This article was downloaded by: [Colorado College]On: 01 December 2014, At: 16:44Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of the History of theNeurosciences: Basic and ClinicalPerspectivesPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/njhn20

Jean‐Martin Charcot and theepilepsy/hysteria relationshipDiana P. Faber aa Psychology Department , University of Liverpool , EleanorRathbone Building, Liverpool, United Kingdom , L69 3BXFax:Published online: 23 Sep 2009.

To cite this article: Diana P. Faber (1997) Jean‐Martin Charcot and the epilepsy/hysteriarelationship, Journal of the History of the Neurosciences: Basic and Clinical Perspectives,6:3, 275-290, DOI: 10.1080/09647049709525714

To link to this article: http://dx.doi.org/10.1080/09647049709525714

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information(the “Content”) contained in the publications on our platform. However, Taylor& Francis, our agents, and our licensors make no representations or warrantieswhatsoever as to the accuracy, completeness, or suitability for any purpose of theContent. Any opinions and views expressed in this publication are the opinions andviews of the authors, and are not the views of or endorsed by Taylor & Francis. Theaccuracy of the Content should not be relied upon and should be independentlyverified with primary sources of information. Taylor and Francis shall not be liablefor any losses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly or indirectly inconnection with, in relation to or arising out of the use of the Content.

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly

forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

Journal of the History of the Neurosciences1997, Vol. 6, No. 3, pp. 275-290

0964-704X/97/0603-275S12.00© Swets & Zeitlinger

Jean-Martin Charcot and the Epilepsy/Hysteria Relationship

Diana P. FaberPsychology Department, University of Liverpool, Liverpool, United Kingdom

ABSTRACT

Research from many perspectives has been made on the work of the French neurologist, J.-M. Charcot(1825-1893) with particular reference to his fame for his studies and "construction" of hysteria. What hasnot been demonstrated so far is the extent to which Charcot's construction can be explained by the per-ceived relationship between hysteria and epilepsy and Charcot's access to epileptic patients at LaSalpêtrière. From the confusion that reigned concerning hysteria and epilepsy, both separately and inrelation to each other, Charcot claimed to have isolated hysteria as a distinctive and universal pathology.This claim was partly based on the "grande attaque", representing the most intense degree of hysteria. Acomparison with Gowers, the contemporary English neurologist suggests that diagnosis was the functionof the practitioners' preferences; and a linguistic analysis pinpoints Charcot's problems in describing anisolated pathology in terms of its relation to its neighbour, epilepsy.

Keywords: Epilepsy, hysteria, "grande attaque", hystero-epilepsy.

INTRODUCTION

Any historical research into the topic of hysteriasoon reveals the almost bewildering abundance)f studies that have been made, so much so thatvlicale (1995) has claimed that the history oflysteria is highly important as a cultural phe-nomenon. In "Approaching Hysteria", hemakes a critical appraisal of what he calls the"new hysteria studies" which he identifies asbeginning in the late 1970s and comprisingforemostly the feminist interpretations of hyste-ia, and also medical, social, cultural and politi-cal approaches. The topic of hysteria thus pres-:nts us with a "daunting historical eclectism:isycho-medico-socio-cultural scholarship" (p.!88). Micale would like to see an interdisciplin-try and cross-cultural approach which wouldinify and synthesise these various approaches,"ailing this, according to Micale's historio-;raphic recommendations, the researcher should:xplain the approach being adopted. He assertshat, as all history writing is perspectival, the

historians should "acknowledge as explicitly aspossible the perspectives they have chosen."(P- 129)

AIMS AND METHODOLOGY

It is generally agreed that it was the French neu-rologist Jean-Martin Charcot (1825-1893) whobrought the phenomenon of hysteria into promi-nence for the medical profession and laity alike.The context of my research is therefore the lastthree decades of nineteenth century France, withparticular reference to the work of Charcot andhis descriptions of hysteria. My thesis is that hisconstruction of hysteria is substantially indebtedto epilepsy in various ways-through his directaccess to epileptic patients; to the mutual influ-ences of epileptic and hysteric patients uponeach other; to Charcot's apparent preference fora diagnosis of hysteria over epilepsy; and to theconfusion in terminology which allowed him todescribe a form of a hystero-epileptic attack as

Address correspondence to: Dr. D.P. Faber, Department of Psychology, University of Liverpool, EleanorRathbone Building, Liverpool L69 3BX, United Kingdom. Fax: 01517942945.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

276 DIANA P. FABER

"hysterie". This does not challenge Jan Gold-stein's thesis (1982, 1987) that Charcot's con-struction of hysteria was in part political, butseeks to complement it.

My research has involved an examination ofcontemporary perceptions and diagnoses of epi-lepsy and hysteria and their relationship, and theclinical and theoretical traditions to which Char-cot was heir. Given these research proceduresand the focus on Charcot's method and an analy-sis of his descriptions, we may claim to beadopting a predominantly internalist approach,but giving consideration to the institutional con-text and to personal motivation.

CHARCOT'S CLAIMS

Micale (1990b, p. 80) has pointed out the ten-dency among researchers of hysteria to focus onthe hysterical attack, thus implying that it wasthe most important or characteristic aspect ofCharcot's work on hysteria, to the neglect of theother aspects (eg. subforms of hysteria in trau-matic neuroses) with which Charcot was con-cerned. The centrality of the attack may bepartly attributable by Charcot himself, for heencouraged and participated in the iconographyof this spectacular disorder as it appeared in theattack. His student and "disciple" Paul Richer

Fig. 1. Jean-Martin Charcot (courtesy of the Wellcome Institute Library, London).

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 277

(1849-1933) produced in 1879 a "Descriptionde la Grande Attaque hysterique" as formulatedby Charcot - the attack which he claimed to rep-resent the most intense degree of hysteria. In1881 this was followed by Richer's com-pendium, "Etudes Cliniques de l'Hystero-Epilepsie" with over one hundred illustrations.Conceptually, the grand attack was important tolharcot for he claimed that, being a demonstra-

tion of true hysteria, it threw light on other andattenuated forms of the attack. But the clinicalstatus of hysteria was generally unclear whenlharcot gave his first lecture on this topic in

1870. At that time, as Micale writes, "epilepsyand hysteria were hopelessly confused and a;ood quarter of the cases in the French medicalliterature during the later nineteenth century car-ried the hybrid label of hystero-epilepsy" (1995,pp. 71-72). Although Charcot used the termhystero-epilepsy as an alternative to hysteria, henevertheless intended it to denote the manifesta-tions of true hysteria. He remarked to Gilles dela Tourette (1893) that the two disorders wereunrelated. This strong claim was supported bythe differential criteria that he established anddescribed in for example, Charcot (1872-1873),Richer (1879,1881) and Charcot and Pierre Ma-rie (1892). Charcot's further claims were thathysteria was not confined to one country, norwas it just a contemporary disorder: he maderetrospective diagnoses whereby demonic pos-session, extreme religious experiences, ecstasy(and hallucinations and phenomena like those ofthe "Convulsionnaires de Saint Medard", forexample, could be explained in terms of hyste-ria. In other words, behaviours given religiousor other explanations in the past could now besubject to what Charcot believed to be scientificscrutiny. His construction of hysteria as a dis-tinct disorder was a product of his pursuit ofscientific endeavour.

JEAN-MARTIN CHARCOT (1825-1893)

During his medical training Charcot worked asan intern at the Paris hospitals of La Salpetriere,La Pitie (1850), and La Charite (1851), and it wasto La Salpetriere that he returned in 1862 when

he was appointed "medecin de l'Hospice de laSalpetriere". Here he initiated "cours libres",semi-public lessons mainly on the disorders ofold age, for he had access to a great many el-derly long term patients. Between 1862 and1870 he laid the foundations for a new medicalspeciality, neurology. In 1872 he was elected tothe Academie de Medecine and in 1883 to theAcademie des Sciences. His appointment in1882 to the Chair of Neuropathology - a chaircreated especially for him - was in recognitionof his work in neurology of which his autopsiesand lessons on localisations of the brain and themedulla were the most esteemed. However,from the mid 1870s onwards some of his interestshifted towards hysteria, and this interest gradu-ally became almost an obsession. It was for hispublic lessons and demonstrations on hypnotisedhysterics that his fame grew among the medicalbody and members of the public, particularlyduring the 1880s. In order to understand thisorientation, his work with hysteric patients, thediagnosis that he created with regard to the hys-teria and the claims he made about its nature, weneed to examine the institutional context inwhich he worked for the greater and last part ofhis career, namely La Salpetriere.

LA SALPETRIERE

According to the historical description ofNadine Simon (1986), L'Hopital General servedas a general asylum which, by the nineteenthcentury, housed the "marginal" or problempopulation which found its way there. Theseconsisted of the poor, the old, vagrants, orphans,foundlings, criminals, alcoholics, "sexual per-verts", syphilitics, epileptics and the insane - inother words those who did not conform to main-stream or "normal" society. La Salpetrierecomplex formed the principal part of this gen-eral asylum, and by 1886 comprised forty-fivemajor buildings. The principal changes whichtook place over this period were the introductionof scientific and teaching facilities, thelaicisation of the staff, and institutional differen-tiation according to diagnoses. As a result of thelatter, by the second half of the nineteenth cen-

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

278 DIANA P. FABER

tury the population of La Salpetriere consistedmainly of the elderly and those deemed insane.They were female patients of long term stay,hence the title, Hospice de la Vieillesse -Femmes. Both Simon (1986) and Pierre Marie(1853-1940) in his "Eloge de Charcot" (1925)described a particular reorganisation that tookplace in the Hopital General in 1867 because ofthe dilapidation of the Sainte-Laure building; asa result, Charcot inherited the section belongingto the psychiatrist LJ.F. Delasiauve whose pa-tients consisted of three ill-defined categories,namely, the insane, hysteric and epileptic. Thelatter then were divided into the sane and theinsane ("epileptiques non-alienees" or "sim-ples") and these, together with the hysterics,were allotted to Charcot to comprise his newsection, known as the "Quartier des Epilep-tiques". The allocation of the epileptics was apt,given Charcot's expertise in neuropathology. Itwas a fairly general practice to include hystericsin with groups of epileptics without making aformal differential diagnosis. The clinical ad-mixture was deemed convenient in practicalterms since hysteria and epilepsy's common de-nominator was the "attack". Temkin (1971)relates how Jean-Etienne Esquirol (1772-1840)and Louis Cameil (1789-1895) studied case his-tories of three hundred and eighty five women ina ward for epileptics and suggested deductingforty six as hysteric, ie. nearly twelve percent,which may have been the proportion of hystericsin Charcot's section of epileptics which he in-herited from Delasiauve. In fact, in his eleventhlesson (1872-1873), Charcot refers to five pa-tients as being nearly the total number of hyster-ics in his section, the "division consacree... auxfemmes atteintes de maladies convulsives,incurables, et reputees exemptes d'alienationmentale." (p. 284)

EPILEPSY AND ITS CLINICAL STATUS

The creation of sections for epileptic patientswithin La Salpetriere and other hospitals andhospices during the mid 1880s shows that epi-lepsy at least, was perceived as being amenableto classification as a disease; in fact it had been

known to the Egyptians and was often dubbed"the falling sickness". While it is commonlyrecognised that hysteria in its symptoms oftenperplexed the physicians, it is not often statedthat in the nineteenth century the diagnosis ofepilepsy was not always clear-cut and that con-troversy existed over the various forms of thisdisorder. To some extent it shared the proteanquality of hysteria. In his entry in the"Dictionnaire des Sciences Medicales" (1815),Esquirol refers to different forms of epilepsy bythe use of the following ill-defined epithets :"epilepsie sympathique; epilepsie essentielle;epilepsie idiopathique; and epilepsie genitale."In 1887 Burlubeaux made a long entry in whichhe referred to "epilepsie vulgaire; sympto-matique; partielle; syphilitique; spinale;toxique", as well as to "pseudo-epilepsie" and"vertige epileptique". In addition he made ref-erence to non-convulsive epilepsy which heclaimed was related to migraine, angina, tics,amnesia, sleeping sickness and somnambulism.In other words, in the nineteenth century epi-lepsy embraced a variety of clinical states. Thestrangeness of this disease and the frighteningaspects of the epileptic convulsion led to variousmyths. Esquirol himself described epilepsy as a"maladie extraordinaire", the results of whichwere always serious for the patient who oftenfell into incurable madness ("demence"), andhe confirmed the link between epilepsy and ma-nia. Alegre (1833), and Dupont (1849), in theirmedical theses expressed similar pessimisticviews, giving a sinister prognosis and confirm-ing the affinity between epilepsy and madness.According to Burlubeaux it was universally ac-cepted that epilepsy was transitory madness("alienation mentale transitoire"). This percep-tion of the link between insanity and epilepsymay partly explain why both sane and insaneepileptics were in the first instance, lodged to-gether. There may have been a further reason:reference to Lanteri-Laura's essay on semeiol-ogy (1980) points to a counter-intuitive phenom-enon, i.e., that the semeiology of hallucinationsand "d61ires" preceded neurology, resulting inthe classification of disorders such as Parkin-son's and epilepsy as "nevroses". This classifi-cation was reflected in the general view that epi-

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 279

lepsy was a moral as well as a physical form ofdegeneracy. Such considerations help to explainthe composition of the original group of patientsbelonging to Delasiauve and to the "epilepticsection" which Charcot inherited from him in1867.

In the second half of the nineteenth century,John Hughlings Jackson (1835-1910) was one ofthe leading specialists in epilepsy, and Charcotknew his work. Articles on this disorder include"on Epilepsy and Epileptiform Convulsions" in"Selected Writings'^ 1958). Jackson claimedthat epilepsy was caused by a "discharging le-sion" in some unstable cells. It was the idio-pathic variety which Jackson termed "epilepsyproper" under his clinical arrangement, and dif-ferentiated this from partial epilepsy whichcould be associated with some type of morbidanatomy such as syphilis or a tumour. Charcotand Jackson knew each other's work, and theredoes not seem to have been any major disagree-ment between them as to the nature of epilepsy.Iharcot pointed out that epileptiform seizures

had been described by Bravais in 1824, and it isprobable that Jackson also knew Bravais' work.In addition Jackson was stimulated by the exper-imental work of Brown-Sequard (1817-1893).Part of Charcot's teaching included lectures onepilepsy while his formal hospital responsibility(as distinct from his out-patients clinic and pri-vate patients) was with the epileptic sectionwhich in 1888 housed some two hundred pa-tients.

As a neurologist Charcot became well knownfor his ability to make fine distinctions in hisclinical observations. For example, in the caseof a patient who underwent spells or episodes ofambulatory automatisms of which he had verylittle recollection, Charcot came to the conclu-sion that the man had experienced unusual epi-leptic seizures: Charcot in other words, pro-posed a form of epilepsy, or epileptic somnam-bulism. He gave two main reasons for his diag-nosis: firstly, that in primary somnambulismepisodes usually took place at night, and sec-ondly, that in the case of this particular patient

bromide lessened the incidence and duration ofthe episodes. In this same Tuesday lesson of the31 st January, 1888 Charcot discussed the symp-toms of petit mal and grand mal in which hepointed out that the results of the former couldbe even more serious than its name implied. Aslate as the 1880's Charcot still had responsibilityfor many epileptic patients at the Salpetriere andremained scientifically interested in epilepsyduring this period of his career, usually identi-fied with his study of hysteria.

One reason epilepsy, and to a lesser extenthysteria, evoked feelings of alarm and fear inCharcot's time was because of its associationwith degeneracy. Dowbiggin (1991) explains theorigins of degeneracy theory in the second halfof the nineteenth century in France, tracing thesein the work of Prosper Lucas (1850), Morel(1857), Moreau de Tours (1859) and the exten-sion of the latter's views in the work of CharlesFere (1884). Moreau de Tours had proposed a"functional lesion" to account for insanity, andhe and his followers claimed that there was acommon source to diseases such as chorea, men-ingitis, typhoid, alcoholism, epilepsy and hyste-ria, and all were transmitted through heredity.According to degeneration theory, the predispo-sition to any one or more of these disorders wasdue to an inherited flaw or "diathesis" - a dif-fused condition or disequilibrium in the nervoussystem. The key neurological disorder wasthought to be epilepsy (Fere, 1884) and its ap-pearance in any family member to be indicativeof a heritable flaw. The topic of heredity and itsimportance was popularized by the influentialpsychologist, Theodule Ribot, in his "HereditePsychologique" (1873). Charcot admiredRibot's work, and he accepted the importance ofheredity, the existence of diatheses and func-tional lesions. According to Micale (1993,p. 505), "His (Charcot's) printed case presenta-tions and unpublished clinical records show thata percentage of his hysterical patients during the1880s came from households with epileptic fam-ily members" — thus supporting, to some extent,a theory of degeneration.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

280 DIANA P. FABER

CONCEPTIONS OF HYSTERIA

In spite of the lack of formal classification ofhysteria, there had long been a recognition of thesymptoms which were both variably and invari-ably associated with hysteria. There were manydifferent cultural and literary expressions of thisso-called disorder, and they were mainly associ-ated with young females, given the etymology ofthe term originating from "hysteria" or womb,whose wanderings were believed to cause thesymptoms. Charcot was familiar with traditionalviews of hysteria, and he probably knew thework of Thomas Sydenham (1624-1689) whohad stressed the clinical fluidity of hysteria andits mimetic capacity. He knew the work of PaulBriquet (1796-1881) whose "Traite clinique ettherapeutique de l'Hysterie" (1859) he oftenpraised. In this work he asserted that hystericsymptoms "obeyed laws that could be deter-mined; that the diagnosis could be made with asmuch precision as other diseases..."1 The coreof Briquet's thinking for Charcot surely lay inthis reference to the possibility of making a pre-cise diagnosis of hysteria by the identification ofits laws, for Charcot's search for laws was inaccord with his belief in a new scientificmethod.

Micklem (1996, p. 3) sums up the paradoxicalnature of the usual perceptions of hysteria thus:"Hysteria is protean: a multi-faced disease pre-senting such a wide variety of appearances thatit has earned the reputation in some circles ofbeing an absurd ailment with a fair proportion ofincomprehensible symptoms"; yet it "projectsan image consistent enough to have gained rec-ognition as hysteria". In other words, hysteriawas often seen and diagnosed - to use a modernterm - as a disease entity. Yet because of its pro-tean and polysymptomatic nature and its per-ceived ability to simulate other disorders it wasproblematic in that it defied classification - the"mocking bird of nosology" as dubbed byJohnson in 1849 (p. 5).

1 Cited in F. Mai, 1983, p. 418.

As late as 1887 in "Lecons sur les Maladiesdu Systeme Nerveux" Charcot asserted that"we see convulsive phenomena reproduce evenan almost perfect imitation the symptoms of par-tial epilepsy ("Nous voyons les accidentsconvulsifsreproduirejusqu'al'imitationparfaitelessymptomesdel'epilepsiepartielle" (p. 286).What is not clear in Charcot's statement and inthose of others who refer to "imitation" is whatis exactly meant by the term "imitate" with re-spect to medical conceptions of physical pro-cesses and diagnosis. Do the symptoms simplylook alike, or do they indicate some substantiverelation between the two disorders? As notedabove, according to degeneracy theory similari-ties between certain disorders could be acceptedand explained by heredity: diseases and patholo-gies could overlap or manifest themselves indifferent ways, even resulting in metamorphosesin the same individual. Thus as Ribot (1873)claimed, convulsions could change into epi-lepsy, epilepsy into hysteria, and vice versa.While Charcot accepted such claims, he wasno doubt discontented with the inadequatenosographical aspects of such views of epilepsyand hysteria, and he preferred to make a differ-ential diagnosis, and to claim for hysteria thestatus of a distinctive pathology. But it shouldnot be forgotten that the initial situation inwhich Charcot worked (from 1867 until the mid1870s) was predominantly with epileptic pa-tients, among whom no formal diagnosis of hys-teria had been made.

THE EPILEPSY-HYSTERIA RELATION-SHIP

In his daily practice Charcot must have becomefamiliar with the attacks and convulsions symp-tomatic of epileptic patients in his charge. He nodoubt knew something of the practical work ofDelasiauve, the psychiatrist who was responsi-ble for the section of epileptics and hystericsboth "alienees" and "non-alienees" before hetook over his sane patients. According toTemkin (1971), Joseph Frank (1771-1842), aswell as Esquirol and Cameil, knew that theirgroups of epileptic patients included a number

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 281

of hysterics. The same situation applied to Char-cot who was well aware, too, of the conceptualconfusions between epilepsy and hysteria: how-ever, he did not see this as a reason for giving upefforts to make distinctions in diagnosis. One ofthe features of his personality was surely persis-tence, a reluctance to accept incoherence, and anintolerance of ambiguity.

The problematic relationship between epi-lepsy and hysteria had already come under dis-cussion before the nineteenth century, for exam-ple by Willis (1621-1675) who had suggestedthat the cause for the similarity between epi-lepsy and hysteria was to be found in the spiritsthat inhabited the brain. Etienne-Jean Georget(1795-1828) claimed that epilepsy and hysteriawere on a continuum (1837). By the 1870s Char-cot's views on the relationship were emerging,and in "Lecons sur les Maladies du SystemeNerveux" (1872-1873) he described how, ac-cording to the "doctrine of the day", hystericattacks ("attaques") and epileptic convulsions("acces") could manifest themselves indepen-dently of each other; and, according to a morecontroversial view in which epilepsy and hyste-ria were deemed to be coequal, the crises couldbe mixed, i.e., "attaques-acces". These repre-sented "hysterie epileptiforme", involving onlyan incomplete form of classic epilepsy or"epilepsie type". This view was confirmed inRicher's report "Description de la GrandeAttaque Hysterique" (1879): this type of attackof hystero-epilepsy "a crises mixtes" repre-sented the highest degree of hysteria - a viewthat Charcot had defended for a long time. I sug-gest that Charcot chose this form of hystero-epi-lepsy because it allowed him to acknowledgeand incorporate epileptic aspects into the crisis,but at the same time relegate them to the appear-ance ("forme") of epilepsy, but not to its sub-stance.

CHARCOT'S APPROACH ANDMETHODOLOGY

Accounts of Charcot's approach and methodscan be found in Janet (1895), Lellouch (1989)and Goetz et al. (1995). We know that on his

appointment as physician and chief of service atLa Salpetriere, Charcot inherited the method forwhich French medicine was famous, and becameknown as the "medecine d'hopital", primarilya method which relied upon observation of pa-tients' symptoms and an accurate description ofthese. An example of this method can be foundin Charcot's statement that the medical problemshould precede the physiological explanation2 -in other words that diagnosis should be pathol-ogy-led. In his teaching Charcot favoured amethod of comparison; for example, a closephysical examination of one patient would befollowed by that of others, and as a result of hispenetrating gaze Charcot would point out simi-larities and differences to be taken into accountwhen making a diagnosis. Such observationsenabled him to find both common denominatorsand distinguishing features in the pathologies.He also found parallels among different fevers.Careful observation also led him to identify dif-ferent varieties of Bright's disease; some of hisfame also rests on his separation of amyotrophiclateral sclerosis (to become known as Charcot'sdisease) from a more general muscular atrophy.These methodological procedures served to sat-isfy his passion for classification, and are evi-dence of what Lellouch described as Charcot'sprodigious capacity for creative nosology. It wasprecisely this capacity and method of analogyand differentiation that were applied to his ob-servations of hysteria and epilepsy, as a descrip-tion of "la grande attaque" shows.

The morphological imperative entailed by theclinical approach also led Charcot to look for -and find - the physical stigmata in hysteric fe-males. They were situated in what he termed thehysterogenic zones, the points in the femalebody which when pressed could set off an hys-teric crisis. Brown-Sequard (1860) had foundepileptogenic zones, and Charcot found a conve-nient parallel to these. He also knew that duringthe epileptic "aura" the application of a ligatureor compression was sometimes found to be ef-fective. In a similar situation i.e., that of the"aura hysterica", Charcot emphasised the role

2 Cited in Janet, 1895, pp. 572-573.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

282 DIANA P. FABER

of ovarian compression in relieving hystericalsymptoms. Lellouch has also pointed out Char-cot's observations of parallels. For example,he differentiated "rhumatisme articulairechronique" from gout, by identifying them asbeing in parallel. It seems to me that the meta-phor of the parallel can be more useful than ananalogy by itself in that the former is doubleedged - it can suggest a similarity but also, byvirtue of its spatial features incorporate the no-tion of differentiation. Did Charcot have in mindthe notion of parallels when he based hisdescription of the "grande attaque" on themodel of epilepsy? The metaphor would havebeen useful to him for it allowed for analogy, asin "epileptoide" (like epilepsy), but could alsoaccommodate a distinction between the two. Theadoption of parallelism was useful in a widerapplication, for in the hands of Moreau de Toursfor example, and others, the functional lesionwas used as a sort of explanation of behaviouralphenomena and symptoms which mirrored anexplanation in terms of an organic lesion. Apartfrom the methodological principles of findingparallels, similarities and distinctions in the pur-suit of classification, Charcot put into practicethe principle of describing what he termed the"type". Charcot's own words explain this:"The method of studying types is fundamentalin nosography...It is indispensable for identify-ing a particular (definitive) pathological speciesout of the chaos of vague ideas...But once thetype has been constituted comes the turn ofthe second nosographic operation: one mustlearn to recognise the type and to analyse it("morceler"). In other words one must learnto recognise the imperfect cases, the rough orpartial and rudimentary forms: then the disor-der created by the method of types appears ina new light."3

The question following this is to ask howCharcot proceeded to construct this type. Heclaimed that the majority of cases were excep-tional, irregular or complicated forms of what-ever disorder he was observing. The type did notpresent the greatest number of symptoms but the

3 Cited in Janet, 1895, p. 573, my translation.

clearest, those most accessible to observationand to our understanding. They also formed anensemble, by virtue of their interdependence.These combinations of symptoms allowed themto be distinguished from neighbouring or similardisorders. One is immediately struck by the arti-ficial nature of the constructed entity: firstly,certain symptoms are put together to form awhole, then by a process of analysis, partial ver-sions of the type can be identified. He claimedthat one should study these "grands types" be-fore approaching the study of their incompleteor attenuated forms. Charcot himself was awareof the inconvenience of this method: he claimedthat it was "trop absolu" - meaning that thetype was, in some sense, an abstraction fromreality, an artificial construct? We might alsowonder whether Charcot was dupe of the "fal-lacy of idealism" as suggested by Micale(1993a). Whatever the merits or faults of thismethod, it was the one that Charcot used to dem-onstrate the grand attack of hystero-epilepsy, theprototype of what he claimed to be "true" hys-teria.

The explanation for the use of types by Char-cot has been attributed both by Lellouch andJanet as partly satisfying teaching requirementsand to achieve the clarity for which he becamefamous among medical students and other audi-ences. More importantly, the creation of typesstemmed from his view of laws and was there-fore a methodological requirement, for by em-bracing the cause of what he saw as a new scien-tific approach, it was incumbent upon him toundertake this method. This entailed the formu-lation of patterns or laws - in other words, to gobeyond the reliance on descriptive morphologyand the data of observations. Janet (1895) re-minded us of the "fatalism" or determinismwithin Charcot's thought: "Nothing is deliveredby chance...on the contrary everything happensaccording to laws, common both inside and out-side the hospital, laws which apply to all coun-tries, for all times and for all races, and conse-quently are universal" (Charcot 1887, p 15).Such a view legitimised his construction of thetype and, in the case of hysteria, conveniently, italso allowed him to incorporate epileptic phe-nomena into this whole or type, as an analysis of

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 283

the language of Charcot's "grande hysterie"will show.

LA GRANDE HYSTERIE

The year 1872 marks the point at which Charcotformulated his first definite diagnosis of hysteriaas an entity distinct from epilepsy, for in thisyear he set out his lessons. The fourth one, forexample is dated the 4th June. Richer's descrip-tions of the "grand attack" as formulated byCharcot can be found in "Le Progres Medical of1879 and in "Etudes Cliniques sur l'Hystero-epilepsie ou Grande Hysterie" (1881). Accord-ing to these descriptions "l'Hystero-Epilepsie acrises mixtes" includes the prodromes, or theprecursory signs as well as the four "periodes"or stages. The prodromes included "secoussesepileptoides" (epileptic-like spasms, a preludeto an epileptoid convulsion) and the "globushystericus" or choking, once known as the"suffocation of the mother'', where mother wassynonymous with womb, and ovarian pain.

The first stage was called the "periodeepileptoide", resembling the epileptic attack.This was divided into three phases - tonic,clonic and its resolution. In the tonic (wild)stage, limb movements were followed by loss ofconsciousness, paleness and distortion of theface, protrusion of the tongue, foaming at themouth, then immobility (tetanism of the wholebody). In the clonic phase, the limbs stiffenedand were subject to localised spasms which laterbecame more general. Then there was calm. Thesecond stage was characterised by violentsweeping movements and contortions of whichthe "arc-en-cercle" was the most well known,and he gave the term "clownisme" to suchmovements. Rage and wild movements weretermed "demonic". In the third stage, the hys-teric adopted emotional poses or "attitudespassionnelles" and was subject to hallucina-tions. Finally consciousness was regained, oftenaccompanied by painful cramp.

What Richer set out was Charcot's construc-tion of the classic case by including the definingbehaviours of hysteria. Where individual attacksfailed to conform entirely to the classic case,

these were described as "frustre" (ie. roughversions) but were not deemed to invalidate theprototype. We may think of this description asthe almost inevitable result of Charcot's "im-pulse to order" which served as a method ofconstructing a diagnostic category, an importantaim in Charcot's seemingly ambitious scheme asa neuropathologist.

DIFFERENTIAL DIAGNOSIS

In the early nineteenth century a clinical distinc-tion between hysteria and other seeminglyneighbouring disorders presented a dauntingtask. However, there was some realisation that adistinction between hysteria and epilepsy wasneeded for theoretical reasons and for the practi-cal purpose of treatment. Temkin (1971) pointsout that by the middle of the nineteenth centurythe use of bromide for the relief and attenuationof epileptic fits was in use. But as early as the1840s, some attempts were being made to estab-lish a distinction between the two disorders. Incommon with other commentators, Quevy(1848) pointed out other disorders to which hys-teria seemed to be related - eclampsy, catalepsy,angina, convulsions in asthma, nymphomaniaand the male equivalent of hysteria, hypochon-dria. He averred that hysteria had its analoguesin self abuse ("manie aigue"), nicotine andother poisonings, hydrophobia, ergotism and theconvulsions witnessed in cases of meningitis.With specific regard to the relationship betweenhysteria and epilepsy, Quevy cites Georget'sproposal that hysteria was but an advanced formof epilepsy, and that the transformation of oneinto the other supported this proposal. Neverthe-less, Quevy set out the table of eighteen differ-ential criteria proposed by H. Landouzy (a doc-tor known to Charcot) in his "Memoire"(sic) of1846, and claims that they constitute "une dis-tinction radicale entre l'hysterie and l'epilep-sie". Some of these criteria were based on theassumption of the genital nature of the origin ofhysteria, and the recommendation for sexualactivity is made in cases of hysteria, while this isfelt more likely to be harmful in cases of epi-lepsy. Three years before Quevy's study,

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

284 DIANA P. FABER

Landouzy had won, jointly with Brachet, theprize awarded for the best explanations of thenature and origins of hysteria - a formal awardgiven by the Academie de Medecine. Charcotmust have been familiar with these proposedcriteria, but did not subscribe to them all: at aprofessional level he discouraged recourse tosexual explanations of hysteria and references tothe womb, replacing this by siting the ovaries asan hysterogenic zone. He would have rejectedsome of the explanatory and descriptive phe-nomena associated with earlier conceptions, andthose which he would have deemed non-scien-tific. Charcot would also have known the differ-ential criteria set out by Delasiauve (1854) andBriquet (1859)4.

In order to establish the distinctive nature ofhysteria Charcot proposed his own differentialcriteria, and these were as follows: Firstly, andthe most important was that ovarian compres-sion could relieve symptoms in cases of hyste-ria, but not of epilepsy. Secondly, that during anattack the temperature of epileptics rose abovethose of hysterics which did not exceed 38 de-grees; thirdly, while potassium bromide workedfor epileptics, it did not for hysterics; more seri-ously, it was claimed that the prognosis for hys-teria was less severe than that for epileptics, andthat epileptics had mental disturbances which insome cases eventually led to insanity. This crite-rion is in line with Quevy. Finally, practitionersviewed recurring epileptic or hysteric attacks as

"un etat epileptique" and "un etat hysterique",that is, pathological states which in the case ofthe former led to death, but not in the latter.Fere, (1892) in his description of epilepsy, threwsome doubt upon the efficacy of ovarian com-pression to relieve or arrest the hysterical attack.However, Charcot thought this method of suffi-cient importance to warrant a move from themanual method of application to the use of tech-nical equipment, designed and used at la Sal-petriere.

Among the lectures on various disorders ofthe nervous system, particularly of the elderly,Charcot gave lectures on cortical epilepsy; andhis fame has come to rest on the disorders suchas rheumoid arthritis, ataxia etc, but not on epi-lepsy. When he was given charge of the epilep-tic section, his preference seems to have been toidentify the hysterics. In Gasser's table of Char-cot's publications on neurological topics thereare one hundred and sixteen on hysteria andeighteen on epilepsy5. This preference is gener-ally seen as a deliberate choice: Charcot seizedupon the opportunity to establish hysteria as adisease entity distinct from other forms of pa-thology. But to my knowledge, the question hasnot been raised as to why Charcot seemed toneglect, relatively speaking, the disorders ofepilepsy, given that he had a ready made epilep-tic population to hand. Goldstein (1982, 1987)has put forward the positive political and expan-sionist motivations for the study of hysteria, but

Fig. 2. Ovarian compressor used during Charcot's tenure as director at the Salpetriere.

4 E. Trillat, 1986, pp. 159-160. 5 reproduced in Goetz et al., 1995, p. 100.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 285

the negative motivation, i.e., his apparent ne-glect of epilepsy does not seem to have beenaddressed. We may speculate upon the reasons;Charcot may not have fully endorsed that aspectof the hereditarian view which put epilepsy inthe forefront of neurological disorders; or whileendorsing it did not wish to explore its implica-tions. Both medical and lay views of epilepsywere made in negative terms, and its outwardsymptoms seen as grotesque and alarming. Thesymptoms or displays of hysteria, while resem-bling those of epilepsy in some respects, alsooffered the spectators (Charcot and his audi-ences) a more fascinating spectacle. These wereto be found particularly in the "attitudespassionnelles", and in the evidence of some log-ical unfolding of symptoms, and some sort ofintentional aspect behind the visual phenomena,or as Gowers described "muscular spasms sogrouped as to resemble that which may be pro-duced by the will"(1881, 1964, p. 1).

CHARCOT AND GOWERS

A comparison between Charcot's and Gowers'approach to diagnosis is instructive to historiansfor it shows that, in the confusion that reigned,there was an alternative approach to diagnosis.In 1870, Gowers was appointed as medical con-sultant at the National Hospital for the Paralyzedand Epileptic in London, housing a patient popu-lation which bore some similarities to Charcot'ssection of epileptics. Out of one thousand caseswhich he studied he found that 815 of these werepurely epileptic and 185 hysteroid (1881,1964)6. He admitted that it was not easy to dis-tinguish these severe hysterical attacks or con-vulsions from simple epilepsy, and further pro-posed that many hysteroid fits were really post-epileptic phenomena. He also proposed that therepetition of the pseudo-epileptic stage of hyste-ria must be regarded as being in part epileptic,though the attacks were in the early instancespurely hysteroid. He also claimed that, in severehysteroid fits, the initial stage "which so closelyresembles an epileptic fit, must be due to a dis-

charge having the same seat as in true epilepsy,although probably differing in its pathologicalcausation." He also suggested that the "spasmof hysteroid type should constitute the convul-sion of a true epileptic fit" (p. 146), thus revers-ing the direction of the type of inference thatCharcot made. In essence Gowers' diagnosticjudgements seem to fall more in favour of, orbiased towards, an explanation in terms of epi-lepsy - in contrast to Charcot's views. Gowersascribed the association of epileptic and hyster-oid convulsions to a special state of the nervoussystem which leads from epilepsy to hysteria,and thus those patients who have hysteroid at-tacks after an epileptic attack are subject to bothdisorders; but the emphasis is on epilepsy wherehysteria is perceived as being essentially post-epileptic ( expressed in the sequelae).

In retrospect, Gower's position seems to havebeen vindicated, for as Micale (1993, pp 506-507) points out, Gowers' interpretation was in-creasingly adopted in Germany, France and else-where. It was also supported by Hughlings Jack-son's "On Epilepsies and on the After-Effectsof Epileptic Discharges" (1876, 1958). Gowersalso allowed that hysteria might be a conjoinedmorbid state, and he suggested that there weresome rare cases in which attacks were interme-diate between the two, as proposed by Trous-seau. On the whole, Gowers opted for the viewof a serial combination of processes underlyinghysteria and epilepsy. The implications for diag-nosis were as follows: "No doubt most of thesecases (convulsions) may be placed, approxi-mately, in one or the other group; but they showthat the two forms are not separated by any fixedand impassable symptomatic boundary" (1964p. 148). This last statement reveals a contrast toCharcot's approach which was less tolerant ofambiguity, more rigid in its commitment to con-struct a category in which epilepsy is annexedby, and subordinated to hysteria in order to fulfilthe requirements of the type , the classical caseof hysteria. Moreover, Charcot seemed to takepersonal pleasure in being able to contest a pre-vious diagnosis and replace it by hysteria7.

6 Gowers preferred to use the term "hysteroid". 7 In Freud, 1962, p. 22.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

286 DIANA P. FABER

LINGUISTIC ANALYSIS

Charcot's awareness of the superiority of hyste-ria over epilepsy in iconographic terms partlyexplains his relative neglect of epilepsy infavour of hysteria; and this was more speciallythe case when he used hypnotism as an experi-mental technique to study hysteria. Freud (1962)described Charcot the "visuel", the man whosees; it is possible that this preference for thevisual elements of hysteria, in demonstrations,drawings and photographs led Charcot to over-look, to some extent, the problems involved inverbal description. The terms "imitate" and"mimicry" describing symptoms associatedwith hysteria are ambiguous in medical descrip-tion. It has already been noted that Charcot usedthe term "imitate" to describe some aspects ofconvulsive phenomena, which seemed to repro-duce symptoms of partial epilepsy - that is,Jacksonian or temporal lobe epilepsy. In thiscase, were the alleged mimetic attributes of hys-teria nothing more than appearances? And werethese symptoms simply the function of the mal-leability of hysteria which Charcot was able todemonstrate through the procedures of hypno-tism? The term "mimicry" generally referred tothe protean nature of the disorder. The problemsof diagnostic description run deep, and we mayalso ask whether the metaphorical language rep-resents simply a way of describing the observedbehaviour or whether, more seriously, it pointsto a single underlying disorder. In terms of de-generacy theory, the terms "imitate", "paral-lel" and "reproduce" have more value thansimple verbal devices: they are testimony to theunderlying relationship and similarity betweendisorders, and in particular the neurologicalones. In spite of this relationship, Charcot wasdetermined to make hysteria an entity in itselfby presenting a clear descriptive account of itssymptoms. However, the construction of a new"disease entity" still entailed the use of existingterminology, and I suggest that he could not ex-clude the use of the terms of epilepsy for variousreasons.

As we have seen, Richer entitled the descrip-tion of the hysterical attack "Hystero-epilepsieou La Grande Hysterie". These titles are thus

set out as alternatives, but they do not appearsynonymous. The first suggests a composite ormixed disorder, and the second the grand or full-blown version. Charcot was not happy with suchterminology and came to prefer the second title,which is not surprising, for the title "hystero-epilepsie" suggests that epilepsy (the noun) isthe substance, while, in fact, Charcot intendedthe inverse, in order to present an unambiguousaccount of hysteria; but he continued to use theterms available. The first stage of the grand at-tack was preceded by prodromes and was identi-fied by an "acces epileptoide". Charcot alsoidentified the first stage itself as a "periodeepileptoide" by describing the tonic symptoms,the spasms and the protrusion of the tongue etc.He described the manifestations of tetanus (ortonic immobility) as falling within the "periodeepileptique". It is not clear whether Charcot wasusing the two terms epileptic and epileptoid todenote different meanings to show that tonicimmobility was epileptic-like while tetanism(still defined as tonic immobility) was epilepticproper, including as it did the sweeping move-ments of the limbs. It might be supposed thatCharcot was using the terms interchangeably,although one denotes a likeness only. As well asepileptoid, the term epileptiform was also usedby Charcot and others. With reference to lin-guistic analysis which identifies "meaning vari-ance", "epileptoid" represents an extension ofthe meaning of epileptic to embrace a wider cat-egory of behaviour or interpretation of it. In thiscase, the use of the term "epileptoid" serves toblend interpretations of symptoms so that theyfall within this new category of hysteria. Butgiven Charcot's preference for the single term"hysterie" (to denote an entity), we may won-der why he used references to epilepsy.

Charcot provided an answer to this query, forhe told Gilles de la Tourette that it was a "lastrespect" to a nomenclature used at the Salpe-triere hospital. Charcot could not ignore tradi-tional views and representations and, asLellouch points out, there was a tension in Char-cot's approach between the traditional and thescientific, as in the introduction of technical in-novations. Such a tension appears here, for inpractical terms, the language of epilepsy was the

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 287

most convenient for describing at least some ofthe manifestations of hysteria. Apart from con-venience, Charcot also seems to have objectedto terminology used outside France where "epi-leptoid behaviour is still called epilepsy. I dis-agree with such terminology and distinctly callthis hystero-epilepsy or hysteria major."8 In themeantime this may partly explain his use of"hystero-epilepsie" - better this than admit to adiagnosis of epilepsy!

DEBT TO EPILEPSY

The debt to epilepsy can be defined and identi-fied in its various aspects: in the verbal descrip-tions we have seen how Charcot phased out theterm epilepsy; conceptually, epilepsy served asa model for hysteria, for we might assume thatCharcot took the notion of stages from the wayin which epileptic seizure was seen anddescribed in its unfolding, from its onset to itsresolution; Charcot's model is based on theidentification of parallels between the two disor-ders in which spatial relations are equated withthe semantics of medical description, suggestingthe relationship between epilepsy and hysteria.Probably following the examples of Brown-Sequard's proposals of the "aura epileptica",epileptogenic zones and the use of ligatures toarrest epilepsy at its first stage (1860), Charcotestablished the equivalents in the hysterical at-tack, and in hysterical patients compression wasapplied on the area of the ovaries. In addition,just as a "status epilepticus" could develop as aconsequence of many attacks over time, so wasa "status hystericus" also identified on thesame grounds. We may also note that the tonicand clonic phenomena in the epileptic seizurewere given their analogies (epileptoid) or paral-lels in hysteria, and then came to be incorpo-rated into this grand attack and claimed to be"vraie hysterie" (true hysteria), to be distin-guished from "hysterie vulgaire" (ordinary hys-teria). These "parallels", then, were the logicalforms of the analogies which Charcot identified.

Furthermore, at a clinical level, Marey's myo-graphic recordings revealed that the three classicstages of epilepsy underlay the attack ofhystero-epilepsy with mixed crises ("crisescombinees).9

At the practical level we can see the debtCharcot owed to the physical presence of theepileptic patients. The differing and similar as-pects of the behaviours of this mixed sectionencouraged, no doubt, mutual influences sincethe epileptics and the hysterics were together inthe same wards, refectories and grounds of LaSalpetriere. The nature and dominant directionof the influences cannot be known for certain,but according to Massey and McHenry (1986, p.65), many of the hysterical women became at-tached to Charcot and, through constant associa-tion with the epileptics, began to mimic convul-sions of major epilepsy. Moreover, if one of theintrinsic features of the hysterical disorder werethe capacity to imitate, then an epileptic-likeperiod within the hysteric attack could be ac-counted for by this capacity and thus support theclaim that this stage was in fact intrinsicallyhysterical. On the other hand, if the epilepticpatients had an "hysteric personality" or wereexcessively emotional or excitable, they mighthave imitated, either consciously or uncon-sciously, some of the symptoms of the grandattack. Such a supposition is supported by Char-cot's comment on the case history of a youngfemale epileptic patient (unnamed). He averredthat the progress of this patient "would certainlyhave been much faster in the ward which sheoccupies, if she had not been in constant inter-course with subjects of hysteria major in whomshe saw the attacks daily" (1882-1885, p 215).Did Charcot imply that epileptic patients wereexaggerating their symptoms and incorporatinghysteric elements into their attacks? If that werethe case, then the number of epileptics withinthe section could have been underestimated, andsome of the so-called hysterics belonged moreproperly to the epileptic category. It is alsoprobable that epileptics took on some of thesymptoms of hysteria in the light of Gowers'

8 In Gilles de la Tourette, 1893, p. 245. 9 E. Trillat, 1986.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

288 DIANA P. FABER

observation of the semi-intentional aspect ofsome of the "attitudes passionnelles". Finally,the case of Blanche Wittmann throws light onthe possible diagnostic fate of some of the epi-leptic patients. According to Signoret (1983) shewas originally diagnosed as "epileptique sim-ple" in 1877, but she became the clinical proto-type for "grande hysterie".

In retrospect we can safely propose extensiveinteractions a century ago between these twotypes of patients with regard to mimicry. But inthis context there are numerous dimensions toimitation: Who imitated whom? Was the imita-tion reciprocal? Does imitation produce some-thing analogous to the original, or is the newbehavioral phenomenon similar in appearanceonly? In either or both cases, are the similarphenomena produced by virtue of a shared pa-thology? And what is the role of consciousnessin the mimetic acts? Was the propensity to imi-tate so inherent in the hysteric that it operated atan unconscious level? If imitation were con-scious or deliberate, as Axel Munthe suggested(1939), or as Charcot himself admitted,10 thenthe similarity between the symptoms might wellhave deceived the practitioner. Viewed in thislight, the question of the proximity of the epilep-tics and their interaction and relationship withthe hysterics bears directly on the process ofdiagnosis.

Charcot explained an intuition that enabledhim to distinguish hysteria: "For many years Iwalked through my wards like a blind man,never seeing hysteria, not because it was notthere, after all it is common, but because I didnot know how to look at things."11 But seeingand observing are not objective activities; theyare subjective and selective. Perhaps Charcotwas helped in distinguishing hysteric patients bythe ribbons and flowers they attached to theirmedical charts, in their self-advertisements andwish to be seen as hysterics - a more colourfuland attention-attracting disorder than epilepsy.These actions on the part of the hysterics weredescribed by Bourneville and Regnard at the

10 In S. Gilman, 1993, p. 370.

11 Cited in C Goetz, 1987, p. 43.

time (1877). Another way of viewing Charcot'sconstruction of hysteria is to attribute it to scien-tific failure: as Thornton (1976) suggests, "Fail-ure to recognize the convulsion of temporal lobeepilepsy over four thousand years led, amongother false trails, to the strange concept of 'hys-teria', allegedly a mental condition causing thepatient to imitate convulsions and other neuro-logical signs and symptoms" (p. 115).

CONCLUSION

Jan Goldstein's has influentially proposed thethesis that Charcot's interest in hysteria in thelate nineteenth century was a political and ex-pansionist move to incorporate the "intermedi-ary zone" of the neuroses into French psychia-try. She supports her claim with references tothe political persona of Charcot and to hisfriendships with political figures like Gambetta.Her interpretation of Charcot's successful ambi-tion may be misleading, however, for she writesas if Charcot were a psychiatrist, which he wasnot. He was, foremostly a neurologist whospecialised in the pathologies of the nervoussystem. Moreover, Charcot's assertion that neu-ropathology and psychiatry were unified and"should, philosophically speaking remain asso-ciated with each other by insoluble ties" (1880,p. 2) does not necessarily denote an incursioninto the study of the neuroses, but rather a pleafor the rapprochement of neurology and psychi-atry, based on a conceptualization of the rela-tionship between the two specializations. In thenineteenth century, the relationship between thetwo domains of practice was evolving and vari-able12 and in Germany, for example, the twospecializations were not distinct. Moreover, inFrance the unity of psychiatry and neuropathol-ogy was confirmed by Fere (1884) as a nosolog-ical question in that he stated that the "family"of inheritable neuroses included neuropathologi-cal phenomena such as goitre, chorea, Parkin-son's disease, migraine and asthma. YetGoldstein's emphasis on the political construc-

12 In C. Goetz et al., 1995, pp. 208-213.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

JEAN-MARTIN CHARCOT AND THE EPILEPSY/HYSTERIA RELATIONSHIP 289

tion of hysteria need not preclude an accountwhich looks at the physical conditions of pa-tients, the state of medical knowledge and diag-nostic theory and practice. A political interpreta-tion on its own is in danger of overlooking themeans by which an object is achieved. The ac-count above should be seen as a necessary com-plement to the political thesis.

My analysis of Charcot's diagnosis of hyste-ria is part of a wider, ongoing story in the do-main of medical and psychiatric practice of di-agnosis. When there are multiple symptoms, thetask of the medical practitioner or psychiatrist isto identify patterns or regularities in their occur-rence so as to present a valid description thatwould lead to the naming of a syndrome or dis-use entity. Mary Boyle (1990) has emphasised

the problems involved in this process. Part ofthe difficulty lies in the determination of ashared cause and deciding which symptom orlymptoms play a pivotal role in the constructionof a syndrome or entity. In the case of hysteriaand epilepsy, the attack, the common denomina-tor of both, contributed to the confusion. Someof the pressure to give a name or a label to;ymptoms originates from the patient. In Char-cot's case, the motive seems to have originatedfrom Charcot himself, in the interests of nosol-ogy, but the kind of celebratory status affordedto some of the hysterics at la Salpêtrière nodoubt made them pleased to have such a label.

Today, a sceptical view and critical eye areoften cast on the processes of naming syndromesand diseases. I have attempted to demonstratethat examples from the history of medicine andpsychiatry may throw light on this issue. Per-haps the foregoing account of Charcot's con-struction of "grande hystérie" will contribute,in a small way, to our understanding of this as-pect of modern medical science and practice.

REFERENCES

Alègre M (1833): Dissertation sur l'Epilepsie etl'Hystérie. Faculté de Médecine, Paris.

Badouin A (1925): Quelques Souvenirs de laSalpêtrière. Paris Médical, 16, pp 517-520.

Boyle M (1990): The Non-Discovery of Schizophre-nia. In R Bentall ed Reconstructing Schizophrenia.London and New York, Routledge.

Bourneville DM, Régnard P (1877-1879) 3 vols:Iconographie Photographique de la Salpêtrière.Paris, Delahaye.

Briquet P (1859): Traité clinique et thérapeutique del'Hystérie. Paris, Baillière.

Brown-Séquard C E (1860): Epilepsy. In Physiologyand Pathology of the Central Nervous System.Philadelphia, Collins.

Burlubeaux (1887): Epilépsie. In DictionnaireEncyclopédique des Sciences Médicales. Paris,Asselin et Houzeau.

Charcot J-M ( 1872-1873): Leçons sur les Maladies duSystème Nerveux faites à la Salpêtrière. Vol 1.Paris, Delahaye.

Charcot J-M (1877): Leçons sur les Maladies duSystème Nerveux. Vol 2. Paris, Delahaye.

Charcot J-M (1880): Introduction. Archives deNeurologie (Juillet, 1880) I, 1-4.

Charcot J-M (1887): Leçons sur les Maladies duSystème Nerveux. Vol 3. Paris, Delahaye.

Charcot J-M, Marie P (1892): Hysteria mainly Hys-tero-Epilepsy. In D Hack Tuke ed. A Dictionary ofPsychological Medicine. London, Churchill.

Charcot J-M, Richer P ( 1887): Les Démoniaques dansl'Art. Paris, Delahaye et Lecroisnie.

Delasiauve L (1854): Traité de l'Epilepsie. Paris,Masson.

Didi-Huberman G (1982): L'Invention de l'Hystérie:Charcot et l'Iconographie photographique de laSalpêtrière. Paris, Macula.

Dowbiggin I (1984): Degeneration and Hereditarian-ism in French Mental Medicine, 1840-1890. In WFBynum et al. eds: The Anatomy of Madness, vol.1.Tavistock Publications.

Dowbiggin I (1991): Inheriting Madness, Professio-nalization and Psychiatric Knowledge in Nine-teenth Century France. Berkeley and Los Angeles,University of California Press.

Dupont E (1849): Considérations sur l'Hystérie etl'Epilepsie (thèse pour doctorat en médecine).Faculté de Médecine, Paris.

Esquirol J E D (1815): Epilépsie. In Dictionnaire desSciences Médicales. Paris, Panckoucke.

Evans M N (1991): Fits and Starts: a Genealogy ofHysteria in Modern France. Ithaca and London,Cornell University Press.

Féré Ch (1884): La Famille Névropathique. Archivesde Neurologie, VII, (19), 1-143.

Féré Ch (1892): Epilepsie. In MH Léauté, Encyclo-pédie des Aide-Mémoire. Paris, Gauthier et fils etMasson.

Freud S (1962): Charcot (1893). Standard Edition ofthe complete psychological works, vol. 3. London,The Hogarth Press.

Georget E (1837): Hystérie. In Dictionnaire deMédecine, 2nd ed. Vol 16, 160-186.

Gilles de la Tourette G (1893): Jean-Martin Charcot.Nouvelle Iconographie de la Salpêtrière, 6, 241-250.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14

290 DIANA P. FABER

Gilman S (1993): The Image of the Hysteric. In SGilman et al: Hysteria beyond Freud. Los Angeles,University of California Press.

Goetz CG (1987): Charcotthe Clinician: The TuesdayLessons. New York, Raven Press.

Goetz CG, Bonduelle M and Gelfand T (1995): Char-cot: Constructing Neurology. Oxford UniversityPress.

Goldstein J (1982): The Hysteria Diagnosis and thePolitics of anti-clericism in late 19th CenturyFrance. Modern History, 104 (2), 209-239.

Goldstein J (1987): Console and Classify: The FrenchPsychiatric Profession in Nineteenth CenturyFrance. Cambridge, Cambridge University Press.

Gowers WR (1881, 1964): Epilepsy. New York, Do-ver Publications Inc.

Gowers W R (1886-88): A Manual of Diseases of theNervous System. London, Churchill.

Guillain G (1959) J-M Charcot: His Life - His Work,translated by P Bailey. New York, Hoeber.

Jackson J H (1876): On Epilepsies and on the After-effects of Epileptic Discharges. Reprinted in Se-lected Writings of John Hughlings Jackson, 1958,vol. 1, London, Staples Press.

Janet Pierre (1894): J-M Charcot: son Oeuvrepsychologique. Revue Philosophique 39, 569-604.

Johnson W (1849): An essay on Diseases of YoungWomen. London, Simkin Marshall.

Landouzy H (1846): Traité Complet de l'Hystérie.Paris, Baillière.

Lanteri-Laura G (1980): L'Hystérie, matrice de laSémiologie neurologique, médicale et philo-sophique à la fin du dix-neuvième siècle. Cahier del'Institut de Recherche Universitaire d'histoire dela connaissance des idées et des mentalités.

Lellouch A (1989): La Méthode de J-M Charcot(1825-1893). Hist Philos of Life Sci, 11, 43-69.

Lucas P (1847-1850): Traité Philosophique et Physio-logique de l'Hérédité Naturelle. Paris, Baillière.

Mai FM (1983): Pierre Briquet: 19th Century Savantwith 20th Century Ideas. Can J Psychiatry, 28.

Marie P (1925): Eloge de J-M Charcot. Bull AcadMédecine, 93, 576-593.

Massey EW and McHenry, Jr (1986): Hysteroepilepsyin the Nineteenth Century: Charcot and Gowers.Neurology, 36, 65-67.

Micale MS (1990a): J-M Charcot and the Idea of Hys-teria in the Male. Med History 34, 4, 5-52.

Micale MS (1990b): Hysteria and its Historiography:the Future Perspective. History of Psychiatry, pp.33-124.

Micale MS (1993a): Beyond the Unconscious: Essaysof H F Ellenberger in the History of Psychiatry.Princetown University Press.

Micale MS (1993b): On the "Disappearance" of Hys-teria, A Study in the Clinical Deconstruction of aDiagnosis. Isis, 84, 496-526.

Micale MS (1995): Approaching Hysteria: Diseaseand its Interpretations. Princetown UniversityPress.

Micklem N (1996): The Nature of Hysteria.Routledge.

Moreau de Tours J J (1843): Psychologie Morbide.Paris, Masson.

Morel B A (1857): Traité des Dégénérescences phy-siques, intellectuelles et morales de l'EspèceHumaine. Paris, Baillière.

Munthe A (1939): The Story of San Michele. London,John Murray.

Quévy N-Abdon (1848): De l'Epilepsie sous le rap-port de son Diagnostic différentiel (Thèse pour ledoctorat en médecine). Faculté de Médecine, Paris.

Ribot Th (1873): L'Hérédité Psychologique. Paris,Masson.

Richer P (1879): Description de la Grande Attaquehystérique. Le Progrès Médical, 2, 11 Janvier,1879.

Richer P (1881): Etudes Cliniques sur L'Hystéro-Epilepsie ou la Grande Attaque. Paris, Lelahaye etLecroisnie.

Signoret JL (1983): Variété Historique: Une Leçonclinique B La Salpêtrière, 1887 par AndréBrouillet. Revue Neurologique, 139, (12) 687-701.

Simon N (1986): La Pitié-Salpêtrière, Arbre à Images(Hopitaux de France, Histoire et Architecture).

Temkin O (1971): The Falling Sickness: a History ofEpilepsy from the Greeks to the Beginnings ofModern Neurology. 2nd rev ed. Baltimore/London,John Hopkins University Press.

Thornton E (1976): Hypnotism, Hysteria and Epi-lepsy: an historical synthesis. London, Heineman.

Trillat E (1986): L'Histoire de l'Hystérie. Paris,Seghers.

Dow

nloa

ded

by [

Col

orad

o C

olle

ge]

at 1

6:44

01

Dec

embe

r 20

14