At home or abroad, however, Bernheim did not meet with ready acceptance, for all the clarity of his thought. There were powerful forces ranged against him. The war between physiology and psychology is far from over even now – are schizophrenics deranged or suffering from a chemical imbalance in the brain? Should certain violent criminals be acquitted because of their extra Y chromosome or deficient serotonin? Bernheim was simply on the side of psychology in one phase of the drawn-out fighting.
Charcot and the Paris School
If Bernheim and Liébeault are the heroes of this chapter, their opponent, Jean-Martin Charcot, is hardly an unmitigated villain. He was the most famous medical man in the world, and it was his interest in hypnosis that finally established it as a legitimate subject of scientific enquiry.
In 1862 Charcot was appointed chief physician to the Salpêtrière, an immense 100-acre complex on the left bank of the Seine, comprising forty-five run-down buildings, almost a town in its own right, with streets, squares and gardens, housing about 5,000 destitute, or insane, or senile, or disturbed women (the neighbouring Bicêtre housed men), who were jumbled together with no real attempt to classify their disorders and put them in separate wards. This was a paradise for a budding neurologist such as Charcot, but until he made it famous and added laboratories, a museum, and research and teaching units, it was an inferno most doctors wanted to avoid. Within twenty years, as a result of his numerous publications, and of the eminence of many of his pupils, he had achieved international fame and founded the science of neurology. He identified multiple sclerosis, increased understanding of poliomyelitis, had a neurological disorder named after him and so on and so forth.
Charcot, physician to kings and princes, was a small, stout, vigorous man with a big head, a bull's neck and a low forehead. He somewhat resembled Napoléon and liked to cultivate the similarity; he had no objection to his nickname, ‘the Napoléon of the Neuroses’. Artistic and learned, with a famed collection of old and rare books on witchcraft and demonic possession, he was a spellbinding teacher and an authoritarian figure who couldn't stand criticism at home or at work. By the 1880s, he was surrounded by what has wittily been called a ‘charcoterie’ of adoring students, and his already huge prestige was enhanced by an aura of mystery and a reputation for achieving ‘miracle’ cures. Not only did he often display an uncanny insight into patients’ disorders, but if he recognized a case of hysterical paralysis, he simply commanded the patient to throw away his crutches and walk.
The range of problems classed in the nineteenth century as ‘hysteria’ became Charcot's special field. It was a protean disorder, used to label a variety of different ailments, both organic and neurotic. Anyone liable to hallucinations, fainting, non-organic paralyses, or fits was likely to be classified as a hysteric. (Nowadays, what used to be called ‘hysteria’ is covered by four diagnostic categories: post-traumatic stress disorder, Briquet's syndrome, conversion disorder and dissociative disorder.) In order to bring order to the chaos, Charcot defined grand hysteria as involving three phases: a fainting fit, convulsions and intense expression of some emotion. Sometimes there was a fourth phase, of delirium, lasting up to several days. Charcot believed that hysteria was an organic disorder, the sign of a diseased brain, but a less retrogressive aspect of his work was to point out that men were just as liable to hysterical complaints as women; previously (as the etymology of the word, from the Greek for ‘womb’, shows) it was thought that only women were afflicted by hysteria. An important subclass of hysterics were somnambulists and those who were liable to fugue states, in which they might forget for a while who they were and take on a different personality, with neither of the two personalities having much or any memory of the other.
Charcot cured hysterics effectively by a kind of faith healing. So great was his fame and prestige that he had only to win the patient's confidence and encourage her, and half the battle was won. The other half consisted of various forms of treatment, which may have had a physical component, even though, again, the psychological component was what did the healing. For instance, if a hysteric was suffering from paralysis of the arm, Charcot would get him to exercise the paralysed arm; but since there was no organic damage to the arm, this too was a form of psychological healing. He came to believe that hysterical symptoms were caused by autosuggestion. To take a simple example, suppose a man sustains a slight injury at work – an injury that could have been worse. It preys on his mind: ‘If I'd been a few centimetres to the left, my whole arm would have been crushed.’ As a result, although the slight injury heals perfectly, his arm develops hysterical paralysis.
Charcot's friend Charles Richet, the recipient in 1913 of the Nobel Prize for medicine, persuaded him to try hypnosis on his patients. Having forged a connection between hysteria and suggestibility, Charcot was inclined, when he turned to consider the nature of hypnosis, to find further connections. He found that his patients entered one or another of three states of hypnosis – lethargy, catalepsy, somnambulism. Lethargy is total inertia, like the fainting phase of hysteria, but if the subject's eyes were opened, it passes into catalepsy, where the limbs retain any position imposed on them by the operator. This catalepsy he compared to hysterical paralysis, and another similarity with hysteria was that if the limbs of one of his hypnotized subjects were put into an aggressive position, aggressive thoughts and actions followed. Somnambulism was also related to hysteria, in the manifestation of anaesthesia: anaesthesia of the hand (‘glove anaesthesia’) or of the arm (‘sleeve anaesthesia’) was not uncommon among hysterics. Charcot concluded that hypnosis was an artificially induced modification of the nervous system which could be achieved only in hysterical patients and which manifested itself in three distinct phases (as above). It was this scientistic talk above all which gave an aura of scientific credibility to the previously taboo subject of hypnotism.
Charcot's interest in hypnosis, which began in 1878, was triggered not only by Richet's researches, but by the ‘metallotherapy’ of Victor Burq (1822–84) who proposed, among other things, that metals and magnets could be used either to inhibit or to bring on a trance state. The researches of Charcot and his colleagues (especially J.B. Luys) into metallotherapy form a bizarre footnote to the story of hypnosis. They found not only that hysterical anaesthesias, spasms and paralyses could be removed if the appropriate part of the body were touched with magnets or various metals, but also that symptoms could be transferred from one side of the body to the other. Charcot's student Joseph Babinski even found that symptoms could be transferred from one patient to another. Luys then developed an incredible therapy.
He would transfer the real symptoms of a hysteric patient to a hypnotized patient by drawing a magnet along a limb of the ill person and on to the corresponding limb of the healthy but hypnotized one. The latter would assume not only the symptoms but also the personality of the hysteric. Then the somnambule would be awakened, the symptoms would vanish from everyone, and the hysteric would assume her own personality, without the paralysis or whatever else afflicted her.
Bernheim argued, to the contrary, that all these results were due to suggestion.
In 1882, having already held a variety of chairs, Charcot was appointed to the Chair of Diseases of the Nervous System, which was created by governmental decree especially for him. In a bold move, when he was up for election to the Academy of Sciences in 1883 – the Academy which had a pretty consistent history of condemning mesmerism – he presented to them a paper on hypnosis. Perhaps his assimilation of hypnosis to hysteria, and his belief that hysteria was an organic disease, made it more respectable: he could claim that he wasn't talking about the forbidden topic of animal magnetism, but a brain disorder which mimicked hysteria, another brain disorder. He was elected, the dam burst, and from then on hypnosis was a viable subject for scientific research. Psychology became an academic discipline in its own right, distinct for the first time from philosophy.
Charcot's prestige and the semi-public nature of his
lectures (which were often attended by members of high society and reporters) also catapulted hypnosis into the popular press, which indulged in vivid descriptions of cataleptic patients and, later, lurid stories, often false, of clairvoyance and sexual seduction under hypnosis. Charcot was so famous that stage hypnotists advertised their shows as ‘in the manner of Charcot at the Salpêtrière’. Among other discoveries Charcot reached as a result of using hypnosis on his patients, he proved that psychological factors alone could cause some paralyses, by suggesting a paralysis to hypnotized patients and demonstrating that their symptoms were identical to those of organic paralyses, and he was able to distinguish ‘dynamic amnesia’ (in which memories can be recovered) from ‘organic amnesia’ (in which memories are irrecoverable).
Charcot didn't invent the assimilation of hypnosis to hysteria. Not only had many hypnotists in the past remarked that hysterics are deeply hypnotizable, but at least one had pre-empted Charcot in defining hypnosis as a morbid state. The Salpêtrière researchers felt that they were just confirming all these hypotheses by careful experiments. But, seeking clarity, they used only the best subjects – about a dozen in all, all female hysterics, inpatients of the hospital, who displayed the three phases Charcot was looking for more or less perfectly. And there's the rub: he was already looking for the three phases, and this is not a scientific way of going about research, using only subjects who confirm your preconceived notions. In fact, it is not impossible that they were trying to please him by going along with his suggestions. The Salpêtrière was crowded, intimate; doctors and patients jostled one another in the wards and corridors, and patients inevitably overheard what the doctors were talking about, and then gossiped to other patients. Patients knew, then, what was expected of them in experiments. It is even unclear how often Charcot himself practised hypnosis on patients, rather than getting his assistants to prepare them in advance for him; it is possible, then, that the patients were more or less told by these assistants what the great man would expect from them. Charcot thought that the three phases of hypnosis occurred spontaneously, but in all probability both patients and his assistants were showing him only what he expected to see. Certainly no independent researcher has been able to corroborate his results.
At this point, Charcot's eminence obviously had pernicious results. Although he had succeeded in making hypnosis respectable, his theory that hypnosis was a form of hysteria was patently limited and false, and yet his eminence guaranteed that it received serious consideration. It even followed from Charcot's theories that, despite Liébeault's and Bernheim's string of remarkable cures, hypnotherapy was downgraded, because according to Charcot hypnosis could be dangerous, in that it could arouse latent hysteria. In any book on hypnosis, Charcot is bound to receive a bad press; while his important work on neurology goes almost unmentioned, his belief in metallotherapy and his misleading views on hypnosis are given prominence. He was a great man, one of the giants of nineteenth-century science; but like all great men, he had blind spots.
The Rivalry Between the Schools
Battle was joined between the two schools, and the Parisians, at any rate, waded in with unscholarly rancour, denouncing the Nancy school as provincial cranks and Bernheim's book as unscientific. Bernheim, in response, proved that Charcot's three stages or phases of hypnotism were an illusion. Here is one of Bernheim's measured statements against Charcot:
The hypnotic condition is not a neurosis, analogous to hysteria. No doubt, manifestations of hysteria may be created in hypnotized subjects; a real hypnotic neurosis may be developed which will be repeated each time sleep is induced. But these manifestations are not due to the hypnosis, – they are due to the operator's suggestion, or sometimes to the auto-suggestion of a particularly impossible subject whose imagination, impregnated with the ruling idea of magnetism, creates these functional disorders which can always be restrained by a quieting suggestion. The pretended physical phenomena of the hypnosis are only psychical phenomena. Catalepsy, transfer, contracture, etc., are the effects of suggestion. To prove that the very great majority of subjects are susceptible to suggestion is to eliminate the idea of a neurosis.
To this Charcot and his colleagues could only make the weak reply that it was nonsensical to think that most of us are hypnotizable. On the offensive, the Paris school widened the attack and took in those who still adhered to magnetic views. They accused the magnetizers of being money-grubbing charlatans, but since not a few of them were priests it was hard to make the image stick. For their part the magnetizers, divided though they were on other issues, were unanimous in decrying Charcot's positivistic approach and the reduction of hypnosis to hysteria, and his voyeuristic displays of hysterical patients at the Salpêtrière. They said he was inducing hysterical attacks in his patients, rather than proving that hypnosis was hysteria, and joined Bernheim in arguing that Charcot's patients were complying with his suggestions. And in due course, for the ultimate good of hypnosis, the views of Charcot and his pupils at the Salpêtrière were gradually defeated by the Nancy school. After Charcot's death in 1893, one by one his former students and colleagues recanted their views, until by 1903 Bramwell was able to write simply: ‘The views of the mesmerists and those of the Salpêtrière school have ceased to interest scientific men.’
In the law courts, however, when the question of the coercion of hypnotized subjects arose, the tables are turned. Here it is Charcot who is the hero, and Bernheim who seems to have barked up the wrong tree. Since Bernheim believed in the absolute power of suggestion over a susceptible subject, then, as his colleague Liégeois argued at the Gouffé trial, a hypnotized person might as well be an automaton – a tool without a will, as the Swedish psychologist Fredrik Björnström, a follower of the Nancy school, would later put it. Not only can a hypnotized person be a victim of crime, but she can be made to act against her conscience. But Charcot's researches led him to believe that a hypnotized person still has a functioning conscience, and so can be held accountable for his actions. Only in extreme cases of mental illness, which do not include hysterics, is the capacity for willed action lost. Bramwell, though sympathetic to the Nancy school, found himself as a result of his own experiments ‘forced to abandon all belief in the so-called “automatism”, or better termed “helpless obedience”, of the subject’.
Bernheim likened the state of hypnotized automatism to the automatism of reflex action. This is certainly an exaggeration of the degree to which a subject, even a deeply hypnotizable subject, loses control. One of the weaknesses of all experiments designed to get subjects to perform antisocial actions is that the subjects presumably know in advance, or guess, that the circumstances are artificial and that no real danger is involved to themselves or others. Relatedly, Bernheim seems to me to have ignored the extent to which hypnotized subjects are capable of and may actually enjoy role-playing. Many of his most crucial tests smack too strongly of role-playing to be secure evidence. For instance, here is a section of his work with a man known simply as ‘C.’, who is identified only as a forty fouryear old photographer:
I provoked a truly dramatic scene one day with him, as I was anxious to see just how far the power of suggestion went with him. I showed him an imaginary person at the door and told him that he had been insulted by him. I gave him an imaginary dagger (a paper-cutter) and ordered him to kill the man. He hastened forward and ran the dagger resolutely into the door, and then stood staring with haggard eyes and trembling all over. ‘What have you done, unhappy man?’ I said. ‘He is dead, he is bleeding, the police are coming.’ He stood terrified. He was led before an imaginary magistrate (my intern). ‘Why did you murder this man?’ ‘He insulted me.’ ‘We do not kill the man who insults us. You must be complained of to the police. Did any one tell you to kill him?’ He answers, ‘M. Bernheim did.’ I say to him, ‘You are to be taken before the justice. You killed this man. I said nothing to you, you acted as your own master.’
The poor man is then taken before an imaginary judge. On
another occasion, Bernheim, sounding rather like a stage hypnotist, got the same subject in rapid succession to imagine that he was a young boy, a young girl, a military commander, a priest and a dog. Each time C. does his eager best to comply.
But Bernheim's work with criminal cases was not all misguided. His emphasis on suggestibility also led him to be the first to recognize and clearly state that alleged criminals could be induced to make false confessions, and witnesses give false reports, in order to please their interrogators, and to suggest guidelines to check that no such falsification is taking place.
On the criminal potential of hypnotism, Gilles de la Tourette was the spokesman for the Salpêtrière in response to Nancy: he argued that subjects are play-acting, that hypnotism does not alter character. A famous event at the Salpêtrière seems to prove de la Tourette's point:
On one occasion Charcot had invited a distinguished audience of jurists, magistrates, and specialists in forensic medicine to a demonstration in the lecture theatre at the Salpêtrière. Blanche [Blanche Wittmann, Charcot's subject], in a state of somnambulism, had obediently performed the most bloodthirsty tasks, ‘shooting’, ‘stabbing’, and ‘poisoning’. The notables withdrew from a room littered with fictive corpses. The medical students who remained, being very like medical students in all times and places, then told Blanche (still in a state of somnambulism) that she was alone in the hall and should undress and take a bath. But Blanche, who had waded through blood without turning a hair, found this suggestion too infamous and came abruptly out of hypnosis.
Hidden Depths: The Story of Hypnosis Page 28