Invention Of Hysteria: Charcot and the Photographic Iconography of the Salpêtrière (Book Review)

Author:  Didi-Huberman, Georges (Translated By Alisa Hartz)
Publisher: Cambridge: MIT Press, 2003
Reviewed By: Marilyn Jacobs, Summer 2005, pp. 72-74

Invention of Hysteria: Charcot and the Photographic Iconography of the Salpêtrière was originally published in a French language edition in 1982. An English translation was made available by MIT Press in 2003. The flyleaf of the book describes the book as a “… classic of French cultural studies …”. In the twenty years since its publication, it has been called a “legendary text,” “brilliant” and “remarkable.” This work is indeed a singular study into the origins of the concept of hysteria in Western thought and the clinical practice of psychology. It is also an important study, given how the phenomenon of hysteria has been the central construct of psychoanalysis and how it has been the basic idea upon which puzzling physiological functioning is often explained in medicine and psychiatry. A vast literature has evolved concerning the nature of hysterical processes since Sigmund Freud’s original writings.

The author of Invention of Hysteria traces how hysteria was constructed by the great neurologist Jean-Martin Charcot in a particular socio-historical context and how the meaning of the concept is tied to those origins. Didi-Huberman relates, “The ‘image’ of hysteria in the nineteenth century—and certainly something of it remains with us today—the vulgarized image of hysteria was the one produced and proposed by Charcot,” The reader is taken on a journey through Belle Époque France and its institutions, particularly the medical establishment. The story is not entirely a happy one as we are given insights into institutional and social processes wherein the events unfolded in a manner that was less than scientific and far less honorable than we would hope they might have been.

One of the most significant stories in the canon of psychoanalytic lore are the events surrounding Sigmund Freud’s visit, in 1885, to the Salpêtrière Psychiatric Hospital in Paris and the influence of Charcot on his thinking. Freud was among many physicians from all over Europe who visited to Paris to attend Charcot’s famous Tuesday Lectures. There are many references in the psychoanalytic literature as to how inspired Freud was with his observations of Charcot’s method with female hysterics. When Freud returned to Vienna he did so in a mood of great inspiration about hysterical phenomenon, which became the major tenet of psychoanalytic theory.

[According to Ernest Jones, Freud felt Charcot to be “ … As a teacher, Charcot was perfectly fascinating: each of his lectures was a little masterpiece in construction and composition, perfect in style, and so impressive that the words, spoken echoed in one’s ears, and the subject demonstrated remained before one’s eyes for the rest of the day ”. (p. 138). Jones concluded that “… the abiding impressions left on him were Charcot’s pronouncements on the subject of hysteria … “(p.139).]

[The Peter Gay biography of Freud relates how Freud regarded Charcot as “… always stimulating, instructive and splendid.”(p. 48), and “… one of the greatest physicians, a genius and a sober man, simply uproots my views and intentions. After some lectures I walk away as from Notre Dame, with a new perception of perfection” (p. 49). 1]

The Invention of Hysteria is all the more compelling given the author’s analysis of Freud’s involvement with Charcot: “Freud had had to pass through the great theater of hysteria at the Salpêtrière before beginning to listen and before inventing psychoanalysis. The spectacle and its pain were necessary; first he had to get an eyeful.” The work frequently makes reference to how Freud was influenced by Charcot’s work.

Invention of Hysteria begins with an “Argument”: “In the last few decades of the nineteenth century, the Salpêtrière was what it had always been: a kind of feminine inferno, a citta dolorosa confining four thousand incurable or mad women. It was a nightmare in the midst of Paris’s Belle Époque. This is where Charcot rediscovered hysteria. I attempt to retrace how he did so, amidst all the various clinical and experimental procedures, through hypnosis and the spectacular presentations of patients having hysterical attacks in the amphitheater where he held his famous Tuesday Lectures. With Charcot we discover the capacity of the hysterical body, which is, in fact, prodigious, it is prodigious; it surpasses the imagination, surpasses “all hopes,” as they say. Whose imagination? Whose hopes? There’s the rub. What the hysterics of the Salpêtrière could exhibit with their bodies betokens an extraordinary complicity between patients and doctors, a relationship of desires, gazes, and knowledge. This relationship is interrogated here. What remains with us is the series of images of the Iconographie photographique de la Salpêtrière. … “[and the “Argument” ends with] Freud was the disoriented witness of the immensity of hysteria in camera and the manufacturing of images. His disorientation was not without bearing on the beginnings of psychoanalysis.”

This work is a cultural study that depicts how, during the latter part of the 19th century, the concept of hysteria was created by Charcot. This occurred within the confines of the Salpêtrière psychiatric hospital. The author contends that hysteria came to be amidst the concomitant development of photography, which made possible the realization of hysteria as a valid medical concept. The hysterical manifestations of the female patients were documented and thus reified Charcot’s vision of hysteria. Thus, the work is a study of the development of both hysteria and of photography.

Didi-Huberman centers his work on a strongly held premise, “I maintain that everything that happened at the Salpêtrière, the great epic story of the clinic, is vested in hypocrisy, if the complexity of the practices this word designates are admitted, and if this complexity is not dismantled.”

This work is a fascinating addition to the genre of social construction of knowledge. It is a compelling account which subsumes gender studies, the philosophy of science, and the history of clinical medicine, psychiatry and sociology. The work is all the more richer by its inclusion of a vast array of photographs taken from a variety of sources but mainly from the multi-volume work, Iconographie Photographique de la Salpêtrière, a collection of photographs which depicts the mad women inmates and their hysteria.

The story begins with the origins of the Salpêtrière, “the general hospital for women, or rather for the feminine dregs of society.” These unfortunates were “whipped on arrival, the ‘punishment certificate’ was completed and they were interned.” In about 1862, Charcot was put in charge of the service concerned with epileptics and hysterics. In 1872 he was named Professor of Pathological Anatomy and then in 1881, Clinical Chair of Diseases of the Nervous System. Charcot was known for the exploration of many domains of medicine and he had an international following. He was known as the founder of neurology, which led him to become the expert in hysteria. Charcot distinguished hysteria from epilepsy and identified it as a pure nosological form. Freud wrote an obituary for Charoct upon his death in 1893. He compared Charcot to Adam for the discovery of the idea of hysteria.

Didi-Huberman admits that Charcot’s work was an effort to understand hysteria and to do so by a method. Charcot characterized hysteria as being distinct from epilepsy and also from all other mental disorders. He identified hysteria as a “pure nosological object.” However this attempt at understanding this “pathological life” went badly array.

At the same time in which Charcot was making his observations about the phenomenon of hysteria, photography was invented and in wider use. A photography studio (seen as a hospital service) came into being which was to become du Service Photographique de la Salpêtrière. This enabled Charcot to use photography as a tool in his study of hysteria.

In the study of hysteria at the Salpêtrière, the face became the evidence of scientific inquiry, (“a codifiable, recordable state of signification”). Portraits of hysterical madness were constructed as evidence (“… the photographic portrait required not only studios and make-up … but also headrests, knee-braces, curtains and scenery …”). Didi-Huberman alerts us to the fact that hysteria was la bete noire (the black beast) 2 … “Because hysteria represented a great fear for everyone, it was the bete noire of physicians for a very, very long time: for it was aporia3 made into a symptom, It was the symptom, to put it crudely, of being a woman”.

During the 19th century, many treatments were directed at the clinical problem of hysterical madness. These treatments included stimulants, antiphologistics4, narcotics, and revulsives5. The question was raised as to whether hysteria was incurable. Did-Huberman furthers the analysis—due to all of the many treatment failures, hysteria was treated with the therapy of “putting under observation.”

The author makes the case that the women who responded to Charcot’s instigation of the hysterical performance did so in order to provide him with ‘evidence’ that heightened his ‘scientific’ reputation as a brilliant discoverer of malady. They were given special status among the other patients for their hysterical performances and threatened with loss of this status if they did not pose for the photographs during episodes of hysteria. This research into the conditions under which these women were patients at the Salpêtrière concludes that: “… in fact, every hysteric had to make a regular show of her orthodox ‘hysterical nature’ … to avoid being transferred to the severe ‘division’ of the quite simple and so-called incurable ‘alienated women.’”

One of Charcot’s most studied (and photographed) “cases” was that of a fifteen year old girl, Augustine, who was admitted to the Salpêtrière for paralysis of sensation in the right arm and attacks of severe hysteria, preceded by pains in the lower right abdomen. “Augustine was the thus the star model for a whole concept of hysteria …” Augustine figures prominently in the albums of the Iconographie Photographique de la Salpêtrière. Many of the photographs included in the book from this album are of Augustine during her hysterical attacks (e.g., Plate XIII: Augustine: Lethargy: Artificial Contracture; Plate XIV: Lethargy: Muscular Hyperexcitability; Plate XV: Catalepsy; Plate XVI: Hemi-Lethargy and Hemi-Catalepsy). Didi-Huberman relates that “A hysteric can be a living work of art, and I will continue to speak of Augustine as a masterpiece, the masterpiece and “thing” of her physicians.” Augustine was given special attentions by Charcot.

The hysterical attacks of Augustine and the other women were witnessed, studied, photographed and reinforced. They became ritualized madness. The author concludes: “The hysterics of the Salpêtrière were so ‘successful’ in the roles suggested to them that their suffering had lost something like its basic credibility. They were so ‘successful’ as subjects of mimesis that, in the eyes of the physicians who had become the directors of their fantasies, they entirely lost their status as subjects of distress.” Perhaps as a consequence, the women who performed developed hatred and would not comply, losing interest.

Invention of Hysteria considers all of these elements and more. Interspersed with the author’s historical narrative are references to Freud’s theoretical developments. The many photographs of the hysterical women during their attacks are fascinating. The story is told in a poetic and literary style.

To this reader, one of the book’s major flaws is the English translation, which is often stilted and hesitant.6 The book is a deconstruction of the idea of hysteria and for this reason there is an overly ironic and at times sarcastic tone to the discussion. It also seems that the work lacks historical relativity to the context of late 19th century Europe. Clearly, there was a patriarchal social structure where women lacked power and influence and where society did not place a high value on social welfare. Issues of power and dominance were not widely considered to be egalitarian rights.

Also, the concept of hysteria, although decidedly flawed, has contained heuristic value in the development of psychoanalytic thinking and has increased our understanding about the unconscious and the primacy of emotional life. We can judge Charcot and the physicians of the time for their power motivations, gender biased view of science and their lack of a valid method. Nonetheless, the work in this area stimulated a new way of thinking about psychic function.

Invention of Hysteria is an important work which also provides insight into the process of social construction of psychological knowledge which all psychoanalysts would benefit from thinking about in relation to historical context and the work which is done within it.

Footnotes

1 Gay, P. (1988). Freud: A life for our time. New York: W.W.Norton. [top]
2 One that is particularly disliked or that is to be avoided [top]
3 An insoluble contradiction or paradox in a text’s meanings [top]
4 Reducing inflammation or fever; anti-inflammatory [top]
5 Counterirritation used to reduce inflammation or increase the blood supply to the affected area [top]
6 In a recent review in Artforum International Magazine, Armstrong (2003) has illuminated the problems with the translation of this work: “Perhaps texts like Invention of Hysteria should remain in French. Deconstructionist formulations abound in this book which flow with relative fluidity in French but read peculiarly in English. English … is less simply less suited to French to that kind of play.” [top]

Reference

Jones, E. (1953). The life and work of Sigmund Freud. New York: Basic Books.

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