Returning to Charcot (Book Review)

Book: Medical Muses: Hysteria in Nineteenth-Century Paris
Author
:  Asti Hustvedt
Publisher: Norton, 2011
Reviewed By: Mark Stafford, Spring 2012, 238 pp.

In 1928 the French poet Andre Breton, who had studied to become a psychiatrist, published photographs of a young woman whose gaze was suggestive of both religious and sexual ecstasy. The journal came to be called La Revolution Surrealiste and these photographs, drawn from a massive archive of similar images (whose significance had been dismissed by Breton's teacher Joseph Babinski) were intended by Breton to celebrate the "fiftieth anniversary of hysteria."

The subject of the photos, Augustine Gleizes, if she ever knew of their publication, would have been 67 at the time, but no one knew of her whereabouts. The photos had been taken 30 years before in the Hospital Salpetriere in Paris, from which Augustine, whose symptoms were beginning to disappear (according to her doctor, Désiré-Magloire Bourneville), had escaped disguised as a man.

By publishing her photograph alongside the poetry of Paul Eluard and the images of Salvador Dalí and Andre Masson, Breton was restoring to Augustine the role that she had played at Salpetriere, once more anointing the hysteric as Muse. Prior to becoming the Muse of surrealist poets, the hysterics of Salpetriere, as Asti Hustvedt shows in her intellectually exciting and very moving new book, had been "Medical Muses" who had inspired J.-M. Charcot in his construction and documentation of an illness that fascinated the 19th-century public—Hysteria.

Hustvedt, a scholar of 19th-century French literature and society, has organized her book around three remarkable women, whom she has rightly restored to their important place in the history of psychiatry: Blanche Wittman, Genevieve Legrand, and Augustine Gleizes. Up to this point they have existed largely as visual images, part of an extensive photographic archive that documented their gestures, facial expressions, and physical poses as they passed through attacks of hysterical convulsions. Hustvedt has given an account of their life stories based on the oral testimony they gave when they were admitted to the (in)famous Hospital Salpetriere.

The most famous of the hysterics to be treated by J.-M. Charcot was Blanche Wittman, who was immortalized in the famous engraving by Andre Brouillet, A Clinical Lesson at the Salpetriere, which showed the "Napoleon of medicine" presenting his patient to interns and students, one of whom was the young Sigmund Freud, who hung a copy of the picture in his office.

But before telling Blanche's story, Hustvedt examines Charcot, and there is no doubt that like his famous patients he too challenged the social conventions of his time, including the limitations of its medical discourse. There has been much recent scholarship on Charcot (in particular: Charcot; Constructing Neurology, by Goetz, Bonduelle, & Goetz [1995]), but one curious omission from Hustvedt's book is any discussion of the question of male hysteria, despite the fact that in the transcripts of Charcot's "Tuesday Lectures" (1991) at least a third of the patients discussed are men.

Nearly all the men who suffered from "hysterical" symptoms, such as hemathesia (a form of paralysis), are said to have been involved in "traumatic" accidents (most notably the famous "railway accidents" that Freud studied in his early work), which preceded the emergence of the hysterical symptoms. Despite the relation between a traumatic event and the emergence of hysteria in men, Charcot seemed unable to make any comparable link with his female patients. Rather, he appears to have been "blinded" in his encounter with hysterical women by the difficulty of reconciling two conflicting traits in his own character.

In the aftermath of the extensive challenges to Freud's theory of hysteria offered by, among others, Dominique David-Mendand (1989) and Mikel Borch-Jacobson (1989), it has become de rigeur to suggest that women patients in the Salpetriere were the subjects of their male doctors' fantasies about women, femininity, and madness. Frequently, the treatment of these women did indulge their male doctors' sexual fantasies. However, Hustvedt approaches the impact of sexual difference and desire in the treatment of the hysterics with more subtlety.

Charcot established a medical-psychiatric category that enabled women to receive some degree of medical protection when they might otherwise have suffered penal servitude or worse; moreover, he was prepared, unlike his contemporaries, to recognize that the symptomology of the hysteric was "true." But in contrast to Freud, Charcot investigated this truth primarily through hypnotism and suggestion, which led to considerable doubts as to the "truth value of the symptom."

Charcot's nosology was positivistic in both inspiration and application. He believed that medicine could be done scientifically and that society should adopt rational and scientific principles in order to give each human being a chance to prove their own merits. He was a French Republican and strongly anticlerical.

Although the women admitted into the Salpetriere often had to work as ward assistants looking after more severely disabled or dying patients, Charcot was certainly a reformer who wished to create both an asylum and a research center. He wanted to produce (visual) data that would contradict the Catholic Church's influence on the social position and treatment of women who were often incarcerated simply for "amorous activity" and who were forced to abandon "unwanted children" under conditions of great cruelty simply to preserve a (hypocritical) religious morality.

Certainly there were forms of treatment in the Hospital Salpetriere, such as hydrotherapy, electrical stimulation, and isolation, that cannot be described as anything other than torture. But Charcot did not believe (unlike his contemporaries or post-Charcotians) that hysteria was a symptom of degeneracy. However, his own psychic conflicts reveal themselves in the following conundrum—although he could not ignore that the etiology of hysteria was neither hereditary nor organic (despite his lifelong search for hysterical lesions), he could not believe that the hysteric had access to the truth of their own symptom.

Charcot saw himself as a liberator who would conquer the mystery of hysteria for womankind (and thereby restore the harmony of the sexes). Freud respected Charcot for his powers of observation and for not compromising his spirit of inquiry. He often quoted Charcot's remark, "Theory is all very well, but it doesn't stop something from existing," but very early in his own work Freud recognized that Charcot's theory was in fact too caught in the limitation of the medical clinic; he was a great "visual," but that left him with a considerable blind spot.

Like the great natural historian Buffon, Charcot believed that to get to the origin of a natural mystery science needed to produce a visual record of the different phases of the illness. Largely ignoring the obvious (for example, that the patients were also enacting a dramatic scene during many crises), he instead concentrated on the iconography of the attack as though the patient were presenting a tableau that medicine would later decode.

Once Charcot abandoned the idea of only publishing photographs in the Iconographie de Salpetriere and also published the case histories of the patient, it became clear to some (particularly D.-G. Bourneville, who took most of the photographs that appeared in the hospital publications) that the patients themselves were suggesting links between the attack and the kind of violence, often sexual, that they had experienced earlier in their lives.

Charcot's work on male hysteria indicated that attacks were not simply a direct representations of earlier traumas. But in his search for some form of psychic agency that produced the "repetition" of the attack, he overemphasized the role of "suggestion." Charcot was entranced by the fact that the most distinguishing (and nonphysiological) characteristics of these "hysterical" symptoms was that they could be reproduced. But he couldn't accept the idea that they hysterical event was in some sense "enjoyed" by the patient and that this "enjoyment" was a substitute satisfaction for the traumatic encounter with experiences whose psychic effect the patient could not "work through" or repress.

Charcot was at a loss as to how to reveal (beyond hypnotism) any form of nonphysiological psychic mechanism. He had no interest in the dreams of his patients, even though they were recorded in their case histories. He acknowledged that the human subject did not consist merely of a mechanistic consciousness, but he was drawn to a "return" to hypnotism, which scientific psychiatry had almost completely discredited following Anton Mesmer's Paris shenanigans.

At the Salpetriere under Charcot, hypnotism began once again to be an object of scandal as patients were hypnotized to play out humiliating scenes, often sexual, and, even more highly controversial, induced to commit crimes. Charcot's reintroduction of hypnotism contributed to a distinct air of scandal surrounding the hospital and its doctors, who were already under attack from conservative forces who wished to negate any idea that a woman's sexual activity (or suffering) might be linked to psychic illness. But it did add to the sense that psychiatry was involved in some new form of drama, an atmosphere the Master did nothing to diminish.

Charcot was center stage at the Salpetriere, directing every aspect of the operation of the hospital. By promoting the hospital's achievements (such as its use of photography), he also promoted a republican program of meritocracy, a political philosophy in which his own life could be seen as exemplary. He was not ashamed to have risen from a background of considerable poverty, and when he eventually married a wealthy widow he was able entertain French high society in style in an impressive apartment off St. Germain.

No doubt that his own awareness of poverty and the toughness of everyday life contributed to his clinical insight. He did not condemn his patients out of ignorance and disrespect for their social position. Unlike Freud and Breur's patients, Charcot's were all from extremely poor backgrounds. There were no reputations to protect or any particular need for discretion or subterfuge.

One of the patients admitted to the Salpetriere was a young woman who came to be known as Blanche Wittman, whose early life was filled with a horrifying catalog of deaths and madness (her father died insane) to which was added unwanted sexual attention at a very early age from the men who employed her.

When she entered the Salpetriere she appears to have been renamed. "Blanche" never appeared on her birth certificate (which read "Marie") and the anomaly of her name leads Hustvedt to allow herself a rare (and convincing) analytic construction that Blanche—white in French—is in fact the "blanche" or "white" sheet of paper upon which Charcot could write his own phantasmatic constructions of femininity and its relation to the mystical; one might add that this was a "whitening" that appealed to Marie Wittman, who adopted it in order to erase the trauma of her previous life.

Blanche did became her own creation at Salpetriere. This creation involved a particular relation to her body. Her skin was highly sensitive and medical interns were able to literally write on her skin. Her capacity to undergo hypnotism became legendary, and she enacted scenarios that were both humiliating and at the same time clearly related to the conflicts that she experienced regarding her sexual desire. And, of course, there was her ability to enact the various stages of the hysterical crisis.

Although many of her stages of crisis were photographed, her real fame derived from the fact that she could apparently reproduce symptoms under Charcot's instruction in public presentations. So famous were these "performances" that great actresses came to the hospital to study. Blanche did indeed produce the "theater" of hysteria that Charcot wished to claim he had discovered. She ended her life in great pain, one of the early victims of the cancer and barium sickness that affected the early users of the x-ray.

Upon Charcot's death, her symptoms disappeared and she was assigned work in the new x-ray laboratory in the hospital, having nowhere else to go. Literally on her death bed, Blanche was interviewed by a journalist who wished to gain a final confession that she had been faking her symptoms. "Simulation! Do you think it would have been easy to fool Monsieur Charcot? Oh yes, there were certainly some jokers who tried! He would look them straight in the eye and say, 'Be still'" (p.141).

Blanche Wittman may have been the prototype of the 19th-century hysteric whose various stages of hysterical illness could be depicted in caricatures, but Augustine Gliezes, the figurehead of La Revolution Surrealistic, brought a particular presence to the unique relationship that Charcot had established between photography and hysteria.

If the most pathogenic elements in the early life of Blanche Wittman appear to be the sudden and painful deaths of so many of her siblings, then the pathogenic element in Augustine's early life was probably her mother's willingness to prostitute her daughter in order to obtain various economic and possibly sexual favors for herself. Initially Augustine was threatened with very severe forms of punishment when she arrived at the hospital, because she refused to accept many of its rules, but once she discovered that, like Wittman, she could in fact receive considerable privileges for collaborating with the photographic work, she became an icon who could also challenge and confront her doctors.

The photographer and psychiatrist Désiré-Magloire Bourneville, who worked with her throughout the time she was in the hospital, was far more attentive to what she said about her early life than Charcot appears to have been about any of his patients, and he continued to advocate for her even after her initial attempts to escape from the hospital. The existence of relationships between doctors and patients was a widely known scandal, but also a form of "mass hysteria" promulgated by the Catholic Church in its battle with medical and scientific materialism. Augustine stated clearly to her doctor that in fact there was an intern, who she called Camille, who she was in love with, but who most notably had disappointed her by not agreeing to have sex with her.

Ultimately this lover "Camille" managed to assist in her escape from the hospital disguised as a man. Who Camille was and whether they ended there lives together remains a mystery, but Bourneville protected his identity while at the same time recording what they both said about their sexual experience, an experience that clearly bordered on the ecstatic. When Bourneville's case notes were published, the British Medical Journal chastised the work of the French doctor for including sexual details of a kind that lowered the moral dignity of the otherwise scientifically important work—such were the challenges that faced the 19th-century investigators into hysteria

The final figure in Hustvedt's triptych is Genevieve Legrand. In the combination of her origins and symptoms, she represents both Charcot's culmination and apotheosis. As he grew more successful, and no doubt aided by the wealth he acquired though marriage, Charcot was able to explore his passion for painting, particularly of the saints and the mystics of the medieval period and the early Renaissance. He had copied these images as a child and now he could acquire them and reacquaint himself with a field that preceded his interest in portraying the various stages of epileptic-hysteria. Epilepsy in the medical tradition of the Greeks had, of course, been assumed to be a "possession" by the Gods; now Charcot had the radically subversive insight that the women who had previously been characterized as saints or mystics were in fact suffering from the kinds of symptoms, particularly stigmata, that he considered to be hysteria.

Rather uncannily, Genevieve had been born in the famous city of Loudon, where in 1632 one of the greatest cases of demonic possession in European history had taken place. The mother superior of the local convent, Jeanne des Anges, claimed that she had been "visited" by a sexually voracious priest by the name of Urban Grandier, who had "seduced her with caresses." Grandier was burnt at the stake, convicted on the testimony of "Leviathan," who, speaking through the mother superior, claimed that the Devil and Grandier had signed a pact in blood. The priory of Loudon remained notorious because even after Grandier's execution the mother superior continued to be possessed, as did many of the other nuns, an event that they ultimately turned into a kind of marketing device until the Catholic Church broke up the priory.

Genevieve appeared at the Salpetriere displaying signs that she was cutting and mutilating herself; she had already removed a nipple, but claimed to have felt no pain. She was also anorexic, as well as capable of displaying stigmata and adopting the pose of "crucifixion" that had become well-known in Charcot's iconography.

Whereas both Wittman and Gleizes had spoken of their strong desire for men, tortured encounters with anonymous men, pregnancy, abandonment, and the desire to mother are the traits that stand out in Genevieve's case. She had been abandoned at birth to a foundling hospital, whose civic duty it was to try to pass her on to a farming family who would be expected to raise her in order to acquire another pair of hands. Such adoptions were understandably harsh, but it appears that Genevieve's rural family was actually quite concerned about her well-being. What was traumatic was that when she did became pregnant, she was forced (as an unwed mother) to abandon the child, and, according to Hustvedt, this may have occurred more than once.

Unlike Wittman and Gliezes, who identified with their doctors' quest for knowledge, Genevieve identified instead with another mystic-hysteric, a Belgian woman Louise Lateau, who had become an international sensation (a New York Times article of 1884 was entitled "A Queer Being"!) largely because she displayed on her body the stigmata of Christ.

For a period of time Genevieve thought she would visit Louise Lateau, but in fact she didn't need to, because her doctor, D.-M. Bourneville, was writing a book about Lateau. Bourneville's intention was to use the book as a means to continue to struggle against clericalism and what he considered the superstitious thinking of the Church, but the Church was itself suddenly awakening to the need to study forms of hysteria.

In 1858, a 14-year-old girl named Bernadette Soubirous claimed to have seen the Virgin Mary by a spring close to her home of Lourdes; when visitors started to claim that drinking from the spring cured them of all manner of illnesses, not only did the accusations of fabrications subside, but the Catholic Church, which had recently decreed the Immaculate Conception doctrine, began to investigate. Charcot did as well; in addition to his late books on the imagery of the hysteric in art, he also wrote a book entitled The Faith Cure, largely based on what was happening at Lourdes, in which he argued that the cures were a case of "auto-suggestion."

For its part, the Catholic Church, afraid of what might turn out to be another major fraud, set up a medical office at Lourdes to verify the cures that pilgrims were claiming to have experienced. The same medical office began to make inquiries and investigate the nature of the "cures by faith" that appeared to be coming from Charcot's hospital, where stigmatics were frequently found.

The pieces were there in front of Charcot's eyes—the relation of the symptom to a nonconscious agency in the subject that could be revealed by both hypnotism and suggestion; the conversion of a psychical trauma into a physical symptom; the intertwining of religious ecstasy and the call for love; and the violence and the hypocrisy of the encounter between the sexes—but he could not put them together into any kind of readable theory of subjectivity.

Charcot had followed his artistic sensibility and entered into experiences of subjective Otherness (what Freud called the Unheimlich or Uncanny) that medicine and positivistic science (in no small part because of their antimysticism) could not accept, but all that he was ultimately able to say about this was that somehow the human subject could cure themselves of hysteria through auto-suggestion or "faith."
Early in this highly original book, Hustvedt modestly remarks that she intended to write a nonhysterical book about hysteria. Why should she? In fact, she had a very "hysterical" question behind the book. Were this to have only been a book that reminds us of the remarkable archive created by Charcot, or that further emphasizes the crucial difference between Charcot's study of hysteria and Freud's theories, this would already have been a considerable achievement, particularly because it contains an entirely new account of the women who worked with and inspired Charcot.

At the same that it is a work of detailed research, identifying the cruelties and the scandals of 19th-century medicine, the mysterious appetite for novels and plays about mad women, and their struggle against the repressive influence of the Church, Hustvedt's book is also punctuated by a series of difficult questions: "Is there any contemporary hysteria?"

How do we account, writes Hustvedt, for the phenomena that Margarot Talbot describes in her New York Times articles following the attacks on the World Trade Center, when it appeared that children in elementary and middle school around the United States were suddenly displaying bumps and rashes that eluded medical diagnoses? Was this, as Hustvedt bravely claims, an instance of mass hysteria? On this point she reminds us that Dr. Gary Smalls was heavily criticized and ultimately ostracized from the medical community for merely suggesting that a mass psychotic illness could exist.

Furthermore, she questions the use of the term "syndrome" for conditions that the Merck Manual describes as "illness of uncertain origin." Hustvedt adds that so virulent is the suspicion of any use of the term hysteria that when Elaine Showalter proposed in her book Hystories that the Gulf War syndrome might be considered as a new form of hysteria, she received death threats. Crucially, Hustvedt writes that "our medical model is essentially the same one that Charcot established, but the status of hysterical or 'functional' disorders has been demoted, i.e. symptoms that can be traced to a biological source in blood tests, imaging, biopsy, etc., or to be environmental contaminants, are thought of as real, those that elude medical testing are deemed 'not real'" (p.303).

Throughout the book, in deceptively innocuous and humble asides, Hustvedt develops the question that no doubt inspired the book: does hysteria still exist, and what contemporary forms does it take? As she notes in her moving epilogue—one which gives the work the quality of A. S. Byatt's novel Possession—as she was researching the book she kept finding stories in the newspaper and media that seemed to resonate with the lives of Blanche, Augustine, and Genevieve, stories that indicate that the hysteric still speaks through the "unaccountable" symptom, the symptom that challenges the scientific discourse, the symptom that challenges the master discourse, the symptom that is present wherever there is both a refusal to acknowledge the reality of sexual difference and the reality of particular subjective experience.

These experiences cannot be subsumed under a universal claim of human knowledge, and so, "after decades of Freudianism in which medically inexplicable symptoms were understood as physical conversion of unconscious conflicts we have entered an era that in many ways resembles Charcot's. We are now in the process of assigning concrete, rather than unconscious sources to just about every aspect of human behaviour. But unlike Charcot we no longer treat symptoms that have no biological origin with dignity"(p.304).

References

Borch-Jacobsen, M. (1989). The Freudian subject. Stanford, CA: Stanford University Press. Goetz, C., Bonduelle, M., & Gelfand, T. (1995). Charcot: Constructing neurology. Oxford, UK: Oxford University Press.

Charcot, J.M. (1991). Clinical lectures on diseases of the nervous system (Tavistock Classics in the History of Psychiatry). London: Routledge

David-Monand, M. (1989). Hysteria: From Freud to Lacan. Cornell, NY: Cornell University Press.

Freud, S. (1968). Studies on Hysteria. In The standard edition of the complete psychological works of Sigmund Freud (Vol. 2). London: Hogarth Press.

Didi-Huberman, G. (1982). Invention de l'hysterie: Charcot et l'iconographie Photographique de la Salpetriere. Paris: Macula.

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