frag-
mented in this way, how is she to synthesize these experiences?
c. Fragmentation
Bartky (1990) argues that fragmentation operates as an oppressive mechanism
that underlies stereotyping and objectification. When the individual is consis-
tently split into parts by coercive forces, she is left at war with herself, unsure
of herself and her own needs, and sees herself as an object in the same un-
welcome ways that others do. This slowly erodes one’s sense of self and renders
one essentially powerless to fight against these oppressive structures.
David Morris (2016), a veteran and war journalist, wrote a bestseller about
his experience with PTSD. Though it is about his experience in whole and about
combat-related PTSD in general, a part of the book centered on his negative
experience with Prolonged Exposure (PE) therapy. PE is a type of cognitive
behavioral therapy in which the patient repeatedly visualizes the traumatic
event in great detail until the event loses its emotional ‘‘charge.’’ Originally de-
signed for victims of a single sexual assault (rather than, say, a series of assaults
over childhood, or the repeated exposure to trauma that many experience in
combat), it is a method that has garnered much attention and received a great
deal of funding. Like any therapeutic tool, however, it does not work for every-
one. Morris describes his experience:
I began to think of the treatment not as therapy so much as punishment.
Penance.
It went on like this for weeks. I would show up with some things I wanted
to talk about, thoughts I’d had, questions that had arisen when I looked over
the journals I’d kept during the war, and after hearing me out, Scott would
invariably direct me back to the imaginals. At one point, I went in and out
of the cul-de-sac in Saydia eleven times in one afternoon. I say ‘‘I’’ went . . .
because I always felt like I was alone in this activity. This . . . was a controlled
form of treatment. Scripted even. Stage-managed. I had a role to play. The
role was that of the patient diligently repeating his story, ad infinitum. . . . It
was, I would later learn, a ‘‘manualized’’ therapy. A therapy, in other words,
whose results were designed by researchers for researchers, a therapy designed
to be touted by medical administrators as being ‘‘efficacious’’ and scientifically
tested. (181)
Morris also wrote articles for the New York Times and Slate Magazine, which
were widely shared and commented on. Most notable about his book was his
critique of PE therapy. In response, Richard J. McNally (2015), a well-known
Harvard psychologist, gave an online interview to the Association for Psycho-
logical Science in which he states:
David Morris is a former Marine officer who experienced multiple traumatic
events as a civilian war correspondent embedded within American combat
units in Iraq. He is a thoughtful and excellent writer. Troubled by PTSD
symptoms, he sought help at the San Diego VA and received Prolonged Ex-
posure (PE) therapy, the treatment with the strongest evidence of efficacy.
Sadly, however, his distress did not diminish during imaginal exposure sessions,
and he terminated treatment early. His case is atypical; most patients do benefit,
and many recover from PTSD. Although his symptoms apparently worsened
temporarily, persistent worsening is very rare for patients receiving PE.
His first three sentences—carefully leavened with a compliment about Morris’s
writing—remind us of who Morris really is: a ‘‘troubled’’ patient who cannot
possibly speak to the therapy in general or the science behind it. The inter-
view—though it represents a singular view on the topic—is called ‘‘The Facts
About Prolonged Exposure Therapy for PTSD,’’ as if to suggest that Morris
slapped together some journal entries on his experience and sent it off to
press, and the purpose of this article is to remind us of the facts. Further,
McNally’s assertion that Morris’s case is atypical and that most patients do
benefit is at best inaccurate and at worst incorrect. What seems to be most
predictable about veterans who enroll in PE therapy protocols is that they
will drop out (Najavits 2015).
Though there is much that can be said about Prolonged Exposure, what is
most relevant about this is how easy it is to dismiss Morris. How easy it is to
16 Hysterical Girls
reduce him to his struggles with PTSD, to assume that his complaints are
probably exaggerated, even a little hysterical. The problem is not just about
hearing Morris’s story; it is about to whom we are trained to give epistemic
authority, and about how the authority always goes to the person in the position
of strength, while the other voice is dismissed as weak, crazy, or irrelevant.
4. Rethinking the traumatic response

We inherit sexist practices, not just as individuals but on a systemic, societal
level as well. Since these practices are inherited and not always overtly conscious,
they can be detrimental in insidious ways that are difficult to unravel. In regards
to our understanding of trauma, I have argued that we have inherited the funda-
mentally sexist idea that the traumatic response is a result of a weakness—one
that is at its root a result of a failure that somehow belongs to femininity.
This idea is still operative and destructive. Above, we see some of the ways
in which it reifies the cycles that have historically enabled us to dismiss violence
and trauma that happen to women and veterans as self-caused. It is further
destructive in that it holds us back from understanding that the traumatic
response is fundamentally one that arises from resilience, not out of weakness.
However, there is hope. If Allan Young (1995) is right—if PTSD and the ways
in which we treat it are in some important ways socially constructed—PTSD
and our methods of treatment of it are always open for reconstruction. Cur-
rent technological advancements have allowed us to gather more information
about the nature of trauma and PTSD. Though they have revealed validating
biological bases for the traumatic response, the idea that someone who has
PTSD is weak is one that persists. This is because we have not yet been able
to shake the gendered origins of our understanding of trauma and see the
traumatic response as one that is at is roots a protective and adaptive one.
In the most general sense, the capacity to adapt refers to an organism’s
ability to cope with or adjust to fluctuations within its body and/or in its envi-
ronment. It is a condition for the possibility of survival. For example, if we
were not able to adjust our body temperature in accordance with the tempera-
ture in the environment, we would not survive. Adaptation, then, is an essential
part of being a living animal. It is also at the root of the biology and psychology
behind the traumatic response. We can see this clearly if we briefly consider a
simplified explanation of what goes on biologically during a traumatic event.
When an event elicits an especially strong emotional response (i.e., one in
which one feels significant threat), the neurobiological process focuses on
adapting to that threat (MacLean 1990; Porges 1995; Katz and Yehuda 2006).
As a result, many normal processes are overridden to reprioritize blood and
energy flow toward the brain functions necessary for focus and response
(Shin et al. 1999; LeDoux 1993; LeDoux 1996; Le Doux 2000; Van der Kolk
et al. 1996; Van der Kolk 2014).
Essentially, the brain and body work in unison to redirect blood and energy
flow the better to ensure survival. Though this can become problematic, the
process by which information bypasses certain sections of the brain is an evo-
lutionarily adaptive one (Sapolsky et al. 1990; Sapolsky 1996). When the subject
is experiencing a threatening event, the amygdala sends information to the brain
stem that the body is under attack. The brain stem responds by sending a signal
to release stress hormones (e.g., norepinephrine and cortisol) that prepare

the body to deal with the situation. Both of these hormones have functions
that increase the chance of survival for the individual (LeDoux 1993; LeDoux
1996; Shin, et al. 1999).
When norepinephrine is released in the body, the senses are sharpened to
perceive the specifics of the situation better, the heart rate and blood pressure
are heightened to guarantee faster response time, and the body is prepared to
respond to the threat quickly and effectively. To accomplish these enhance-
ments, the parts of the brain responsible for higher-level discernment, recogni-
tion, and cognition are temporarily diminished or shut down. Cortisol aids in
this process by reprioritizing the bodily functions and redistributing energy to
ensure effective and efficient response (Bremner et al. 1997; Bremner 2005).
Bodily functions not necessary in the moment are suppressed so that the rest
of the body can have the fuel that it needs to act. Some of the functions that
get shut down are the immune system, the reproductive system, digestion, and
the sensation of pain or fatigue.6
These are essential survival processes, and in the moment of a threat they
are necessary. Even the lesser-discussed dissociative response, on which re-
searchers are just beginning to focus more attention, is a protective coping
mechanism. Dissociation—though it can be experienced in several different
ways—is detachment from the moment. It is thought to occur because what
is being witnessed is too much to bear; thus, one way to survive is to detach
from it (Van der Hart and Horst 1989). Though this can lead to problematic
symptoms later, it is grounded in an impulse to protect oneself, to survive
(Gurvits et al. 1996). Again, we find resilience rather than weakness at the root.
In the case of PTSD, these survival processes (and the hormone responses
associated with them) become chronic (Bremner 2005). While this is, of course,
a problem, how might trauma change if we were able to think about it as
originating in resilience rather than weakness or as an impulse to survive that
needs to be turned down rather than some inherent, unseemly flaw? This
seems especially salient in the case of combat veterans, given that some of the
things that appear as symptoms upon their return from deployment, such as
hypervigilance, are skills that we actively train them to have. It is no wonder
that Participant A felt so confused at ‘‘being thrown away.’’
Returning to the original hysterical patients of the 1800s, we can now
better understand the ways in which Charcot, Janet, Freud, and Breuer were
partially right about them. As it turns out, increased hormone levels in the
18 Hysterical Girls
trauma response effectively shuts the hippocampus down, which is responsible

for creating an autobiographical memory that has relevance to other memories.
In the moment of threat, this kind of organizing of data is less important than
responding to that threat. When the hippocampus is partially or completely
shut off to promote more expedient processing in other areas of the brain, an
autobiographical ‘‘memory’’ that the subject can recognize as a memory does
not get fully formed. What does become encoded is an implicit memory, or a
set of somatic (or bodied) responses: that is, increased heart rate, heightened
senses, hyperarousal, and so on. These bodily responses and emotions attached
to the implicit memory can be triggered when the subject is reminded of the
original event. When this occurs, she feels the emotions and goes through the
bodily responses as if she were experiencing the event all over again.
When Freud and Breuer ([1895] 2004) accidentally discovered the talking
cure, they wrote:
For we found, to our great surprise at first, that each individual hysterical
symptom immediately and permanently disappeared when we had succeeded
in bringing clearly to light the memory of the event by which it was provoked
and in arousing its accompanying affect, and when the patient had described
the event in the greatest possible detail and had put the affect into words.
(40–41)
That is, together with the therapist, they were creating an explicit hippocampal
memory where there previously had been only an implicit, somatic one. The
cycle is completed—what was initially an adaptive response that then becomes
maladaptive is finally corrected through the help of another. The hysterical
girls—though soon to be abandoned, maligned, and then forgotten—had the
answers all along.
If the mechanisms behind trauma and the traumatic response have been
uncovered, it would seem, then, that the case is closed. However, the idea that
the traumatic response is adaptive or that the roots of PTSD are to be found in
resilience and not weakness are still foreign ideas on the societal and clinical
levels. This is because our understanding of trauma and PTSD is still rooted
in the idea that this illness comes from a feminine failure to thrive. This does
not just impact the way we see trauma; it also bleeds into the way we treat the
traumatized.
5. Conclusion
Before Yealland (1918) demanded of patient A1 that ‘‘you must behave like
the hero I expect you to be,’’ he first appealed to the young soldiers’ sense of
masculine responsibility: ‘‘You are a young man with a wife and child at home;
you owe it to them if not yourself to make every effort to restore yourself ’’ (8).
Here, Yealland makes it very clear that patient A1 is not just failing to get
better (as if it were a mere choice), but that he is failing ‘‘to be a man.’’ He
is failing to provide for his family, failing to have the right kind of masculine
determination that would get him through this, and failing to be strong.
Until we shake the idea that trauma is borne of a particularly feminine kind
of weakness, there will always be an echo of Lewis Yealland in our treatment
of combat veterans. We will always be in some sense saying that ‘‘you must
behave like the hero,’’ by which we mean ‘‘the man we expect you to be.’’
Our understanding of trauma has deep roots in the feminine experience.

Historically, those experiences were first dismissed, silenced, kept in the dark,
and then momentarily heard and partially understood, only to be silenced
again precisely because they had their roots in the feminine experience. Only
when we uncover these roots and trace them forward into the present and
witness the ways in which we are still stereotyping, objectifying, and fragment-
ing the combat veteran can we understand and appreciate the ways in which
combat trauma is a feminist issue.
NOTES
1. Current reports on veteran suicide data estimate that twenty-two veterans commit
suicide every day, a statistic that is cited often. What many people do not know
is that these current reports don’t include veterans who have been dishonorably
discharged, nor those who are active service members, nor those who die by over-
dose, nor the deaths that occur in Texas and California, as these states have not
provided data. There is significant reason, then, to think that the actual number
of suicides due to military-related PTSD is much higher than twenty-two people
a day. See Kemp and Bossarte 2012 and Kemp 2014.
2. Though it was long thought that the term originated with Hippocrates, it cannot
be found in any Hippocratic writings, though he did write about this kind of
madness and its cure (King 1993). For our purposes, the exact origin of the term
is not as relevant as its continued use in the late nineteenth century.
3. Judith Herman (1992) aptly called these Tuesday night lectures ‘‘theatrical events’’
attended not just by physicians and students but also by many other members of
society who were also fascinated with hysteria (10–11). This certainly raises the
question of whether Charcot was making these hysterical patients legitimate, or
further delegitimizing them by turning them into spectacles. Setting aside ques-
tions about the ethics of his treatment of them, Charcot should be credited with
bringing them into the psychological landscape in a new way.
4. This term is largely credited to Charles Myers (1915) who wrote about the phe-
nomenon in ‘‘A Contribution to the Study of Shell-Shock.’’ He recanted his work
in 1919 in ‘‘The Study of Shell-Shock.’’
5. The qualitative data cited here were obtained in compliance with all IRB protocol
and were approved by Institutional Review Boards at College of the Holy Cross
and Old Dominion University.
6. This is, quite obviously, a very simplified view of what is going on neurobiologi-
cally. The purpose here is not to give an exhaustive account of the neuroscience of
trauma, but simply to establish the fact that the processes behind these symptoms
are evolutionary and adaptive. There are many accounts of a variety of accessibility
that explain trauma and the brain.
20 Hysterical Girls
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22 Hysterical Girls
CONTRIBUTOR INFORMATION
MaryCatherine McDonald is an assistant professor of philosophy at Old Dominion
University. Her research lies at the junction of phenomenology and psychology. She
has recently published essays on the phenomenology of combat trauma, the history of
post-traumatic stress disorder, and moral injury.

Mcdonald 2018

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Hysterical Girls: Combat Trauma

${protocol}://utpjournals.press/doi/pdf/10.3138/ijfab.11.1.3 - Monday, June 04, 2018 7:57:54 AM - IP Address:80.82.77.83

Keywords: history of post-traumatic stress disorder, masculinity and combat trauma,

6 IJFAB: International Journal of Feminist Approaches to Bioethics 2018

origin, trauma was considered a weakness: in particular, a feminine kind of

2. The birth of trauma

Had the history of trauma continued to proceed as fruitfully as it began

In trauma’s beginnings, the way in which the controversy and anathema

fields. They were well-known enough to be represented in film and literature.

to face those people?

4. Rethinking the traumatic response

to release stress hormones (e.g., norepinephrine and cortisol) that prepare

trauma response effectively shuts the hippocampus down, which is responsible

Our understanding of trauma has deep roots in the feminine experience.

American Journal of Psychiatry 154 (5): 624–29. https://doi.org/10.1176/

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