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Original Neurosciences and History 2016; 4(1): 21-33

Swann’s way: Proust as a neurobiologist and neurologistL. C. ÁlvaroDepartment of Neurology, Hospital Universitario Basurto, Bilbao; Department of Neurosciences, Faculty of Medicine, UPV/EHU, Spain.

ABSTRACT

Introduction and objectives. Marcel Proust is one of the great authors of both 20th century and universalliterature. He was no stranger to the scientific breakthroughs of his time (theory of relativity, quantum fieldtheory), or to currents in philosophy (Bergson), psychology (William James), and medicine (Freud). We cantherefore expect to find the influence of these disciplines in his works. To this end, we read Swann’s way andextracted and analysed any excerpts related to neurobiology or clinical neurology.Results. Time and memory are the central themes in this book. The latter functions by means of automatic orinvoluntary processes. In the creation of memories, sensory elements linked to an emotional factor play a crucialrole. The mechanism used by the memory consists of the mental images or representations that constituteconsciousness. A deposit or unit of memories is also present. This forms mental reality, which is created insideand projected outwardly, on external objects, echoing what has been learned. A later re-encounter will seemunsatisfactory based on the partial, subjective memories which it evokes.As for clinical references, the book describes migraines, a variety of conversion disorders, personality disorders,and mental illnesses. The plot also calls for the presence of society doctors, rural doctors, alienists, and surgeons.Conclusion. We identified the influence of Einstein and Bergson, but not Freud, whose concepts were farremoved from Proust’s. These ‘Proustian’ mechanisms have been found to be present in modern disciplinesincluding the extended mind, emotional intelligence, and Damasio’s somatic marker hypothesis. They are alsoactive in the consolidation of memory through synaptic reinforcement and LTP mediation. A final reading froman ethical perspective proposes that individuals survive through art, whether perceived or created.

KEYWORDS Marcel Proust, medicine, neurology, neurobiology, memory, emotions

story grows in concentric circles, with new material thatexpands the scope of the novel in an elaborate styleexercise both cumulative and complex; it recalls Monet’sbold brushstrokes, or the sum of new notes that growfrom an opening theme or leitmotif in Ravel’scompositions. The above traits define currents inimpressionism, and our author is a distinguishedrepresentative of that movement.

Proust’s convoluted prose, with its long uninterruptedsentences, leaves few pauses for its readers2 and providesa clear view of the author and his purpose: to chronicle

Corresponding author: Dr. Luis Carlos Álvaro GonzálezE-mail: luiscarlosalvaro@yahoo.es

Received: 27 January 2016 / Accepted: 11 March 2016© 2016 Sociedad Española de Neurología

Impressionism and science

Marcel Proust (1871-1922) is regarded as a pivotal authorin both 20th century and universal literature (Figure 1).His unfinished novel In search of lost time (orRemembrance of things past) possesses the dimensionsand solidity of one of those great Gothic cathedrals —alsounfinished— that the author so admired.1 The novel ispresented in seven volumes; the first was published in1913, while the last appeared posthumously in 1927,edited by the author’s brother Robert. They function as afresco or mosaic depicting his time. Like a mosaic, the

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his time. André Gide —who slighted Proust by rejectinghis novel while at Gallimard, only to recognise its valueat a later date— said that by reading it aloud, one couldhear the precisely chosen resonant sounds in the text; nodetail was superfluous.1 But Proust’s style is not all-encompassing merely for aesthetic reasons; in fact, itreflects the diverse, rich currents of knowledge flowingin the early years of the 20th century, in psychology,philosophy, science, and medicine. These years saw theemergence of the works of William James, Henri Bergson(Proust’s cousin by marriage), Albert Einstein, andSigmund Freud.3 Given this historical context, it is fittingthat we should find echoes of their fields of study inProust’s novel.

Ever since childhood, he had been frail, sickly, andsensitive, with a tremendous affinity for the arts. Whilehe eagerly received lessons from his mother, who camefrom a wealthy family and had enjoyed an excellenteducation in the humanities, Proust did not shareinterests with his father, a prestigious and influentialdoctor and epidemiologist. Proust’s younger brotherRobert became a surgeon, thereby fulfilling their father’swish to pass on his medical knowledge. Nevertheless,medicine is present throughout Proust’s novel. It makes

Figure 1. Images of Marcel Proust as a child and as an adult. To the right, his mother Jeanne Weil, who greatly influenced his career. Proust would remainvery close to her.

its presence known when doctors are included ascharacters, and in the descriptions of mood, personalitydisorders, and authentic clinical entities.

In light of the above, reading Proust constitutes a medico-literary and even a neuro-literary journey. In this text, weanalyse the first of the seven volumes constituting hismagnum opus: Du côté de chez Swann4 (Swann’s way;Figure 2). First, we identify excerpts touching onneurobiological or neuroscientific topics in the originalnovel in French, from among which we select those ofdirect medical or clinical interest. The former will reflectthe influence of the discoveries of his time, whereas thelatter will be proof of Proust’s powers of observation andhis skill at including medical and clinical information inhis character profiles. These data, analysed within theirhistorical context, will provide the means for aninterpretation of this novel in which the author shines asa neurobiologist ahead of his time and a skilful clinicalobserver.

In addition to the excerpts from the original, we haveprovided the corresponding text from the English versiontranslated by C.K. Scott Moncrieff and published by theUniversity of Adelaide.

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(time regained). What instants are retrieved, how they areevoked —what mechanisms bring them to mind— andlastly, how they influence or reshape our present, arecrucial questions that revolve not only around memory(converted to time), but also emotions and consciousness.This is the terrain which the novel explores.

Time, or more accurately the passing of time, is a difficultconcept to define. Saint Augustine illustrated its immensecomplexity in his answer to “What then is time?” inchapter XI of his Confessions: “If no one asks me, I knowwhat it is; if I wish to explain it to him who asks, I do notknow”.6 In Proust’s eyes, the past and the future are merelyrecollections and expectations created by the mind. Thisplaces us in what is called cognitive time, which markshow our minds function over the course of a lifetime, andas we think.7,8 This is a subjective and specifically humantype of time, and it can be manipulated. In contrast to thistype is biological time, which results from the activity ofbiological clocks and is linked to homeostatic functions.It therefore differs from cognitive time in that it is not aproduct of consciousness, but exists universally in livingthings and is difficult to manipulate. Another variety oftime is cultural in nature; it is an anthropogenic construct

Time and memory

The central theme of this novel is time, as its new titleinforms us: In search of lost time. This ‘lost time’ is thepast, evoked with profound yearning and emotion by afirst-person narrator of whom very little is known, exceptthat he is male, as French grammatical conventionsinform us in the very first sentence (Je me suis couché debonne heure). Enmeshed in the society and culture ofProust’s time, and populated by a rich panoply ofcharacters almost all of whom bear some resemblance tothe author’s real acquaintances, the novel concludes itslong journey in the last volume, Time regained. ‘Time lost’and ‘time regained’ are metaphors for memory, which isshaped and structured in time. There can be no timewithout memory, nor memory without time. The twoconcepts intertwine and shape one another until eacharises as a separate entity. And since they are in factseparate, as they mingle each leaves a few of its threadsbehind in the other. As such, intermingled, memorybecomes past time retrieved; time becomes sculptedmemory. This mixture and interplay means that both areimperfect, momentary reflections or flashes of pastinstants (time lost) that are transmitted to the present

Figure 2. The cover of a modern edition of Swann's way in the original French and in Spanish. The book was rejected by André Gide (right), then thedirector of the recently founded publishing company Gallimard. He acknowledged his mistake some years later. Proust himself financed the publication ofthe first volume of In search of lost time.

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cherished flowers from time past:

Car souvent j’ai voulu revoir une personne sans dis-cerner que c’était simplement parce qu’elle me rap-pelait une haie d’aubépines, et j’ai été induit à croire,à faire croire à un regain d’affection, par un simpledésir de voyage.4(p231)

(For often I have wished to see a person againwithout realising that it was simply because that per-son recalled to me a hedge of hawthorns in blossom;and I have been led to believe, and to make someone else believe in an aftermath of affection, by whatwas no more than an inclination to travel.)

Space, like time, is reconstructed in the memory with allof its content, objects and people, with the precision of“un architecte et un tapissier qui gardent leur ouvetureprimitive”4(p232) (“as an architect and an upholsterer mightdo, working upon an original, discarded plan of the doorsand windows”). According to this view, space and timeform a single reality that merges into memory.

On arriving at this point in the description of memoryand time, Proust introduces a distinction that is key tounderstanding his construct: the difference betweenvoluntary and involuntary memory. However, voluntarymemory invoked at will, which he also calls ‘intelligentmemory’, is insufficient for the purpose of recovering thepast. If this were the only type available, the Combray ofhis childhood would only exist as a lifeless memory:

Mais comme ce que je m’en serais rappelé m’eût étéfourni seulement par la mémoire volontaire, lamémoire de l’intelligence, et comme les renseigne-ments qu’elle donne sur le passé ne conservent riende lui, je n’aurais jamais eu envie de songer à ce restede Combray. Tout cela était en réalité mort pourmoi.4(p87-88)

(But since the facts which I should then have reca-lled would have been prompted only by an exerciseof the will, by my intellectual memory, and since thepictures which that kind of memory shews us of thepast preserve nothing of the past itself, I shouldnever have had any wish to ponder over this residueof Combray. To me it was in reality all dead.)

The process that allows the past to persist and remainas a personal creation is involuntary memory. Inbuilding this entirely Proustian concept, with itsFreudian resonances although it clearly differs from thatneuropsychiatrist’s ideas, the author draws from Celticmythology. Within that system, the souls of the departeddo not vanish; rather, they become locked in anotherbeing or an inanimate object. While they remainhidden, only closeness to that object or prison can freethem from death and let them live among us once more.

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which, when combined with such instruments ascalendars and watches, allows us to measure and specifydurations and temporal locations of human activity.Lastly, we find quantum and relativistic time. Accordingto these theories in physics, time is just anotherdimension of space. It extends across the universe to formthe fourth dimension, meaning that we are located withintime (space-time). Quantum and relativistic time permitsa two-way flow, both forward and backward, and allevents are situated (or rather, pre-situated) along thispath.9,10

The quantum concept of time and memory is apparentin Proust when he evokes the past as if it were a museum,with memories like a series of paintings togetherdisplaying a family resemblance:

... comme s’il en était de notre vie ainsi que d’unmusée où tous le portraits d’un même temps ont unair de famille, une même tonalité…4(p63)

(...as though one’s life were a series of galleries inwhich all the portraits of any one period had a mar-ked family likeness, the same [so to speak] tona-lity...)

This concept is expressed even more clearly in the passageon the medieval cathedral at Combray (really Illiers). Wefind here a specific description of the fourth dimension,corresponding to the time through which the cathedralhas travelled, in a triumphant procession throughdifferent epochs in addition to the three dimensions ofspace contained below its nave:

… un édifice occupant, si l’on peut dire, un espace àquatre dimensions — la quatrième étant celle duTemps — déployant à travers les siècles son vaisseauqui, de travée en travée, de chapelle en chapelle,semblait vaincre et franchir, non pas seulementquelques mètres, mais des époques successives d’oùil sortait victorieux…4(p105)

(...a building which occupied, so to speak, fourdimensions of space — the name of the fourth beingTime — which had sailed the centuries with that oldnave, where bay after bay, chapel after chapel, see-med to stretch across and hold down and conquernot merely a few yards of soil, but each successiveepoch from which the whole building had emergedtriumphant...)

According to Proust, “la réalité ne se forme que dans lamémoire”4(p230) (“reality will take shape in the memoryalone”). The only things that he takes seriously and givehim joy are those he used to think of while he wasroaming the Méséglise and Guermantes ways, and thepeople he met there.4(p230) If he felt affection for someone,it was simply because that person reminded him of

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Proust applies the same reasoning to our past:

Il en est ainsi de notre passé. C’est peine perdue quenous cherchions à l’évoquer, tous les efforts de notreintelligence sont inutiles. Il est caché hors de sondomaine et de sa portée, en quelque objet matériel(en la sensation qui nous donnerait cet objet maté-riel), que nous ne soupçonnons pas. Cet objet, ildépend du hasard que nous le rencontrions avant demourir, ou que nous ne le rencontrions pas.4(p88)

(And so it is with our own past. It is a labour in vainto attempt to recapture it: all the efforts of our inte-llect must prove futile. The past is hidden some-where outside the realm, beyond the reach ofintellect, in some material object [in the sensationwhich that material object will give us] which we donot suspect. And as for that object, it depends onchance whether we come upon it or not before weourselves must die.)

Through this way of thinking, the author discovers thatthe common objects linked to his past are the very onesthat veil it. Or to be more precise, it is not so much theobject as the sensation associated with it. Take Proust’sfamous episode with the madeleine, that cake dissolvingin tea on his palate that made him tremble with emotionas it evoked his past. He then felt a delicious thrillovertake him, leaving him indifferent to the everydayevents in his life and reminding him of the manifestationof love. Thus he discovers that “cette essence n’était pas enmoi, elle était moi”,4(p89) a delightful essence that was notwithin him, but was rather he himself, or a part of him.As such, the truth of this essence and the past that he

sought was not in the potion, but within himself. Burieddeep, hidden, and evoked only by this unheralded, casualcontact. Furthermore, this process of evoking memory isactive and creative; only the sensory stimulus can sparkthe workings of the mind, which is what finallyilluminates the past:

Chercher? pas seulement: créer. Il est en face dequelque chose qui n’est pas encore et que seul il peutréaliser, puis faire entrer dans sa lumière.4(p89)

(Seek? More than that: create. It is face to face withsomething which does not so far exist, to which italone can give reality and substance, which it alonecan bring into the light of day.)

The sensations giving rise to this creative process maybe taste stimuli, as in the case of the madeleine, but theymay also be scents, sounds, or sights (Figure 3). On thesubject of visual stimuli, we have also mentioned theassociation with flowers that created a memory. As forauditory stimuli, an artist as sensitive as Proust couldhardly fail to mention music. There are repeatedreferences to the “little phrase by Vinteuil”, a musicaltheme that historians have identified as a reference to apiano sonata by César Franck, a contemporary ofProust’s whom he admired.4(p259) As he listens to the slowrhythm of a musical backdrop, the protagonist comparesit to drawing, architecture, or thought, it suddenly seemsto give way to a new, quicker, and melancholymovement that opens previously unseen perspectives,in a process once again compared to love:

Figure 3. Images of triggers evoking automatic memory: madeleine cakes shaped like scallop shells, as described in the book (left), hawthorn boughs (aubé-pine, centre), and César Franck at the organ (right). The Vinteuil sonata in the novel is based on a sonata for violin and piano by Franck.

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Cette fois il avait distingué nettement une phrase s’é-levant pendant quelques instants au-dessus desondes sonores. Elle lui avait proposé aussitôt desvoluptés particulières, dont il n’avait jamais eu l’idéeavant de l’entendre, dont il sentait que rien autrequ’elle ne pourrait les lui faire connaître, et il avaitéprouvé pour elle comme un amour inconnu. […]l’image d’une beauté nouvelle qui donne à sa propresensibilité une valeur plus grande…4(p257)

(This time he had distinguished, quite clearly, aphrase which emerged for a few moments from thewaves of sound. It had at once held out to him aninvitation to partake of intimate pleasures, of whoseexistence, before hearing it, he had never dreamed,into which he felt that nothing but this phrase couldinitiate him; and he had been filled with love for it,as with a new and strange desire....a new form ofbeauty, which strengthens and enlarges his ownpower of perception...)

Swann associates this musical phrase with his love forOdette, when it withers and he believes it is lost. But thepreviously described sensations of taste, and smell aboveall, are what act upon automatic memory. As if he hadintuited the presence of the reptilian brain and limbicsystem that are linked to these primitive sensations,Proust finds that association between scent and recall isthe most persistent and long-lasting link used in evokingand recording memory. For example, breathing in thescent of the varnish from the staircase in his childhoodhome in Combray reminded him of his mother waitingso anxiously in the room above. That smell was linked tosuch a deep-seated, immediate, toxic, and inevitable rushof sadness that it overcame his ability to think.

Cet escalier detesté où je m’engageais toujours si tris-tement, exhalait une odeur de vernis qui avait enquelque sort absorbé, fixé, cette sorte particulière dechagrin que je ressentais chaque soir, et la rendaitpeut-être plus cruelle encore pour ma sensibilitéparce que, sous cette forme olfactive, mon intelli-gence n’en pouvait plus prendre sa part. […] monchagrin de monter dans ma chambre entrait en moid’une façon infiniment plus rapide, presque instan-tanée, à la fois insidieuse et brusque, par l’inhalation—beaucoup plus toxique que la pénétrationmorale— de l’odeur de vernis particulière à cet esca-lier.4(p71)

(That hateful staircase, up which I always passedwith such dismay, gave out a smell of varnishwhich had to some extent absorbed, made definiteand fixed the special quality of sorrow that I felteach evening, and made it perhaps even more cruelto my sensibility because, when it assumed thisolfactory guise, my intellect was powerless to resistit....my anguish at having to go up to my roominvaded my consciousness in a manner infinitelymore rapid, instantaneous almost, a manner atonce insidious and brutal as I breathed in —a far

more poisonous thing than any moral penetra-tion— the peculiar smell of the varnish upon thatstaircase.)

The strength of the similar sensations of smell and tastewas such that Proust believed them to be the only meansof sensory perception and memory remaining when allothers have been destroyed. The survivors of the ruin oftime and memory, they alone remain to give shape to theedifice of recollection:

Mais, quand d’un passé ancien rien ne subsiste,après la morte des êtres, après la destruction deschoses, seules, plus frêles mais plus vivaces, plusimmatérielles, plus persistantes, plus fidèles, l’odeuret la saveur restent encore longtemps, comme desâmes, à se rappeler, à attendre, à espérer, sur la ruinede tout le reste, à porter sans fléchir, sur leur gout-telette presque impalpable, l’édifice immense dusouvenir.4(p91)

(But when from a long-distant past nothing subsists,after the people are dead, after the things are brokenand scattered, still, alone, more fragile, but withmore vitality, more unsubstantial, more persistent,more faithful, the smell and taste of things remainpoised a long time, like souls, ready to remind us,waiting and hoping for their moment, amid theruins of all the rest; and bear unfaltering, in the tinyand almost impalpable drop of their essence, thevast structure of recollection.)

We see here how memory is formed over time. It occurson the basis of experiences that are activated unconsciously,especially by means of different types of sensorymechanisms. Another trait of this type of memory is howit is formed: after a series of experiences, the memory unitbecomes strengthened, organised, and distinctive:

… cette cohésion, cette unité qui n’appartiennentqu’aux créations de notre esprit…4(p180)

À cause de la solidarité qu’ont entre elles les différentesparties d’un souvenir et que notre mémoire maintientéquilibrées dans un assemblage où il ne nous est paspermis de rien distraire, ni refuser…4(p475)

(... that cohesion, that unity which belongs only tothe figments of the mind...Because of the solidarity that binds together the diffe-rent parts of a general impression, parts that ourmemory keeps in a balanced whole, of which we arenot permitted to subtract or to decline any fraction...)

Memory, shaped and consolidated by these means, becomesentrenched in our minds, a living active entity. We have onlyto absorb the stimuli of the present, and let them distractus, for a memory to burrow into our consciousness:

Mais depuis peu de temps, je recommence à trèsbien percevoir si je prête l’oreille, les sanglots quej’eus la force de contenir devant mon père et que

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éclatèrent que quand je me retrouvais seul avecmaman. En réalité, ils n’ont jamais cessé; et c’est seu-lement parce que la vie se tait maintenant davantageautour de moi que je les entends de nouveau,comme ces cloches de couvents que couvrent si bienles bruits de la ville pendant le jour qu’on les croiraitarrêtées mais qui se remettent à sonner dans lesilence du soir.4(p81)

(But of late I have been increasingly able to catch, ifI listen attentively, the sound of the sobs which I hadthe strength to control in my father’s presence, andwhich broke out only when I found myself alonewith Mamma. Actually, their echo has never ceased:it is only because life is now growing more and morequiet round about me that I hear them afresh, likethose convent bells which are so effectively drownedduring the day by the noises of the streets that onewould suppose them to have been stopped for ever,until they sound out again through the silent eve-ning air.)

The author is quite aware of the limitations of thismemory: searching for reality in the portraits painted bymemory is intrinsically contradictory. They are merelypartial sketches, minimal fragments of a multitude ofstimuli and sensations of a moment that correspondneither to the true complexity of the past nor (alas!) tothe present. If we wish to locate a trace of this past in thecurrent space and time, we discover, with deep dejection,that they do not exist, but were merely errant figments ofthought. This is the precise message contained in the lastparagraph of the book:

Les lieux que nous avons connus n’appartiennentpas qu’au monde de l’espace où nous les situonspour plus de facilité. Ils n’étaient qu’une mincetranche au milieu d’impressions contiguës qui for-maient notre vie d’alors; le souvenir d’une certaineimage n’est que le regret d’un certain instant; et lesmaisons, les routes, les avenues, sont fugitives,hélas! comme les années.4(p476)

(The places that we have known belong now only tothe little world of space on which we map them forour own convenience. None of them was ever morethan a thin slice, held between the contiguousimpressions that composed our life at that time;remembrance of a particular form is but regret for aparticular moment; and houses, roads, avenues areas fugitive, alas, as the years.)

Representations: images and consciousness

If memory is the mental receptacle of recollections inspace and time, and also has the ability to create themusing specific and limited sensory information, thequestion remaining is what mechanisms it uses to do so.We know that the strongest triggers of recall are certainstimuli corresponding to the type of memory called

involuntary memory. When these stimuli are repeated,they will make up a unit or coherent group which, overtime, will form a mental reality that is is subjective andunique. The above occurs because of our ability, on theone hand, to form mental images; and on the other, tolink those images to content that we ourselves findemotionally relevant. In this way, the mental images ofspecific stimuli come together on their own becausethey are linked to something emotionally significant.Without this link, or without the ability to generate theimage, memory would not be possible. Time would belost and never regained. In contrast, when theexperiences we live are also felt, a genuine search forpast time can be undertaken, and in this process, timeis regained. This is the essence of what we might call thephysiology of Proustian memory. We will illustrate it,step by step, using his own text.

Images are already addressed in Proust’s influentialdescriptions of the madeleine and the evocative power ofits flavour:

Certes, ce qui palpite ainsi ou fond de moi, ce doitêtre l’image, le souvenir visuel, qui, lié à cette saveur,tente de la suivre jusqu’à moi.4(p90)

(Undoubtedly what is thus palpitating in the depthsof my being must be the image, the visual memorywhich, being linked to that taste, has tried to followit into my conscious mind.)

But it is when he describes learning from books, and howthey have influenced him, that he most clearly discoversthe ability of images to form memory. When this occurs, itis because they are linked to an intense emotionalexperience. The image of what the first-person narratorhas experienced, or rather read in this case, provoking vividsensations, becomes a part of that person’s mind. Objects,space, time, and emotions are what come together to formhis reality. And this intimate, inward-looking reality willthen be projected outwardly in a process that will in theend transmit the contents of the memory that it forms —the mental reality of the self— to external objects, as thismental reality searches for itself unconsciously andautomatically. The text provides an example:

Mais tous les sentiments que nous font éprouverla joie ou l’infortune d’un personnage réel ne seproduisent en nous que par l’intermédiaire d’uneimage de cette joie ou de cette infortune…4(p129)

(But none of the feelings which the joys or misfor-tunes of a ‘real’ person awaken in us can be awake-ned except through a mental picture of those joys ormisfortunes...)

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The author himself believes that a novelist’s genius lies indiscovering that the image is the essential part of theemotional experience.

… l’ingéniosité du premier romancier consista àcomprendre que dans l’appareil de nos émotions,l’image étant le seul élément essentiel, la simplifi-cation que consisterait à supprimer purement etsimplement les personnages réels serait un perfec-tionnement décisif. […] Qu’importe dès lors queles actions, les émotions de ces êtres d’un nouveaugenre nous apparaissent comme vraies, puisquenous les avons faites nôtres, puisque c’est en nousqu’elles se produisent…4(p129-130)

(...The novelist’s happy discovery was to think ofsubstituting for those opaque sections, impenetra-ble by the human spirit, their equivalent in imma-terial sections, things, that is, which the spirit canassimilate to itself. After which it matters not thatthe actions, the feelings of this new order of crea-tures appear to us in the guise of truth, since wehave made them our own, since it is in ourselvesthat they are happening...)

The image that is created is not always visual, but rathera mental projection of objects or events with emotionalcontent, regardless of the type of sensory stimulus linkedto them. It is through these mental projections that ourconsciousness forms as we get to know ourselves and theoutside world. In turn, representations of theconsciousness will constantly radiate outward from theself. This occurs not only in emotionally stimulatingliterature, as previously mentioned—

… pendant ma lecture, exécutait d’incessantsmouvements du dedans au dehors, vers la décou-verte de la vérité…4(p129)

(...while I was reading, would be constantly amotion from my inner self to the outer world,towards the discovery of Truth...)

—but also in the everyday life of the narrator:

Enfin, en continuant à suivre du dedans au dehorsles états simultanément juxtaposés dans ma cons-cience…4(p132)

(And then, as I continue to trace the outward courseof these impressions from their close-packed inti-mate source in my consciousness...)

In this way, as the author states, one searches withinthings to find the reflections we have projected onthem:

On cherche à retrouver dans les choses, devenuespar là précieuses, le reflet que notre âme a projetésur elles…4(p131)

(We try to discover in things, endeared to us on thataccount, the spiritual glamour which we ourselveshave cast upon them...)

The sonority, flavour, and reflection of things thus cannotbe attributed to echoes from the outside, but rather toresonances of our own private burdens. Earlier, wementioned the Celtic belief that forgotten souls can behidden in objects and awakened to evoke memory. Now,with the memory formed and conscious, the movementis inverse, from consciousness to objects. As occurs withmemory —so often viewed as a fleeting disappointmentwhen compared with the real sensory richness of thepresent— we now find the discouragement of finding thatobjects lack the lustre provided by our own ideas. This isnecessarily so, given that memories are subjective andgenerated from personal, unique representations andemotions:

… on est déçu en constatant qu’elles semblentdépourvues dans la nature, du charme qu’ellesdevaient, dans notre pensée, au voisinage de certai-nes idées…4(p131)

(...we are disillusioned, and learn that they are inthemselves barren and devoid of the charm whichthey owed, in our minds, to the association of cer-tain ideas...)

As slaves to our senses, and to our subjective andtherefore biased emotions, our mental representations,memory, and outward projections often lead us toquestion the reality that the new information orexperience provides:

… nous en sommes réduits à celui de nos sens dontnous nous demandons, devant ce souvenir isolé etincohérent, s’ils n’ont pas été le jouet d’une illu-sion…4(p172)

(...we are reduced to the evidence of our own senses,and we ask ourselves, in the face of this detachedand incoherent fragment of recollection, whetherindeed our senses have not been the victims of ahallucination...)

Proust, believing that reality is formed in the memory,was aware of the limitations intrinsic to the imperfectmechanisms of consciousness described above.Nevertheless, the author knew that only throughsensitivity and emotion can the sentimental baggage weacquire improve our wretched human condition. Oncecaptured, these acquisitions become a permanent part ofour minds, and as such, they will be bound to our fateeven in death. Thanks to their presence, death will be lessbitter, and even less likely, because we will live on in thevalues intrinsic to the sentiments we internalise. Proust

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cites the example of Vinteuil’s phase to describe thisconcept, and the overarching lesson implicit in the novelis that art acts as a saviour that triumphs overnothingness:

Par là, la phrase de Vinteuil avait, comme tel thèmede Tristan par exemple, qui nous représente aussiune certaine acquisition sentimentale, épousé notrecondition mortelle, pris quelque chose d’humain quiétait assez touchant. Son sort était lié à l’avenir, à laréalité de notre âme dont elle était un des ornementsles plus particuliers, les mieux différenciés. Peut-êtreest-ce le néant qui est le vrai et tout notre rêve et-ilinexistant, mais alors nous sentons qu’il faudra queces phrases musicales, ces notions qui existent parrapport à lui, ne soient rien non plus. Nous périrons,mais nous avons pour otages ces captives divines quisuivront notre chance. Et la mort avec elles a quel-que chose de moins amer, de moins inglorieux,peut-être de moins probable.4(p398)

(In that way Vinteuil’s phrase, like some theme, say,in Tristan, which represents to us also a certainacquisition of sentiment, has espoused our mortalstate, had endued a vesture of humanity that wasaffecting enough. Its destiny was linked, for thefuture, with that of the human soul, of which it wasone of the special, the most distinctive ornaments.Perhaps it is not-being that is the true state, and allour dream of life is without existence; but, if so, wefeel that it must be that these phrases of music, theseconceptions which exist in relation to our dream,are nothing either. We shall perish, but we have forour hostages these divine captives who shall followand share our fate. And death in their company issomething less bitter, less inglorious, perhaps evenless certain.)

Doctors and neurological references in Proust

Proust’s novel contains a long list of characters from hisepoch. Doctors are among them, which is not surprisinggiven that the author was chronically ill and both hisbrother and father were doctors. As in Balzac, whomProust greatly admired, and somewhat later in Spanishliterature with Galdós,11 the same characters appear indifferent parts of the story with different attributes toadvance new developments in the plot. Where we find DrMiquis in Galdós, Proust presents Dr Cottard. Dr Cottardmakes his entrance in Swann’s way, which we stress is thesole volume analysed here, in Mme Verdurin’s Parisiansalon. This becomes a key location in the novel in theopening pages of the second volume (In the shadow ofyoung girls in flower). It is not difficult to see the imageof Proust’s own father and his dealings with the Parisiannobility of the time. Dr Cottard attended an upper-classclientèle, making him very different from the ruraldoctors mentioned in the first volume, in Combray. As

was typical in that setting and moment in history, ladiesoften suffered from headaches and strange pains andsymptoms suggesting what we now call conversiondisorder, and they used them to draw the attention andcompassion of others. As soon as she appears in the novel,Mme Verdurin describes what she calls her migraines toguests including Dr Cottard (a young doctor then juststarting his practice):

Alors vous tenez à ce que j’aie ma migraine? Voussavez bien que c’est la même chose chaque fois qu’iljoue ça. Je sais ce qui m’attend! Demain quand jevoudrai me lever, bonsoir, plus personne!4(p236)(Then you want me to have one of my headaches?You know quite well, it’s the same every time heplays that. I know what I’m in for. Tomorrow, whenI want to get up — nothing doing!)At another gathering, she reminds us of her pains:“un rhume de cerveau avec névralgies faciales... onvoit bien que ce n’est pas vous qui garderez le lit huitjours”4(p253)

(“...a cold in the head, and neuralgia all down myface... it is easy to see that none of you will have tostay in bed, for a week”). Such terms as “cold in thehead” or even “cerebral rheumatism” were oftenused in those times since migraines were attributedto changes in the blood and CSF dynamic and fre-quently associated with other rheumatic pains12;today, such patients would probably be diagnosedwith fibromyalgia.

Another of the main characters, Swann’s beloved Odette,also complains of headaches. Characteristically, she doesso during a tense exchange with Swann, displaying agood-sized dash of victimhood that Swann himselfdetects:

... elle se sentait mal à la tête [...] et, peu après, ellese sentait fatiguée et désira s’endormir. [...] l’idée luivint brusquement que peut-être Odette attendaitquelqu’un ce soir, qu’elle avait seulement simulé lafatigue…4(p320)

(...her head ached...a little while later she felt tired andwished to sleep....the idea suddenly struck him that,perhaps, Odette was expecting some one else thatevening, that she had merely pretended to be tired...)

Continuing with the subject of headaches that arise inemotionally charged or conversive contexts, we findthose affecting Aunt Leonine of Combray, the alter egoof the writer’s aunt with whom he spent his summers inthe town known later as Illiers-Combray. Proust’sdescription of his aunt’s ailments is rambling but quitedetailed. She clearly displays histrionic traits, includingbeing a bedridden, dependent recluse with no definedreason or infirmity, and systematically manipulating all

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around her. We will not cite the passages about Leonine’sillness due to their length, but they mention herheadaches, hypersensitive skin, and particularly heraversion to noise (Figure 4), as well as her skill at usingthese symptoms to win the attention of her servantsand family members.

Elle ne parlait jamais qu’assez bas parce qu’elle croyaitavoir dans la tête quelque chose de cassé et de flottantqu’elle eût déplacé en parlant trop fort [...] puis, dansl’inertie absolue où elle vivait, elle prêtait à ses moin-dres sensations une importance extraordinaire [...]elle se les annonçait à elle-même, en un perpétuelmonologue qui était sa seule forme d’activité.4(p94)

(She never spoke save in low tones, because shebelieved that there was something broken in herhead and floating loose there, which she might dis-place by talking too loud...besides, in the life ofcomplete inertia which she led she attached to theleast of her sensations an extraordinary impor-tance...she used to promulgate them to herself in anunceasing monologue which was her sole form ofactivity.)

The father of the child narrator in Combray also sufferedfrom migraines, which he treated using the time-honoured remedy of knotting a scarf around his head13:

On ne pouvait pas remercier mon père […] il étaitencore devant nous, grand, dans sa robe de nuitblanche sous le cachemire de’Inde violet et rose qu’ilnouait autour de sa tête depuis qu’il avait des névral-gies…4(p80)

(It was impossible for me to thank my father...he wasstill confronting us, an immense figure in his whitenightshirt, crowned with the pink and violet scarfof Indian cashmere in which, since he had begun tosuffer from neuralgia, he used to tie up his head...)

Cottard acknowledged the existence of certainneurasthenic states (“il y reconnaissait certains étatsneurasteniques”4(p254)) although he was not strict abouthis prescriptions whenever he took part in socialgatherings in which these patients were often present.Neurasthenic states are by no means the only entitiesmentioned in the novel. Proust also includes otherpersonality disorders of the type already referred to as‘neurotic’, or more generically as ‘neuropathic’. Theseterms derive from ‘neurosis’, that is, a non-inflammatoryaffection of the nerves. Pinel distinguished betweenrelational neuroses and neuroses of private life and theemotions.14 ‘Excessive moral affections’ was listed amongtheir causes. Proust’s description of Swann’s jealousy fallsneatly into this category, as Swann becomes an obsessiveneuropath and suffers to the point of wishing for a ‘realdisease’ to free him from his neuropathic symptoms:

C’est charmant, je deviens névropathe. […] Cettenécessité d’une activité sans trêve, sans variété, sansrésultats, lui était si cruelle qu’un jour, apercevantune grosseur sur son ventre, il ressentit une véritablejoie à la pensée qu’il avait peut-être une tumeurmortelle, qu’il n’allait plus avoir à s’occuper de rien,que c’était la maladie qui allait le gouverner, faire delui son jouet, jusqu’à la fin prochaine. Et en effet, sià cette époque, il lui arriva souvent sans se l’avouerde désirer la mort, c’était pour échapper moins à l’a-cuité de ses souffrances qu’à la monotonie de soneffort.4(p364-365)

(“This is delightful; I’m becoming neurasthenic”...This compulsion to an activity without respite,without variety, without result, was so cruel ascourge that one day, noticing a swelling over hisstomach, he felt an actual joy in the idea that he had,perhaps, a tumour which would prove fatal, that he

L. C. Álvaro

Figure 4. Images of Illiers (left), known today as Illiers-Combray to reflect the name Proust gave to this medieval town in his fictional account. Betweenthe ages of 6 and 9 years, he spent his summers here with his aunt and uncle on his father’s side (Jules and Elisabeth). The latter is portrayed in his novel asaunt Leonie (right), who suffers from conversion symptoms and severe migraines. It was in this house where the writer tasted the famous madeleine.

Swann’s way: Proust as a neurobiologist and neurologist

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need not concern himself with anything further, thatit was his malady which was going to govern his life,to make a plaything of him, until the not-distantend. If indeed, at this period, it often happened that,though without admitting it even to himself, he lon-ged for death, it was in order to escape not so muchfrom the keenness of his sufferings as from themonotony of his struggle.)

In a later passage, when speaking of his rival for Odette(M. de Charlus), he calls him a neuropath, a term he usesinterchangeably with the more specific concept ‘neurotic’.At this junction, he introduces the concept of fellow-feeling as a counter to his ill-wishes for M. de Charlus,and it is his empathy that will triumph:

… c’est la bonté, qu’il ne pouvait au fond répondreque de natures analogues…4(p405)

(...what prevents men from doing harm to theirneighbours is fellow-feeling, that he could not, inthe last resort, answer for any but men whose natu-res were analogous to his own...)

The author presents yet another moral lesson: intelligenceas a synonym of empathy. He goes on to state that ifhighly intelligent individuals are respected, it is not fortheir knowledge, which is not usually well-understood,but rather for their goodness. Today, we might use theterm ‘emotional intelligence’. Proust describes the face ofgoodness as that of a busy surgeon, showing no trace oftenderness, and hiding true empathy behind a seriousfaçade. In this passage, the author highlights theimportance of judging people by their deeds, and nottheir words or mere appearances; other examples appearthroughout the text.

… des incarnations vraiment saintes de la charitéactive, elles avaient généralement un air allègre,positif, indifférent et brusque de chirurgien pressé,ce visage où ne se lit aucune attendrissement devantla souffrance humaine, ce visage où ne se lit aucunecommisération, aucun attendrissement devant lasouffrance humaine, aucune crainte de la heurter, etqui est le visage sans douceur, le visage antipathiqueet sublime de la vraie bonté.4(p127)

(...literally saintly examples of practical charity, theyhave generally had the brisk, decided, undisturbed,and slightly brutal air of a busy surgeon, the face inwhich one can discern no commiseration, no ten-derness at the sight of suffering humanity, and nofear of hurting it, the face devoid of gentleness orsympathy, the sublime face of true goodness.)

This goodness stands in contrast to the total lack ofempathy in those people displaying destructive and toxicbehaviours toward those nearest to them as they seek tofurther their self-interests. An example would be Mlle

Vinteuil, referred to as a sadist in the text. Today, shewould be regarded as a psychopath.

Peut-être n’eût-elle pas pensé que le mal fût un étatsi rare, si extraordinaire, si dépaysant, où il était sireposant d’émigrer, si elle avait su discerner en elle,comme en tout le monde, cette indifférence auxsouffrances qu’on cause et qui, quelques autres nomsqu’on lui donne, est la forme terrible et permanentede la cruauté.4(p210)

(Perhaps she would not have thought of wickednessas a state so rare, so abnormal, so exotic...had shebeen able to distinguish in herself, as in all herfellow-men and women, that indifference to the suf-ferings which they cause which, whatever nameselse be given it, is the one true, terrible and lastingform of cruelty.)

These characters are described as “threatened with theloss of [...] reason”4(p262) and as is only fitting, they call onmad-doctors and alienists, whom Proust describes ashaving professional habits that include being able to callpatients to order with a word and a gesture.4(p65) Togetherwith surgeons, rural doctors, and high society physicians,these characters populate Proust’s world and make itvivid. Without them and their characterisations, the textwould lose some of its richness. There can be no questionthat Proust’s complete works, and not just the volumeexamined here, deserve an analysis of the medical,neurological, and clinical references they contain.

Influences and neurobiological scope

Proust’s conjectures about time and memory have beensupported by modern neuroscience. For example, theidea of outward projection of the contents of the memoryhas been closely echoed by modern theories on theextended mind as proposed by Clark and Chalmers in1998.15 According to these authors, cognition, rather thanbeing limited by the definite boundaries of brain andskin, is not strictly Cartesian or even mental. It stretchesbeyond those confines by means of devices ranging frompaper and pencil to the most sophisticated gadgets,whether external or internal, such as the prostheticdevices that can be inserted in the brain to aid with suchfunctions as memory and seeing movement. This type ofcognition can be transmitted, especially throughlanguage, and in doing so it becomes social or culturalcognition, which is expressed in a variety of ways.16 Ona practical level, the rise of artificial intelligence androbotics is also based on postulates for interaction withthe environment, memory, Bayesian learningmechanisms, and perfecting new interactions.17 Proust

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recognises the limits of outward projection ofconsolidated memory, and a deeper reading shows thisconcept to be similar to the form of extended culturalcognition known as art.

His conception of time as a duration and a transformationinto memory was clearly influenced by Bergson. Proustwas an excellent scholar of philosophy from a young age;he had brilliant professors and his keen interest in this fieldshines through in his novel and his voluminouscorrespondence. Henri Bergson was Proust’s cousin, buthe never showed any particular interest in the latter, andthe two were not close. He did recall Proust as “the cousinwho once gave me some excellent wax earplugs”. Thecentral Bergsonian idea of persistence in time, seen as botha flow and a duration into which both ideas and beings willmerge, is discernible in Proust’s projections of memory,both those moving inward to create memory and thosemoving outward to mould the external world and thecreations of the mind.18 Based on these reflections on thedisplacement and plasticity of the memory in time andspace, we believe that Proust followed in the wake ofBergson’s philosophy. Not all scholars agree,19 however,probably because Proust never confirmed this.1

Proust’s references to the automatic memory and theconscious or intellectual memory suggest that he may havebeen swayed by Freud, another of his contemporaries. Theabove terms evoke the concepts of the conscious andsubconscious mind, and the impact of the elementsmaking up the subconscious mind. Nevertheless, an in-depth analysis shows that Proust’s ideas have nothing to dowith the impulses that Freud regarded as an essential partof the mind and conduct, whether individual or social.20

On the contrary, Proust remained convinced that impulseshave very little influence on the results of our actions. Thedecisive factor in actions that Proust regards astranscendent, such as complying with moral obligations,showing loyalty to friends, or completing a project, is one’sacquired habits,4(p137) that is, consolidated memory and thereality of that memory determine behaviour and its results.Some say Proust never read Freud’s works.1,19 Furthermore,while Freud was exploring the subconscious layers of themind as an exercise in psychopathology, Proust’s exercisewas in aesthetics. An eclectic survey of these two authorsmight describe them as complementary.19

Proust’s mechanism for the creation of memory fromimages linked to emotions is particularly intriguing. We feelthat it is in line with modern theories of emotionalintelligence, especially the somatic marker hypothesis.

Damasio, the author of this hypothesis, shows the influenceof Spinoza —another thinker of Portuguese origin— in histheories.21 While the similarities between these scholarscannot be denied, analysing them is not within the scope ofthis paper, and we prefer to highlight the coherence betweenDamasio’s and Proust’s ideas. In both views, images are themost common form of mental representation; here, theterm ‘image’ refers not only to visual representations, butalso those proceeding from the other senses and toconceptual or semantic representations. Proust recognisesthat the emotion linked to objects or situations plays anessential role, thereby allowing them to generate memoryand what he calls mental reality. This mental function issimilar to what Damasio calls ‘emotionally competentstimuli’. Such stimuli are responsible for an imagerepresentation sequence and a neuro-humoral responsethat constitutes what he terms the somatic marker.22 Thesomatic marker is expressed in a rapid, pre-consciousmanner and then followed by conscious emotion, whichgives way to the motor or behavioural response pertainingto that emotion. This sequence displays similarities toautomatic memory that invades the conscious mind givenan emotional trigger, and may be followed by recognitionof an object or external sequence linked to that trigger, asseen in Proust.

With so many references to memory, we cannot overlookwhat Proust calls consolidation and cohesion, or internalunity. This very mechanism is what forms memory. Infact, a learning process linked to emotions is whatpermits the consolidation and retrieval of what will laterbecome memories. This sequence has been confirmedby our modern knowledge of neuroscience, whichestablishes that memory is formed and consolidatedthrough synaptic reinforcement. This entails an increasein the number of synaptic connections in space and time,and this process occurs thanks to long-term potentiation(LTP). LTP in turn is initiated by neurochemicalmediators such as KREBB proteins or NMDA receptorsactivated by glutamate.23 As we know now, Proust’sconjecture, the link between memory and emotion,underlies not only normal learning, but also pathologicalphenomena including post-traumatic stress syndrome.Knowledge of these neurochemical pathways allowsscientists to test receptor inhibitors such as cycloserine,or substances like anisomycin that block mediatorproteins, in animal models and in clinical medicine.24,25

Conflicts of interestThe author has no conflicts of interest to declare.

L. C. Álvaro

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