Sites of the Unconscious

Hypnosis and the Emergence of the Psychoanalytic Setting

Andreas Mayer, Christopher Barber

• Publisher: University of Chicago Press
• Year: 2013
• Print ISBN: 9780226057958
• eBook ISBN: 9780226058009
• Topic: Psychology
• Subtopic: European History
• Index: Psychology

In the late nineteenth century, scientists, psychiatrists, and medical practitioners began employing a new experimental technique for the study of neuroses: hypnotism. Though the efforts of the famous French neurologist Jean-Martin Charcot to transform hypnosis into a laboratory science failed, his Viennese translator and disciple Sigmund Freud took up the challenge and invented psychoanalysis. Previous scholarship has viewed hypnosis and psychoanalysis in sharp opposition or claimed that both were ultimately grounded in the phenomenon of suggestion and thus equally flawed. In this groundbreaking study, Andreas Mayer reexamines the relationship between hypnosis and psychoanalysis, revealing that the emergence of the familiar Freudian psychoanalytic setting cannot be understood without a detailed analysis of the sites, material and social practices, and controversies within the checkered scientific and medical landscape of hypnotism.

          
Sites of the Unconscious analyzes the major controversies between competing French schools of hypnotism that emerged at this time, stressing their different views on the production of viable evidence and their different ways of deploying hypnosis. Mayer then reconstructs in detail the reception of French hypnotism in German-speaking countries, arguing that the distinctive features of Freud's psychoanalytic setting of the couch emerged out of the clinical laboratories and private consulting rooms of the practitioners of hypnosis.

PART ONE

French Cultures of Hypnosis

1

“Experimental Neuroses”: Hypnotism at the Salpêtrière Hospital

When the young Viennese doctor Sigmund Freud received a travel stipend for Paris in winter 1885 to study neuropathology at Jean-Martin Charcot’s clinic at the Salpêtrière Hospital, he was only one of many curious and skeptical physicians and scientists who wanted to see the “highly surprising” findings of the famous neurologist with their own eyes.¹ Attempts to make hypnosis part of a new experimental approach to understanding the nature of nervous diseases had emerged and proliferated in French hospitals since the late 1870s, and they found their most ambitious representative in Charcot and his definition of “grand hypnotism.” Although it is widely acknowledged that Freud’s encounter with Charcot was a decisive moment for the future development of psychoanalysis, most historical accounts of the French research on hysteria and hypnotism tend to cast this episode as a mere “prehistory” of the Freudian enterprise. In his writings, Freud himself has largely contributed to a portrait of Charcot as a “seer,” a visuel, a genius of clinical observation, thereby fostering a historiography according to which the appeal of hypnotism as an experimental program was explained by the prestige and personal fascination exerted by a single great clinician.² Numerous contemporary and later accounts devoted to the “artist” Charcot speak of the same fascination, be it in a hagiographic or in a debunking key.³ This person-centered focus has led to a neglect of an essential factor in the attractiveness of experimental hypnotism, namely the promise of a new scientific psychology, grounded in the material and social surroundings of the neurological clinic. One of the major reasons (if not the most important one) for the short success of Charcot’s research project lay in the multiple facilities brought together in his clinic at the Salpêtrière, which he presented as a “living pathological museum.”⁴ His attempts to integrate the contested practices of animal magnetism into a laboratory setting were critically dependent on a material apparatus conceived to detach the action of hypnosis from the person of the hypnotist. Somewhat ironically, then, Charcot’s posthumous fame is largely attributed to a personal factor that he sought to eliminate once and for all from a new scientific psychology based on a novel form of clinical experimentation.⁵ In this chapter, I aim to specify the ways in which unconscious processes were made observable and manipulable within a geography of sites installed at Charcot’s clinic between 1877 and 1882, during the formulation of a new experimental program—grand hypnotisme—designed to elucidate one of the most elusive and problematic neuroses of the nineteenth century, hysteria.

The Clinical Geography of Charcot’s New Research Center

In the nineteenth century, the Salpêtrière numbered among the largest and most important hospitals in Paris. The neurologist Jean-Martin Charcot played a decisive role in the modernization of the hospital: during the course of his career, the clinic he headed developed from an institution primarily devoted to the accommodation of poor and elderly women into a world-famous neuropathological research center.⁶ In 1882 a professorship for nervous disorders was created especially for Charcot, allowing him to focus on the systematic teaching of neurological and psychological disorders. The seat of this new research and teaching center consisted of a building complex adjoining the existing clinic. It housed a number of facilities, including an autopsy ward, a physiological-chemical laboratory, an electrodiagnostic laboratory, ophthalmologic and otologic cabinets (for measuring visual and aural capacities), a photographic studio linked to a pathological-anatomical museum with a department for plaster and wax casts, and a large lecture hall equipped with the most modern projection devices. The German physician Ludwig Hirt, who visited the Salpêtrière in 1883, numbered the beds under Charcot’s supervision at between 600 and 650.⁷ With 250 beds, the “ward for hystero-epileptic women” was the hospital’s largest, whereby the parallel ward for men housed twenty beds. Such appellations show that the patient population had increasingly come to be differentiated according to specific disorders. Treatment in the hospital was free, whereby a small number of patients—the pensionnaires payantes—paid a modest fee entitling them to single rooms and additional meals. The patient population, which Charcot referred to as his “material,” generally originated from the lower classes, although a slowly increasing minority of patients came from the petite bourgeoisie.⁸ A hospital stay lasted at least three weeks, but usually months and often years, which allowed the doctors to observe individual cases over an extended period of time. To supplement the “material” gathered for research and teaching purposes with “more mild cases and those of incipient gravity,” an outpatient clinic was erected along the outer wall, where on each day of the week a different physician diagnosed “all needy sufferers of nervous disorders.”⁹

Charcot’s neuropathological service placed the head physician at its center: the cabinet de consultation, where he examined his patients, was located at the middle of a complex of buildings housing the laboratories, the museum, and the lecture hall. Thus the head physician’s daily rounds to the patients’ beds were replaced by a different form of examination: it was not the doctor who visited the patients, but rather the patients who were summoned to various sites where they served in the study or demonstration of clinical facts. As Hirt noted after his visit, Charcot “personally examined and discussed hundreds of interesting and rare neurological cases each year before a small circle of privileged listeners” in his consulting room during his daily three-hour morning visits to the Salpêtrière.¹⁰ Other guests at the clinic, such as the Russian mathematician Sofia Kovalevskaya, characterized Charcot as “the sovereign ruler of this kingdom of neuroses.”¹¹ By the 1880s, the neurologist had become a well-known public figure, particularly on account of his venture into hysteria research using the hypnotic techniques depicted in numerous popular accounts.¹²

Charcot’s famous Tuesday lectures—held at the policlinic beginning in 1881 and transcribed by his students—served a dual purpose.¹³ Firstly, by offering semipublic outpatient treatment the doctors were offering a free service, which in return provided them with cases not represented in the inpatient population. Thus the clinic’s access to patients was expanded to include “mild” and “incipiently severe” cases.¹⁴ Secondly, the lectures presented an audience of physicians in training with a cross section of examinations in which the doctor demonstrated how he reached a conclusive diagnosis when confronted with a specific symptomatology. In the lectures, one or more patients appeared before an audience as objects of comparison and generally received an “instantaneous diagnosis.”¹⁵ The object of these publicly performed examinations was not only to present a variety of typical cases, but also to demonstrate the steps to be taken by the physician in reaching an unequivocal diagnosis.¹⁶ However, the improvised character of these lectures emphasized by many visitors (including Freud)¹⁷ and some later authors has been exaggerated. Before the presentation, Charcot’s assistants examined the patients and carefully prepared “an initial list of diagnoses with the greatest possible precision” for their master. The list was presented to Charcot upon his arrival at the clinic, and from the cases deemed “most interesting at first sight”¹⁸ he selected the patients who would provide him with the material for his lecture. Once the lecture was over, the work was turned over to the chef de clinique, who, assisted by some externs, completed the consultation.

More generally, the Tuesday lectures served Charcot in demonstrating his mastery of the clinical art of observation, which often allowed him to track down the relevant symptoms at first glance. Most of the neurological conditions were deciphered in a differential diagnosis based on tiny characteristic signs that could be observed on the patient’s body (difficulties in walking, trembling hands, blinking eyes, paralysis of facial or other muscles etc.). When observation of the patient alone was not sufficient for reaching a decisive diagnosis, Charcot resorted to various instruments, such as Skoda’s percussion hammer for testing the reflexes. The use of such instruments reinforced the asymmetry between doctor and patient: it indicated the physician’s position of power, replacing the history of illness recounted by the patient and his or her family with a controlled medical semiology.¹⁹

In this semipublic forum, Charcot thus demonstrated how in “uncovering” symptoms the neurologist must refrain from forms of gaining evidence in which the patient and family members are treated as reliable witnesses. First of all, information obtained from patients is of dubious value for establishing a correct diagnosis, because they “make up theories that are not, of course, always based on a correct grasp of the facts.”²⁰ Thus, when patients describe their illnesses, their statements are generally translated into technical terminology by the physician, who at times disabuses them of their faulty thinking or silences them. For Charcot, the “naive accounts” provided by patients are occasionally of interest, “but one must put them in order, since they are almost always formulated very haphazardly.”²¹ Sometimes, the description itself becomes the indicator for the diagnosis: “When a patient comes along with some sort of written account, saying, ‘I have put down some notes on my condition because I don’t want to take up too much of your time.’ They are all neurasthenics, particularly those of the sort with marked tendencies toward hypochondria.”²² Hence the physician presents himself as the authority who is able to distinguish true symptoms from patients’ exaggerations and imprecisions.

And yet the main problem with the patient’s speech is not that it is imprecise and haphazard by the standards of clinical knowledge, but that it is potentially deceitful. Charcot even professes that most of the information provided by patients and their families is intended to lead the physician astray and keep him from discovering the true cause of the illness:

Among the family members there is a solidarity, a conspiracy of silence. To satisfy your questions they make up a tale based on lies, at times involuntary untruths. A dog was raging about in the countryside, the child was afraid, and so on. And sometimes you will hear the child himself repeat the story, believing it is true because he has heard it told so often. The physician, whose duty it is to get to the bottom of things and see them as they are, must not be duped by such babbling.²³

According to Charcot, then, the true cause of illness is commonly to be found in heredity. The histories narrated by patients and their relatives, which can become the oral tradition of a whole family, thus serve as a means to “escape from the uncomfortable idea of a hereditary destiny.”²⁴ Therefore, from the very beginning of the examination, the statements of the patient and his or her family are considered mendacious: for Charcot, they cannot serve as a point of departure in the scientific search for truth. The medical lecture functions as the public representation of a struggle in which the patient’s will to deceive the physician is subjugated to the doctor’s will to discover the truth. In his interrogation, Charcot separates witnesses belonging to the same family for the purpose of bringing to light family secrets: “Plus il y a d’affection de famille et moins il y a de vérité pour le médécin.”²⁵ Discarding the extravagant stories told by patients, the Salpêtrière physicians prefer the synoptic representational form of the family tree, in which they enter the illnesses of family members as revealed in the course of interrogation.²⁶

While the Tuesday lectures held at the outpatient clinic shaped the public image of Charcot and his “theatrical,” visually oriented style, another crucial site of his new research center has received little attention: the museum of pathological anatomy, known as the Musée Charcot, which was set up in the immediate vicinity of Charcot’s consulting room, and where demonstrations of clinical cases were frequently undertaken.²⁷ Summoning patients to this location facilitated comparison with pieces from the museum’s collections. It housed a large quantity of natural anatomical specimens, a collection of brains, a series of lifelike wax casts (busts as well as entire figures), and, as a special attraction, a large collection of images combining photographs of Salpêtrière patients (or engravings created after them) with reproductions of works by Rubens, Raphael, and other European masters.

The collection served several functions: on the one hand, it was an archive, providing evidence to substantiate the universality of the clinical pictures presented by Charcot. In this respect it embodied the program of “retrospective medicine” formulated by the positivists, in which the artistic testaments of earlier eras could be interpreted through a materialist semiotic (a sort of natural grammar of symptoms), thus confirming the factuality of the conditions diagnosed.²⁸ On the other hand, the objects and images preserved in the museum functioned as a supplement to the clinic. One might even assert that they served as its model, for Charcot proudly referred to his clinic as his “living pathological museum.”²⁹ The casts and reproductions were to fill in the gaps in the tableau of diseases that could be demonstrated using living cases. The dead and living objects were two aspects of a single grand pathological collection.

In summary, Charcot’s clinic established a spatial framework that amplified the developing trend in nineteenth-century clinical medicine toward putting the doctor in a position of power over the patient. Within this configuration, which isolated patients from their families and subjected them to a system of medical control, the patient had already been more or less disempowered.³⁰ However, Charcot altered an important aspect of this power relationship: he reversed the p...

Table of contents

• Cover
• Copyright
• Title Page
• Dedication
• Contents
• List of Abbreviations
• Introduction
• Part One. French Cultures of Hypnosis
• Part Two. The Emergence of the Psychoanalytic Setting
• Conclusion
• Notes
• Acknowledgments
• Bibliography
• Index