Sunday, April 06, 2008

Jean-Martin Charcot (1825-1893) influences Freud

Charcot's primary focus was neurology - a medical specialty dealing with disorders of the nervous system.   He named and was the first to describe multiple sclerosis. Born in Paris, Charcot worked and taught at the famous Salpêtrière Hospital for thirty three years. His reputation as an instructor drew students from all over Europe. In 1882, he established a neurology clinic at Salpêtrière, which was the first of its kind in Europe.  On the neurological front he added more symptoms to James Parkinson's clinical description and then subsequently attached the name Parkinson's Disease to this particular syndrome. He made a lot of original discoveries which are beyond the scope of this small post.

Our interest here is his notable influence on Freud's thinking.  Professor Raymond E. Fancher in his magisterial Pioneers of Psychology quotes the following description of Charcot's methodology from Freud's own writings:

He used to look again and again at the things he did not understand, to deepen his impression of them day by day, till suddenly an understanding of them dawned on him.  In his mind's eye  the apparent chaos presented by the continual repetition of the same symptoms then gave way to order: the new [diagnostic] pictures emerged, characterized by the constant combination of certain groups of symptoms.

(Freud quoted in Fancher, op.cit., 350)

From this we can see than our man Charcot was an exceptional clinician.  No wonder he was called the "Napoleon of the Neuroses" in his time. Fancher describes him as a "master showman," who "imitated the symptoms of various neurological diseases, engaged patients in dramatic dialogue, and had them wear hats with long feathers whose different vibrations illustrated different kinds of tremors." (Ibid., 349)  This great neurologist also named the "grand mal" and "petit mal" forms of epilepsy.  However, it was his work on patients suffering from hysteria that was to influence Freud greatly.

A note on Hysteria:

The traditional symptoms of hysteria are: hallucinations, somnambulism, fits of violent emotion,, epileptic seizures, functional anaesthesia, functional paralysis and dissociation.  Now, even to the unprofessional eye, there is a hugely broad array of symptoms - too broad in fact.  The Penguin Dictionary of Psychology has this to say:

The problems with a general classification like this with such an array of symptoms are enormous.  The lack of understanding of the disorder may quite possibly, be due to the fact that there is no single disorder here at all.  In all likelihood what we have is a variety of maladaptive behaviours each of which exists more or less independently of the others with the hysterical syndrome existing only in the mind of the diagnostician.  (Opus citatum, Arthur S. Reber, 1985, 337)

As well as that, for some reason, hysteria was only ever diagnosed in women, never in men.  As the dictionary further points out the more recent DSMs do not list this disease at all, but happily break the phenomenon into three of four disorders that embrace all those symptoms listed above.  So one can see a particularly cultural and sexual bias here immediately.  Like his clinical observation of epilepsy Charcot distinguished between what he called Grande Hystérie and Petite Hystérie.

As I have pointed out both Freud and Alfred Binet acknowledged Charcot as an exceptionally brilliant clinician and an equally formidable diagnostician - well able to spot and clinically describe problems, even though some of his therapies and cures were later debunked.  Between October 1885 and February 1886 Freud had worked under Charcot whose teaching on hysteria awoke his interest in the problems of the neuroses as opposed to the organic diseases of the nervous system. Charcot had demonstrated to Freud that hypnosis could be used to distinguish hysterical paralysis (or neurotic paralysis) from organic paralysis of the CNS (Central Nervous System).  Freud now could see clearly that strange and misguided ideas could cause neuroses and paralysis.  Such paralysis could be cured and and reactivated artificially and cured again and again.

Charcot was noble enough to admit his errors on hypnotism, and privately predicted that his theories on hysteria would not long survive him.  However, he did achieve much.  He had a profound influence on his students as an eminent clinician; he was among the first to explore interactions between emotional and physical factors; he put hypnosis centre stage in the medical field; brought respectability to psychopathology and even influenced later studies into "mob hysteria."

Above a picture of Charcot.

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