The Function of the "Real" Image of the Hysteric in Defining the Nature of Hysteria

In the history of hysteria one image haunts the eye. It is an 1887 painting by André Brouillet of Jean-Martin Charcot presenting his pet hysteric, "Blanche" (Blanche Wittman), to the members of his neurological service at the Salpêtrière.^[1] This portrait, clearly standing within the great tradition of Rembrandt's anatomies and echoing the 1876 portrait, Pinel Freeing the Insane , by Tony Robert-Fleury, which hung in the main lecture hall at the Salpêtrière, has one rather anomalous moment. (Brouillet [1824-1908] was after all a student of Gérôme, whose history paintings always hide a mystery.) All of Charcot's staff are men, with the exception of the one nurse, who is about to catch the somnambulistic patient. Only these two women are placed in such a manner so as to see the rear of the hall; all of the male figures have their backs (or sides) to the rear. And on the rear wall is an enlarged drawing by Charcot's colleague Paul Richer of the arc-en-cercle stage of "grand" hysteria. Charcot described this stage in an 1877 lecture: "The patient suddenly falls to the ground, with a shrill cry; loss of consciousness is complete. The tetanic rigidity of all her members, which generally inaugurates the scene, is carried to a high degree; the body is forcibly bent backwards, the abdomen is prominent, greatly distended, and very resisting."^[2] In Broulliet's engraving, Richer literally sits at Charcot's right hand, sketching the patient who is replicating his own drawing.^[3] Only the women see (and "know," that is, act upon) the image of the hysteric. Their image of the hysteric, both as patient and as health-care practitioner is con-

André Brouillet's image of Jean-Martin Charcot presenting his "pet" hysteric, 
"Blanche" (Blanche Wittman), to the members of his neurological service at 
the Salpêtrière (1887). 
(Bethesda, Md.: National Library of Medicine.)

sciously formed by the visual image of the hysteric as created by a male physician.

The late nineteenth century understood such a pattern as the very model for knowing the world. Oscar Wilde suggested that we learn about nature from the work of art. "External nature," according to Wilde, "imitates Art. The only effects that she can show us are effects that we have already seen through poetry, or in paintings."^[4] And, we might add, in photographs.^[5] This is precisely what Blanche Wittman did at the Salpêtrière, as she learned from the representations of the hysteric how to appear as a hysteric.^[6]

This image does not stand alone but is representative of a series of representations of the hysteric during the latter half of the nineteenth century. In the Jacques-Joseph Moreau de Tours 1890 image, Hysterics of the Charité on the Service of Dr. Luys , a wider range of representa-

Tony Robert-Fleury's  Pinel Freeing the Insane  (1876), which hung in the 
main lecture hall at the Salpêtrière. 
(Paris: The Library of the Salpêtrière.)

Jacques-Joseph Moreau de Tours,  Hysterics of the Charité on the Service of Dr. Luys  (1890). 
(Bethesda, Md.: National Library of Medicine.) 
Photo courtesy Yale Medical Library.

tions of the hysteric is present.^[7] Dr. J.-B. Luys (1848-1897), the author of an early photographic medical atlas,^[8] stands to the rear of the room, with his white mutton-chop whiskers, as his female patients perform. (Moreau de Tour had himself been an intern under J.-É.-D. Esquirol, the creator of the first modern psychiatric atlas, at Charenton.^[9] ) Luys had described and photographed the hysterics of the Salpêtrière for his 1887 study of the effects of hypnotism as therapy.^[10] All of the patients in Moreau de Tours's image are seemingly oblivious to what immediately captures the eye of the viewer. On the rear wall of this ward, a permanent fixture of the room inhabited by the patients, is a chart recording the different phases of hypnosis, the stages that the patient is expected to pass through as she performs for her male audience. It is part of the world of the patient, a means through which to learn how to structure one's hysteria so as to make one an exemplary patient. Indeed, this is paralleled within the images that are so central to Jules Luys's own work, by the photographs of his pet patients, especially "Esther," taken by his brother Georges, which illustrate his-1887 study of the emotions of the hysteric.^[11]

These patients are seen. There is no attempt to mask their identity. In the case studies of the period (even as early as Pinel) there is the use of initials or masked names. But in the visual images that Esquirol brings there is the assumption that the face (its structure or its expression) is so important that it does not need to be masked. But there is also the understanding, given the artistic license of the engraving and the lithograph, that there would be sufficient difference between the image of the patient and the final representation as to mask the patient's identity. (This is not always the case, as one can see in Georges-François-Marie Gabriel's admittedly unpublished image of Eugéne Hugo, the brother of the author.^[12] ) The exception to this seems to prove the rule. In the Nouvelle iconographie de la Salpêtrière , Charcot's house organ, there are rarely images of patients that are intentionally masked, usually naked women, such as the image of a young anorexic female reproduced in the fifth volume.^[13] (The Nouvelle iconographie de la Salpêtrière is not the only journal of its type. The Revue photographique des Hôpitaux des Paris flourished in the 1870s.)

The importance of the image of the hysteric represented as learning from the medical images that surround her can be gleaned from the following anecdote. In an account of Charcot's experiments with hypnotism in the British Medical Journal of 5 October 1878, Arthur Gamgee, Professor of Physiology at Owens College, Manchester, observed:

One of the patients was suspected of stealing some photographs from the hospital, but she indignantly denied the charge. One morning [Mr.]

The masked image of the hysteric. From Louis Battaille, "Deux Cas 
d'Anorexie Hystérique,"  Nouvelles Iconographie de la 
Salpêtrière 5  (1892), plate opposite p. 277. 
Photo courtesy Wellcome Institute Library, London.

Richer, after having made some experiments upon other subjects, found the suspected thief with her hand in the drawer containing the photographs, having already concealed some of them in her pocket. [Mr.] Richer approached her. She did not move; she was fixed—she was transformed into a statue, so to speak. The blows on the gong made in the adjoining ward had rendered her cataleptic at the very moment when, away from the observation of all, she committed the theft.^[14]

It is Paul Richer, the creator of the archetypal image, the ornament of the lecture room in which rounds were held, who captures the "cataleptic" woman, a figure so mired in her internalization of his idea of the hysteric that she literally freezes as an incidental occurrence to the "experiment" taking place just beyond her ken.^[15] This is not the world of Charcot in the role of Pinel "freeing the insane," whose image graced the public lecture hall in which the so-called Tuesday lectures took place. For here the "insane" patient is captured rather than freed by the intervention, no matter how incidental, by the physician. But why is this woman stealing photographs?^[16] And whose photographs are they?

The photographs are those of the exemplary patient taken by Albert Londe, the head of the photographic service at the Salpêtrière, indeed

The hypnotized patient and the tuning fork. From Paul Richer, "Gonflement 
du cou chez un hystérique,"  Nouvelles Iconographie de la Salpêtrière 2  
(1889), plate 34. 
Photo courtesy Wellcome Institute Library, London.

the first professional photographer to have a full-time appointment in any hospital in Europe. His job was to document the progress and manifestation of the patient's disease, to capture the stages and processes as they represented themselves on the visible surface of the patient, on the patient's physiognomy, posture, actions, as a means of cataloging the disease process. This Linnaean means of describing illnesses through their visible signs and symptoms (to use Jean-Martin Charcot's term, taken from the witch-hunting manuals of the Inquisition, the stigmata of the illness, from the stigmata diaboli that marked the body of the witch) dominated nineteenth-century European, but especially French, psychiatry. To describe was to understand, to describe in the most accurate manner meant to avoid the ambiguity of words, and to rely on the immediate, real image of the sufferer.

But the malleability of the symptoms in hysteria troubled the fin-de-siècle scientist. As Charcot noted, "Symptoms . . . have their destiny: Habent sua fata ." Symptoms, "after having enjoyed a certain degree of favour, doubtless on account of the theoretical considerations connected with [them, have] gone somewhat out of fashion . . ." But this is to be understood from the standpoint only of the physician-nosologist; from the standpoint of the patient, the symptoms are real, even if the patients are duplicitous: "You will meet with [simulation] at every step in the history of hysteria, and one finds himself sometimes admiring the amazing craft, sagacity, and perseverance which women, under the influence of this great neurosis, will put in play for the purposes of deception—especially when the physician is to be the victim. . . . It is incontestable that, in a multitude of cases, they have taken pleasure in distorting, by exaggerations, the principal circumstances of their disorder, in order to make them appear extraordinary and wonderful."^[17] This deception is, for Charcot and his time, an absolute sign of the hysteric, and it can only be read correctly by a good diagnostician.

For hysteria must be "seen" to have observable symptoms, such as the changes of the skin or the wasting of the body, to be understood as a real disease: "Hysteria is a real disease, as real as small-pox or cancer, and . . . it has a physical basis, probably of a chemical nature, although this is yet very imperfectly understood."^[18] As an early review of the first major journal from the Salpêtrière devoted to the visual representation of the insane noted, the camera was as necessary for the study of hysteria as the microscope was for histology.^[19] This fantasy of realism captured the belief of the nineteenth century, both the doctor's and the patient's. For the doctor, the image is the patient, as it is for the patient. This search for an ontological representation of illness parallels the undertak-

ing of the exemplary fin-de-siècle scientist, Louis Pasteur, whose germ theory of contagious disease relied on the visibility of the germ for its power.^[20] As Georges Canguilhem notes: "After all, a germ can be seen, even if this requires the complicated mediation of a microscope, stains and cultures, while we would never be able to see a miasma or an influence."^[21] To see the patient means to develop the technique for seeing, a technique that is "scientific"; the patient, in turn, as the object of the medical gaze becomes part of the process of the creation of an ontological representation of the disease, a representation that is labeled hysteria. This does not deny the underlying pathology of the hysteric; it reflects only the meaning attributed to the symptoms created to represent the pathology as a disease.

One can speculate on whether the official nosology of American (and increasingly, world) clinical psychiatry, the DSM-IIIR (soon to be DSM-IV), in its restructuring of hysterical neurosis into conversion disorder, dissociative disorder, histrionic personality disorder, and brief reactive psychosis, did more than relabel an existing disease or whether these new labels are the self-conscious description of the manifestation of the hysteric in the 1980s.^[22] But at least the compilers of DSM-IIIR saw their undertaking as the description of the disease, rather than as the search for its etiology. This does not mean, however, that the physician and the patient place any less reliance on the meaning of these definitions in order to shape our contemporary sense of the patient. How many patients today learn to have "conversion disorders" or "factitious disorders with psychological symptoms" from the medicalized world in which they—the sufferers from the dis-ease of hysteria—must function?

For the patient knows how to be a patient, as we see mirrored so well in André Brouillet's image of Charcot, only from the representation of the way the physician wishes to see (and therefore to know) the patient as the vessel of a disease, not any disease, but the disease of images and imagining, hysteria. It is this shared sense of the importance of the image, for the doctor as well as for the patient, which is reflected in the image of the hysteric.