what did charcot observe while using hypnosis to treat women with hysteria?

Jean-Martin Charcot (1825–1893), cheers to his insight as a clinician tin can be said to be 1 of the precursors of scientific psychology. Charcot'due south 30 years of activity at La Salpêtrière hospital display an intellectual trajectory that decisively inverse the idea of man psychology by favouring the emergence of two concepts: the subconscious and the unconscious. It was his collaboration with Pierre Janet (1859–1947), a philosopher turned dr., that led to this development, relying on the search for hysteria'southward aetiology, using hypnosis equally a method of exploration. Focusing on clinical psychology that was experimental and observational, Janet congenital a theory of psychic automatism, "the involuntary exercise of retentiveness and intelligence" leading to "independence of the faculties, freed from personal power." From all that came the idea of the subconscious, a operation as a passive mental mechanism, resulting from a more than or less temporary dissociation of previously associated mental content.

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Jean-Martin Charcot

Jean-Martin Charcot (1825–1893) is recognized equally one of the precursors of neurology, working in the 2d half of the 19th century in Paris (Fig. one). During his training in various hospitals, it was non mental pathology that sparked his intellectual curiosity. In 1862, he was appointed to direct a department of chronic patients in what was originally a nursing home also as an asylum, the Hospice de la Vieillesse Femmes de La Salpêtrière. Due to the battered condition of the Sainte-Laure building, on the verge of collapse, the patients treated upwards to that point by the hospital alienist, Louis Delasiauve (1804–1893), were transferred in 1868 to the Petites Loges facility, which Charcot oversaw. This unexpected administrative decision led him to treat epileptics and hysterics. At the time, medical science regarded these pathologies with disdain, because them of piddling interest. As Charcot put it: "A decision we did non ask for placed a department of nigh 150 beds nether our responsibleness. We tin can now find all forms of epilepsy and serious hysteria" [1]. And in the words of the diarist Jules Clarétie (1840–1913): "Chance brought the state of affairs about, from which scientific discipline benefited" [two]. Taking on hysteria, with the invaluable aid of his educatee Désiré Magloire Bourneville (1840–1909), Charcot brandish a trajectory of precursor of scientific psychology, availing himself of his discernment as a clinician. Charcot's xxx years of activity at La Salpêtrière infirmary elucidate an intellectual trajectory that decisively changed the idea of human psychology past favouring the emergence of two concepts: the subconscious and the unconscious. "His work equally a clinician-teacher, only establishing doctrine as tested by specific cases, which implied slow sedimentation and permanent revision, had the consequence of refracting alter." [three]. Charcot's abiding modifications to his thinking made him a true researcher able to contradict himself, whereas the works of his students, Paul Richer (1849–1933) [4] and Georges Gilles de la Tourette (1857–1904) [5], at times suggest the edification of a airtight, fixed dogma. The mythification of his work, and his research on hysteria in particular, was regarded with ambivalent fascination, more often leading to its unjust denigration than to the appreciation of the resulting concepts and advances, notably the accuracy of neurological examinations achieved by his educatee Joseph Babiński (1857–1932), which enabled distinguishing organic disturbances from functional disturbances [6, vii]. This happened at a menses during which the young Third Republic, imbued with positivism and to the slow evolution of a novel way of thinking, shaped by the imperious need to secularize medical thought and, in particular, the aetiology of mental diseases.

Fig. 1.

Jean-Martin Charcot (1825–1893) (Collection OW).

Charcot and the Psychological Origin of Hysteria

Early on in his career, Charcot laid the ground for agreement the spinal and cognitive origins of paralysis, using the anatomo-clinical method, but starting in 1890, he identified, with the assist of Pierre Janet (1859–1947), "diseases of representation," establishing their neurological equally well as psychic functioning. Subsequently obstinately searching for a lesion in nervous system structures visible through the microscope that would explain hysteria, Charcot arrived at the concept of an abnormal idea, or a lesion in a representation. He used pathophysiological models (hysterogenic zones) and experimental physiology (hypnosis) to improve his understanding of hysteria, then attributed to trauma the psychophysiological caption of a causal amanuensis (interior mental work). Starting with his 1870 lessons, his utilise of the analogy of his observations and the miraculous cures reported by the lexicographer Émile Littré (1801–1881) in his Philosophie positive indicate that the psychic matrix of hysteria was implicitly integrated, and from an early phase, in his thinking. The description of the extraordinary facts disseminated by religion, based on a psychic caption, is another constant in Charcot'due south work and that of his students. According to his biographer Paul Peugniez (1859–1943): "He had to have unshakable organized religion in his doctrine, and especially needed his extraordinary mental lucidity to risk studying these discredited subjects, to lift the veil that had terrified others upon their merely encountering it, the veil that had halted the nearly learned and accomplished men, including Lasègue. No other professor with an official chair had attempted to written report these occult phenomena, which since Antiquity had fascinated public opinion" [eight].

Charcot and Hypnosis

Charcot presented the use of hypnosis as an experimental technique, without whatever attempt to plow it into a therapy, on February 13, 1882. He sought to strengthen his candidacy for the French Academy of Sciences even though the Chair of Nervous System Diseases had recently been created for him. He entitled his presentation: "Sur defined états nerveux déterminés par l'hypnotisation chez les hystériques (On various nervous states determined by hypnotisation in hysterics)" [9]. He distinguished 3 phases in hypnotism: lethargy, catalepsy, and somnambulism, recalling what the dr. Charles-Humbert Despine (1777–1852) had written equally early as 1840 [x]. The scientific backing that Charcot lent to hypnosis rehabilitated it and enabled Paul Richer (1849–1933), followed by Georges Gilles de la Tourette (1857–1904) and other La Salpêtrière students, and then Janet, to utilise it for their own experimental research on the "mental state of hysterics," the subject of Janet'southward thesis for his doctorate in medicine, presided over by Charcot on July 29, 1893, ii weeks before the Principal's decease [11]. In the preface, Charcot wrote for the commercial version of Janet'south thesis, he noted: "The studies of my educatee Janet confirm the thinking oft expressed in our lessons, namely that hysteria is largely a mental affliction. This is one aspect of the illness that we must never neglect if we wish to understand and treat it" [12]. Freed of the supernatural, hypnosis became the validated experimental model of hysteria: "Between the organism's regular functioning and the spontaneous disturbances acquired past the illness, hypnotism becomes an approach open to experimentation. The hypnotic land is nothing but an bogus or experimental nervous state, the multiple manifestations of which announced or disappear according to the needs of the written report and the wishes of the observer. Seen in this low-cal, hypnotism becomes footing to exist mined, yielding precious results for the physiologist and the psychologist, besides as for the physician" [xiii]. Abandoning the quest for a lesion, and using a psychic aetiology for hysteria, Charcot opened the way to theoretical report and conceptualization not only past Pierre Janet just also by the beginning neuropsychologist Paul Sollier (1861–1933) and Sigmund Freud (1856–1939) and probably did non even realize the full scope of his approach for subsequently researchers. This development did not mask his constant desire to integrate hysteria in the neurological nosography, forth with all the other diseases he had been the first to place and depict. This would hateful that hysteria, a nervous system condition, would have a crusade explained past a rational physiology of the cerebral cortex, whereby psychology would laissez passer as a science [fourteen]. In an article on Charcot, Janet concluded: "Charcot did not invent hypnotism; this cannot be denied. He was not even the first to note its psychological value, but he did reveal information technology. Cheers to the considerable authority of his proper name, he was able to fully elucidate facts that until then had been observed in the shadows and to bring science to bear in areas previously surrounded by mystery and superstition" [xv].

Pierre Janet

Pierre Janet was born in Paris on May 30, 1859, to a family unit of office employees and thus of pocket-sized means (Fig. ii). His uncle was the philosopher Paul Janet (1823–1899). At the École Normale Supérieure, he began preparing for the competitive exam to become a philosophy professor, along with Henri Bergson (1859–1941), Emile Durkheim (1858–1917), and Jean Jaurès (1859–1914). At the same time, he worked as an assistant to Albert Dastre (1844–1917), a physiology professor at La Sorbonne. This activeness served every bit the equivalent of the first 2 years of medical schoolhouse. After passing the philosophy agrégation exam on September 07, 1881, he began teaching at the secondary school in the northwestern French city of Le Havre in 1883. Le Havre was a maritime, industrial, and commercial centre from which information technology was quick and piece of cake to reach Paris. Janet, thus, often visited his family and participated in the intellectual milieus he establish enriching [xvi].

Fig. 2.

Pierre Janet (1859–1947) (Collection OW).

He initially planned to study hallucinations for his doctoral thesis in literature. By take chances, one of his students was the son of a physician at the hospital, Joseph Gibert (1829–1899), and Janet got to know him and spent time in the department he directed with Léon-Jean Powilewicz (1852–1932), a section known for treating all "the neurotics in Normandy." Influenced by the teaching of the philosopher Théodule Ribot (1839–1916) and by his old friendship with the time to come Nobel Prize recipient Charles Richet (1850–1935) [17], Janet came up with the idea of using a mental pathology, hysteria, of which there were several cases in Gibert's section, every bit a natural experimental status, presaging Ribot's words in 1909: "The pathological method is based on both pure observation and experimentation. Disease is the most subtle form of experimentation, instituted past nature itself in specific circumstances and with processes that human art lacks. In this style, illness attains the inaccessible" [18]. Janet conducted his own hypnosis experiments in an endeavour to elucidate the pathophysiology of hysteria, like to what Charcot had been studying with his residents at La Salpêtrière for over 10 years. Janet initially focused on the case of i female patient, the "clairvoyant and magnetist Léonie," a 40-year-old servant from Normandy whom Gibert had catalogued as a "somnambulant hysteric." Charcot accepted Gibert's invitation to come to Le Havre in 1885 and examine this famous Léonie, along with other members of the French Gild of Physiological Psychology, created with Ribot and Richet that same yr. This beginning meeting with Charcot reoriented Janet's career, first through the access he gained to the Dispensary of Nervous Arrangement Diseases at La Salpêtrière, where he observed consultations, and more than broadly, through his decision to pursue medical studies.

Janet described Léonie's case this way: "This young woman was brought from the country to the Le Havre hospital at the age of nineteen, because she was considered crazy and at that place was nearly no promise for a cure. In reality, she had periods of convulsive attacks and delirium that went on for days. Afterward a fourth dimension of observation, information technology was like shooting fish in a barrel to meet that the affliction involved periodic accidents that recurred regularly with menstruum and other less serious accidents occurring irregularly in the intervals and extending over time. Regarding the first type of accident, Marie'south character inverse equally her periods approached; she became dark and fierce, unusual for her, and she experienced pain and nervous shaking in all limbs…" In addition to this clinical case, he collated observations and experiments that he had conducted with 19 hysterics of both genders and with 8 psychotics and epileptics to provide textile for his doctoral thesis in literature, defended in 1889, entitled L'automatisme psychologique, essai de psychologie expérimentale sur les formes inférieures de l'activité humaine (Psychological automatism, an experimental psychology essay on the inferior forms of human activity) [xv], a powerful showtime draft containing the main ideas that Janet would develop over one-half a century.

Janet and Psychic Automatism

Already in 1845, the alienist at La Salpêtrière (Fig. 3), Jules Baillarger (1809–1890), put frontwards an outline of a theory of psychic automatism, "the involuntary exercise of memory and intelligence" leading to "independence of the faculties, freed from personal power" [19]. In the diseases of personality, peculiarly disturbances linked to multiple personalities, Janet recognized the means of studying the phenomena of consciousness. He introduced the idea of the subconscious, "which is below consciousness, but of the same nature," to explain cases of double personality, initially, from a distinctly more philosophical than medical perspective. In his thesis, Janet revealed his Cartesian materialism in analysing the mental state of his patients before, during, and after hypnotic proposition, thereby establishing a descriptive, structural study of hypnosis. He tin can be said to have recycled the analysis proposed by Charcot in his dissertation as a candidate for the French Academy of Sciences, defining catalepsy, sluggishness, and somnambulism as "inferior forms of mental life" [20]. Present in normal humans, they are characterized past a mental state exterior voluntary control, thus condign the source of behaviours that appear automatic, uncontrolled. To describe it without whatsoever relation to lesional activity in the nervous organization, Janet introduced the idea of the subconscious, rather than the unconscious, whose manifestation would exist considered to underlie a loss of functional (or lesional) activity in the brain. He thought of its functioning as a passive mental mechanism, resulting from a more than or less temporary dissociation of previously associated mental content. Whatever private could experience this dissociation, either spontaneously or following trauma (accident, rape, etc.), or experimentally, as occurs in hypnosis. His own familiarity with the old practices of magnetism probably led Janet to these conclusions. He ended up interpreting the dissociative fact or "mental disintegration" equally the cause of all mental illnesses. As office of a unmarried personality, the salubrious private integrated and produced memories and bodily external (from the senses) and internal perceptions (or cenaesthesia, i.east., the internal perception of our own body or interoception), making him or her witting of his or her ain identity. The weakening of this chain by a psychological injury created the state of mental disintegration that prevented the sick individual from recognizing certain memories of facts, even though they had actually been encountered, every bit his or her own personal feel. The importance Janet accorded to suppressed memories led him to a new psychogenesis centred on unlike types of recollections and capacities of cued call up for remembrance. Was this based on chance coincidence? In the years that followed, Marcel Proust (1871–1922) created his novel A la recherche du temps perdu (In Search of Lost Time) past applying these approaches and the ane that is, the involuntary memories triggering re-experiencing, a new caption he learned when he stayed under the care of Paul Sollier [21]. Janet used his theory to achieve a conceptual tour de force, that of confirming classical philosophy, based on an introspective approach, all while giving psychiatric semiology a psychophysiological basis that was truly cerebral.

Fig. 3.

Outpatients department at La Salpêtrière in the fourth dimension of Charcot, engraving by Irène Zurkinden (1909–1987) (Collection OW).

It must be recalled that, as a tool for exploring the depths of the psyche, automatic writing occupied an initiatory place in Surrealism's identity. Merely André Breton (1896–1966) had systematically failed to acknowledge publicly that he had read and reread Pierre Janet's volume Fifty'Automatisme psychologique[22].

In 1889, the showtime international conference on experimental and therapeutic hypnotism was held from 8 to 12 August at Hôtel-Dieu hospital in Paris. Charcot was the honorary president, and the reports were written past the doc Edgar Bérillon (1859–1948). His teacher, Victor Dumontpallier (1826–1899), presided over the debates, an occasion for Gilles de la Tourette and the Nancy's physician Hippolyte Bernheim (1840–1919) to face off once more on the powers of proffer. Many presentations dealt with the therapeutic use of hypnosis, an objective that Charcot had always refused to consider [23]. In studying hysteria past means of hypnosis, Charcot placed emphasis on the psychological aetiology of the neuroses, and he had no wish to go any further. The debate between the Nancy and Salpêtrière schools was focused around a few cases of crime committed allegedly nether hypnosis. Dissimilar Bernheim, for Charcot'south pupils, subjects are unable to commit crime under hypnosis. The controversy betwixt these two schools afflicted medical, legal, and public in the Belle Époque [24].

The psychiatrist Auguste Forel (1848–1931) from Switzerland gave a presentation in which he drew a parallel betwixt the hypnotic country and "negative hallucination in lunatics" (the absence of prototype in the mirror, e.g., in the novel Le Horla by the writer Guy de Maupassant), that is, suggesting homology betwixt the two dissociated states. He also put forward this thesis in a volume he published around the aforementioned time in German language: Der Hypnotismus, seine Bedeutung und seine Handhabung (Hypnotism, its meaning and its treatment) [25]. The conference concluded with an extensive visit of La Salpêtrière, with Charcot hosting some 100 participants at the Clinic of Nervous System Diseases.

Janet at La Salpêtrière

Undoubtedly impressed past the originality of Janet's thesis and its influence, Charcot offered him a position in 1890 at the head of "a psychology laboratory" within the Dispensary of Nervous System Diseases and aligned with his thinking, as he expressed it during the lesson of Tuesday, January 17, 1888: "We must create a psychology that is strengthened by the pathological studies nosotros are conducting. This is what we are doing with psychologists who, this time, are willing to non exclusively consider what we telephone call interior observation" [26]. Later on initially turning to Ribot, a pure philosopher, Charcot placed his hopes in the younger Janet, soon to be a doc, for a psychopathological caption of hysteria. Janet directed the Salpêtrière laboratory, created expressly for him, with the abiding support of Charcot'south successor, Fulgence Raymond (1844–1910), with whom he published two books: Névroses et idées fixes (Neuroses and stock-still ideas) in 1898 and then Les obsessions et la psychasthénie (Obsessions and psychasthenia) in 1903. Notwithstanding, Jules Dejerine (1849–1917), Charcot's third successor, dismissed him and opposed his election to the French Academy of Medicine. The alienist-physician and neuropathologist Jean Nageotte (1866–1948) gave Janet a small function so that he could continue working at La Salpêtrière. Probably out of nostalgia, Janet connected all his life to publish his major works nether the auspices of the Salpêtrière psychology laboratory, even though information technology no longer existed [27, 28]. For Janet, the apogee of all his efforts was his election to the Chair of Experimental Psychology at the Collège de France in January 1902, where he had been Ribot's replacement in this chair since 1895. He would remain in this position until 1934.

Afterward Charcot'due south death, Fulgence Raymond remained faithful to the concepts developed past Charcot, enriched by Janet's contributions, in particular regarding the reality of hysteria in men, which Gilles de la Tourette continued to support also [five]. As for Babiński [29], he renounced his initial ideas [thirty], adjustment himself instead with the concepts defended by Bernheim and the Nancy Schoolhouse. For them, the physical and mental automatisms of hysterics and hypnotized patients were nothing more than the exaggeration of ordinary behaviours appreciable in all people, explained by natural credulity, for which Bernheim coined the term "crédividité naturelle." Hypnosis was merely the augmentation past suggestion of an innate human capacity, or passive obedience [31, 32]. The public demonstrations at La Salpêtrière were nothing more than than the product of the culture of proposition at that place.

Whereas the influence of Wilhelm Maximillian Wundt (1832–1920) in Germany oriented psychology towards a science that measured psychic functions, Janet focused on clinical psychology that was experimental and observational: "The method nosotros have tried to implement, without whatsoever pretension of having succeeded, is the method of the natural sciences […]. Nosotros have collected facts through observation; that is, the simple deportment we wished to study […]. Undoubtedly, nosotros only have indirect cognition of the psychological phenomena in other people, and psychology could not start past studying them; but according to actions, gestures, and language, we can induce their beingness, in the same fashion the pharmacist determines the elements in stars from the rays of the spectrum, and the certainty of i type of operation is as great as that of the other" [15].

Janet'due south Contributions to Psychology

Throughout the years he taught at the Collège de France, Janet used the same explanatory principles; that is, the dissociation of memories and somaesthesic perceptions, between the conscious and the subconscious, the loss of ability to appreciate reality, when he studied fatigue (1902), emotion (1903), movement (1904), hysteria (1905), and psychasthenia (1906). Similar to John Hughlings Jackson (1835–1911) [33], he enriched this approach by incorporating the Theory of Evolution of Charles Darwin (1809–1882) and its extension into realms of sociology past Herbert Spencer (1820–1903) to bear witness that psychological disorders, classified based on a scale of complexity, proceed from the junior to the superior, that is, in the opposite management of phylogenetic improvements, or ontogenetic progress. In this way, Janet was a forerunner to behaviourism. In 1926, Janet proposed 9 levels of psychic functioning in his De l'angoisse à 50'extase (From feet to ecstasy). His propositions can exist simplified as follows: agitation without any purpose emerges before language and corresponds "to the everyman actions, those that reappear when more than suitable and superior actions are excluded or become insufficient." Elementary mental operations requite rise to symbols and linguistic communication which retentivity underlies. For example, beliefs can be divided into "believing beliefs," that is, those linked to desire, resulting in swell variability, and manifesting themselves in the process of proposition (for Janet, they were at the root of legends and religious beliefs) and into "reflected behavior," that is, those "reproducing inside ourselves the word of an assembly and preventing assent until internal word has taken place," Finally, rational behaviours along with executive, experimental, and elaborate conduct represent to the highest development of individual action and can exist associated with the concept of progress and seeking progress, whatever the forms.

Janet also developed the dynamic aspect of psychology by hypothesizing psychic energy, that is, by examining the capacity to support a number of psychological acts over time. The variability of these parameters takes business relationship of the chapters to support the duration of psychic tension. The highest level results in successful social behaviour that is harmonious in i'south interactions with others and in line with reality. Deductions from these findings have become common cognition, involving psychological forcefulness or weakness in the face up of contingencies in family or professional life. Janet's psychology, thus, dealt with the psychic free energy and dynamics of behaviour.

Janet equally Therapist

Janet did not forget that he was a physician and in 1923 released his La médecine psychologique (Psychological medicine), which expanded upon Les médications psychologiques (Psychological medications), published in 1919. The volume started with a history of psychotherapies, the earliest of which Janet likened to religious practices and miracles. He went on to depict a parallel with "animal magnetism" and the practices of hypnosis at the terminate of the 19th century. In a section entitled "The clearance of traumatic memories," Janet made the following argument: "While treatments using aesthesiogenesis have non had a brilliant career until at present, the same is not true for seeking out traumatic subconscious memories, which I have identified in studies on somnambulism and which accept given ascent to various sects of psychoanalysis. There has been considerable development of a psychotherapeutic practise that recalls the enthusiasts for mesmerism, Christian Science, or hypnotism." Undoubtedly surprised by the dissemination of Sigmund Freud's ideas, he expressed bitterness at being stripped of his own ideas and theories: "At that time, a strange physician, Dr. S. Freud (from Vienna), came to La Salpêtrière and became interested in these studies; finding the facts to be based in reality, he published new observations of the same blazon. In these publications, he starting time changed the terms I used, referring to psychoanalysis for what I had called psychological analysis, and to a complex for what I had chosen a psychological arrangement, which indicates all facts related to conscience and movement, whether in the limbs or the viscera, and which on the whole comprises the traumatic memory. What I considered a reduction of consciousness, he saw every bit repression; to what I called psychological dissociation or moral disinfection, he gave the name of catharsis. Merely most importantly, he transformed clinical observation and a therapeutic process with specific and limited indications into a vast organisation of medical philosophy" [34]. Imbued with his discovery of psychological automatism, Janet argued for the do of hypnotic suggestion and for directively shaping the patient'due south behaviour ("conquering and fixation of new tendencies"), which form the ground for electric current cognitive-behavioural therapy. Janet too argued for motivating behaviours (which he chosen excitations), whereas previously Paul Dubois (1848–1918) in Bern and Jules Dejerine (1849–1917) had used prolonged bed rest with a milk-rich diet (infantile regression) [21, 35, 36]. The following passage from his writings could have served as a conclusion for him and expresses a form of pessimism: "It is easy to see that these various psychotherapies all have a strange progression: they sally suddenly, pridefully affirm that they alone are powerful and useful treatments, so invade the world with the speed of an epidemic, before gradually or all of a sudden losing influence and becoming ridiculous or forgotten" [34].

In Perspective

Janet's capacity, heightened at the end of his career, to integrate the social context, notably through the hierarchy of behaviours, into his psychological enquiry, underscored his perseverance in incorporating his studies into real life. This prevented him from becoming cutting off through a purely bookish science.

"Janet is a hitting example of the way in which fame and oblivion are unequally distributed among scientists. In 1900, his contemporaries had the impression that he would before long become the founder of a great school. However, despite the constant development of his piece of work, it seemed he gradually drifted away from the general trend. Many psychiatrists and psychologists, as well every bit cultured persons, still regarded him exclusively as the author of the psychological automatism and as the consultant who had exactly described obsessive neuroses. Insufficiently few people seemed to realize that he was creating a synthesis of enormous scope and dimensions" [37]. This sentence from Henri Ellenberger (1905–1993) partly explains the long "purgatory" endured by Janet. Sacha Nacht (1901–1977) concluded at best: "Janet has shown us how and Freud why. And some tend to forget about the how" [38]. Thanks to Charcot allowing Janet to become a md while remaining a philosopher. And then, he prepared the advent of modernistic psychiatry and of psychology, the organo-dynamism past Ey, the notion of dissociation, the debate around relations between cognitive physiology and psychology.

Acknowledgements

Many thank you to Jacques Poirier and Hubert Déchy for their circumspect readings and suggestions and to Anna Fitzgerald for her translation.

Statement of Ideals

The authors have no ethical conflicts to declare.

Disclosure Statement

No potential conflict of interest was reported past the authors.

Funding Sources

The authors received no fiscal support for the research, authorship, and/or publication of this article.

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