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yearnings and sexual inhibitions are in conflict with one another and the result is a more or less severe hysteria.”⁴³

      Austrian philosopher Otto Weininger shared the view that hysteria was brought about mainly by a woman's inability to admit to herself the reality of sexual desire latent within. In his disturbing yet nonetheless influential Sex and Character (1903),⁴⁴ Weininger criticized Josef Breuer and Sigmund Freud's 1895 Studies on Hysteria for presenting “hysterics in particular as eminently moral individuals. All that hysterics have done is to allow morality, which was originally alien to them, to take them over from outside more completely than other people.”⁴⁵ Hysterical fits resulted when “sexual desire threatens to prevail against the seeming restraint…Their reaction is always their last untruthful defense against the tremendous eruption of their own constitution: the attitudes passionelles of hysterical women are nothing but this demonstrative rejection of the sexual act.”⁴⁶ While he did not link hysteria specifically to a woman's marital status, Weininger's typology of hysterics connoted singlehood through the well-worn stereotypes of the maid and the shrew. Historian Chandak Sengoopta interprets Weininger's use of the dyad in the following manner: “The hysterical woman belonged to the psychological type ‘Maid.’ She was born, not made…The Maid was opposed to the Shrew, who represented the type of woman least susceptible to hysteria. The Shrew vented her wrath (deriving from lack of sexual satisfaction) on others; the Maid vented it on herself.”⁴⁷ Desire—or more precisely, fear of desire—impelled the mind of the Maid toward hysterical disturbances.

      Freud also tapped into this fear of desire in the case history of Katharina, a “rather sulky-looking girl of perhaps eighteen.”⁴⁸ While hiking in the Alps, Freud met a girl who complained of a nervous affliction. Since he could not conduct a full psychotherapeutic investigation while in the midst of his trek, Freud was forced to try “a lucky guess. I had found often enough that in girls anxiety was a consequence of the horror by which a virginal mind is overcome when it is faced for the first time with the world of sexuality.”⁴⁹ Freud termed this condition as ‘virginal anxiety’: “The anxiety from which Katharina suffered in her attacks was a hysterical one…a mere suspicion of sexual relations calls up the affect of anxiety in virginal individuals.”⁵⁰ Freudian thought held that sexual apprehension could bring forth hysterical illness and frigidity among both girls and women.

      Johannes Rutgers, a Dutch birth control pioneer, elicited the aura of Altjungfertum in describing the symptoms of his hysterical patients: “The absent sexual life reveals itself even more in the vascular system…The blood, which in this period of life should be actively stimulating the reproductive organs, obviously takes an inverted turn in the case of abstinence!…Muscle tone can become flaccid; the lymphatic circulation can become inertial. The clinical case will emerge as indolent, lymphatic, even scrofulous.”⁵¹ The blood betrays the maiden; the body becomes barren. Neither child nor bride, this woman is destined to be a specimen. Rutgers saw her as an all too familiar character: “Who does not know a host of these ‘suchenden Seelen [searching souls]’? The more normal or elevated a person's disposition, all the more has she the desire and the need for love in its fullest fruition.”⁵² Hysteria emerged from an empty and asexual life, conditions sexologists widely ascribed to unmarried women, especially those of the middle-and upper-classes.⁵³

      Freud presented just such an elevated disposition in reporting the case history of 24-year-old Fräulein Elisabeth von R. One of five cases in Freud and Breuer's Studies on Hysteria, this text offers a fine demonstration of the sexological link between marital status and hysteria. Freud described Elisabeth as exhibiting great giftedness and ambition, traits he recognized among many hysterics.⁵⁴ Her positive nature belied her physical afflictions: “She seemed intelligent and mentally normal and bore her troubles…with a cheerful air—the belle indifference of a hysteric.”⁵⁵ In noting such belle indifference, even as he attempted to provide a modern and scientific understanding of hysteria, Freud affirmed his readers' prejudices regarding the nature of the condition and in so doing revealed his own as well.⁵⁶

      Freud's patient had a troubled history: in the space of just a few years, Elisabeth had nursed her beloved father through an ultimately fatal illness; her mother subsequently fell ill; Elisabeth's own health problems soon followed; her married sister then died after giving birth to her second child; and family tensions arose among the survivors of these tragic events.⁵⁷ An unhappy story, indeed—but how did this chain of misfortune lead to hysterical pain? Freud diagnosed the conversion as involving several factors: the worry produced through prolonged sick-nursing,⁵⁸ the confusion stimulated by Elisabeth's emerging sexuality,⁵⁹ and the anxiety created over the uncertainty of her future.⁶⁰ Myriad elements characterized Elisabeth's case, yet neither grief over her father's declining health, wistfulness for her fleeting youth, nor the frustrated misery of being unable to fall in carefree love were factors that emerged as most critical in Freud's evaluation. Instead, sex formed the centerpiece of this single woman's story, as inhibited sexual desire was the Freudian path toward affliction.

      Thwarted love persecuted Elisabeth. After months of therapy, Freud realized a startling fact: his patient was in love with her dead sister's husband, and had been so long before her sister had passed away. The “psychical excitations” occasioned by her attraction to her brother-in-law and the extraordinary reservoir of will that enabled Elisabeth to “fend them off” created a mental strain her body could not bear.⁶¹ These excitations were caused neither by the impossibility of her affectionate inclination nor by the pure horror at the fleeting thought inspired by viewing her sister's deathbed—“Now he is free again and I can be his wife!”⁶² Sexual attraction prevailed: “A circle of ideas of an erotic kind…came into conflict with all her moral ideas…The coldness of her nature began to yield and she admitted to herself her need for a man's love. During the several weeks which she passed in his company…her erotic feelings as well as her pains reached their full height.”⁶³ Sexual desire and hysterical pain went hand-in-hand. Of course, the extreme circumstances of Elisabeth's case served as significant contributing factors to her pathology. But the Freudian diagnosis of hysteria mandated the existence of sexual repression; other circumstances were merely predispositional.

      Yet not even erotic ideas could explain the particular physical manifestation of Elisabeth's hysteria. When she could no longer fend off the excitations created by sexual desire, she experienced such severe leg pain that, at times, she could not walk. Why? One factor was the fact that while nursing her father, Elisabeth's legs touched those of the ill man's, forming “an artificial hysterogenic zone.”⁶⁴ This precipitating event was intensified by the great mental strain caused by Elisabeth's uncertainty and anxiety over her future; as Elisabeth moved out of girlhood, she was “overcome by a sense of her weakness as a woman and by a longing for love in which, to quote her own words, her frozen nature began to melt.”⁶⁵ After a walk with her brother-in-law during a period of self-doubt, Elisabeth again experienced excruciating leg pains. In hearing of this episode, Freud began to divine an answer to the question occasioned by the peculiar location of her pain: Elisabeth was loathe to become an alleinstehende Frau—a woman standing alone.

      Fear of never marrying helped to make Elisabeth hysterical. The means of this process was a mechanism Freud termed ‘symbolization’: “She found…a somatic expression for her lack of an independent position and her inability to make any alteration in her circumstances…such phrases as ‘not being able to take a single step forward’, ‘not having anything to lean upon’, served as the bridge for this fresh act of conversion.”⁶⁶ Elisabeth had told Freud as much during a therapeutic session: “The patient ended her description of a whole series of episodes by complaining that they had made the fact of her ‘standing alone’ painful to her.” Freud observed that, “I could not help thinking that the patient had done nothing more nor less than look for a symbolic expression of her painful thoughts and that she had found it in the intensification of her sufferings.⁶⁷ He did not consider the fact that marriage itself offered little promise to Elisabeth, a woman who had watched her sister be destroyed by its fruits.⁶⁸ Freudian diagnosis settled on a view of Elisabeth as frozen in time—her family ill and dying,

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