To be able to
reproduce
a pathological state is perfection, because it seems that we hold the theory when we have in our hands the means to repro duce the morbid phenomena.
Foucault-Psychiatric-Power-1973-74
) have no greater pleasure than deceiving and leading the people with whom they have relations into error.
Hysterics, who exaggerate their convulsive movements (which are often partly simulated), equally misrepresent and exaggerate all the movements ol their soul (.
.
.
).
In short, the life ol hysterics is just a constant lie (.
.
.
)"; reprinted in Etudes cliniqaes sur les maladies mentales el nerveuses (Paris: J.
B.
Bailliere, 1889), Study II, p.
502.
27. It wasjules Dcjenne who expressed himself in this way in his "Lec. on inaugurale a la clin- ique des maladies du systcme nerveux" on 31 March 1911, La Presse medicale, V1 April, 1911, pp. 253-258: "Through his studies on hysteria, Charcot rescued a domain from the psychi- atrists that the latter vainly tried to regain. Certainly his doctrine of hysteria has not remained wholly intact. But even if Charcot had only the merit of making doctors under- stand that, beyond material lesions, the problems posed by certain psychical disorders oflered their activity a considerable field, for this we would owe him all our gratitude. " Quoted in G. Guillain, J. -M. Charcot (1825-189)): sa vie, son cruvre (Paris: Masson, 1955) p. 143. An illustration ol this will be the transfer of paternity rights over hysteria to neurologists in medical encyclopedias and dictionaries.
28. Foucault is relerring here to the obituary notice Freud wrote in August 1893 and published in the Wiener medt\inische Wochenschrift, vol. 43, no. 37, 1893, pp. 1513-1520: "In the hall in which he gave his lectures there hung a picture which showed 'citizen' Pinel having the chains taken oil the poor madmen in the Salpetnere. " S. Freud, "Charcot" GW, vol. 1,1952, p. 28; English translation, "Charcot" in Standard Edition, vol. 3, p. 18; French translation, "Charcot" trans. J. Altounian and others in S. Freud, Resultats, Idees, Problemes, vol. I, 1890-1920 (Paris: Presses universitaires de France, 1984) p. 68.
29. J. M. Charcot, Lecons sur les maladies du sysleme nerveux, vol. 1, Lecture 11: "De l'hyperesthesie ovanenne," pp. 320-345; English translation, Clinical Lectures on Diseases of the Nervous System, trans. George Sigerson (London: New Sydenham Society, 1877) vol. 1, Lecture 11: "Ovarian hyperaesthesia" pp. 262-282: "most ol the accidents which persist, in
a more or less permanent manner, in the intervals between the convulsive (its ol hysterical patients, and which almost always enable us, on account ol the characteristics they present, to recognise the great neurosis lor what it really is, even in the absence of convulsions" p. 262. Thus "Hemianaeslhesia, paralysis, contracture, fixed painful points occupying dillerent parts of the body," p. 262.
30. J. -M. Charcot, Lecons, vol. 1, Appendice V: "Des troubles de la vision chez les hystenques," pp. 427-434- (This appendix is omitted Irom the English translation. )
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31. Lemons, vol. 1, Lecture 10: "De l'heminesthesie hysterique" pp. 300-319; Clinical Lectures, vol. 1, "Hysterical hemianaesthesia" pp. 246-261.
32. Ibid. Lecture 12: "De la contracture hysterique" pp. 347-366; "Hysterical contracture" pp. 283-299; Lecons sur les maladies, vol. 3, Lecture 7: "Deux cas de contracture hysterique d'origine traumatique" pp. 97-107, and Lecture 8, (continued), pp. 109-123; Clinical Lectures, vol. 3, Lectures 7 and 8, "Two cases of hysterical contracture of traumatic origin" pp. 84-106.
33. Thus, in the Policlinique of 21 February 1888, "Hysteria in young boys," Charcot acknowl- edged: "It is very strange that in particularly mental forms the stigmata do not appear. " Lecons du mardi a la Salpetriere. Policlinique 1887-1S88, vol. 1, p. 208: "All these stigmata (. . . ) are constants in hysteria, but despite their constancy, I have to acknowledge that it quite often happens that we do not find them all, or even, when it comes to it, any. "
34- Sketched out Irom 1872 in the Lecons (vol. 1, Lecture 13: "De Phystero-epilepsie" pp. 373-374, and Appendice 6: "Description de la grande attaque hysterique" pp. 435-448; Clinical lectures, vol. 1, Lecture 13, "Hystero epilepsy" pp. 302-307, [the appendix is omitted from the English translation]), it was codified in 1878 when Charcot reduced it to a "a very simple formula": "All these apparently disordered and variable phenomena . . . follow a rule of development. The complete attack is made up ol four periods: 1. Epileptoid period. It may and usually does resemble the genuine epileptic attack (. . . ). There are grounds for dividing this epileptic period into three phases: a) tonic phase (. . . ); b) clonic phase. Limbs and the whole body are shaken by brief and rapid oscillations ( . . . ) which end in big generalized jolts ( . . . ) ; c) phase of resolution ( . . . ) . 2. Period of contortions and large movements (. . . ). 3. Period of passionate poses. Hallucination clearly governs this third period. The patient herself comes on the stage and through the expressive and ani- mated gesticulations to which she abandons herseli ( . . . ) it is easy to lollow all the episodes of the drama at which she thinks she is present and in which she olten plays the leading role (. . . ). 4. Terminal period. Finally the patient returns to the real world. " P. Richer's record of "Description de la grande attaque hysterique. Hospice de la Salpetriere," Progres medical, 7th year, no. 2, 11 January 1879, pp. 17-18.
35. While the term "hystero-epilepsy" (see above, note 19) covered, as Charcot recalls, "a com- bination of the two neuroses, varying in proportions in different cases," constituting "a mixed form, a kind of hybrid composed half oi hysteria and hall ol epilepsy," Charcot means to distinguish between epilepsy and hystero-epilepsy as pathologically distinct entities, which could not come together to iorm "a hybrid" illness. He also distinguishes a "hystero-epilepsy with distinct crises," in which epilepsy is the primary disease on which hysteria becomes grafted, and a "hysteria, with mixed attacks," in which the epileptic Iorm of convulsion only appears as "an accessory element": "in these cases, hysteria is solely and always present, taking on it the semblance of epilepsy" Lecons, vol. 1, Lecture 13: "De 1' hystero epilepsie" pp. 368-369; Clinical Lectures, vol. 1, Lecture 13: "Hystero epilepsy" pp. 301-302. So the term "hystero-epilepsy" designates no more than the final degree oi hysteria taken to its extreme development, or major hysteria. He will later reject the term itself: "My respect lor tradition previously led me to retain this denomination hystero epilepsy; but I confess to you that it bothers me a great deal, lor it is absurd. There is not the least relationship between epilepsy and hystero epilepsy, even with mixed attacks" Lecons du mardi, Lesson XVIII, 19 March 1889, pp. 424-425. Foucault returns to the question in Les Anormaux, lecture of 26 February 1975, p. 167; Abnormal, p. 224. See also, C. Fere, "Notes pour servir a I'histoire de Phystero-epilepsie," Archives de neurologic, vol. Ill, 1882, pp. 160-175 and pp. 281-309.
36. On this differential picture, see the lecture, "Caracteres differentiels entre I'epilepsie et I'hystero epilepsie," summarized in Progres medical, 2,K' year, no. 2, 10 January 1874, pp. 18-19, and, Lecons, vol. 1, Lecture 13; Clinical Lectures, vol. 1, Lecture 13.
37. Lecons, vol. 3, Lecture 18: "A propos de six cas d'hysterie chez l'homme" pp. 260-261; Clinical Lectures, vol. 3, Lecture 18: "Concerning six cases of hysteria in the male,": "a
woman named Aurel -, now 62 years of age ( . . . ) left hemianaesthesia, complete ( . . . ) which ( . . . ) still exists to day, that is to say, after the long period of thirty-four years! This patient has been under our observation for fifteen years and the hemianaesthesia has never ceased (. . . ) to be present" pp. 226-227.
? 38. The case was thai of Habill, who, "had two series of attacks in December 1885: the first, which lasted 13 days in which 4506 attacks were counted, and the other, which lasted 14 days, in which 17,083 attacks were counted" Lemons du mardi, vol. II, Le^on IV, Policlinique du mardi 13 November 1888: Attaque de sommeil hystenque, p. 68.
39- Reference to the artificial reproduction of hysterical manifestations under hypnosis, with regard to which Charcot stated: "Then it is truly that we see before us the human machine in all its simplicity, dreamt of by De la Mettrie" Lecons, vol. Ill, p. 337; Clinical Lectures, vol. 3, Lecture 21: "On two cases of hysterical brachial monoplegia in the male of traumatic origin. --Hystero traumatic monoplegia (continuation)" p. 290. See Julien Offray de La Mettrie (1709-1751), L'Homme machine (Paris: 1747); English translation, Machine Man and Other Writings, trans. Ann Thomson (Cambridge: Cambridge University Press, 1996).
4(). Charcot, Lecons du mardi, vol. I, Polichnique du mardi 24 January 1888: "Paralysies hystero- traumatiques developpees par suggestion," pp. 135-136: "This paralysis ( . . . ) could be reproduced artificially in certain circumstances, which is the wonderful thing about it and ideal in pathological physiology.
To be able to reproduce a pathological state is perfection, because it seems that we hold the theory when we have in our hands the means to repro duce the morbid phenomena. " See, ibid. Policlinique of Tuesday 1st May 1888: "Production artificielle de parlaysie dans Fetal hypnotique: procedes de guerison de ces paralysies expcnmentales" (in a hypnotisable hystero epileptic) pp. 373-385.
41. In 1870, owing to renovations to the Sainte-Laure building, in which the insane, epileptics and hysterics in Louis Delasiauve's department were hospitalized, the administration put the insane and reputedly insane epileptics in Baillarger's department, and opened a department lor the other epileptics and hysterics: the "section of simple epileptics," which was entrusted to Charcot in 1872. See the "Le^on d'ouverture" of the chair of the clinic of illnesses of the nervous system, in Lecons, vol. Ill, pp. 2-3; Clinical Lectures, vol. 3, "Introductory" pp. 2-3.
42. J. -M. Charcot, "Metallotherapie et hypnotisme. Electrotherapie," in CEuvres completes, vol. IX (Paris: Lecrosnier & Babe, 1890) p. 297: "The research undertaken at the hospital
of la Salpetriere by M. Charcot and, under his direction, by several of his students, date from 1878. " Charcot set out his first results in "Lemons sur le grand hypnotisme chez les hysteriques. " At the Academie des sciences on 13 February 1882 he gave a paper that proposed a description in neurological terms and sought to give hypnosis a scientific status: "Physiologie pathologique. Sur les divers etats nerveux determines par Fhypnotisation chez
les hysteriques," Comptes rendus hebdomadaires des seances de VAcademie des sciences, vol. 94, no. \, 13 February 1882 (Paris: Gauthier Villars, 1882) pp. 403-405. See, A. R. Owen, Hysteria, Hypnosis and Healing: the Work ofJ. -M. Charcot (London: D. Dobson, 1971).
43. In the 1860s problems arose linked to series of industrial and railway accidents: problems
o( expertise, indemnities, and the determination of employment disability. With regard to industrial accidents, La Securite Generate, supported by the Credit Industriel et Commercial, was created by decree on 14 November 1865- The law of 11 July 1868 recom mended the creation of two national funds for insurance in cases of death and accidents arising from industrial and agricultural work; it was spelled out by the decree of 10 August 1868. In May 1880, a draft bill on "responsibility lor the accidents suffered by workers in their work" was put forward by Martin Nadaud; it was not until 9 April 1898 that the law on accidents at work was passed. See (a) G. Hamon, Histoire generale de I'assurance en France et a Vetranger (Paris: A. Giard and F. Briere, 1897); (b) V. Senes, Les Origines des compagnies d'assurance (Paris: L. Dulac, 1900); (c) J. -P. Richard, Histoire des institutions d*assurance en France (Paris: Ed. de FArgus, 1956); ( d ) H. Hatzfeld, Du pauperisme a la Securite sociale, 1850-1940 (Paris: 1971). Foucault returns to the question in October 1974: see, "Crise de la medecine ou crise de Fantimedecine," Dits et Ecrits, vol. 3, p. 54.
44. In January and February 1867, Henri Legrand du Saulle (1830-1886) devoted a series of lectures to the question published in his Etude medico-legale sur les assurances sur la vie (Paris: Savy, 1868).
45- Thus, Cl. Guillemaud deals with the question of screening for simulation in his work, Des accidents de chemin defer et de leurs consequences medico-judiciaires (Paris: 1851) pp. 40-41. A. Souques devotes his thesis to the question of simulation: Contribution a I'etude des syndromes hysteriques "simulateurs" des maladies organiques de la moelle epiniere, Medical Thesis, Pans,
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no. 158 (Paris: Lecrosnier & Babe, 1891). See also above, note 20 to lecture of 12 December
1973, and note 20 to lecture of 30 January 1974.
46. See above p. 184 sq and p. 234 sq. In the second half of the nineteenth century there is a
growing literature on the results of these accidents: [A] Anglo Saxon, which attributes
them to an inflammation either of the spine ("Railway Spine") or the brain ("Railway
Brain"). See (a) J. E. Erichsen, On Railway and Other Injuries of the Nervous System (Philadelphia: H. C. Lea, 1867), and On Concussion of the Spine, Nervous Shock, and Other ObscureInjuriesoftheNervousSystem(New York:Wood,1875);(b) H. W. Page,Injuriesofthe
Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in their Surgical
and Medico-legal Aspects (London: J. Churchill, 1883), and his book, a dedicated copy ol
which he sent to Charcot, Railway Injuries with Special Reference to those oj the Back and Nervous System in their Medico-legal and Clinical Aspects (London: Griffin and Co. ,
1891). | B | German, which considers the results to be a specific "traumatic neurosis. " See,
(a) H. Oppenhcim and R. Thomsen, "Uber das Vorkommen und die Bedeutung der sensorishcen Aniisthesie bei Erkrankungen des zentralen Nerven-systems" Archiv fur Psychiatrie (Berlin, 1884) vol. 15, pp. 559-583 and pp. 663-680; (b) H. Oppenhcim, Die traumatischen Neurosen (. . . ^(Berlin: Hirschwald, 1889). Charcot devotes an 1877 lecture to
the question: "De Pinfluence des lesions traumatiques sur le developpement des phenomenes d'hyserie locale" (lecture given at la Salpetriere, December 1877), Progres medical, 6th year, no. 18, 4 May 1878, pp. 335-338. Not accepting the existence of a specific
clinical entity and arguing for the possibility of reproducing paralyses under hypnosis sim
ilar to traumatic paralyses, Charcot defined a variety of hysteria: "traumatic hysteria. "
Between 1878 and 1893 he published twenty cases oi paralysis due to accidents at work or
railway accidents: (1) Lecons, vol. Ill, Lecture 18 (in which he criticizes the German con ception) p. 258; Lecture 22: "Sur deux cas de monoplegie brachiale hystenque chez l'homme," pp. 354-356; Lecture 23: "Sur deux cas de coxalgie hysterique chez Phomme,"
pp. 370-385; Lecture 24 (pp. 386-398 in which draws an analogy between the English "nervous shock" and the hypnotic state produced by suggestion), and Appendix 1,
pp. 458-462; English translation, Clinical Lectures, vol. 3: Lecture 18, "Concerning six cases
of hysteria in the male," pp. 224-225; Lecture 22, "On two cases ol hysterical brachial monoplegia in the male (continuedy'; Lecture 24, "On a case of hysterical hip disease in a
man resulting from injury"; and Appendix 1, "Two additional cases of hystero-traumatic paralysis in men"; (2) Lecons du mardi, vol. II, Policlinique of Tuesday 4 December 1888,
Lecture 7, pp. 131-139, Appendix 1: "Hysterie et nevrose traumatique. Collision des trains
et hysterie consecutive," pp. 527-535; (3) Clinique des maladies du systemenerveux, vol. 1,
Lecture 3, 13 November 1889, pp. 61-64; (4) J. M. Charcot and P. Marie, "Hysteria,
mainly hystero epilepsy"--which opposes the German conception ol a specific "traumatic neurosis"--in, D. Hack Tuke, Dictionary of Psychological Medicine, vol. 1 (London: J. &
A. Churchill, 1892) pp. 639-640. See also, (a) Ch. Vibert, La Nevrose traumatique. Etude medico-legale sur les blessures produites par les accidents de chemin defer et les traumatismes analogues (Paris: J. B. Bailliere, 1893); ( b ) E. Fischer-Homberger, "Railway Spine und traumatische Neurose. Seele und Ruckenmark," Gesnerus, vol. 27, 1970, pp. 96-111, and since then we
have his book Die Traumatische Neurose. Vom somatischen %um so^ialen Leiden (Berne: Hans Huber, 1975).
47. Lecons, vol. Ill, Lecture 24, "Sur un cas de coxalgie hystenque de cause traumatique chez l'homme" (from Dr. P. Mane) pp. 391-392; Clinical Lectures, vol. 3, Lecture 24: "On a case of hysterical hip disease in a man, resulting from injury" pp. 333-334- To demonstrate that Ch. , a sawyer, the victim of an accident at work, was suffering from hysterical coxalgia, without organic lesion, Charcot reproduced the coxalgia in two patients placed in a "hypnotic state. "
48. On simulation, see above, note 45. There are references to this literature in: ( a ) A. Laurent, Etude medico-legale sur la simulation de lafolie; ( b ) E. Boisseau, article, "Maladies simulees," in Dictionnaire encydopedique des sciences medicales, 2nd series, vol. IV (Paris: Masson/Asselin, 1876) pp. 266-281; (c) G. Tourdes, article, "Simulation. " Charcot takes up the question
on several occasions: (1) Lecons du mardi, vol. I, Policlinique of Tuesday 20 March 1888: "Ataxie locomotnce. Forme anormale," pp. 281-284; (2) Lecons, vol. I, Lecture 9, "De l'ischurie hysterique" ? "Simulation" pp. 281-283, Clinical lectures, vol. 1,
? Lecture 9: "Hysterical ischuria" pp. 230-232; vol. Ill, "Lecon d'ouverture de la chaire de la clinique des maladies du systeme nerveux" ? VII, "Simulation" pp. 17-22; vol. 3, Lecture 1: "Introductory--? Simulation," and Lecture 26, "Cas de mutisme hysterique chez l'homme. Lcs simulations" p. 422; "A case ol hysterical mutism in a man--? Malingerers. "
49. From the 1880s, Hippolyte Bernheim (1840-1919), professor of the Faculty and president of the Nancy Societe medicale, criticized Charcot's experiments: De la suggestion dans I'etat hypnotique et dans I'etat de veille (Paris: Doin, 1884). He makes the criticism clearer in Hypnotisme, Suggestion, Psychotherapie. Etudes nouvelles (Pans: Doin, 1891) p. 172: "One would not believe how many neuropaths and hysterics we are liable to produce by unconscious suggestion: we create neuralgia, hysterogenic zones (? ? ? ); we externalize our conceptions on the patient; we fabricate an observation with the preconceived ideas we have in our mind. " Already, in an article that appeared in Le Temps, 29 January 1891, he declared: "I believe that the attack of grand hysteria that la Salpetnere gives us as classical, unfolding in clear and precise phases (. . . ) is an hysteria of culture. " Refusing moreover to confine hypnotism in the pathological register, he asserts that "what we call hypnotism is nothing other than the activation ol a normal property of the brain, suggestibility, that is to say the capacity to be influenced by an accepted idea and to seek its realization. " On the Charcot Bernheim debate, see Hillman, "A scientific study of hystery" Bulletin of the History of Medicine, vol. 29, no. 2, 1955, pp. 163-182.
50. The notion o( "trauma," understood first of all as a "mechanical action" liable to trigger hysterical accidents, was established from 1877. See, Lecons, vol. I, Appendix VII, "De l'influence des lesions traumatique sur lc development des phenomenes d'hystene locale" (December 1877) pp. 446-457 |the Appendix does not appear in the English translation, Clinical Lectures]. From 1885 the notion is deepened in the sense o( taking a mechanism of "traumatic suggestion" into account; see, ibid. vol. Ill, Lectures, 20, 21 and 22, "Sur deux cas de monoplegie brachiale hysterique, de cause traumatique chez l'homme" (with a sec- tion devoted to "Hypnotism and nervous shock"); Clinical Lectures, vol. Ill, Lectures 20, 21 and 22, "On a case of hysterical hip disease in a man, resulting from injury. "
51. This is the case of Le Logeais, a messenger of 29 years, knocked down on 21 October 1885 by a horse-drawn van. After being hospitalized twice, at Beaujon and the Hotel Dieu, he was admitted into Charcot's department on 21 March 1886, with paralysis and anesthesia of the limbs; see, Lecons, vol. Ill, Appendix I, "Cas de paralysie hystero traumatique survenue a la suite d'un accident de voiture" (Observation recorded by M. Berbez) pp. 541-559; Clinical Lectures, vol. 3, Appendix 1: "A case of hystero traumatic paraplegia supervening on a street accident. " The accident "gave rise to the conviction in Le Log 's mind that the wheels of the van which knocked him over 'passed over the body,' as he puts it. Nevertheless, this conviction, which has even appeared to him in his dreams, is completely erroneous" p. 386.
52. Ibid. pp. 553-554; ibid. p. 385: "in the very fact of local shock, and particularly in the sensory and motor phenomena attached thereto, must be sought the point of departure ol the suggestion. The sensation of heaviness or even absence of the limb struck, and, again, the paralysis which is never wanting, in some degree at any rate, will give rise quite naturally, as it were, to the idea of motor weakness of the limb. And this idea, by reason of the som nambulic mental condition, comes to acquire, after a period of incubation, a considerable development, and is finally able to become realised objectively in the form of a complete paralysis" p. 385.
53.
27. It wasjules Dcjenne who expressed himself in this way in his "Lec. on inaugurale a la clin- ique des maladies du systcme nerveux" on 31 March 1911, La Presse medicale, V1 April, 1911, pp. 253-258: "Through his studies on hysteria, Charcot rescued a domain from the psychi- atrists that the latter vainly tried to regain. Certainly his doctrine of hysteria has not remained wholly intact. But even if Charcot had only the merit of making doctors under- stand that, beyond material lesions, the problems posed by certain psychical disorders oflered their activity a considerable field, for this we would owe him all our gratitude. " Quoted in G. Guillain, J. -M. Charcot (1825-189)): sa vie, son cruvre (Paris: Masson, 1955) p. 143. An illustration ol this will be the transfer of paternity rights over hysteria to neurologists in medical encyclopedias and dictionaries.
28. Foucault is relerring here to the obituary notice Freud wrote in August 1893 and published in the Wiener medt\inische Wochenschrift, vol. 43, no. 37, 1893, pp. 1513-1520: "In the hall in which he gave his lectures there hung a picture which showed 'citizen' Pinel having the chains taken oil the poor madmen in the Salpetnere. " S. Freud, "Charcot" GW, vol. 1,1952, p. 28; English translation, "Charcot" in Standard Edition, vol. 3, p. 18; French translation, "Charcot" trans. J. Altounian and others in S. Freud, Resultats, Idees, Problemes, vol. I, 1890-1920 (Paris: Presses universitaires de France, 1984) p. 68.
29. J. M. Charcot, Lecons sur les maladies du sysleme nerveux, vol. 1, Lecture 11: "De l'hyperesthesie ovanenne," pp. 320-345; English translation, Clinical Lectures on Diseases of the Nervous System, trans. George Sigerson (London: New Sydenham Society, 1877) vol. 1, Lecture 11: "Ovarian hyperaesthesia" pp. 262-282: "most ol the accidents which persist, in
a more or less permanent manner, in the intervals between the convulsive (its ol hysterical patients, and which almost always enable us, on account ol the characteristics they present, to recognise the great neurosis lor what it really is, even in the absence of convulsions" p. 262. Thus "Hemianaeslhesia, paralysis, contracture, fixed painful points occupying dillerent parts of the body," p. 262.
30. J. -M. Charcot, Lecons, vol. 1, Appendice V: "Des troubles de la vision chez les hystenques," pp. 427-434- (This appendix is omitted Irom the English translation. )
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31. Lemons, vol. 1, Lecture 10: "De l'heminesthesie hysterique" pp. 300-319; Clinical Lectures, vol. 1, "Hysterical hemianaesthesia" pp. 246-261.
32. Ibid. Lecture 12: "De la contracture hysterique" pp. 347-366; "Hysterical contracture" pp. 283-299; Lecons sur les maladies, vol. 3, Lecture 7: "Deux cas de contracture hysterique d'origine traumatique" pp. 97-107, and Lecture 8, (continued), pp. 109-123; Clinical Lectures, vol. 3, Lectures 7 and 8, "Two cases of hysterical contracture of traumatic origin" pp. 84-106.
33. Thus, in the Policlinique of 21 February 1888, "Hysteria in young boys," Charcot acknowl- edged: "It is very strange that in particularly mental forms the stigmata do not appear. " Lecons du mardi a la Salpetriere. Policlinique 1887-1S88, vol. 1, p. 208: "All these stigmata (. . . ) are constants in hysteria, but despite their constancy, I have to acknowledge that it quite often happens that we do not find them all, or even, when it comes to it, any. "
34- Sketched out Irom 1872 in the Lecons (vol. 1, Lecture 13: "De Phystero-epilepsie" pp. 373-374, and Appendice 6: "Description de la grande attaque hysterique" pp. 435-448; Clinical lectures, vol. 1, Lecture 13, "Hystero epilepsy" pp. 302-307, [the appendix is omitted from the English translation]), it was codified in 1878 when Charcot reduced it to a "a very simple formula": "All these apparently disordered and variable phenomena . . . follow a rule of development. The complete attack is made up ol four periods: 1. Epileptoid period. It may and usually does resemble the genuine epileptic attack (. . . ). There are grounds for dividing this epileptic period into three phases: a) tonic phase (. . . ); b) clonic phase. Limbs and the whole body are shaken by brief and rapid oscillations ( . . . ) which end in big generalized jolts ( . . . ) ; c) phase of resolution ( . . . ) . 2. Period of contortions and large movements (. . . ). 3. Period of passionate poses. Hallucination clearly governs this third period. The patient herself comes on the stage and through the expressive and ani- mated gesticulations to which she abandons herseli ( . . . ) it is easy to lollow all the episodes of the drama at which she thinks she is present and in which she olten plays the leading role (. . . ). 4. Terminal period. Finally the patient returns to the real world. " P. Richer's record of "Description de la grande attaque hysterique. Hospice de la Salpetriere," Progres medical, 7th year, no. 2, 11 January 1879, pp. 17-18.
35. While the term "hystero-epilepsy" (see above, note 19) covered, as Charcot recalls, "a com- bination of the two neuroses, varying in proportions in different cases," constituting "a mixed form, a kind of hybrid composed half oi hysteria and hall ol epilepsy," Charcot means to distinguish between epilepsy and hystero-epilepsy as pathologically distinct entities, which could not come together to iorm "a hybrid" illness. He also distinguishes a "hystero-epilepsy with distinct crises," in which epilepsy is the primary disease on which hysteria becomes grafted, and a "hysteria, with mixed attacks," in which the epileptic Iorm of convulsion only appears as "an accessory element": "in these cases, hysteria is solely and always present, taking on it the semblance of epilepsy" Lecons, vol. 1, Lecture 13: "De 1' hystero epilepsie" pp. 368-369; Clinical Lectures, vol. 1, Lecture 13: "Hystero epilepsy" pp. 301-302. So the term "hystero-epilepsy" designates no more than the final degree oi hysteria taken to its extreme development, or major hysteria. He will later reject the term itself: "My respect lor tradition previously led me to retain this denomination hystero epilepsy; but I confess to you that it bothers me a great deal, lor it is absurd. There is not the least relationship between epilepsy and hystero epilepsy, even with mixed attacks" Lecons du mardi, Lesson XVIII, 19 March 1889, pp. 424-425. Foucault returns to the question in Les Anormaux, lecture of 26 February 1975, p. 167; Abnormal, p. 224. See also, C. Fere, "Notes pour servir a I'histoire de Phystero-epilepsie," Archives de neurologic, vol. Ill, 1882, pp. 160-175 and pp. 281-309.
36. On this differential picture, see the lecture, "Caracteres differentiels entre I'epilepsie et I'hystero epilepsie," summarized in Progres medical, 2,K' year, no. 2, 10 January 1874, pp. 18-19, and, Lecons, vol. 1, Lecture 13; Clinical Lectures, vol. 1, Lecture 13.
37. Lecons, vol. 3, Lecture 18: "A propos de six cas d'hysterie chez l'homme" pp. 260-261; Clinical Lectures, vol. 3, Lecture 18: "Concerning six cases of hysteria in the male,": "a
woman named Aurel -, now 62 years of age ( . . . ) left hemianaesthesia, complete ( . . . ) which ( . . . ) still exists to day, that is to say, after the long period of thirty-four years! This patient has been under our observation for fifteen years and the hemianaesthesia has never ceased (. . . ) to be present" pp. 226-227.
? 38. The case was thai of Habill, who, "had two series of attacks in December 1885: the first, which lasted 13 days in which 4506 attacks were counted, and the other, which lasted 14 days, in which 17,083 attacks were counted" Lemons du mardi, vol. II, Le^on IV, Policlinique du mardi 13 November 1888: Attaque de sommeil hystenque, p. 68.
39- Reference to the artificial reproduction of hysterical manifestations under hypnosis, with regard to which Charcot stated: "Then it is truly that we see before us the human machine in all its simplicity, dreamt of by De la Mettrie" Lecons, vol. Ill, p. 337; Clinical Lectures, vol. 3, Lecture 21: "On two cases of hysterical brachial monoplegia in the male of traumatic origin. --Hystero traumatic monoplegia (continuation)" p. 290. See Julien Offray de La Mettrie (1709-1751), L'Homme machine (Paris: 1747); English translation, Machine Man and Other Writings, trans. Ann Thomson (Cambridge: Cambridge University Press, 1996).
4(). Charcot, Lecons du mardi, vol. I, Polichnique du mardi 24 January 1888: "Paralysies hystero- traumatiques developpees par suggestion," pp. 135-136: "This paralysis ( . . . ) could be reproduced artificially in certain circumstances, which is the wonderful thing about it and ideal in pathological physiology.
To be able to reproduce a pathological state is perfection, because it seems that we hold the theory when we have in our hands the means to repro duce the morbid phenomena. " See, ibid. Policlinique of Tuesday 1st May 1888: "Production artificielle de parlaysie dans Fetal hypnotique: procedes de guerison de ces paralysies expcnmentales" (in a hypnotisable hystero epileptic) pp. 373-385.
41. In 1870, owing to renovations to the Sainte-Laure building, in which the insane, epileptics and hysterics in Louis Delasiauve's department were hospitalized, the administration put the insane and reputedly insane epileptics in Baillarger's department, and opened a department lor the other epileptics and hysterics: the "section of simple epileptics," which was entrusted to Charcot in 1872. See the "Le^on d'ouverture" of the chair of the clinic of illnesses of the nervous system, in Lecons, vol. Ill, pp. 2-3; Clinical Lectures, vol. 3, "Introductory" pp. 2-3.
42. J. -M. Charcot, "Metallotherapie et hypnotisme. Electrotherapie," in CEuvres completes, vol. IX (Paris: Lecrosnier & Babe, 1890) p. 297: "The research undertaken at the hospital
of la Salpetriere by M. Charcot and, under his direction, by several of his students, date from 1878. " Charcot set out his first results in "Lemons sur le grand hypnotisme chez les hysteriques. " At the Academie des sciences on 13 February 1882 he gave a paper that proposed a description in neurological terms and sought to give hypnosis a scientific status: "Physiologie pathologique. Sur les divers etats nerveux determines par Fhypnotisation chez
les hysteriques," Comptes rendus hebdomadaires des seances de VAcademie des sciences, vol. 94, no. \, 13 February 1882 (Paris: Gauthier Villars, 1882) pp. 403-405. See, A. R. Owen, Hysteria, Hypnosis and Healing: the Work ofJ. -M. Charcot (London: D. Dobson, 1971).
43. In the 1860s problems arose linked to series of industrial and railway accidents: problems
o( expertise, indemnities, and the determination of employment disability. With regard to industrial accidents, La Securite Generate, supported by the Credit Industriel et Commercial, was created by decree on 14 November 1865- The law of 11 July 1868 recom mended the creation of two national funds for insurance in cases of death and accidents arising from industrial and agricultural work; it was spelled out by the decree of 10 August 1868. In May 1880, a draft bill on "responsibility lor the accidents suffered by workers in their work" was put forward by Martin Nadaud; it was not until 9 April 1898 that the law on accidents at work was passed. See (a) G. Hamon, Histoire generale de I'assurance en France et a Vetranger (Paris: A. Giard and F. Briere, 1897); (b) V. Senes, Les Origines des compagnies d'assurance (Paris: L. Dulac, 1900); (c) J. -P. Richard, Histoire des institutions d*assurance en France (Paris: Ed. de FArgus, 1956); ( d ) H. Hatzfeld, Du pauperisme a la Securite sociale, 1850-1940 (Paris: 1971). Foucault returns to the question in October 1974: see, "Crise de la medecine ou crise de Fantimedecine," Dits et Ecrits, vol. 3, p. 54.
44. In January and February 1867, Henri Legrand du Saulle (1830-1886) devoted a series of lectures to the question published in his Etude medico-legale sur les assurances sur la vie (Paris: Savy, 1868).
45- Thus, Cl. Guillemaud deals with the question of screening for simulation in his work, Des accidents de chemin defer et de leurs consequences medico-judiciaires (Paris: 1851) pp. 40-41. A. Souques devotes his thesis to the question of simulation: Contribution a I'etude des syndromes hysteriques "simulateurs" des maladies organiques de la moelle epiniere, Medical Thesis, Pans,
6 February 1974 329
? 330 PSYCHIATRIC POWER
no. 158 (Paris: Lecrosnier & Babe, 1891). See also above, note 20 to lecture of 12 December
1973, and note 20 to lecture of 30 January 1974.
46. See above p. 184 sq and p. 234 sq. In the second half of the nineteenth century there is a
growing literature on the results of these accidents: [A] Anglo Saxon, which attributes
them to an inflammation either of the spine ("Railway Spine") or the brain ("Railway
Brain"). See (a) J. E. Erichsen, On Railway and Other Injuries of the Nervous System (Philadelphia: H. C. Lea, 1867), and On Concussion of the Spine, Nervous Shock, and Other ObscureInjuriesoftheNervousSystem(New York:Wood,1875);(b) H. W. Page,Injuriesofthe
Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in their Surgical
and Medico-legal Aspects (London: J. Churchill, 1883), and his book, a dedicated copy ol
which he sent to Charcot, Railway Injuries with Special Reference to those oj the Back and Nervous System in their Medico-legal and Clinical Aspects (London: Griffin and Co. ,
1891). | B | German, which considers the results to be a specific "traumatic neurosis. " See,
(a) H. Oppenhcim and R. Thomsen, "Uber das Vorkommen und die Bedeutung der sensorishcen Aniisthesie bei Erkrankungen des zentralen Nerven-systems" Archiv fur Psychiatrie (Berlin, 1884) vol. 15, pp. 559-583 and pp. 663-680; (b) H. Oppenhcim, Die traumatischen Neurosen (. . . ^(Berlin: Hirschwald, 1889). Charcot devotes an 1877 lecture to
the question: "De Pinfluence des lesions traumatiques sur le developpement des phenomenes d'hyserie locale" (lecture given at la Salpetriere, December 1877), Progres medical, 6th year, no. 18, 4 May 1878, pp. 335-338. Not accepting the existence of a specific
clinical entity and arguing for the possibility of reproducing paralyses under hypnosis sim
ilar to traumatic paralyses, Charcot defined a variety of hysteria: "traumatic hysteria. "
Between 1878 and 1893 he published twenty cases oi paralysis due to accidents at work or
railway accidents: (1) Lecons, vol. Ill, Lecture 18 (in which he criticizes the German con ception) p. 258; Lecture 22: "Sur deux cas de monoplegie brachiale hystenque chez l'homme," pp. 354-356; Lecture 23: "Sur deux cas de coxalgie hysterique chez Phomme,"
pp. 370-385; Lecture 24 (pp. 386-398 in which draws an analogy between the English "nervous shock" and the hypnotic state produced by suggestion), and Appendix 1,
pp. 458-462; English translation, Clinical Lectures, vol. 3: Lecture 18, "Concerning six cases
of hysteria in the male," pp. 224-225; Lecture 22, "On two cases ol hysterical brachial monoplegia in the male (continuedy'; Lecture 24, "On a case of hysterical hip disease in a
man resulting from injury"; and Appendix 1, "Two additional cases of hystero-traumatic paralysis in men"; (2) Lecons du mardi, vol. II, Policlinique of Tuesday 4 December 1888,
Lecture 7, pp. 131-139, Appendix 1: "Hysterie et nevrose traumatique. Collision des trains
et hysterie consecutive," pp. 527-535; (3) Clinique des maladies du systemenerveux, vol. 1,
Lecture 3, 13 November 1889, pp. 61-64; (4) J. M. Charcot and P. Marie, "Hysteria,
mainly hystero epilepsy"--which opposes the German conception ol a specific "traumatic neurosis"--in, D. Hack Tuke, Dictionary of Psychological Medicine, vol. 1 (London: J. &
A. Churchill, 1892) pp. 639-640. See also, (a) Ch. Vibert, La Nevrose traumatique. Etude medico-legale sur les blessures produites par les accidents de chemin defer et les traumatismes analogues (Paris: J. B. Bailliere, 1893); ( b ) E. Fischer-Homberger, "Railway Spine und traumatische Neurose. Seele und Ruckenmark," Gesnerus, vol. 27, 1970, pp. 96-111, and since then we
have his book Die Traumatische Neurose. Vom somatischen %um so^ialen Leiden (Berne: Hans Huber, 1975).
47. Lecons, vol. Ill, Lecture 24, "Sur un cas de coxalgie hystenque de cause traumatique chez l'homme" (from Dr. P. Mane) pp. 391-392; Clinical Lectures, vol. 3, Lecture 24: "On a case of hysterical hip disease in a man, resulting from injury" pp. 333-334- To demonstrate that Ch. , a sawyer, the victim of an accident at work, was suffering from hysterical coxalgia, without organic lesion, Charcot reproduced the coxalgia in two patients placed in a "hypnotic state. "
48. On simulation, see above, note 45. There are references to this literature in: ( a ) A. Laurent, Etude medico-legale sur la simulation de lafolie; ( b ) E. Boisseau, article, "Maladies simulees," in Dictionnaire encydopedique des sciences medicales, 2nd series, vol. IV (Paris: Masson/Asselin, 1876) pp. 266-281; (c) G. Tourdes, article, "Simulation. " Charcot takes up the question
on several occasions: (1) Lecons du mardi, vol. I, Policlinique of Tuesday 20 March 1888: "Ataxie locomotnce. Forme anormale," pp. 281-284; (2) Lecons, vol. I, Lecture 9, "De l'ischurie hysterique" ? "Simulation" pp. 281-283, Clinical lectures, vol. 1,
? Lecture 9: "Hysterical ischuria" pp. 230-232; vol. Ill, "Lecon d'ouverture de la chaire de la clinique des maladies du systeme nerveux" ? VII, "Simulation" pp. 17-22; vol. 3, Lecture 1: "Introductory--? Simulation," and Lecture 26, "Cas de mutisme hysterique chez l'homme. Lcs simulations" p. 422; "A case ol hysterical mutism in a man--? Malingerers. "
49. From the 1880s, Hippolyte Bernheim (1840-1919), professor of the Faculty and president of the Nancy Societe medicale, criticized Charcot's experiments: De la suggestion dans I'etat hypnotique et dans I'etat de veille (Paris: Doin, 1884). He makes the criticism clearer in Hypnotisme, Suggestion, Psychotherapie. Etudes nouvelles (Pans: Doin, 1891) p. 172: "One would not believe how many neuropaths and hysterics we are liable to produce by unconscious suggestion: we create neuralgia, hysterogenic zones (? ? ? ); we externalize our conceptions on the patient; we fabricate an observation with the preconceived ideas we have in our mind. " Already, in an article that appeared in Le Temps, 29 January 1891, he declared: "I believe that the attack of grand hysteria that la Salpetnere gives us as classical, unfolding in clear and precise phases (. . . ) is an hysteria of culture. " Refusing moreover to confine hypnotism in the pathological register, he asserts that "what we call hypnotism is nothing other than the activation ol a normal property of the brain, suggestibility, that is to say the capacity to be influenced by an accepted idea and to seek its realization. " On the Charcot Bernheim debate, see Hillman, "A scientific study of hystery" Bulletin of the History of Medicine, vol. 29, no. 2, 1955, pp. 163-182.
50. The notion o( "trauma," understood first of all as a "mechanical action" liable to trigger hysterical accidents, was established from 1877. See, Lecons, vol. I, Appendix VII, "De l'influence des lesions traumatique sur lc development des phenomenes d'hystene locale" (December 1877) pp. 446-457 |the Appendix does not appear in the English translation, Clinical Lectures]. From 1885 the notion is deepened in the sense o( taking a mechanism of "traumatic suggestion" into account; see, ibid. vol. Ill, Lectures, 20, 21 and 22, "Sur deux cas de monoplegie brachiale hysterique, de cause traumatique chez l'homme" (with a sec- tion devoted to "Hypnotism and nervous shock"); Clinical Lectures, vol. Ill, Lectures 20, 21 and 22, "On a case of hysterical hip disease in a man, resulting from injury. "
51. This is the case of Le Logeais, a messenger of 29 years, knocked down on 21 October 1885 by a horse-drawn van. After being hospitalized twice, at Beaujon and the Hotel Dieu, he was admitted into Charcot's department on 21 March 1886, with paralysis and anesthesia of the limbs; see, Lecons, vol. Ill, Appendix I, "Cas de paralysie hystero traumatique survenue a la suite d'un accident de voiture" (Observation recorded by M. Berbez) pp. 541-559; Clinical Lectures, vol. 3, Appendix 1: "A case of hystero traumatic paraplegia supervening on a street accident. " The accident "gave rise to the conviction in Le Log 's mind that the wheels of the van which knocked him over 'passed over the body,' as he puts it. Nevertheless, this conviction, which has even appeared to him in his dreams, is completely erroneous" p. 386.
52. Ibid. pp. 553-554; ibid. p. 385: "in the very fact of local shock, and particularly in the sensory and motor phenomena attached thereto, must be sought the point of departure ol the suggestion. The sensation of heaviness or even absence of the limb struck, and, again, the paralysis which is never wanting, in some degree at any rate, will give rise quite naturally, as it were, to the idea of motor weakness of the limb. And this idea, by reason of the som nambulic mental condition, comes to acquire, after a period of incubation, a considerable development, and is finally able to become realised objectively in the form of a complete paralysis" p. 385.
53.
