Freud and the Scene of Trauma

John Fletcher

• Publisher: Fordham University Press
• Year: 2013
• Print ISBN: 9780823254606
• eBook ISBN: 9780823254613
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

This book argues that Freud's mapping of trauma as a scene is central to both his clinical interpretation of his patients' symptoms and his construction of successive theoretical models and concepts to explain the power of such scenes in his patients' lives. This attention to the scenic form of trauma and its power in determining symptoms leads to Freud's break from the neurological model of trauma he inherited from Charcot. It also helps to explain the affinity that Freud and many since him have felt between psychoanalysis and literature (and artistic production more generally), and the privileged role of literature at certain turning points in the development of his thought. It is Freud's scenography of trauma and fantasy that speaks to the student of literature and painting.

Overall, the book develops the thesis of Jean Laplanche that in Freud's shift from a traumatic to a developmental model, along with the undoubted gains embodied in the theory of infantile sexuality, there were crucial losses: specifically, the recognition of the role of the adult other and the traumatic encounter with adult sexuality that is entailed in the ordinary nurture and formation of the infantile subject.

Part I The Power of Scenes

ONE

Charcot’s Hysteria: Trauma and the Hysterical Attack

Freud refers to the hallucinatory scene in the darkened room discussed in the Prologue as an ‘attack,’ and his theory of the hysterical attack, closely related to the notions of trauma and traumatic neurosis, derives from the work of the great French neurologist Jean-Martin Charcot (1825–93). Freud studied with Charcot for five months from October 1885 to February 1886 at La Salpêtrière in Paris, the vast women’s hospital for nervous diseases with its five thousand resident ‘incurables.’ Freud’s experience there under the influence of Charcot was a turning point for him. It initiated a shift from his medical training and laboratory experience within the field of neurology, with its concern with the anatomical structure of the brain and its relation to the central nervous system, to the problem of psychopathology, in particular, hysteria, the effects of trauma, and the practice of hypnotism. While Freud continued to make contributions to neurology for the next ten years or so and to gain a considerable reputation in the field, dealing in particular with the brain diseases of children, his passion was now for the study and clinical treatment of the psychoneuroses.

Charcot held the Chair in Neuropathology, established especially for him in recognition of his foundational role as “a unique organiser in the history of a new discipline … the constructor of a medical speciality,” and in acknowledgment of the importance of his work in consolidating neurology, the study of the nervous system and its diseases (neuropathology), as an autonomous medical field.1 Charcot had won his reputation as a great identifier and classifier of nervous diseases, assigning each its typical clinical picture, based on its distinctive complex of symptoms, establishing the fully developed or extreme ‘type’ and then the various deviations from it. As Freud wrote,“with these types as a point of departure, the eye could travel over the long series of ill-defined cases—the ‘formes frustes’—which, branching off from one or other characteristic feature of the type, melt away into indistinctness.”2 In his admiring obituary of Charcot, two volumes of whose work he translated into German, Freud compared him, as a bringer of order to the chaos of symptoms and malfunctions, to Cuvier, the great classifier of species in the animal world, and even to the mythic figure of Adam, distinguishing and naming the creatures God brought before him in the Garden of Eden. Charcot’s treatment of nervous diseases entailed the identification of characteristic combinations of symptoms and the demonstration of their basis in certain underlying pathological anatomical changes, distinguishing and describing multiple sclerosis, lateral sclerosis (‘Charcot’s disease’), and locomotor ataxy with its distinctive features (‘Charcot’s joints’), among others. From 1870 onward he turned his attention to hysteria. This coincided with, if it was not occasioned by, an administrative decision by the authorities at La Salpêtrière to split up the population of patients with the common symptom of convulsive fits (‘les convulsionaires’) previously housed together. The mixed population of those with epilepsy and severe hysteria but not deemed insane was assigned to Charcot’s ‘service’ and those considered insane to the care of an alienist (i.e. a psychiatrist).

In his inaugural lecture on taking up the new Chair in Neuropathology in 1881, Charcot outlined his ‘anatomo-clinical method’ as a correlation of the symptomatic disease pictures clinically encountered at the bedside with the lesions established by anatomy in the postmortem room. He also went on to argue, using the example of the new spinal pathology, that the progressive differentiation of the spinal cord into newly discovered regions, each with its circumscribed lesion, could reveal “the special functions belonging to the affected structures.”3 In other words, the field of physiological functioning and its failures, and the localization of functions in different parts of the brain and nervous system (a recent discovery of nineteenth-century anatomy), were annexed to the new field of neurology and subordinated to Charcot’s method. To his initially triumphalist vision, hysteria and other neuroses “evidently having their seat in the nervous system” but “which leave in the dead body no material trace” posed a challenge. “These symptomatic combinations deprived of anatomical substratum” lack the appearance of “solidity” and “objectivity” and “come before us like so many Sphinx” (ibid., 12), Charcot declared.

In 1869, the year before taking over responsibility for La Salpêtrière’s mixed population of epileptics and hysterics, Charcot had attended a meeting of the British Medical Association and heard a lecture by a leading London physician and expert on epilepsy, J. Russell Reynolds. Reynolds argued that “some of the most serious disorders of the nervous system, such as paralysis, spasm, pain, and otherwise altered sensation, may depend upon a morbid condition of emotion, of idea and emotion, or of idea alone,” that they have the appearance of “complicated diseases of the brain or spinal cord,” and that consequently in their case it is important to distinguish between the effects of “organic lesion” as distinct from those of “morbid ideation.”4 Reynolds, whose 1869 paper Charcot cited as seminal for his own work, belonged to a British tradition familiar to Charcot and beginning with Sir Benjamin Brodie’s work in the 1830s on “local nervous affections” or “local hysterias,” in which symptoms ranging from pains and swellings of the joints to paralyses, nervous tremblings, loss of voice, back and neck pains, and urinary retention were found to have no organic basis.5 In 1873 Sir James Paget published a series of lectures on what he called “nervous mimicry” or “neuromimesis,” which he considered an objective disorder of ‘the nervous centres’ and not a question of either conscious simulation and deception, or the mental error of imagination. Imitated diseases are found in children and ignorant or slow-minded people, who know nothing of the diseases imitated.6 Significantly, both Reynolds and Paget reject the assimilation of idea-based or imitated symptoms to hysteria. Paget is vehement: the term “hysteria” should be used, if at all, for patients with the classical hysterical symptoms of convulsions and suffocation “and those other signs of nervous disorder that are not imitations of other diseases.” The characters of nervous mimicry “make a distinct group with another name … we may call them hyperaesthetic or hyperneurotic; anything but hysterical” (ibid., 173). While they were talking about the same range of symptoms, it is not clear that Paget conceived his involuntarily imitated diseases as ideogenic or idea-based in quite the same way Reynolds did, as he was concerned to protect their objective reality from any suggestion of the imaginary, by basing it in the “erroneous workings of sensitive and motor nerve-centres” (ibid., 183). Repudiating the idea that they might be understood as the effect of the mind over the body, Paget seems to want to postulate an involuntary and therefore objective production of the signs and symptoms of organic diseases by the organism, but without the organic lesions that would usually cause them. Nervous mimicry is distinct from mental disorder for “surely, any nervous centre may ‘go mad’ as well as any part of the brain” (ibid., 186).

Transferring his ‘anatomo-clinical’ method to the sphere of hysteria, Charcot, nevertheless, assimilated the range of ideogenic and imitated symptomologies to hysteria, despite the caveats of Paget and Reynolds. He proceeded to defend the genuineness and objectivity of hysterical phenomena even as he distinguished them from the organically based symptoms that they imitated and with which they were often confused. Citing Paget’s term “neuromimesis” in his inaugural lecture, Charcot took the resemblance of hysterical symptoms to the hemianesthesia (one-sided loss of sensation) produced by cerebral lesions, or the paraplegia (paralysis) produced by spinal lesions, as a guide or clue to the enigma of hysteria. Instead of an organic, anatomical lesion, he posited what he called a functional or dynamic lesion as the immediate cause of hysterical symptoms; beyond the similarity of symptoms, the pathologist “perceives a similarity in the anatomical seat, and mutatis mutandis, localises the dynamic lesion from the data furnished by an examination of the corresponding organic one” (Charcot 1889, 14). Charcot read back from the imitated organic disease to its hysterical imitation and inferred the same location for the functional lesion as for the organic one. He continued to affirm his neurological project of explaining hysteria in terms of a localizable, albeit functional or dynamic, lesion, virtually up to his death in 1893, although he was never able to succeed in locating the lesions specific to hysterical symptoms and so enforce his ambitious claim, that the neuroses “do not form, in pathology, a class apart, governed by other physiological laws than the common ones” (ibid., 13).

However, in his last publication on hysteria in 1892, the year before his sudden death, in a long article for a British dictionary of psychological medicine, in response to the question, “What, then, is hysteria?,” he wrote:

According to our notion it is less a disease in the ordinary sense of the word, than a peculiarly constituted mode of feeling and reaction. We do not know anything about its nature, nor about any lesions producing it; we know it only through its manifestations, and are therefore only able to characterise it by its symptoms, for the more hysteria is subjective, the more it is necessary to make it objective, in order to recognise it.7

This looks like a partial admission of his failure to draw hysteria within the law-like framework of neurology, at least as far as identifying an etiology specific to it. If the elusive lesion escaped Charcot, he had, nevertheless, he felt, submitted it to neurological law and order by having both enlarged and stabilized the hysteria diagnosis as a clinical picture and a symptomatic field, differentiating it from its neighboring nervous disorders, epilepsy and neurasthenia, as well as from the organically based and anatomically demonstrable diseases of the nervous system.

La Grande Hystérie: The Hysterical Attack

In his influential nosography of the field of hysterical phenomena, Charcot divided it into two major forms, the convulsive and the nonconvulsive. Convulsions and the hysterical fit were part of the traditional description of hysteria going back to ancient Greek medical treatises. Charcot foregrounded this as central to the clinical picture, although he vigorously rejected the classical etiology (from hystera, meaning the womb) that located its cause in the wandering of the unsatisfied womb around the body, rising from the stomach or chest to the throat in the classical globus hystericus, or ball in the throat. In Charcot’s account, hysteria was not a specifically female disease in the field of gynecology but a disease of both men and women in the field of neurology (although the uterine theory persisted among gynecologists, especially in Anglophone countries, right through the nineteenth century and into the early twentieth).8 The description and spectacular clinical demonstrations of the ideal type of the hysterical attack in the lecture theaters of La Salpêtrière, often before an audience drawn from literary, artistic, and fashionable circles, and in its published photographic records, brought both high drama and notoriety to Charcot’s study of hysteria.9 Charcot called this hysteria major or la grande hystérie, having rejected the standard term ‘hystero-epilepsy’ for its misleading implication that this was basically epilepsy presenting in hysterical form, when what was at stake was in fact ‘epileptiform hysteria,’ a terminology that both he and Freud preferred.10 ‘Epileptiform convulsions’ provided the presenting symptom or medium from which emerged the ‘phonographic’ reproductions that Freud heard in the case first cited at the beginning of the Prologue to this book, and this suggests that it belonged to the third phase of the attitudes passionelles, to be discussed later.

Charcot formulated a schematic outline of the full-scale hysterical attack, dividing it into a preliminary ‘aura’ followed by four main phases.11 The aura consisted of anticipatory states of excitement, palpitations, constriction in the head with hammering in the temples and ringing in the ears, increases in body temperature, and a sense of suffocation from the notorious globus hystericus (ball in the throat) that rises from below and feels like a foreign body or obstruction. Very often the aura is characterized by an intense sensation starting from a single point, the hysterogenic point or zone, and spreading to the throat or head. In women this point is often in the ovarian region, although the zones may be located in other parts of the body, including the scalp, under the breast, and, in men, in the abdominal wall, testicles, and spermatic cord. Pressure brought to bear on these points can sometimes abort an attack or lower its intensity, although attacks can also be provoked by applying pressure on the same points.

The convulsive sequence or attack proper begins with the first epileptoid phase, which is characterized by agitation of the limbs, loss of consciousness, suspension of breathing and foaming at the mouth. The hands are pronated (bent inward), and the forearms and legs are rigidly contracted (the tonic subphase). This is followed by clonic spasms in which contractions and relaxations violently oscillate. Then stertorous and painful breathing begins again.

The second phase of grands mouvements or ‘clownism,’ involves contortions and acrobatic convulsions, such as the famous arc de cercle, in which the body, bent over backwards, rests on the feet and head and the trunk is raised up like a bridge. This gives way to ‘salaam’ movements in which the patient moves from lying back to sitting up, then to bending forward as if in salutation. Freud remarks that, “Hysterical movements are always performed with an elegance and co-ordination, which is in strong contrast to the clumsy coarseness of epileptic spasms” (1888b, 42).

It is, however, the third phase that was to become the significant one for Freud’s reworking of Charcot’s clinical picture into a psychoanalytic theory of hysteria. This is the phase of attitudes passionelles, in which “the psychical element begins to play the first part” and there appears the purposefulness that Charcot contrasts with the purposelessness of the purely convulsive second phase. It is characterized by what he calls “expressive mimicry” of a series of emotions—love, hatred, fear, fright, ecstasy—related to experiences that have played a part in the onset of the hysterical symptoms: “We sometimes see the patient recall a whole scene in his former life (some dispute, accident, etc.)” (Charcot and Marie 1892, 630). The mode of behavior is that of mimicry and enactment, involving screaming and the making of long speeches (Charcot’s assistants referred to the imaginary addressees of these speeches as the patient’s “Invisibles”12). Freud describes this phase as “distinguished by attitudes and gestures which belong to scenes of passionate movement, which the patient hallucinates and accompanies with corresponding words” (1888b, 43).

A final fourth phase of terminal delirium sometimes succeeds in which the patient repeats the themes and preoccupations of the third phase while gradually returning to normal. The four phases constitute the fully developed ‘type.’ The complete sequence of phases does not always appear in every attack, which may consist of one or two of the four phases, while some may be missing; or, the sequence may start over again halfway through with the first phase of epileptoid movements and continue on repetitively for hours, or in some cases days, in which hundreds of separate attacks might be recorded. It is as if a repeating mechanism has taken over the subject and plays itself out according to some internal balance of forces. In other cases the attack may be represented only in rudimentary or abbreviated form. Despite the varieties of combination of the different phases of the attack, Charcot confidently asserted that “it will always be easy for those who possess the formula to bring them under one fundamental type” (Charcot 1889, 13).13

This scenario of the grande attaque...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• List of Figures
• Acknowledgments
• Preface
• Half Title
• Prologue: Freud’s Scenographies
• Part I: The Power of Scenes
• Part II: Memorial Fantasies, Fantasmatic Memories
• Part III: Screen Memories and the Return of Seduction
• Part IV: Prototypes and the Primal
• Part V: Trauma and the Compulsion to Repeat
• Epilogue
• Bibliography
• Index of the Works of Freud
• General Index