It was in 1882 that Charcot publicized his use of hypnosis with the Salpêtrière hysterics. During the six years before, Eugène Azam (1822–99), son of an alienist, and a Bordeaux high-flier who was to become in turn chief surgeon at the asylum for women there, had published numerous papers on the strange doubling of personality he had witnessed and the scientific uses to which he had put hypnosis. These made an early patient of his, ‘Félida X’, famous. Félida, a seamstress, had from the age of thirteen suffered from a wide variety of hysterical symptoms–terrible headaches, neuralgia, and eventually extreme pulmonary and gastric bleeding. There was no evident physiological basis for her pain or the blood that poured from her mouth. On top of this, she fell into daily trances, without the use of hypnosis. She awoke from these after a few minutes into a better version of herself: pain-free, happier and, as Azam discovered when he did use hypnosis on her, far cleverer. This second Félida knew everything about the first, had clear memory of her ‘ordinary’ state in which she was most often morose and depressed. But the first Félida, who returned after a few hours, knew nothing of her more vivacious double. When she came to Azam to complain of stomach pains and he determined she was pregnant, it was only the second Félida who admitted to it and promptly went off to marry her beau.
By the time he started writing about her, Azam was treating Félida X once more. Now her secondary personality was longer in evidence than her first one. But it was the first which was present through each of her eleven childbirths. It was also the first Félida who worked hard in the family grocery, and grew increasingly miserable with the growing severity of her pains and the dramatic bleeding from the mouth. Azam found no cure for her condition. His hypnosis was largely a form of experimental observation, part of the new science of psychology that the Germans, principally, had pioneered.
Or so it came to seem from the writings of another major influence on Pierre Janet–Théodule Ribot. Professor of the newly established Chair of Psychology at the Sorbonne and then at the Collège de France, Ribot had already discussed English experimental psychology when, in 1876, he wrote a history of the field in Germany, which at once traced a lineage for the subject and set out what became the classic boundaries of the discipline. In La Psychologie allemande contemporaine (translated ten years later and widely disseminated as German Psychology of Today) Ribot showed how psychology had been mapped out by Herbart, Fechner and Wundt by refuting Kant’s prediction that it could never be raised to the rank of an exact natural science. These pioneering scientists had shown that mathematics could indeed be applied to internal phenomena; and that these subjective phenomena were accessible to experiment.
Ribot’s ideas consolidated the new and radical positivist position, so closely allied with the secular thrust of the Third Republic. Like the English empiricists, the German scientists provided solid counter-arguments to any religious notion of a single and unitary transcendental consciousness, proposed by the French spiritualists and associated with the Second Empire. Taine, positivism’s most powerful exponent, conceived of a Lockean self which was shaped out of ‘sensations, memories, images, ideas, perceptions, conceptions, which are diverse and transient’. For Ribot, hypnotism provided a powerful method of experimenting with this shifting self. Azam’s Félida fell in perfectly with the notion. Her ‘disease’ was an ‘experiment in nature’, and he included Azam’s description of her case in the series of monographs on diseases of memory, the will and personality which he wrote through the 1880s.
Paul Janet, Pierre Janet’s uncle, an important philosopher of the spiritualist persuasion, was, despite his position, greatly influenced by these developments in psychology. He, too, wrote about Félida and other cases of doubling. Indeed dédoublement, or ‘doublings of personality’, had now been found not only in France, but in England, Switzerland and America. Through the 1880s, such cases helped to shape the time’s imagination and conception of itself. They became a popular feature in the literature of the day. Stevenson’s Dr Jekyll and Mr Hyde of 1885, Wilde’s Picture of Dorian Gray, Dostoievksi’s The Double can all be seen as part of the period’s interrogation of the self. (Dostoievski, indeed, was dubbed by a contemporary ‘the Shakespeare of the lunatic asylum’.) Poised on the edge of the Gothic in an idiom of good and evil that is already shaky, these are stories contemporaneous with the experiments in hypnosis and psychology. In the latter, the language of the moral, and certainly of the spiritual, gives way to the language of science and disease. Where demons reign, the ‘positivist’ neurologist or psychologist sees the slippages of conscious mind and identity. He attributes these to lesions and degeneration and/or to an un(sub)conscious which reigns in sleep and can produce doubles or alternative selves, aberrations of memory, alongside dreams and secret drives. French doublings, or dédoublement, were also translated as ‘splitting’, and were elided in the mid-twentieth century with American ideas about split personality.
Pierre Janet read Ribot while he was studying philosophy at the Ecole Normale and followed his monographs through the 1880s. Together with the case of Félida and Charcot’s clear 1882 positioning of hypnosis as a scientific tool rather than a mere popular spectacle, set out in his paper to the Academy of Sciences, Ribot’s work helped to shape and feed Pierre Janet’s interest in sleep pathologies. During Janet’s second teaching job in Le Havre and while he was gathering material for his thesis–in part at the local hospital, where he was eventually given a small ward for hysterics that he nicknamed ‘Salle Saint-Charcot’–he looked around for a suitable subject for psychological experimentation. He soon found her in ‘Léonie’, who could write while asleep, thus ‘automatically’.
A forty-five-year-old peasant woman, Léonie was referred to Pierre Janet by a well known Le Havre doctor. She served as a subject for the first time with Janet for three weeks in September–October 1885. Highly susceptible to hypnosis, she even responded to it at a distance, and engaged in automatic writing during which a second ‘sleeping’ self emerged, an independent self, calling herself Léontine, who was also capable of commenting on Léonie’s parlous state in a letter to Janet.
A paper presented in November about Léonie on Pierre’s behalf by his Uncle Paul created a stir at the Société de Psychologie Physiologique in Paris, and in April 1886 a delegation arrived from Paris and from the Psychical Research Society in England to observe Janet’s experiments. To Janet’s chagrin, he was to find that Léonie’s great suggestibility was in fact the residue of earlier ‘experiments’. She was in that sense an unreliable subject, one already trained in the ways of hypnotism by earlier, ‘unscientific’ magnetizers, in particular one known as Dr Perrier. While Léontine, Léonie’s second, hypnotized self, was in the throes of hallucination, she produced a third personality called Lénore. Lénore confessed to Janet that she had been created by the animal magnetizer. Astonishingly, this earlier self suffered from none of the anaesthesias that both Léonie and Léontine had. Perhaps produced as a cure for hysteria by Perrier, this Lénore was ‘healthy’ and had alternated with Léonie over more years than had Léontine.
Janet described Léonie’s case in the papers which together made up his doctoral thesis, L’Automatisme psychologique (1889), where fourteen hysterical women, five men, and eight psychotics and epileptics are featured. Léonie had taught him several things. Namely, that it is essential to check patients’ long histories to ascertain how they might have been influenced by past treatments; it is important to examine them alone, without observers, and to record everything that is said and done by them.
Janet concluded from his research that the human subject did not have a single consciousness: parts of the mind could live alongside each other in mutual ignorance. The waking or normal personality had no memory of the hypnotized state. The subject who arose in hypnosis, however, did remember and know about the waking state and sometimes about other successive or earlier states. Such states could come with their own mood or character and were called by other investigators, such
as Morton Prince, ‘alternating personalities’, and more recently in America, ‘multiples’.
Partial automatism, what we might call trance, could be induced in the subject: it was evident in feats of automatic writing or when instructions given under hypnosis were unknowingly carried out by the subject while ‘awake’. Or the subject might suddenly burst into tears without being aware of the reason. Therapeutically, this existence of different areas of consciousness meant that symptoms could be worked on in one without the other being aware. What is perhaps most astonishing in Janet’s experiments is that he found that, like Azam with Félida, he could replace the normal waking personality, with all its symptoms, with another personality that seemed altogether healthy. He gave this phenomenon the name of ‘complete somnambulism’. Other patients were to repeat aspects of Léonie’s case, even though they had not been subject to prior magnetizers.
Nineteen-year-old Lucie suffered from convulsions and delirium, brought on by terror, as well as from anaesthesias. These were labelled as ‘hysterical’ symptoms. They disappeared when Janet put her into ‘hypnotic sleep’, a state she forgot when she was woken. However, if Janet clapped his hands some time after she had woken, she would follow an instruction he had given her in her sleep state and do what he had asked, though without understanding what drove her to the action. Continuing his experiments into the existence of a ‘subconscious’ state that could propel actions without the subject’s awareness, Janet would–while Lucie was distracted and talking to someone else–whisper questions to her. She answered these by ‘automatic writing’. It was in this writing that she revealed the source of the fear that characterized her madness: when she was seven, two men hiding behind a curtain had frightened her, had done so as a joke.
Since Lucie roundly denied that she had written what was in front of her, Janet gave her writing second self, who could also feel sensation where Lucie could not, another name: Adrienne. Soon Adrienne began to speak and became the dominant consciousness. Unlike Lucie, she could remember everything, and like Félida’s other self, she exhibited none of Lucie’s hysterical symptoms. Janet called Lucie in her state as Adrienne another instance of ‘complete somnambulism’. This second consciousness lasted only a short time before Lucie, with all her ailments, returned. Janet thought of a new ‘therapeutic’ experiment: he began to suggest anaesthesias to Adrienne, and as he did so, Lucie began to have sensation exactly where Adrienne lost it. Interestingly, when her ability to feel sensation had completely returned, she lost her suggestibility, her special pliant relationship to Janet the hypnotist, which had been part of her ‘hysteria’. Now Adrienne could no longer be wooed back. Clearly, Janet deduced, anaesthesia was linked to amnesia. Lockean in this respect, Janet reasoned that memory was dependent on sensation. ‘When a particular kind of sensation has been abolished, the images and as a result the memories of phenomena that have been created by that sensation are abolished as well.’
Janet thought of Lucie as an hysteric, that catch-all diagnosis for the period. He understood the ability to dissociate, to have a double conscience, as a quintessential part of the pathology. Freud and Breuer in Studies on Hysteria (1895) acknowledge their debt to him:
The longer we have been occupied with these phenomena the more we have become convinced that the splitting of consciousness which is so striking in the well-known classical cases under the form of ‘double conscience’ is present to a rudimentary degree in every hysteria, and that a tendency to such dissociation, and with it the emergence of abnormal states of consciousness (which we shall bring together under the term ‘hypnoid’), is the basic phenomenon of this neurosis.
Freud in 1895 had ‘nothing new to say on the question of the origin of these dispositional hypnoid states’, except to note that women’s work made them particularly susceptible to trance and its accompanying doubling. These hypnoid states, ‘it would seem, grow out of the daydreams which are so common even in healthy people and to which needlework and similar occupations render women especially prone’. Shades of Mary Lamb.
As ever, with Freud, and this is certainly the origin of his pervasive influence over twentieth-century conceptions of the human, he normalizes pathological tendencies, situating what it is that might make us mad at the very heart of what we are. The tug in Freud’s work is always and ever to bring into the open our kinship with the mental processes of patients who manifest the most extreme of symptoms, such as hysterics do in their dissociated condition: ‘in their hypnoid states they are insane, as we all are in dreams. Whereas, however, our dream-psychoses have no effect upon our waking state, the products of hypnoid states intrude into waking life in the form of hysterical symptoms.’
These hysterical symptoms are translations into bodily ills, for both Freud and Janet in this early period of their work, of memories repressed because the horror the initial lived experience aroused was impossible for the patient to confront. This particular aberration of memory was one Freud dubbed ‘conversion hysteria’. It played itself out in the case of Janet’s Marie as it did in Freud and Breuer’s Anna O, and in both cases led to similar forms of treatment.
Marie and Anna O
Nineteen-year-old Marie arrived at the Le Havre hospital suffering from extreme attacks of convulsive delirium. During these fits she saw blood and fire everywhere, and in horror would try to flee. Reverting to a childhood self, she would leap and jump on furniture and call for mother. Her attacks came on regularly and always just preceded menstruation. This was accompanied by intense pain, nervous spasms and shivering. Marie also suffered from blindness in one eye, and various anaesthesias with no physical basis–which Janet later linked to particular forgettings. During the months in which he merely observed her, Janet noted a pattern. Marie’s period lasted for about twenty hours before it stopped suddenly and the girl went into her ‘hysterical crisis’. This ended after two days, in a great vomiting of blood.
After eight months, Janet had the inspiration of hypnotizing Marie in order to find out how ‘her periods had been inaugurated and had been interrupted’. Under hypnosis, Marie told Janet that when she started her periods around the age of thirteen, she tried to stop the shaming flow by plunging herself secretly into a tub of cold water. Her period stopped, but violent shivering and several days of delirium came in its place. After that, her period didn’t return for five years. During this time she was well. When the menstrual flow started again, it came with the symptoms she enacted in the hospital. The shivering was evidently related to her immersion in freezing water, as was the abrupt and now repeated stopping of the flow. Marie remembered none of this phase of her life when she was awake.
Janet set about removing the subconscious idée fixe which had stopped Marie’s periods and brought on the accompanying attacks. To do so he had to bring her back to her thirteenth year and the initial circumstances of the delirium. Then, while she was under hypnosis, he convinced her that her menstruation had never been interrupted, and no subsequent illness had been suffered. In other words, he erased an unconscious memory. That done, Marie’s next period proceeded without a hitch.
But there were more memories to remove: the fear of blood was also linked for Marie with the death she had witnessed of an old woman plunging down a flight of stairs. Janet replaced this with a scene which had the old woman merely stumbling, with no suicidal intention. Marie’s ‘attacks of terror’ ceased. As for her blindness, under hypnosis Janet traced it to a scene in Marie’s sixth year when she had been forced to share a bed with a child suffering from impetigo, one side of whose face was wholly covered in hideous pustules. Her fear of the child had been converted into an unconscious mimicking of the malady. Under hypnosis, Janet turned the feared child into a healthy, sweet and unfrightening creature, and after two sessions Marie’s hysterical blindness disappeared.
This ‘cathartic’ method of removing symptoms while the patient is under hypnosis is one Joseph Breuer practised in what has been enshrined as the founding case of psychoanaly
sis. Anna O, or the real Bertha Pappenheim, is a prime exemplar of the ways in which symptoms are the expression of unconscious ideas–forgotten or repressed scenes of great emotional impact which return in disguise by imprinting themselves on the body.
Freud’s early mentor, Breuer was a consultant in internal medicine, who like many internists of the time took on ‘nervous’ patients. He treated Anna O in 1881, though the case was only written up for Studies on Hysteria much later, in 1895. The young woman, daughter of a wealthy and respected but traditional and over-protective Jewish family, had fallen ill at the age of twenty-one while nursing her father, to whom she was greatly attached. Clever and imaginative, though schooled at home rather than permitted the formal education of her brother, Anna had early developed a habit of daydreaming, or entering her own ‘private theatre’. With her father’s illness, this imaginative escapism escalated into a conscience seconde, a dissociated trance state into which various hallucinations gradually entered, completely incapacitating her.
Alongside this doubling, Anna generated a series of severe symptoms–paralyses, anaesthesias, coughs and finally a deterioration in language which left her German a series of nouns without syntax and, in stretches, allowed her to speak coherently only in English. With her father’s death, some eight months after his and Anna’s illnesses had invaded their lives, her condition worsened. She could no longer recognize people. Often subject to states of manic anger, she couldn’t sleep. She also refused food and water, though her doctor, whose love she craved rather more intensely than Breuer noticed, was able to distract her into eating far better than anyone else–and eventually into the ‘chimney sweeping’ which formed the basis of her treatment.
Mad, Bad, and Sad: A History of Women and the Mind Doctors Page 19