The Pseudosciene of Delirium
Readers who can’t identify Jean-Martin Charcot as the name of the French neurologist whose 19th-century experiments with hypnosis influenced Sigmund Freud’s theory of neurosis may yet recognize the work he conducted at the Saltpêtrière Hospital in Paris.
Photographs and illustrations of Charcot’s patients, all women suffering hysteria, remain in currency today, 140 years after they were made, if more as curiosities than as clinically valuable documents. Once seen, these images - of, for example, a woman wearing little more than a tangle of bed sheets, her eyes rolled up into her head in either “ecstasy” or “delirium,” or fixed on the invisible object of her “amorous supplication” - are not easily forgotten, let alone dismissed. Poses classified as “passionate attitudes,” they have the disquieting aspect of pornography masquerading as intellectual inquiry.
Charcot, as portrayed in Asti Hustvedt’s consistently enthralling “Medical Muses,” focused intently - myopically, one could argue - on using hypnosis to induce hysteria and make “his hysterics, with their bizarre fits and spasms, into ideal medical specimens.” But the provocative behavior of those “specimens” transformed Saltpêtrière into something closer to a carnival than a teaching hospital. As much showman as physician, Charcot gave weekly two-hour lectures to a packed amphitheater, including demonstrations designed to captivate an audience accustomed to staged séances and exhibitions of mesmerism or telepathy. One of Charcot’s students described the dramatic potential of exhibiting hypnotized women: “We can cut them, prick them and burn them, and they feel nothing.”
Plus ça change, Charcot might say, were he to cast his eye, described in Freud’s obituary of his teacher as artistic rather than intellectual, over current illnesses that, like hysteria, exist, Hustvedt says, “on the problematic border between psychosomatic and somatic disorders”: anorexia and bulimia nervosa, self-mutilation, idiopathic chronic fatigue, dissociative identity disorder. Charcot died in 1893 without having found the brain lesion he believed caused his patients’ confounding symptoms. Two years later Freud declared hysteria to be the result of “repressed memories and ideas,” and in 1925 faulted the neurologist for failing to examine the psychology of what he deemed manifestations of repressed emotion.
By 1977, a University of Rochester scientist, George L. Engel, had posited today’s “biopsychosocial” paradigm, a ready example of the gun analogy frequently applied to anorexia nervosa, in which, as is often said, “genes load the gun and environment pulls the trigger.” As Elaine Showalter concluded in “Hystories,” her controversial study of 20th-century manifestations of hysteria, the illness, “relabeled for a new era,” is more contagious than ever, a result of mass and increasingly instant media. But no matter how hysteria might mutate, virus-like, from one age to the next, in the public imagination it remains what Hustvedt says it partly always was: “an illness of being a woman in an era that strictly limited female roles.”
So how did the 19th-century hysteric announce her condition? Evidence of primping - “the care that she takes in her toilette; the styling of her hair, the ribbons she likes to adorn herself with” - was enough for Charcot’s disciple, Désiré-Magloire Bourneville, to predict what diagnostic hair-pulling, pinching and pricking confirmed. The attacks that followed - which might include fainting, contortions, paralysis, vomiting, screaming, hallucinations and seizures - proved the doctors’ findings. “The hysteric always seems to be outside the rule,” Bourneville explained.
Often misperceived as willful bids for attention, yesterday’s hysteria and neurasthenia, today’s eating disorders, and whatever problematic behaviors emerge in the future command attention because they defy reduction by medical minds. They resist treatment. Sometimes, in their sufferers’ refusal to be fixed and studied like insects pinned to a board, they inspire sadism. For his part, Charcot, the author notes, “confronted the chaos of the hysterical female body” and discovered “hysterogenic zones” privileging the ovaries and breasts that, when stimulated, either provoked or halted hysterical symptoms. Certainly his “ovary compressor,” a device whose illustration begs for inclusion in a catalog of arcane implements of torture, got his patients’ attention like nothing else could, allowing Saltpêtrière’s doctors to administer what “closely resembled a sexual assault” with clinical detachment, dirtying no one’s hands.
If such therapies were not purposefully misogynistic, they were imposed, Hustvedt shows, by “healthy, educated and bourgeois” male doctors on “diseased, uneducated and lower-class” women who had been committed, often for life, to a warehouse for not only the mad but also the homeless, the pregnant and unwed, and others who refused to abide by the conventions of a stifling society - in other words, the same disenfranchised women who, centuries earlier, might have been tried and executed as witches. The lure of voyeurism made hysterical patients into celebrities, muses for their doctors and for a public that regarded the “condition of being a woman” as “one that can at any moment veer out of control and is therefore in need of medical regulation.” But if Hustvedt’s meticulous analysis of Charcot’s methodology provides evidence of his exploitation of what he called his vast “reservoir of material,” it also demonstrates that patients collaborated in what was an iatrogenic condition, “forged between patient and doctor.”
The “career” of Marie Wittmann, known throughout Europe as the “Queen of Hysterics” began inauspiciously. “Remarkable for her spirit of duplicity, lying and simulation” (as all women suffering hysteria were said to be), Wittmann, called Blanche by Charcot, arrived at Saltpêtrière because she had nowhere else to go after a childhood marked by tantrums so violent they prevented her going to school, the predation of an insane father, the early deaths of her mother and five of her eight siblings, and apprenticeship to a lecherous furrier whose advances provoked convulsions and loss of consciousness. Eighteen years old, exhausted by squalor and strife, she entered the hospital where she would spend the rest of her days.
Initially too “unpredictable and unruly” to be of clinical value, Wittmann was transferred from the hysterics’ quarters to a cell in the ward for the mad. Allowed to return to Charcot’s care after seven and a half months of what had been intended as a punishment for breaking windows and tearing up linens, she worked to secure her place in her increasingly famous physician’s magnum opus, the ward for hysteria offering freedom and comforts denied inmates of other wards. There, the ubiquity of “photographs, drawings, wax casts, as well as staged re-enactments” encouraged any enterprising patient to determine and reproduce the ideal hysterical profile. Once she evolved into the “most hypnotizable” (and therefore predictable) of hysterics, she became Charcot’s star performer, her symptoms “molded, altered and tweaked to fit his elaborate nosology.” She even requested the “ovary compressor.”
Is it progress to replace antiquity’s notion of the wandering womb with the conceit that there wasn’t any hysteria - any acting out - that couldn’t be effectively treated by striking out at the very organs in which femaleness resides? Though “equating hysterical symptoms with hypnotically induced symptoms” allowed Charcot to lay the groundwork for psychoanalysis, he necessarily failed to cure what “Medical Muses” reveals as women’s defiance of patriarchal strictures. Misogyny and hysteria: another circle, this one vicious, to add to the notorious chicken-and-egg.
Source: NY Times Book Review
Also, can we add a mental health or psychology tag?
Photographs and illustrations of Charcot’s patients, all women suffering hysteria, remain in currency today, 140 years after they were made, if more as curiosities than as clinically valuable documents. Once seen, these images - of, for example, a woman wearing little more than a tangle of bed sheets, her eyes rolled up into her head in either “ecstasy” or “delirium,” or fixed on the invisible object of her “amorous supplication” - are not easily forgotten, let alone dismissed. Poses classified as “passionate attitudes,” they have the disquieting aspect of pornography masquerading as intellectual inquiry.
Charcot, as portrayed in Asti Hustvedt’s consistently enthralling “Medical Muses,” focused intently - myopically, one could argue - on using hypnosis to induce hysteria and make “his hysterics, with their bizarre fits and spasms, into ideal medical specimens.” But the provocative behavior of those “specimens” transformed Saltpêtrière into something closer to a carnival than a teaching hospital. As much showman as physician, Charcot gave weekly two-hour lectures to a packed amphitheater, including demonstrations designed to captivate an audience accustomed to staged séances and exhibitions of mesmerism or telepathy. One of Charcot’s students described the dramatic potential of exhibiting hypnotized women: “We can cut them, prick them and burn them, and they feel nothing.”
Plus ça change, Charcot might say, were he to cast his eye, described in Freud’s obituary of his teacher as artistic rather than intellectual, over current illnesses that, like hysteria, exist, Hustvedt says, “on the problematic border between psychosomatic and somatic disorders”: anorexia and bulimia nervosa, self-mutilation, idiopathic chronic fatigue, dissociative identity disorder. Charcot died in 1893 without having found the brain lesion he believed caused his patients’ confounding symptoms. Two years later Freud declared hysteria to be the result of “repressed memories and ideas,” and in 1925 faulted the neurologist for failing to examine the psychology of what he deemed manifestations of repressed emotion.
By 1977, a University of Rochester scientist, George L. Engel, had posited today’s “biopsychosocial” paradigm, a ready example of the gun analogy frequently applied to anorexia nervosa, in which, as is often said, “genes load the gun and environment pulls the trigger.” As Elaine Showalter concluded in “Hystories,” her controversial study of 20th-century manifestations of hysteria, the illness, “relabeled for a new era,” is more contagious than ever, a result of mass and increasingly instant media. But no matter how hysteria might mutate, virus-like, from one age to the next, in the public imagination it remains what Hustvedt says it partly always was: “an illness of being a woman in an era that strictly limited female roles.”
So how did the 19th-century hysteric announce her condition? Evidence of primping - “the care that she takes in her toilette; the styling of her hair, the ribbons she likes to adorn herself with” - was enough for Charcot’s disciple, Désiré-Magloire Bourneville, to predict what diagnostic hair-pulling, pinching and pricking confirmed. The attacks that followed - which might include fainting, contortions, paralysis, vomiting, screaming, hallucinations and seizures - proved the doctors’ findings. “The hysteric always seems to be outside the rule,” Bourneville explained.
Often misperceived as willful bids for attention, yesterday’s hysteria and neurasthenia, today’s eating disorders, and whatever problematic behaviors emerge in the future command attention because they defy reduction by medical minds. They resist treatment. Sometimes, in their sufferers’ refusal to be fixed and studied like insects pinned to a board, they inspire sadism. For his part, Charcot, the author notes, “confronted the chaos of the hysterical female body” and discovered “hysterogenic zones” privileging the ovaries and breasts that, when stimulated, either provoked or halted hysterical symptoms. Certainly his “ovary compressor,” a device whose illustration begs for inclusion in a catalog of arcane implements of torture, got his patients’ attention like nothing else could, allowing Saltpêtrière’s doctors to administer what “closely resembled a sexual assault” with clinical detachment, dirtying no one’s hands.
If such therapies were not purposefully misogynistic, they were imposed, Hustvedt shows, by “healthy, educated and bourgeois” male doctors on “diseased, uneducated and lower-class” women who had been committed, often for life, to a warehouse for not only the mad but also the homeless, the pregnant and unwed, and others who refused to abide by the conventions of a stifling society - in other words, the same disenfranchised women who, centuries earlier, might have been tried and executed as witches. The lure of voyeurism made hysterical patients into celebrities, muses for their doctors and for a public that regarded the “condition of being a woman” as “one that can at any moment veer out of control and is therefore in need of medical regulation.” But if Hustvedt’s meticulous analysis of Charcot’s methodology provides evidence of his exploitation of what he called his vast “reservoir of material,” it also demonstrates that patients collaborated in what was an iatrogenic condition, “forged between patient and doctor.”
The “career” of Marie Wittmann, known throughout Europe as the “Queen of Hysterics” began inauspiciously. “Remarkable for her spirit of duplicity, lying and simulation” (as all women suffering hysteria were said to be), Wittmann, called Blanche by Charcot, arrived at Saltpêtrière because she had nowhere else to go after a childhood marked by tantrums so violent they prevented her going to school, the predation of an insane father, the early deaths of her mother and five of her eight siblings, and apprenticeship to a lecherous furrier whose advances provoked convulsions and loss of consciousness. Eighteen years old, exhausted by squalor and strife, she entered the hospital where she would spend the rest of her days.
Initially too “unpredictable and unruly” to be of clinical value, Wittmann was transferred from the hysterics’ quarters to a cell in the ward for the mad. Allowed to return to Charcot’s care after seven and a half months of what had been intended as a punishment for breaking windows and tearing up linens, she worked to secure her place in her increasingly famous physician’s magnum opus, the ward for hysteria offering freedom and comforts denied inmates of other wards. There, the ubiquity of “photographs, drawings, wax casts, as well as staged re-enactments” encouraged any enterprising patient to determine and reproduce the ideal hysterical profile. Once she evolved into the “most hypnotizable” (and therefore predictable) of hysterics, she became Charcot’s star performer, her symptoms “molded, altered and tweaked to fit his elaborate nosology.” She even requested the “ovary compressor.”
Is it progress to replace antiquity’s notion of the wandering womb with the conceit that there wasn’t any hysteria - any acting out - that couldn’t be effectively treated by striking out at the very organs in which femaleness resides? Though “equating hysterical symptoms with hypnotically induced symptoms” allowed Charcot to lay the groundwork for psychoanalysis, he necessarily failed to cure what “Medical Muses” reveals as women’s defiance of patriarchal strictures. Misogyny and hysteria: another circle, this one vicious, to add to the notorious chicken-and-egg.
Source: NY Times Book Review
Also, can we add a mental health or psychology tag?