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Mon May 23, 2011
NPR Story

Excerpt: 'Medical Muses: Hysteria in Nineteenth-Century Paris'

Note: Author's footnotes have been omitted.

Chapter 1

During the decade of the 1870s, three young women found themselves in the hysteria ward of the Salpetriere Hospital in Paris under the direction of the prominent neurologist Jean-Martin Charcot. All three — Blanche, Augustine, and ­Genevieve — would become medical celebrities. The stories of their lives as patients on the ward are a strange amalgam of science and religion, medicine and the occult, hypnotism, love, and theater. The illness they suffered from was hysteria. This disease was not an arcane preoccupation of the doctors that treated them, but an affliction that would increasingly capture the public imagination. Stories about hysterical patients filled the columns of newspapers. They were transformed into fictional characters by novelists. Hysterics were photographed, sculpted, painted, and drawn. Every week, eager crowds arrived at the hospital to attend Charcot's demonstrations of hysterics acting out their hysterical symptoms. And it wasn't only medical students and physicians who came to view the shows, but artists, writers, actors, socialites, and the merely curious. Hysteria had become a fascinating and fashionable spectacle. But who were these hysterical women? Where did they come from? What role did they play in their own peculiar form of stardom? And what exactly were they suffering from?

To answer these questions, I combed hospital records and municipal archives. I read case histories, gathered testimony from the scientific and the popular press of the day, and sifted through visual documents. I read memoirs and letters written by those who spent time at the Salpetriere in the late nineteenth century, including the young Sigmund Freud, who admired Charcot, and the enormously vindictive Leon Daudet, who did not. I pursued false leads and hit dead ends. History is filtered by subjectivity, and I repeatedly stumbled on the Rashomon effect of conflicting narratives. I relied heavily on the work of medical historians whose clarity in the face of so many bewildering accounts was enormously helpful.

I first came across this material when I was a graduate student in French at New York University. I was writing my dissertation on a late-nineteenth-century novel, The Future Eve by Villiers de l'Isle-Adam. At that time, hysteria was a fashionable topic in literary theory, and I came across multiple references to various hysterical women, but they were usually in passing, in footnotes, or in evidence to support an argument. Long after I had finished my Ph.D. work, those tantalizing bits of information continued to haunt me, and I decided to write a book about the women themselves.

Hysteria was at least partly an illness of being a woman in an era that strictly limited female roles. It must be understood as a response to stifling social demands and expectations aptly expressed in paralysis, deafness, muteness, and a sense of being strangled. Blanche, Augustine, and Genevieve exhibited symptoms that physically illustrated their actual social conditions. They lived at a time when women were exclusively defined through their relations with men. Fatherless, unmarried, and poor, these three women found themselves in a world that had little use for them. I began writing with a preconceived notion: the hysterics were victims of not only their home lives, but of a misogynist institution led by the tyrannical Charcot. I would rescue them from that narrative and tell their stories, from their perspective. Despite my intention, the more I read, the more I found myself admiring Charcot's brilliance. I also became a reluctant fan of some — not all — of the members of his coterie, a group of physicians who worked with him at the Salpetriere. Desire-Magloire Bourne­ville's humanitarian compassion for the oppressed and Gilles de la Tourette's ferocious loyalty are both laudable. Instead of a clear-cut world of exploited women and exploiting men, I entered something far more nuanced. Blanche, Augustine, and Genevieve were undeniably victimized, both inside and outside the hospital. That said, they also participated in a hospital culture that was in many ways less oppressive than the world beyond it. The Salpetriere provided a language — the language of hysteria — that allowed them to articulate their distress. Blanche, Augustine, and Genevieve mastered its vocabulary and were rewarded.

I set out to write a nonhysterical book about hysteria, to ground my work in something real. At first I found it unfathomable that these women really were suffering from the spectacular forms of illness recorded by their doctors, an illness that no longer exists. But now I believe that Blanche, Augustine, and Genevieve were indeed ill. They suffered from chronic debilitating symptoms. To what degree their disease was socially determined and to what degree it was physically determined is impossible to say. If they showed up at a hospital today, suffering from the same symptoms, they would probably be diagnosed with schizophrenia or conversion disorder or bipolar disorder. They would undoubtedly be diagnosed with eating disorders because they had bouts of willful starving and vomiting. However, if these women were alive today, they might not have become ill to begin with and no doubt would suffer from other symptoms.

I am convinced that Blanche, Augustine, and Genevieve were neither frauds nor passive receptacles of a sham diagnosis. They really did "have" hysteria. Located on the problematic border between psychosomatic and somatic disorders, hysteria was a confusion of real and imagined illness. In an era without demons and before Freud's unconscious, hysteria fell into a theoretical vacuum. The female body was viewed as the site of a disturbing and incomprehensible split between its inside and outside. The theatrical symptoms of the external body had no internal reference, no location. They did not reveal the workings of the unconscious. They were themselves only, baffling, alarming, but revelatory of nothing. Unable to find an organic source, Charcot tried to isolate and reproduce these symptoms. The hysterics who cooperated in this project became pure signs of their illness, divested of any interiority. Their symptoms pointed to no inner source. Charcot's goal was to transform his hysterics, with their bizarre fits and spasms, into ideal medical specimens — into living dolls.

Hysteria may be an illness of the past, but the medical and ideological notions of femininity that lie behind it offer insights into the illnesses of the present and the way they are perceived. And while modern medicine no longer talks about hysteria, it nonetheless continues to perpetuate the idea that the female body is far more vulnerable than its male counterpart. Premenstrual syndrome, postpartum depression, and "raging hormones" are among the more recent additions to a medical mythology that is centuries old. As I researched nineteenth-century hysteria, accumulating books, articles, notes, and images on the subject, a second pile of information — at first glance unrelated — had also piled up on my desk. Newspaper and magazine clippings, recently published books and downloaded information from the Internet on eating disorders, self-mutilation, chronic fatigue syndrome, multiple personality disorder, and outbreaks of rashes following the September 11 attacks on the World Trade Center competed for space in my already crowded office. Why has my study of a disease that is no longer officially a medical diagnosis compelled me to collect information on these new disorders? Why do the lives of three women who lived more than a hundred years ago feel so relevant today and resonate so strongly with the lives of women who are my contemporaries?

A partial explanation can be found in Freud, or rather, in his absence. When Freud was at the Salpetriere, he had yet to invent psychoanalysis. Charcot and his colleagues worked in a pre-Freudian era. The dynamic unconscious was not a possible explanation for hysterical symptoms. Now, we seem to have entered a post-Freudian period. The brilliant founder of psychoanalysis has been attacked from all sides, and in the nature/nurture debate, nature is, at least for the time being, in the lead. Psychiatric disorders are increasingly understood to be "chemical imbalances" and are treated with drugs. Like their nineteenth-century predecessors, today's scientists are scrambling to find biological explanations for behavior, and everything from human mating strategies to homosexuality, from shyness to alcoholism, has been supposedly located in biology.

There is, however, a crop of bizarre new illnesses that, like hysteria, afflict mostly young women and stubbornly resist biological explanation. No drug exists to cure anorexia, bulimia, self-mutilation, chronic fatigue syndrome, and multiple personality disorder, and no genetic flaw has been found to explain them. Furthermore, as was true for hysteria, these contemporary disorders are thought to be contagious, spread by suggestion, imitation, and therapy. The numbers of women diagnosed with multiple personality disorder, for example, soared after the television airing of Sybil, the story of a twentieth-century medical celebrity. Accounts of bulimics entering treatment clinics for eating disorders and emerging as trained anorexics exist, as does a newsletter, the Cutting Edge, in which self-mutilators can swap trade secrets. And in yet another parallel to hysteria, discussion of these illnesses is not limited to medical circles, but has infiltrated every area of public discourse, from tabloid television to scholarly tomes.

The cultural and historical homologies between hysteria and these present-day diseases are so detailed and undeniable that it would be accurate to categorize them all as incarnations of hysteria. They are perceived as social and cultural diseases that express in some direct, if undetermined way social and cultural conditions. Moreover, I believe that they may be read as a metaphor both for women's position in society and for the image of the feminine in the history of scientific discourses. Hysteria, that bizarre rupture between symptom and source played out on the female body has resurfaced in our post-Freudian era in new but oddly familiar forms. My desire to write Medical Muses was not merely a desire to recapture a lost historical experience. I hoped to achieve an understanding of, and perspective on, ourselves and our social world.

Charcot: Art and Medicine

Jean-Martin Charcot's life spanned a period of radical political change in France as monarchists and republicans clashed in bloody battles for power. On November 29, 1825, when Charcot was born, the ultra­royalist Charles X was on the throne doing his utmost to suppress what remained of liberty, fraternity, and equality in France. The revolts of 1830 sent the reactionary king into exile, and the nation entered a period of relative stability under a more moderate monarch, the "citizen king" Louis-Philippe. The Revolution of 1848 led to the proclamation of the Second Republic, only to see democracy squelched by the 1851 coup d'etat that ushered in the Second Empire when Napoleon III declared himself emperor. His authoritarian regime came to an end in 1870 following the humiliating defeat of the French by the Prussians. The Third Republic was declared, and gave rise to the Paris Commune. For two months, the official government army attacked the insurgents, killing an astounding 25,000 Parisians. The Third Republic, in power when Charcot died in 1893, endured until 1940, when it was replaced by the Vichy Regime.

Charcot was the second of four boys born in a working-class family. His father was a carriage builder in Paris, a skilled artisan, and while not wealthy, the Charcots were by no means poor. According to legend, there was enough money to pay for the higher education of only one boy, and Charcot's father decided that his oldest would take over the family workshop, his two youngest would join the military, and his most studious son, Jean-Martin, would pursue a professional degree. A career in medicine was one route to upward social mobility in nineteenth-century France. Freed from the "Molieresque" tradition of the doctor as bumbling fool, physicians rose to new prominence in the nineteenth century. During Charcot's early childhood, doctors joined the republican opposition in the July Revolution of 1830 and, after the cholera epidemic of 1832, became public heroes. For a working-class boy, the medical profession offered not only an avenue to economic prosperity, but the allure of a noble cause. Charcot was a quiet child. He loved animals and preferred to spend time alone reading and drawing. He never outgrew his love for animals, literature (his favorite authors were Shakespeare, Dante, and Rabelais), and art. Before he decided on medical school, he had considered a career as an artist, and he continued to draw throughout his life, both for pleasure and for work.

Charcot drew constantly. He drew landscapes, still lifes, and portraits. He drew when he traveled, when he saw patients, and when he smoked hashish. As one of his students wrote regarding his experiment with hashish: "The entire page was covered with drawings: prodigious dragons, grimacing monsters, incoherent personages who were superimposed on each other, and who were intertwined and twisted in a fabulous whirlpool." In the large house in the Faubourg Saint-Germain where he lived at the end of his life, Charcot installed an art studio, where he painted. He used his artistic skills to narrow in on anatomical abnormalities wherever he came across them, whether he was in the hospital or traveling. One sketch he made depicts an old man he saw in North Africa. To my untrained eye, the drawing looks like a hand-drawn ethnic postcard: a bearded man sits in a caftan, framed by a Moorish arch. For Charcot, the portrait showed the joint deformities of a man suffering from Parkinson's disease. He was a gifted caricaturist and sketched strangers as well as people he knew — his children, professors, students, patients, and colleagues — ­sometimes with a great deal of wit. During one of the many competitive examinations he sat for — the test to become a professor "agrege" on the Faculty of Medicine, a high-level distinction — Charcot covered his test paper with doodles and sketches. Among them is a group portrait of the faculty of medicine, drawn in their formal caps and gowns, but with the faces of monkeys. He failed the exam the first time he took it — maybe this less-than-reverential drawing was from that round. While he is often described as cold and proud, Charcot was capable of self-mockery as well. The Charcot Library has preserved self-portraits, or rather self-caricatures, in which he exaggerated his beakish nose. In one he drew himself as a parrot. Astute observation and an ability to pinpoint distinguishing characteristics, whether for humorous effect in a drawing or to diagnose the disease of a patient, were among Charcot's defining gifts. As his famous student Sigmund Freud later remarked, Charcot "had the nature of an artist." He was "a visuel, a man who sees."

The Salpetriere

In 1852, the twenty-seven-year-old Charcot spent a year of his medical internship at the Salpetriere Hospital. The Salpetriere, the name of which derives from its sixteenth-century origin as an arsenal for gunpowder (made from saltpeter), was first used as a women's hospital in the seventeenth century, but "hospital" is not a noun that applies well to its function. It was more of a warehouse for female outcasts: women who were mad, violent, crippled, chronically ill, mentally retarded, unmarried and pregnant, or simply old and poor. In the 1680s, Louis XIV built a prison on the grounds called La Force that added prostitutes and female convicts awaiting execution or transportation to the colonies to this mix of unwanted women. It is here that Manon Lescaut, the great femme fatale of Abbe Prevost's novel and Puccini's opera, was confined before she was deported to America. When the king repealed the Edict of Nantes in 1685, female heretics joined the ranks of women incarcerated at the Salpêtriere.

The grim notoriety of the Salpetriere was further magnified when, during the September Massacres of 1792, a mob attacked the building and women imprisoned there were gruesomely murdered. After the French Revolution, the prison was shut down, the prostitutes and criminals were sent elsewhere, and the Salpetriere became a fortress to house elderly and insane women. Three years after the September Massacres, Philippe Pinel became chief physician, the same position Charcot would later occupy, and applied more moderate revolutionary ideals to the hospital. Pinel freed the female inmates, now "citoyennes," from their chains. While his role as great emancipator has been overstated, he was undeniably important in bringing more humane practices to the hospital. All forms of physical violence, for example, were banned under his watch. The next generation of doctors continued to implement reform at the hospital, but the Salpetriere had yet to shed its reputation as a dismal repository for unwanted and incurable women. The Salpetriere still exists, and in a sad coincidence that seems oddly relevant to the story I am telling here, it is to this Parisian hospital that Princess Diana was taken after her fatal car accident.

When Charcot's internship ended, he famously resolved to return to the Salpetriere and stay. This was an odd ambition for a promising young doctor because the Salpetriere was not considered a prestigious institution. It was an old-fashioned place without laboratories or teaching facilities. Charcot himself called it "that grand asylum of human misery." But where others saw a professional dead end, Charcot saw opportunity. As Freud recalled more than forty years later, Charcot was inspired by "the wilderness of paralyses, spasms and convulsions" he had seen at the Salpetriere. Ten years later, he returned as chief physician of medical services and began the long process of reorganizing the Salpetriere, transforming the outdated hospital for epileptic, insane, and aging women into a modern medical institution, complete with laboratories, teaching facilities, and separate wards. The large population of old and sick women, many of them suffering from disorders of the nervous system and many of them admitted for life, provided Charcot with what he called a vast "reservoir of material." The ambitious doctor maintained that he was "in possession of a kind of museum of living pathology whose holdings were virtually inexhaustible."

Excerpted from Medical Muses: Hysteria in Nineteenth-Century Paris by Asti Hustvedt. Copyright 2011 by Asti Hustvedt. Excerpted by permission of W.W. Norton & Company. All rights reserved. Copyright 2011 National Public Radio. To see more, visit http://www.npr.org/.