Freud - Complete Works (53 page)

Charcot

280

   Charcot was in the very prime of
life when this abundance of facilities for teaching and research
were placed at his disposal. He was a tireless worker, and always,
I believe, the busiest in the whole institute. His private
consultations, to which patients flocked ‘from Samarkand and
the Antilles’, could not keep him from his teaching
activities or his researches. There is no doubt that this throng of
people did not turn to him solely because he was a famous
discoverer but quite as much because he was a great physician and
friend of man, who could always find an answer to a problem and
who, when the present state of science did not allow him to
know
, was able to make a good guess. He has often been
blamed for his therapeutic method which, with its multiplicity of
prescriptions, could not but offend a rationalistic conscience. But
he was simply continuing the procedures which were customary at
that time and place, without deceiving himself much about their
efficacy. He was, however, not pessimistic in his therapeutic
expectations, and repeatedly showed readiness to try new methods of
treatment in his clinic: their short-lived success was to find its
explanation elsewhere.

   As a teacher, Charcot was
positively fascinating. Each of his lectures was a little work of
art in construction and composition; it was perfect in form and
made such an impression that for the rest of the day one could not
get the sound of what he had said out of one’s ears or the
thought of what he had demonstrated out of one’s mind. He
seldom demonstrated a single patient, but

mostly a series of similar or contrasting
cases which he compared with one another. In the hall in which he
gave his lectures there hung a picture which showed
‘citizen’ Pinel having the chains taken off the poor
madmen in the Salpêtrière. The
Salpêtrière, which had witnessed so many horrors
during the Revolution, had also been the scene of this most humane
of all revolutions. At such lectures Maître Charcot himself
made a curious impression. He, who at other times bubbled over with
vivacity and cheerfulness and who always had a joke on his lips,
now looked serious and solemn under his little velvet cap; indeed,
he even seemed to have grown older. His voice sounded subdued. We
could almost understand how ill-disposed strangers could reproach
the whole lecture with being theatrical. Those who spoke like this
were doubtless accustomed to the formlessness of German clinical
lectures, or else forgot that Charcot gave only
one
lecture
in the week and could therefore prepare it carefully.

   In this formal lecture, in which
everything was prepared and everything had to have its place,
Charcot was no doubt following a deeply-rooted tradition; but he
also felt the need to give his audience a less elaborated picture
of his activities. This purpose was served by his out-patient
clinic of which he took personal charge in what were known as his
‘
Leçons du mardi
’. There he took up cases
which were completely unknown to him; he exposed himself to all the
chances of an examination, all the errors of a first investigation;
he would put aside his authority on occasion and admit - in one
case that he could arrive at no diagnosis and in another that he
had been deceived by appearances; and he never appeared greater to
his audience than when, by giving the most detailed account of his
processes of thought and by showing the greatest frankness about
his doubts and hesitations, he had thus sought to narrow the gulf
between teacher and pupil. The publication of these improvised
lectures, given in the year 1887 and 1888, at first in French and
now in German as well, has also immeasurably widened the circle of
his admirers; and never before has a work on neuropathology had
such a success with the medical public as this.

Charcot

281

   At about the time at which the
clinic was established and at which he gave up the Chair of
Pathological Anatomy, a change occurred in the direction of
Charcot’s scientific pursuits, and to this we owe the finest
of his work. He now pronounced that the theory of organic nervous
illnesses was for the time being fairly complete, and he began to
turn his attention almost exclusively to hysteria, which thus all
at once became the focus of general interest. This, the most
enigmatic of all nervous diseases, for the evaluation of which
medicine had not yet found a serviceable angle of approach, had
just then fallen into thorough discredit; and this discredit
extended not only to the patients but to the physicians who
concerned themselves with the neurosis. It was held that in
hysteria anything was possible, and no credence was given to a
hysteric about anything. The first thing that Charcot’s work
did was to restore its dignity to the topic. Little by little,
people gave up the scornful smile with which the patient could at
that time feel certain of being met. She was no longer necessarily
a malingerer, for Charcot had thrown the whole weight of his
authority on the side of the genuineness and objectivity of
hysterical phenomena. Charcot had repeated on a small scale the act
of liberation in memory of which Pinel’s portrait hung in the
lecture hall of the Salpêtrière. Once the blind fear
of being made a fool of by the unfortunate patient had been given
up - a fear which till then had stood in the way of a serious study
of the neurosis - the question could arise as to what method of
approach would lead most quickly to a solution of the problem. A
quite unbiased observer might have arrived at this conclusion: if I
find someone in a state which bears all the signs of a painful
affect - weeping, screaming and raging - the conclusion seems
probable that a mental process is going on in him of which those
physical phenomena are the appropriate expression. A healthy
person, if he were asked, would be in a position to say what
impression it was that was tormenting him; but the hysteric would
answer that he did not know. The problem would at once arise of how
it is that a hysterical patient is overcome by an affect about
whose cause he asserts that he knows nothing. If we keep to our
conclusion that a corresponding psychical process
must
be
present, and if nevertheless we believe the patient when he denies
it; if we bring together the many indications that the patient is
behaving as though he
does
know about it; and if we enter
into the history of the patient’s life and find some
occasion, some trauma, which would appropriately evoke precisely
those expressions of feeling - then everything points to one
solution: the patient is in a special state of mind in which all
his impressions or his recollections of them are no longer held
together by an associative chain, a state of mind in which it is
possible for a recollection to express its affect by means of
somatic phenomena without the group of the other mental processes,
the ego, knowing about it or being able to intervene to prevent it.
If we had called to mind the familiar psychological difference
between sleep and waking, the strangeness of our hypothesis might
have seemed less. No one should object that the theory of a
splitting of consciousness as a solution to the riddle of hysteria
is much too remote to impress an unbiased and untrained observer.
For, by pronouncing possession by a demon to be the cause of
hysterical phenomena, the Middle Ages in fact chose this solution;
it would only have been a matter of exchanging the religious
terminology of that dark and superstitious age for the scientific
language of to-day.

Charcot

282

   Charcot, however, did not follow
this path towards an explanation of hysteria, although he drew
copiously upon the surviving reports of witch trials and of
possession, in order to show that the manifestations of the
neurosis were the same in those days as they are now. He treated
hysteria as just another topic in neuropathology; he gave a
complete description of its phenomena, demonstrated that these had
their own laws and uniformities, and showed how to recognize the
symptoms which enable a diagnosis of hysteria to be made. The most
painstaking investigations, initiated by himself and his pupils,
extended over hysterical disturbances of sensibility in the skin
and deeper tissues, over the behaviour of the sense organs, and
over the peculiarities of hysterical contractures and paralyses,
and of trophic disturbances and changes in metabolism. The many
different forms of hysterical attack were described, and a
schematic plan was drawn up by depicting the typical configuration
of the major hysterical attack as occurring in four stages, which
made it possible to trace the commonly observed ‘minor’
attacks back to this same typical configuration. The localization
and frequency of occurrence of the so-called ‘hysterogenic
zones’ and their relationship to the attacks were also
studied, and so on. Once all this information about the
manifestations of hysteria had been arrived at, a number of
surprising discoveries were made. 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; it was possible to subsume under hysteria a
whole number of affections which had hitherto not been understood
and which had remained unclassified; and where the neurosis had
become joined with other disorders to form complex pictures, it was
possible to separate out the part played by hysteria. Most
far-reaching of all were the investigations into nervous illnesses
which followed upon severe traumas - the ‘traumatic
neuroses’ - views about which are still under discussion and
in connection with which Charcot has successfully put forward the
arguments in favour of hysteria.

   After the latest extensions of
the concept of hysteria had so often led to a rejection of
aetiological diagnosis, it became necessary to enter into the
aetiology of hysteria itself. Charcot put forward a simple formula
for this: heredity was to be regarded as the sole cause.
Accordingly, hysteria was a form of degeneracy, a member of the
‘
famille névropathique
’. All other
aetiological factors played the part of incidental causes, of
‘
agents provocateurs
’.

   The construction of this great
edifice was naturally not achieved without violent opposition. But
it was the sterile opposition of an old generation who did not want
to have their views changed. The younger among the
neuropathologists, including those in Germany, accepted
Charcot’s teaching to a greater or lesser degree. Charcot
himself was completely certain that his theories about hysteria
would triumph. When it was objected that the four stages of
hysteria, hysteria in men, and so on, were not observable outside
France, he pointed out how long he himself had overlooked these
things, and he said once more that hysteria was the same in all
places and at every time. He was very sensitive about the
accusation that the French were a far more neurotic nation than any
other and that hysteria was a kind of national bad habit; and he
was much pleased when a paper ‘On a Case of Reflex
Epilepsy’, which dealt with a Prussian Grenadier, enabled him
to make a long range diagnosis of hysteria.

Charcot

283

   At one point in his work Charcot
rose to a level higher even than that of his usual treatment of
hysteria. The step he took assured him for all time, too, the fame
of having been the first to explain hysteria. While he was engaged
in the study of hysterical paralyses arising after traumas, he had
the idea of artificially reproducing those paralyses, which he had
earlier differentiated with care from organic ones. For this
purpose he made use of hysterical patients whom he put into a state
of somnambulism by hypnotizing them. He succeeded in proving, by an
unbroken chain of argument, that these paralyses were the result of
ideas which had dominated the patient’s brain at moments of a
special disposition. In this way, the mechanism of a hysterical
phenomenon was explained for the first time. This incomparably fine
piece of clinical research was afterwards taken up by his own
pupil, Pierre Janet, as well as by Breuer and others, who developed
from it a theory of neurosis which coincided with the mediaeval
view - when once they had replaced the ‘demon’ of
clerical phantasy by a psychological formula.

   Charcot’s concern with
hypnotic phenomena in hysterical patients led to very great
advances in this important field of hitherto neglected and despised
facts, for the weight of his name put an end once and for all to
any doubt about the reality of hypnotic manifestations. But the
exclusively nosographical approach adopted at the School of the
Salpêtrière was not suitable for a purely
psychological subject. The restriction of the study of hypnosis to
hysterical patients, the differentiation between major and minor
hypnotism, the hypothesis of three stages of ‘major
hypnosis’, and their characterization by somatic phenomena -
all this sank in the estimation of Charcot’s contemporaries
when Liébeault’s pupil, Bernheim, set about
constructing the theory of hypnotism on a more comprehensive
psychological foundation and making suggestion the central point of
hypnosis. It is only the opponents of hypnotism who, content to
conceal their lack of personal experience behind an appeal to
authority, still cling to Charcot’s assertions and who like
to take advantage of a pronouncement made by him in his last years,
in which he denied to hypnosis any value as a therapeutic
method.

Charcot

284