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Jean Martin Charcot and Blanche Wittmann

Jean Martin Charcot (1825 to 1893) was appointed physician-in-charge at the Salpêtriere hospital for nervous diseases (a Paris hospital for poor women) in 1862. In 1881 he was given the title Professor of Neuropathology (nerve illness).

Earlier in the nineteenth century, the Salpetriere had been an asylum that aimed to cure its patients. This "asylum therapy" had proved a failure and, by the end of the century, it was widely believed that insanity is incurable. The insane were sent to asylums to protect them from exploitation and to protected society from them. A large asylum like the Salpetriere, however, offered a doctor an enormous field for research. The patients were cases that could be clinically analysed and kept on the wards, almost like a living museum. When they were dead, their brains and nervous systems could be preserved and dissected to see what damage to them might have caused the symptoms they exhibited in their lives.

In the medical tradition of Western Europe, to be medical something had to concern the body. If a state of mind was considered an illness, it implied that something wrong with the body was causing the state of mind. This is no longer the case. Today a state of mind can be described as due to illness, even though it is not believed to have a biological basis. The work of Charcot was an important stage in this development from body-based- psychiatry to a psychiatry that includes functional disorders with no suspected biological base.

The case of Charcot's char-lady illustrates the body-based approach to psychiatry. This account is taken from Freud's account of Charcot:

""During his student days chance brought him into contact with a charwoman who suffered from a peculiar form of tremor and could not get work because of her awkwardness. Charcot recognised her condition to be 'choreiform paralysis', already described by Duchenne, of the origin of which, however, nothing was known. In spite of her costing him a small fortune in broken plates and platters, Charcot kept her for years in his service and, when at last she died, could prove in the autopsy that 'choreiform paralysis' was the clinical expression of multiple cerebro-spinal sclerosis."
Charcot never gave up the idea that genuine medical illnesses have a biological base, and that base is neurological. His theories of hypnotism and hysteria, however, paved the way for others to break the link between a damaged body and a malfunctioning mind

Hypnotism

In 1882, Charcot persuaded the French Academy of Sciences that hypnotism is a respectable subject of study. He argued that it is a pathology of certain people's nerves. Its victims have nerves that are susceptible to hypnotism and (in its "grand hypnotisme" form") it behaves like an illness with three clinical stages: catalepsy, lethargy and somnambulism. His clinical picture of hypnotism is similar in form to the clinical picture he previously developed for epilepsy.

Charcot developed clinical demonstrations of his theories at the Salpetriere in the form of public performances, with himself as the lecturer and trained patients as the models. His most famous model was Blanche Wittmann. A painting by Andre Brouillet, in 1887, shows Charcot demonstrating on Blanche Wittmann. It is called Une Lecon Clinique a la Salpetrie, and is now in The National Library of Medicine, Bethesda, Maryland. The drawing below shows the central characters.


Click for
Blanche Wittmann
Jean Martin Charcot
Sigmund Freud

Blanche Wittmann's faints are focus from which we can explore

  • the development in our culture of a concept of mental illness without an organic base

    and

  • Sigmund Freud's development of psycho-analysis, a metatheory that has tried to explain society and culture in a new way.

    • See the timelines for social science and mental health

     
    I use extracts from Freud's last work, An Outline of Psychoanalysis (1938) as a summary of his theories. His comments On John Stuart Mill give some indication of the break he was making with traditional, rational, approaches to the analysis of society. The extracts from Interpretation of Dreams (1900) give a detailed insight into his early work and those from Totem and Taboo (1913) show how he related the analysis of individual personality to the analysis of society. There is also a collection of shorter extracts for other works.



    Hysteria

    Blanche Wittmann was nick-named the "Queen of Hysterics". The hysterics were a group of patients about whom the doctors were very embarrassed. They had clear physical symptoms, but no physical cause for them could be found and there were features about the symptoms that did not fit in with the doctor's understanding of what neurological damage would do. The suspicion was that the hysterics might be malingerers: people acting an illness in order to gain sympathy and benefits.

    Charcot argued that hysteria is a genuine illness. The neurological base was a degeneration of the nervous system across generations that made the hysteric liable to hysteria. This, however, was not something that Charcot demonstrated by autopsies. Instead, he demonstrated the genuineness of the illness by showing a consistency of the clinical patterns in his patients, and by demonstrating a method of relieving the symptoms. Blanche Wittmann, and other patients, would demonstrate the clinical patterns at Charcot's public performances.

    Charcot also argued that susceptibility to hypnosis is a symptom of a hysterical personality. Hysteria and hypnosis are essentially the same disease, and Charcot's patients would demonstrate both. The method that Charcot devised for relieving the symptoms of hysteria was not hypnosis, but pressing on zones of the patient's body that he identified as "hysterogenic zones". In women, one of these hysterogenic zones was on the lower belly, near the uterus. Freud once heard Charcot exclaim very excitedly that, in these cases, there was always something to do with reproduction involved:

      "Mais, dans des cas pareils c'est toujours la chose genitale, toujours...toujours"

    In 1885, Sigmund Freud was appointed Privatdozent (University Lecturer) in Neuropathology in Germany, and from October 1885 to February 1886 he studied under Charcot at the Salpetriere. It was in watching Charcot and his performing patients that Freud's interest first turned to hysteria and hypnosis. He also visited a practitioner who was using hypnosis to cure hysteria. When Freud later took up hysteria (neurosis) as his speciality, he was handicapped by being unable to hypnotise his patients, but fortunetly discoveed that the techniques of psychoanalysis (free-association) worked just as well.

    In Freud's work the links between neurotic illness and the nervous system become very weak. In fact, Freud even wrote of Charcot that he turned his attention from "the theory of organic nervous diseases" to hysteria. A new kind of illness had been gained for medicine, the illness of the mind when there is nothing wrong with the body. In his final summary of his life's work, Freud wrote that his task had been to map the mind, not the brain. (Freud 1940 pars 1.1 + 1.2)

    		   

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