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ment of a fluid enclosed in a malleable container, in a bladder, for example, that when I press it would eject liquid through a tube") and a corpuscular movement for sensation ("this is the movement of a succession of ivory balls"). Thus sensation and movement can be produced at the same time in the same nerve: any tension and any relaxation in the fiber will alter both movements and sensations, as we can observe in all nervous diseases.
And yet, despite all these unifying virtues of the nervous system, is it certain that we can explain, by the real network of its fibers, the cohesion of such diverse disorders as those which characterize hysteria or hypochondria? How conceive the liaison among the signs that from one part of the body to the other betray the presence of a nervous affection? How explain, and by tracing what line of connection, that in certain "delicate and highly sensitive" women a heady perfume or the too vivid description of a tragic event or even the sight of a combat produces such an impression that they "fall into syncopes or suffer convulsions"? One seeks in vain: no precise liaison of the nerves;
no path proceeding from the original cause; but only a remote, indirect action which is rather on the order of a physiological solidarity. This is because the different parts of the body possess a "very determined faculty, which is either general and extends throughout the entire system of animal economy, or particular and influences certain parts principally." This very distinct property of both "the faculty of feeling and that of moving" which permits the organs to communicate with each other and to suffer together, to react to a stimulus, however distant—is sympathy. As a matter of fact, Whytt succeeded neither in isolating sympathy in the ensemble of the nervous system, nor in defining it in relation to sensibility and to movement. Sympathy exists in the organs only insofar as it is received there through the intermediary of the nerves; it is the more
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marked in proportion to their mobility, and at the same time it is one of the forms of sensibility: "All sympathy, all consensus presupposes sentiment and consequently can exist only by the mediation of the nerves, which are the only instruments by which sensation operates."18 But the nervous system is no longer invoked here to explain the exact transmission of a movement or a sensation, but to justify, in its totality and its mass, the body's sensibility with regard to its own phenomena, and its own echo across the volumes of its organic space.
Diseases of the nerves are essentially disorders of sympathy; they presuppose a state of general vigilance in the nervous system which makes each organ susceptible of entering into sympathy with any other: "In such a state of sensibility of the nervous system, the passions of the soul, violations of diet, sudden alternation of heat and cold or of heaviness and humidity of the atmosphere, will very readily produce morbific symptoms; so that with such a constitution, one will not enjoy steady or constant health, but generally suffer a continual succession of more or less severe pains." Doubtless this exaggerated sensibility is compensated by zones of insensibility, of sleep, as it were; in a general way, hysterical sufferers are those in whom this internal sensibility is the most exquisite, hypochondriacs possessing it, on the contrary, in a relatively blunted form. And of course women belong to the first category: is not the womb, with the brain, the organ that maintains most sympathy with the whole organism? It suffices to cite "the vomiting that generally accompanies the inflammation of the womb; the nausea, the disordered appetite that follow conception; the constriction of the diaphragm and of the muscles of the abdomen during childbirth; the headache, the heat and the pains in the back, the intestinal colic suffered when the time of the menstrual flow approaches." The entire female body is riddled by obscure but strangely
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direct paths of sympathy; it is always in an immediate complicity with itself, to the point of forming a kind of absolutely privileged site for the sympathies; from one extremity of its organic space to the other, it encloses a perpetual possibility of hysteria. The sympathetic sensibility of her organism, radiating through her entire body, condemns woman to those diseases of the nerves that are called vapors. "The women whose systems have generally more mobility than those of men are more subject to nervous diseases, which are also more serious in them."19 And Whytt assures us he has witnessed that the pain of a toothache caused convulsions in a young girl whose nerves were weak, and an unconsciousness lasting several hours and returning when the pain became more acute."
Diseases of the nerves are diseases of corporeal continuity. A body too close to itself, too intimate in each of its parts, an organic space which is, in a sense, strangely constricted: this is what the theme common to hysteria and hypochondria has now become; the rapprochement of the body with itself assumes, for some, the aspect of a precise-all too precise—image: such is the celebrated "shriveling of the nervous system" described by Pomme. Such images mask the problem, but do not suppress it, and do not keep the enterprise from continuing.
Is this sympathy, basically, a property hidden in each organ—that "sentiment" which Cheyne spoke of—or a real propagation through an intermediary element? And is the pathological proximity which characterizes these nervous diseases an exasperation of this sentiment, or a greater mobility of this interstitial body?
It is a curious but doubtless characteristic phenomenon of medical thought in the eighteenth century, in the period when physiologists tried to define most precisely the functions and the role of the nervous system (sensibility and
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irritability; sensation and movement), that physicians used these ideas indiscriminately in the undifferentiated unity of pathological perception, articulating them according to a schema entirely different from that proposed by physiology.
Sensibility and movement are not distinguished. Tissot explains that the child has more sensibility than anyone else because in him everything is lighter and more mobile; irritability, in the sense in which Haller understood a property of the nervous fiber, is identified with irritation, understood as the pathological state of an organ aroused by a prolonged stimulus. It would thus be acknowledged that nervous diseases were states of irritation combined with an excessive mobility of the fibers.
"On occasion one sees persons for whom the smallest moving cause occasions much more movement than it produces in healthy persons; they cannot sustain the slightest alien impression. The faintest sound, the weakest light affords them extraordinary symptoms."20 By this deliberately preserved ambiguity in the notion of irritation, medicine at the end of the eighteenth century could in effect show the continuity between disposition (irritability) and the pathological event (irritation); but it could also maintain both the theme of a disorder proper to an organ which suffers, but in a fashion all its own, a general attack (it is the sensibility particular to the organ which assures this nonetheless discontinuous communication), and the idea of a propagation in the organism of a single disorder that can attack it in each of its parts (it is the mobility of the fiber which is responsible for this continuity, despite the diverse forms it assumes in the organs).
But if the notion of "irritated fiber" certainly plays this role of concerted confusion, it also permits a decisive distinction in pathology. On one hand, nervous sufferers are the most irritable, that is, have the most sensibility: tenu-
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ousness of fiber, delicacy of organism; but they also have an easily impressionable soul, an unquiet heart, too strong a sympathy for what happens around them. This sort of universal resonance—simultaneously sensation and mobility-constitutes the first determination of the illness. Women who have "frail fibers," who are easily carried away, in their idleness, by the lively movements of their imagination, are more often attacked by nervous diseases than men who are "more robust, drier, hardened by work." But this excess of irritation has this peculiarity: that in its vivacity it attenuates, and sometimes ends by extinguishing, the sensations of the soul; as if the sensibility of the nervo
us organ itself overcharged the soul's capacity to feel, and appropriated for its own advantage the multiplicity of sensations aroused by its extreme mobility; the nervous system "is in such a state of irritation and reaction that it is then incapable of transmitting to the soul what it is experiencing; all its figures are disordered; it can no longer interpret them."21 Thus appears the idea of a sensibility which is not sensation, and of an inverse relation between that delicacy which derives as much from the soul as from the body, and a certain numbness of the sensations that prevents nervous shocks from reaching the soul. The hysteric's unconsciousness is only the reverse of his sensibility. It is this relation, which the notion of sympathy could not define, which was contributed by the concept of irritability, though so little elaborated and still so confused in the thinking of pathologists.
But by this very fact, the moral significance of "nervous complaints" was profoundly altered. Insofar as diseases of the nerves had been associated with the organic movements of the lower parts of the body (even by the many and confused paths of sympathy), they were located within a certain ethic of desire: they represented the revenge of a crude body; it had been as the result of an excessive vio-
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lence that one became ill. From now on one fell ill from too much feeling; one suffered from an excessive solidarity with all the beings around one. One was no longer compelled by one's secret nature; one was the victim of everything which, on the surface of the world, solicited the body and the soul.
And as a result, one was both more innocent and more guilty. More innocent, because one was swept by the total irritation of the nervous system into an unconsciousness great in proportion to one's disease. But more guilty, much more guilty, because everything to which one was attached in the world, the life one had led, the affections one had had, the passions and the imaginations one had cultivated too complacently—all combined in the irritation of the nerves, finding there both their natural effect and their moral punishment. All life was finally judged by this degree of irritation: abuse of things that were not natural, the sedentary life of cities, novel reading, theatergoing, immoderate thirst for knowledge, "too fierce a passion for the sex, or that other criminal habit, as morally reprehensible as it is physically harmful."22 The innocence of the nervous sufferer, who no longer even feels the irritation of his nerves, is at bottom only the just punishment of a deeper guilt: the guilt which makes him prefer the world to nature: "Terrible state! . . . This is the torment of all effeminate souls whom inaction has plunged into dangerous sensuality, and who, to rid themselves of the labors imposed by nature, have embraced all the phantoms of opinion. . . . Thus the rich are punished for the deplorable use of their fortune."23
We stand here on the threshold of the nineteenth century, where the irritability of the fibers will enjoy physiological and pathological fortunes. What it leaves for the moment, in the domain of nervous diseases, is nonetheless something very important.
This is, on the one hand, the complete identification of
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hysteria and hypochondria as mental diseases. By the capital distinction between sensibility and sensation, they enter into that domain of unreason which we have seen was characterized by the essential moment of error and dream, that is, of blindness. As long as vapors were convulsions or strange sympathetic communications through the body, even when they led to fainting and loss of consciousness, they were not madness. But once the mind becomes blind through the very excess of sensibility—then madness appears.
But on the other hand, such an identification gives madness a new content of guilt, of moral sanction, of just punishment which was not at all a part of the classical experience. It burdens unreason with all these new values: instead of making blindness the condition of possibility for all the manifestations of madness, it describes blindness, the blindness of madness, as the psychological effect of a moral fault. And thereby compromises what had been essential in the experience of unreason. What had been blindness would become unconsciousness, what had been error would become fault, and everything in madness that designated the paradoxical manifestation of non-being would become the natural punishment of a moral evil. In short, that whole vertical hierarchy which constituted the structure of classical madness, from the cycle of material causes to the transcendence of delirium, would now collapse and spread over the surface of a domain which psychology and morality would soon occupy together and contest with each other.
The "scientific psychiatry" of the nineteenth century became possible.
It was in these "diseases of the nerves" and in these "hysterias," which would soon provoke its irony, that this psychiatry took its origin.
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VI
DOCTORS AND PATIENTS
the therapeutics of madness did not function in the hospital, whose chief concern was to sever or to "correct." And yet in the non-hospital domain, treatment continued to develop throughout the classical period: long cures for madness were elaborated whose aim was not so much to care for the soul as to cure the entire individual, his nervous fiber as well as the course of his imagination. The madman's body was regarded as the visible and solid presence of his disease: whence those physical cures whose meaning was borrowed from a moral perception and a moral therapeutics of the body.
1. Consolidation. There exists in madness, even in its most agitated forms, an element of weakness. If in madness the spirits are subjected to irregular movements, it is because they have not enough strength or weight to follow the gravity of their natural course; if spasms and convul-
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sions so often occur in nervous illnesses, it is because the fiber is too mobile, or too irritable, or too sensitive to vibrations; in any case, it lacks robustness. Beneath the apparent violence of madness, which sometimes seems to multiply the strength of maniacs to considerable proportions, there is always a secret weakness, an essential lack of resistance;
the madman's frenzies, in fact, are only a passive violence. What is wanted, then, is a cure that will give the spirits or the fibers a vigor, but a calm vigor, a strength no disorder can mobilize, since from the start it will be subject to the course of natural law. More than the image of vivacity and vigor, it is one of robustness that prevails, enveloping the theme in a new resistance, a young elasticity, but subjugated and already domesticated. A force must be found within nature to reinforce nature itself.
The ideal remedy would "take the part" of the spirits, and "help them conquer the cause that ferments them." To take the part of the spirits would be to struggle against the vain agitation to which they are subject in spite of themselves; it would also permit them to escape from all the chemical ebullition that heats and troubles them; finally it would give them enough solidity to resist the vapors that try to suffocate them, to make them inert, and to carry them off in their whirlwind. Against the vapors, the spirits are reinforced "by the most stinking odors"; disagreeable sensation vivifies the spirits, which in a sense rebel and vigorously flock to the place where the assault must be repelled; to this effect "asafetida, oil of amber, burnt leather and feathers will be used—that is, whatever can provide the soul with strong and disagreeable feelings." Against fermentation, theriac must be given, "anti-epileptic spirits of Charras," or best of all, the famous Queen of Hungary water;1 acidity disappears and the spirits regain their true influence. Finally, to restore their true mobility, Lange recommends that the spirits be subjected to sensa-
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tions and movements that are both agreeable, measured, and regular: "When the animal spirits are dispersed and disunited, remedies are necessary which calm their movement and return them to their natural situation, such things as give the soul a sweet and moderate feeling of pleasure:
agreeable odors, walks in delightful spots, the sight of persons who are in the habit of providing diversion, and Music." This firm gentleness, a proper gravity, ultimately a vivacity intended only t
o protect the body—all these are means to consolidate, within the organism, the fragile elements connecting body and soul.
But there is probably no better fortifying procedure than the use of the substance which is both the most solid and the most docile, the most resistant but the most pliable in the hands of the man who knows how to forge it to his purposes: iron. Iron unites, in its privileged nature, all those qualities that quickly become contradictory when they are isolated. Nothing resists better, nothing can better obey; it is a gift of nature, but it is also at the disposal of all of man's techniques. How could man help nature and lend it an abundance of strength by a surer means—that is, one closer to nature and more obedient to man—than by the application of iron? The old example of Dioscorides is always cited, who gave to the inertia of water the vigorous virtues foreign to it by plunging into it a bar of red-hot iron. The ardor of fire, the calm mobility of water, the rigor of a metal treated until it had become supple—all these elements, united, conferred upon water powers of reinforceent, of vivification, of consolidation, which it could transmit to the organism. But iron is efficacious even aside from any preparation; Sydenham recommends it in its simplest form, by the direct absorption of iron filings. Whytt instances a man who, in order to cure himself of a weakness of the stomach nerves involving a permanent state of hypochondria, took 230 grains of iron every day. This was
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