Focusing on the individual case, Charcot spoke what he saw and made a spectacle of diagnosis. Students as well as a growing influential and often international public flocked to his leçons du mardi, when the newly instituted ‘outpatients’, men amongst them, came for a quick and brilliant evaluation. When he was stumped, the Maître–for whom the post of Professor of Neuropathology in the Faculty of Medicine had been created in 1881–would openly exclaim it. On Fridays, in his more formal lectures, the long-term residents of the Salpêtrière were presented for examination. Their cases had been under scrutiny for some time. They came before students and public to demonstrate, for example, the ease with which hysterics could be hypnotized. Asleep, they moved paralysed limbs or reproduced the traumatic scenes which had toppled them into their condition.
It is worth noting that for Charcot hysteria was equally a male illness, though, given the Salpêtrière’s female population, most of his famous hysterics were women. Freud had emphasized in his obituary of the Master that ‘Hysteria in males, and especially in men of the working class, was found far more often than had been expected; it was convincingly shown that certain conditions which had been put down to alcoholic intoxication or lead-poisoning were of a hysterical nature.’
Like his predecessors, including Georget, who believed in the power of physiognomy to reveal insanity, Charcot had his patients represented for medical purposes. He used not the old artisanal technologies of paint and plaster casts or wax, but the new ‘objective’ technology that couldn’t lie: photography. The Salpêtrière photographs, it was thought, could provide a physiognomic map of the passions: traces, imprints on the body through time of maladies of the nerves and of the deranged emotions and mental processes they could produce. Trainee medics could learn diagnosis from such an amassed natural history of symptoms, as could doctors in hospitals and practices far and wide. If today the Salpêtrière photographs of hysterics can look melodramatically posed, and hardly useful as instruments for contemporary diagnosis, it is worth noting that their status in their own time was not unlike brain scans or magnetic resonance imaging today. Scans are no more an accurate rendition of a ‘reality’ than these older images once were; after all, they are computer-generated images processed, sometimes in glorious colour, in accordance with algorithms most doctors find incomprehensible, and then read using codes whose assured parsing requires great subtlety and experience.
Through the late nineteenth century’s representational technology of photography, the Salpêtrière amassed a vast archive of the iconography of mental illness. Charcot’s hysterics, like the early silent film stars who may well have imitated their expressions, went through the dramatic paces of their condition for the camera. Depending from where the judgement is made, either they provided the documentation, the evidence for the four stages of hysteria, or they enacted them as Charcot and his doctors had suggested them. From the careful and detailed observation of individual cases–a procedure which paid tribute to his admiration for the time’s leading philosophy of positivism–Charcot arrived at what was the ‘type’ of the repeated mechanism of the hysterical attack.
All of these stages were captured on photographic plates redolent of the mystery which early photography, with its long, slow takes and erratic developing procedures, instils. They were also drawn and tabulated by the talented Paul Richer, Professor of Artistic Anatomy at the Ecole des Beaux Arts in Paris. So widely diffused were the dramatic images recording the four stages of the hysterical attack, so much talked about were Charcot’s hysterics, it is hardly surprising that various forms of contemporary malaise found their way into an unconscious mimicking of the popularized symptoms.
The fact that Charcot proceeded by focusing on individual cases so as to arrive at general rules and a specimen type, a universal into which all hysterics fitted, allowed for what was almost certainly an over-recognition and over-diagnosis of the condition. It also allowed it to be learned, in the way that Charcot’s first hysterical patients, housed as they were in the epileptics’ ward, learned the enactment of fits. If a woman displayed any of the characteristics of the four stages–an anaesthesia, or a passional attitude–the other stages might be deduced and the categorization of ‘hysteric’ attributed. Just as with monomania, the culture of the times, the doctors and patients all collaborated in creating that pattern of illness and discontent which was hysteria.
Augustine came early. In 1876, just after her arrival at the hospital, the Iconographie photographique de la Salpêtrière series was established, and its splendid volumes recording patients through image and text began to be published by the wonderfully named Bureau de Progrès Médical. These books act as a testimonial to Charcot’s Salpêtrière and the set of behaviours, postures and experimental procedures which make up what became its most famous diagnosis. They also serve as the fullest hospital guide yet available to the patients, containing not only the images Charcot was so intent on, but a record of their own words–that language of dream, delirium and memory which would form the focus of Charcot’s most famous student Freud’s practice.
The doctor who writes Augustine’s case notes, and simultaneously reveals what, in a clinical picture, the doctors of the Salpêtrière found noteworthy, is D.M. Bourneville. It is he, together with the photographer P. Regnard, who gives Augustine to history and helps to make her one of the Salpêtrière’s star hysterics. Introducing Augustine, Bourneville describes her as ‘sweet, capricious, wilful, and far too saucy for her age’. Despite appearances, for she is tall and full of figure, she is prepubertal. Many had previously thought hysteria could only come with menstruation.
In the photograph taken of her fully dressed and depicting a ‘normal state’–perhaps one of those intervals between attacks that Charcot noted as habitual in hysterics–Augustine gives the camera a fetching smile which reaches her light eyes. She leans back against a chair, a pretty, pneumatic figure, one hand raised to her carefully coiffed head, while her other arm, the tell-tale limb, lies in her lap–this is the arm which doesn’t altogether feel sensations, and later doesn’t move.
Bourneville tells us in his summary notes that Augustine is ‘active, intelligent, affectionate, impressionable, temperamental and likes drawing attention to herself’. She is coquettish, spends time on her appearance and in arranging her abundant hair in one style or another, taking particular delight in brightly coloured ribbons. So far, were it not for the report of fainting fits and the arm, the portrait could be one of any ordinary teenager. A lack of mobility and sensation with no underlying physical cause is one of the determining features for a diagnosis of hysteria. Augustine is tested with all the existing indicators of neurological conditions, such as the Mathieu dynamometer, to see the difference in movement between left and right sides. She is pricked and scratched, her reflexes prodded, alongside her hearing, taste and sight. Charcot is first and foremost a neurologist, one who named and described a vast range of disorders while he taught the art of diagnosis.
Augustine’s whole right-hand side is affected. The anaesthesia on one side is paralleled by an oversensitivity–a hyperaesthesia–in other parts. As for vision–and Charcot and his clinicians are highly alert to the links between perception and nervous disorders–acuity is diminished and Augustine’s notion of colour itself is gone. All this marks only the beginning of the picture of hysteria that Charcot will flesh out with the help of photography and patients who, like most, are open to suggestion.
Bourneville’s notes indicate that Augustine was brought to the Salpêtrière by her mother, a servant in good health, whose only possible neurological blemish lies in the migraines she suffered in youth. She is forty-one to the father’s forty-five, and he too is a servant, sober and rather stern of character. According to her mother, who supplies a part of this information, Augustine is the eldest of seven children, of which only she and her younger brother survived. She lived with her mother for her first nine months, was then sent off to relatives in the countryside, and fro
m the age of six to thirteen and a half lived in a convent, where she learned to read and write, and sew lingerie. Her only illness before the bout that brought her to the Salpêtrière was bronchitis.
Without giving us the exact source of the information that follows, Bourneville then proceeds to fill in Augustine’s story with dramatic flair. We later realize that a part of the material must come from her utterances during states of delirium, which is the last phase of a full hysterical attack as the Salpêtrière understood it. The story also emerges from her own reports of her dreams, or her ‘hallucinations’ under the influence of ether, amyl nitrate or hypnosis. Each of these ‘drugs’ is used as a means of gathering scientific data, as well as for soothing: Charcot’s patients are always also experimental subjects, who will perhaps throw light on a disease entity. Hence the chemical ‘tools’, the careful recording of material, the attention paid to those traditional indicators–excretion, temperature (of various body parts), menstruation.
The machinations Bourneville depicts as background to Augustine’s hystero-épilepsie, without in any way linking them absolutely or making them directly causative of her illness, might make us wonder whether Freud’s hysterics were merely middle-class variations on the everyday narrative of belle époque life. Augustine’s story is replete with violent sensation and melodramatic incident. In part because of this, certain aspects of her history feel more ‘true’ than others. But Charcot’s doctors, even early on, were alert to the inventive side of hysterics, their ability to fabulate, on top of the protean nature of the condition. We can therefore only assume that the observational details Bourneville integrates in setting up Augustine’s case are the ones he believed. From a Freudian perspective, of course, the evidential base is less important than the story itself.
In terms of a history of the Salpêtrière, however, it is worth noting that certain parts of Augustine’s narrative, for example the evocation of scenes of religious ecstasy in the convent of her childhood, feel as if they have arisen from cues and suggestions within her present environment–as do the dramatic hysterical fits so akin to epileptic attacks which the women in the hospice perform and which occur as an aspect of hysteria almost nowhere else. In the convent, Bourneville tells us, the nuns often punish Augustine for what they see as her rebelliousness, her irreligious utterances, her fits of anger during which she purportedly turns black. Holy water is thrown in her face to calm her. The nuns think she is possessed and during a retreat she is sent off to be exorcized. On another occasion, because she and two other little girls touch themselves, the sisters punish them by tying up their hands at night. One of the other girls suffers ecstasies, which Augustine compares to those of a fellow hysteric at the Salpêtrière, Geneviève, another of Bourneville’s documented cases. This is a patient Charcot uses to demonstrate that religious ecstasy, like demonic possession, is a component of hysteria.
While at the convent, Augustine sometimes goes to visit the wife of a painter/decorator. The woman drinks and rows with her husband, who grows violent. On one occasion he hits his wife, ties her up by the hair and turns on Augustine. He tries to kiss her and even rape her. She is terrified. Only that summer, when she is home on holidays, does her brother explain to her how babies are made. That same summer, her mother takes her to the house where she and her husband work as servants. Augustine is urged to call the man of the house, C., ‘Daddy’, and to kiss him.
When she leaves the convent at the age of thirteen and a half, she is brought to live in C.’s house. Her mother says that she will be raised alongside the other children here, and taught to sing and to sew. But C. makes use of his wife’s absence to try and have sex with Augustine. The first time he fails because of her resistance. So, too, the second time. The third time he attempts seduction, promises beautiful dresses. He threatens her with a razor, and while she’s in a state of terror, forces alcohol on her, throws her on the bed and rapes her. The next day she is in pain. She can’t walk. When she finally comes to table the day after, she can’t bring herself to give C. the customary kiss. His wife, also noticing her pallor, grows suspicious.
Meanwhile, C. throws her warning looks across the table. When she continues unwell, she is sent home. She vomits. Everyone thinks her malaise is tied to the onset of menstruation. But it doesn’t come. What come are fits: when she is resting in her darkened room, she sees a green-eyed cat coming at her in the dark. She screams and suffers a convulsive attack which ends in laughter. For a month and a half there are daily attacks. One day, she meets C. in the street. He catches her by the hair. The convulsive attack which follows is particularly violent.
Later, at the Salpêtrière, the scene of the rape revisits her repeatedly. In a state of delirium she spits, makes small pelvic movements, calls out, ‘Pig, pig!…I’ll tell Papa…Pig! You’re so heavy! You’re hurting me!’ A year or so later, under the influence of ether, she rehearses the moment, adding a new element: ‘Mr C. said he would kill me…I didn’t know it was an animal that would bite.’
Augustine is sent to work as a housemaid to an old woman. Her brother introduces her to his friends and she starts having sexual relations with one of them, Emile, for some six months. She also sleeps, perhaps only once, with his friend George: the tussle between the two youths is enacted during her attacks at the Salpêtrière, where she cajoles Emile not to be jealous of George, entices him to bed her, or rebukes him for trying it on at the Salpêtrière itself (where he has come to visit).
During the time before her arrival at the hospital, Augustine has frequent arguments with her parents, who also row with each other about her adventurous and irregular habits. She realizes that her mother has long had relations with C., to whom she delivered Augustine perhaps as a kind of proxy, or as a gift. She also learns that her brother might well be C.’s son, not her father’s, with whom his relations have always been cold. In her delirium, she chastises her mother for delivering her to a man who put rats up her fanny.
Like Freud’s Dora, Augustine gradually reveals to her doctors a highly sexualized fabric of daily life. It is one her parents, whatever their disapproval or strict behaviour on the surface, effectively deliver her to at a young age in order to cover up or facilitate their own sexual activity. Endemic to the family, it would seem, are certain forms of coercion and sexual exploitation, particularly of girls. Augustine shares this ‘past’ with others of the Salpêtrière’s hysterics and with Freud’s. The difference is that Freud sets out to focus on and understand the sexual genesis of the condition, and sees that understanding as part of the treatment. For him, the family and a hypocritical sexual morality are the instigating problem. A history of conflicts between what a child can see and feel and what she is told–the struggle, as he puts it, against accepting ‘a difficult piece of reality’–often forms part of the clinical picture of hysteria.
Freud’s appreciation of the arc of hysteria meets the case of Augustine in other respects, too. The disgust and attraction towards sex which she enacts so vividly and repeatedly during her hysterical attacks, the ‘serpent’ in the trousers she both fears and wants, foreshadow Freud’s interpretation of Dora. Augustine’s ability to perform passive and active sexual roles during these attacks, her double identification with male and female parts, the traumatic internalization of what is tantamount in her case to a rape (though it could be something far less, like a kiss, or a glance that cut across a face), also seem fundamental to Freud’s picture of hysteria. Freud was certainly familiar with the specificities of her case. He possessed a copy of the Salpêtrière’s Iconographie photographique as well as Charcot’s archive. When he attended Charcot’s lectures in 1885, the resident hysterics must have proved just as vivid as Augustine.
What Freud also learned from the great teachers that were Charcot and his patients was something that Charcot never explicitly taught, though from an off-hand remark it was evident to him and became more and more so to Freud as his years of practice mounted. La chose génitale, conflicted sexuality,
was often at the root of ‘severe illness’. This fact seemed to be part of the unofficial knowledge of the medical profession, though it was never taught or actually stated.
In his history of the psychoanalytic movement, Freud reminisces about one of the moments of his research trip to France that marked him most profoundly:
at one of Charcot’s evening receptions, I happened to be standing near the great teacher at a moment when he appeared to be telling Brouardel a very interesting story about something that had happened during his day’s work…a young married couple from a distant country in the East–the woman a severe sufferer, the man either impotent or exceedingly awkward. ‘Tâchez donc,’ [keep trying] I heard Charcot repeating, ‘je vous assure, vous y arriverez.’ [I assure you, you will get there] Brouardel, who spoke less loudly, must have expressed his astonishment that symptoms like the wife’s could have been produced by such circumstances. For Charcot suddenly broke out with great animation: ‘Mais, dans des cas pareils c’est toujours la chose génitale, toujours…toujours…toujours’ [But, in such cases it’s always the genital thing, always…always…always]; and he crossed his arms over his stomach, hugging himself and jumping up and down on his toes several times in his own characteristically lively way. I know that for a moment I was almost paralysed with amazement and said to myself: ‘Well, but if he knows that, why does he never say so?’ But the impression was soon forgotten; brain anatomy and the experimental induction of hysterical paralyses absorbed all my interest.
By the time Ida Bauer, the patient Freud calls ‘Dora’, came to him in 1899, Freud had left behind Charcot’s experimental induction through hypnosis of hysterical paralyses and learned the unofficial lesson. Repressed sexual conflicts, perhaps produced by traumatic events–but equally occasioned by the difficulties of growing up woman at a time when idealizations of the family were at odds with lived experience–were the seedbed of hysteria and a variety of neuroses.
Mad, Bad, and Sad: A History of Women and the Mind Doctors Page 16
