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Photography and the “discovery” of hysteria

Abstract

The concept of hysteria has been historically situated in the opposition between the organic and the mental. It continues to be at the center of controversies between important areas, such as psychoanalysis and psychiatry. We tried to elucidate the origin of the concept of hysteria by contrasting a conception that defends the existence of a world independent of the human mind (realism), and another that denies it (antirealism). Following the scientific trend of the 19th century, the French physician Jean-Martin Charcot used photography - at that time photography was seen as the scientist’s “true retina” - to create a typology of human beings. Situating this construction of knowledge and its sociocultural context provokes a questioning as to its objectivity. Our suggestion is that to think in a critical way about the origin of the concepts gives us elements for a better exercise of alterity in psychopathology.

Keywords:
psychopathology; reality; photography; hysteria; Charcot

Resumo

Historicamente marcado na oposição entre orgânico e psíquico, o conceito de histeria continua no centro de controvérsias entre saberes influentes como psicanálise e psiquiatria. Contrapondo uma concepção que defende a existência de um mundo independente da mente humana (realismo) e uma que a nega (antirrealismo), buscamos pensar como se deu a criação desse conceito. Em acordo com o movimento científico do século XIX, o médico francês Jean-Martin Charcot utilizou a fotografia, entendida na época como a “verdadeira retina” do cientista, para criar uma classificação do ser humano. Inserir essa construção de conhecimento em seu contexto sociocultural possibilita diversos questionamentos quanto à sua objetividade. Nossa concepção é a de que refletir criticamente sobre a formação dos conceitos contribui com elementos para um melhor exercício da alteridade no interior da psicopatologia.

Palavras-chave:
psicopatologia; realidade; fotografia; histeria; Charcot

Résumé

Historiquement marqué par l’opposition entre l’organique et le psychique, l’hystérie continue au centre des débats entre d’influents savoirs tels que la psychanalyse et la psychiatrie. En mettant en contre-position deux conceptions - l’une qui défend l’existence d’un monde indépendant de la psyché humaine (réalisme) et l’autre qui la nie (anti-réalisme) - nous cherchons à penser comment s’est construit le concept de l’hystérie. Suivant le mouvement scientifique du siècle XIX, le médecin français Jean-Martin Charcot se sert de la photographie, sous-entendue à l’époque comme “véritable rétine” du scientiste, pour créer une typologisation de l’être humain. En insérant la construction de ce savoir en son contexte socioculturel, il est possible de se poser plusieurs questions sur son objectivité. Notre conception est de penser qu’une critique réflexive sur la formation des concepts apporte des éléments pour un meilleur exercice de l’altérité au sein de la psychopathologie.

Mots-clés:
psychopathologie; réalité; photographie; hystérie; Charcot

Resumen

Históricamente marcado por la oposición entre lo orgánico y lo psicológico, el concepto de histeria sigue en el centro de la controversia entre los conocimientos influyentes como lo de psicoanálisis y la psiquiatría. Contrastando una concepción que defiende la existencia de un mundo independiente de la mente humana (realismo) a otra concepción que la niega (anti-realismo), buscamos investigar cómo se creó el concepto de histeria. De acuerdo con el movimiento científico del siglo XIX, el médico francés Jean-Martin Charcot utilizó la fotografía, entendida en su momento como la “verdadera retina” del científico, para crear una clasificación de lo humano. Introducir esta construcción del conocimiento en su contexto sociocultural permite muchas preguntas acerca de su objetividad. Nuestra concepción es que reflejar críticamente sobre la formación de los conceptos contribuye con elementos que visan mejorar el ejercicio de la alteridad dentro de la psicopatología.

Palabras clave:
psicopatología; realidad; fotografía; histeria; Charcot

Our eye finds it more comfortable to respond to a given stimulus by reproducing once more an image that it has produced many times before, instead of registering what is different and new in an impression. The latter would require more strength… Even in the midst of strangest experiences we still do the same: we make up the major part of the experience and can scarcely be forced not to contemplate some event as its “inventor”… All this means: basically and from time immemorial we are accustomed to lying. Or put it more virtuously and hypocritically, in short more pleasantly: one is much more of an artist than one knows.

(Nietzsche)1 1 The translation of the references in this article were made by the author and revised by a translator.

The use of quotation marks may indicate different senses in a text. Aiming to consider a classic topic of psychology jointly with a critical light, the use of quotation marks allows us to both highlight the term “discovery” and suggest the questioning of its use. To that we will use contemporary thinking tendencies referring to fields of knowledge like philosophy, psychoanalysis, medicine and history to think over the constructing and use of the concept of hysteria.

This concept is of utmost relevance to the development of psychology at large and, more specifically, of psychoanalysis (like Freud [1927/1996]Freud, S. (1996a). Apéndice de 1927 de “Análisis profano - psicoanálisis y medicina”. In S. Freud, Obras completas de Sigmund Freud (L. L. B. y de Torres, trad., tomo III, p. x-x). Madrid, España: Biblioteca Nueva. (Trabalho original publicado em 1927) we understand psychoanalysis as part of the psychology). Hysteria is a classic topic of the so-called “psi field”. It is present since ancient times, including Classic Antiquity: “the word ‘hysteria’ appears for the first time in Hippocrates’ thirty-fifth aphorism, where it is said: “When a woman suffers from hysteria or difficult labor an attack of sneezing is beneficial” (Didi-Huberman, 2003, p. 70). This Greek view on hysteria - whose etymology stems from “uterus” - is not the one to be directly worked on herein. However, it is useful to recall other possible meanings of the term.

For psychoanalysis, hysteria is present since psychoanalysis itself came into life. That is so because Freud’s studies on this topic, based on his clinical experience since his supervised practice with Jean-Martin Charcot, at Hospital Salpêtrière (from October 1885 to February 1886), subverted the concept of anatomic and physiological body existing by that time. Hysterical women have directly contributed with the emergence of concepts such as the sense of symptom and sexual unconscious. Some (like Roudinesco, 2000Roudinesco, E. (2000). Por que a psicanálise? Rio de Janeiro, RJ: Jorge Zahar.) say that Anna O. (or Bertha Pappenheim) - a patient that Freud and Breuer considered to be hysterical - was the one to create psychoanalysis. That is so because, by the time of her therapy, she asked the physician to let her talk freely, then performing her ‘chimney sweeping’ (although German was the patient’s mother tongue, she employed the term in English) and to perform a ‘talking cure’.

Throughout history, several meanings were assigned to hysteria, which is a controversial term in the cotemporary psychopathology. If, on one hand, it remains broadly used by psychoanalysts, on the other hand it has been set aside by the psychiatric diagnosis handbooks (such as the CID and the DSM). Therefore, this concept is perfectly legitimated to some, but rejected and considered to be obsolete by others. It hinders the interdisciplinary dialogue in the psychopathological field. The old organic/psychical dichotomy is in the heart of this issue and, as such, the concept remains worth of theoretical in-depth studies.

Reality(ies) and its understandings

Realities are what we make them, not what they make us, or what they make us do.

(Wagner)

Nothing better to illustrate our question than applying it on common-sense knowledge. For example, let us take a typical issue of our school times in Brazil: who discovered Brazil? And the memorized response that typically follows this question: Pedro Álvares Cabral! First of all, this information can be considered wrong since, according to (Lopez and Mota, 2008Lopez, A., & Mota, C. G. (2008). História do Brasil: uma interpretação. São Paulo, SP: Senac São Paulo.) there is evidence enough proving that the Portuguese Duarte Pacheco Pereira arrived in this region, further named Brazil, at least two years earlier than Cabral.

Secondly, the use of the term “discovery” to think about Brazil is far from being a mere neutral description of reality. It clearly is a European perspective (rather than a Tupi-Guarani view, for example) typically repeated with no further critical thinking. Brazil was not merely discovered; it was - and keeps on being - invented.

Consider the building of knowledge and reality as a discovery or an invention implies deep epistemological differences, and recalls the differences between realism and antirealism. As said by several authors (Kirk [1999]Kirk, R. (1999). Relativism and reality: a contemporary introduction. London, England: Routledge., Beebee & Dodd [2007]Beebee, H., & Dodd, J. (2007). Reading metaphysics: selected texts with interactive commentary. Milton, Australia: Blackwell. and Devitt [2008]Chalmers, A. F. (1993). O que é ciência afinal? São Paulo, SP: Brasiliense.) we can understand realism as the perspective of existing a world apart from the human mind. Therefore, the atoms, vegetal, unconscious, hysteria and serotonin, for example, would have always lived in a purported “natural world”, regardless if human beings recognized it or not. In the light of realism, thus, the human being would use the right (scientific) methods and instruments to discover the world. This last would be characterized as the court of all propositions aimed to define reality. (Silva, 1998Silva, M. R. (1998). Realismo e anti-realismo na ciência: aspectos introdutórios de uma discussão sobre a natureza das teorias. Ciência & Educação, 5(1), 7-13.) says:

To the realist and in an ontological light, the world is constituted by autonomous properties. This way, the external world, in a hardly trivial sense - considering the considerable source of debate between realist and antirealist positions -, would be independent from scientific theories. This shows the basic claim of the scientific realism: scientific laws are discovered in opposition to the antirealist position that believes these are inventions. (Our translation, p. 7)

Typically, the realist concept is more easily understood because it is also used in the common sense. Even the scientific community frequently ignores questions about reality, truth and construction of knowledge, because realism is taken as the assumption. However, many disputes in metaphysics can be characterized as disputes between realists and antirealists that disagree about the existence of an entity or type of reality (Beebee, Effingham, & Goff, 2011Beebee, H., Effingham, N., & Goff, P. (2011). Metaphysics: the key concepts. New York, NY: Routledge., p. 212). As (Richardson, Fowers & Guignon, 1999) state:

Most of the academic psychology has successful defended itself against the contemporary debates about nature of knowledge, its historical inclusion, or to which extent it is socially built, as well as its interrelation with moral values and political powers. Few psychologists have a critical view about the metaphysical and moral grounds of their methods and theories. (Our translation, p. 173).

Many researchers may have difficulties to abandon the self-image of neutral and objective scientists to think over the viewpoints included in their methods, theories and observations. However the issue between realism and antirealism may be ignored in psychology; thinking about the statute of reality is unavoidable to those who appraise critical thinking and coordination of knowledge. That does not mean to say that the separation between realism and antirealism is the only way of thinking theories about truth. Rather, it is just a didactic way of presenting remarkable differences of perspective (deflationism, theory of correspondence and theory of coherence are examples of other possibilities of thinking over truth).

The very essence of the antirealist concept is to challenge the possibility of an alleged external world untouched by human beings, considering that all one can affirm about the world is being intermediated by human language. Therefore, the language itself would impose limitations to the scope of our apprehensions and also define the locations about which we are talking.

According to (Kirk, 1999Kirk, R. (1999). Relativism and reality: a contemporary introduction. London, England: Routledge.): “realists sustained that reality is independent from our thinking, although how to think it is up to us. The relativists [or antirealists] disagree and sustain that what exists, and what is true, depends on our point of view” (p. ix). Therefore, in the antirealism light, reality - be it Brazil, hysteria or even the planetary system - would not be independent from human mind. To make it clear, let us take as example something apparently untouched by our minds. According to (Beebee et al., 2011Beebee, H., Effingham, N., & Goff, P. (2011). Metaphysics: the key concepts. New York, NY: Routledge.):

Planets have clearly not been created by us: we have not shaped them from large pieces of rock and then launched them in the solar system. However, when we talk about planets, we are talking about a world classified or conceptualized by use, and not about the world as it is per se. (Our translation, pp. 48-49)

The quote above makes clear that thinking in terms of antirealisms does not imply denying the existence of reality. It is about emphasizing the dimension of interdependence between the human mind and the reality perceived. The criteria used to classify the world are always human and, according to the antirealists, would not merely correspond to a reality external to us. Nature does not provide us with classifications. For planets, for example, there are several criteria to define a celestial body such as the orbit path and its size. But, why would the adoption of some criteria and classifications to categorize a given object ensure access to a reality external to the human mind?

From now on we will challenge the traditional perspective (realist) on the movement of emergence of hysteria in the 19th century. We will try to show how the context of time and the personality of Charcot have influenced the invention of this diagnosis. In other words, rather than being something “discovered” by a neutral clinical observation, the concept of hysteria can be understood as the result of historical invention.

However, there is an important consideration here. When we say “invention” instead of “discovery” we do not intend to disqualify the concept of hysteria, but to value the sociocultural component about its creation. Moreover, thinking in terms of invention does not imply free fantasy. It is not “anything goes” because the context imposes criteria to define the validity of knowledge.

Photography and disclosure of reality2 2 As should be made clear throughout the text, the work Invention de l’hystérie: Charcot et l’Iconographie photographique de la Salpêtrière by Georges Didi-Huberman was crucial for us. In our view, the originality of his work remains little explored in the field of psychopathology.

Not even tourists or children take pictures naively. They act conceptually, because technically. Every aesthetic, political or epistemological intention must go through the screening of conceptualization before resulting in image. The device was programmed to that. Pictures are images of concepts, are concepts transcoded into scenes.

Flusser (our translation)

As (Perrot, 1991Perrot, M. (Org.) (1991). História da vida privada: da Revolução Francesa à Primeira Guerra (Vol. 4). São Paulo, SP: Companhia das Letras.) states, the individual picture has influenced gradual individualization in the Western society. Although prior to the 19th century people had to pay lots of money for a painter to produce a portrait, inventions like the physionotrace (by Gilles-Louis Chrétien) and the daguerreotype (by Louis-Jacques-Mandé Daguerre) made portrait more affordable. This allowed a larger number of people to benefit from having their own images.

On the Parisian squares and, few later, in other countries also, people sought more and more for this technology. According to (Perrot, 1991Perrot, M. (Org.) (1991). História da vida privada: da Revolução Francesa à Primeira Guerra (Vol. 4). São Paulo, SP: Companhia das Letras.) the picture had something special: acquiring and posting self-image disarms anguish; it means showing your existence, registering your memory (p. 423). Still by that time the photo camera was created. This would make obsolete the remainder methods of taking pictures. According to (Perrot, 1991Perrot, M. (Org.) (1991). História da vida privada: da Revolução Francesa à Primeira Guerra (Vol. 4). São Paulo, SP: Companhia das Letras.):

This way, photography will allow democratizing the portrait. For the first time the fixing, possession and serial consumption of self-image are affordable to commoners. Registered in 1841, the patent of this new process undergoes several technical improvements throughout the next 10 years. Posing time is gradually shortened until the instant register is discovered in 1851. (Our translation, p. 425)

In the imagination of photographers by that time the portrait would certify forever the existence of each being (in this sense, the saying “an image is worth a thousand words” is perfectly applicable). The invention of the instant record enables the large-scale use of photography. Since then, it has been used by many people and for different purposes. According to (Samain, 2001Samain, E. (2001). Quando a fotografia (já) fazia os antropólogos sonharem: o jornal La Lumiére (1851-1860). Revista de Antropologia, 44(2), 89-126.):

In the sparking half of the 19th century marked by the fever of order and progress, rationality and light, the French anthropologists-naturalists discover, jointly with many other scientists, the heuristic possibilities that photography could offer to their “view” about “anthropology”, i.e., an attempt to track the “human species”, races and, among them, the human types, in a clearly evolutionist light. (Our translation, p. 89)

Photography has contributed to expand the categorizations of the world and of the human being. Typology is one of the forms of categorization. It is the creation of types always involving classes, models or examples of a given object of study. This way of characterizing the world and the human being aims to be oriented to what is typical, i.e., to what fits into general formulations. (Jaspers, 1913/2003Jaspers, K. (2003). Psicopatologia geral: psicologia compreensiva, explicativa e fenomenologia (Vol. I). São Paulo, SP: Atheneu. (Trabalho original publicado em 1913)) says we create types:

Whenever we make one or many qualities as the ground for a broad and general conception; when we seek an understandable connection in its work on the whole individual; when we see how it communicates with everything the human creature experiences and does. (Our translation, p. 518)

A form of typologization used in the past was that of establishing races among human beings. This has no longer been used in the last decades. In the scientific concepts of humanity and diversity existing now, talking about human races is something problematic (and about “primitive societies”, for example). This recalls us the existence of sociocultural aspects that influence categorization and typologization that are senseless per se, because they depend on the context. The reality is literally changed based on the categories we decide to use.

Returning to the 19th century, there are many theoretical influences regarding the use of photography. Buffon’s naturalism that tried to map humanity, Darwin’s ideas about evolution and August Comte’s positivist view of the world granted scientists and the common sense with unshakeable confidence regarding the possibility of order and progress. Some methodological issues were introduced in this context:

The emergent anthropology defines the issue of observation: one must know to see, learn to look, specify and define in which place and from which angle we focus our view, be provided with technological instruments capable of offering the most objective and accurate register possible of the types of all human races and distinguishing physiognomic characters of each of them. (Our translation of Samain, 2001Samain, E. (2001). Quando a fotografia (já) fazia os antropólogos sonharem: o jornal La Lumiére (1851-1860). Revista de Antropologia, 44(2), 89-126., p. 99, highlights by us)

The quote above clearly bears a realist perspective about knowledge. It brings the subjacent idea that we can learn human nature if we use reliable methods. It is in this context that photography comes about, tasked with the mission of cataloguing types and races. According to (Samain, 2001Samain, E. (2001). Quando a fotografia (já) fazia os antropólogos sonharem: o jornal La Lumiére (1851-1860). Revista de Antropologia, 44(2), 89-126.):

This comprehensive effort of “typologization” of the human species will lead to many other experimentations: anthropometric pictures (Thomas Henry Huxley, John Lamprey); composite pictures (Francis Galton, Arthur Batut); typology of mental and nervous disorders (Hugh W. Diamond, John Conolly, Jean-Martin Charcot and Albert Londe); or identification of criminal, murder, crazy personalities (Cesare Lombroso). (Our translation, p. 117, highlights by us)

As (Jaspers, 1913/2003Jaspers, K. (2003). Psicopatologia geral: psicologia compreensiva, explicativa e fenomenologia (Vol. I). São Paulo, SP: Atheneu. (Trabalho original publicado em 1913)) says, almost all authors believe to have learned the human essence, defend their schemes in a more or less absolute way and, in principle, clarify the less critical reader (p. 519). This is also true in the field of psychopathology. In our view, we must be attentive to this dimension of the knowledge building. The naturalization of the vocabulary used (one of the traps of language) is common. But dealing with otherness many times implies being critical with ourselves. In the next section we will see how photography played a decisive role to the invention of the hysteria “type”, but we can advance that, as (Samain, 2001Samain, E. (2001). Quando a fotografia (já) fazia os antropólogos sonharem: o jornal La Lumiére (1851-1860). Revista de Antropologia, 44(2), 89-126.) says:

Photography, by that time, is not only the “genuine representation” of reality. It provided or, even better, “provides” reality in all of its nudeness..... This mystic of transparence and objectivity that surrounds it goes even farther. In the full sense of the word, photography is a “disclosure’..... Therefore, the photography not only “shows” the world things in a completely new way and an amazing precision; it “discloses” and makes possible “discovering” these things. (Our translation, p. 105)

Therefore, photography was perceived as an absolutely objective record of reality. It would disclose reality in a way that avoids the intrusion of human subjectivity and sociocultural aspects. Therefore, if compared to other typical forms of representation by that time, like drawing, painting and plaster molds, photography was granted the seal of highest reliability by scientists and artists, as well as by society at large. However, if the realist perspective prevailed when photography was created, today it can be understood in other ways, as does (Sontag, 2004Sontag, S. (2004). Sobre fotografia. São Paulo, SP: Companhia das Letras.):

Even when photographers are more concerned in mirroring reality, they are harassed by demands of taste and consciousness ..... When deciding about the aspect of an image, by electing one exposure over the other, photographers always impose standards to their topics. Although in some sense the camera effectively seizes reality, rather than just construing it, pictures are an interpretation of the world as much as are the paintings and drawings. (Our translation, p. 16-17)

If a realist perspective understands the possibility of right methods and instruments to reveal reality - and that was how photography was understood in the 19th century - on the other hand, we can make criticisms to that understanding, which are close to an antirealist perspective. As (Flusser, 2011Flusser, V. (2011). Filosofia da caixa preta: ensaios para uma futura filosofia da fotografia. São Paulo, SP: Annablume.) says, “the apparent objectivity of technical images (images produced by devices) is illusory, because in reality these are as symbolic as any other image” (our translation, p. 30).

As widely known, there is always a human being behind the device deciding what will be photographed, according to given interests. The selected scene in fact details the environment (one should keep in mind that in the 19th century photography was black and white), but the scene per se, i.e., what is selected to be “disclosed” is selected by a person and not by the camera. According to (Flusser, 2011Flusser, V. (2011). Filosofia da caixa preta: ensaios para uma futura filosofia da fotografia. São Paulo, SP: Annablume.): “what we see when we look at technical images is not ‘the world’, but some concepts related to the world”. In other words, it brings several values and expectations (aesthetic, ethic, political, etc.).

Didi-Huberman, in a text named Quando as imagens tocam o real states that “just like there is no form without formation, there is no image without imagination” (2012, p. 208). To the author, one could say that images could “touch the real”, not in the sense of showing an objective image, but because it would be a mistake considering imagination as a faculty of derealization. This perspective also resembles the antirealism, because it is not about denying reality, but about considering human aspects when interpreting reality. That is what we will do next.

The artistic view of Charcot

That is the truth. I have never said anything different, I am not used to propose things that cannot be experimentally demonstrated. You know it is a principle of mine to not mind about theory and leave all prejudices aside: if you want to clearly see, you should accept things as they are. It could seem that hysteria-epilepsy exists only in France and only, as some say, at Salpêtrière, as if I had created it using the power of my will. It would be really fantastic if I could create diseases according to my whim and imagination. But, indeed, here I’m nothing but a photographer; I register what I see…

(Our translation of Charcot apud Didi-Huberman, highlights by us)

As one can notice, Charcot was in tune with the scientific thinking of that time. His outstanding capacity of making neurological diagnosis and prognostics gave him fame, profit, acknowledgment and lots of authority. Tsars, princes (like Dom Pedro II), great traders and bankers were his patients - something notorious for the son of a builder of carts (Scull, 2009Scull, A. (2009). Hysteria: the biography. Oxford, England: Oxford University.).

However, Charcot had other additional talents. According to (Didi-Huberman, 2003): “all biographers of Charcot insist in his “competence” and artistic “taste”, as well as his vocation as painter” (Our translation of p. 30). Freud, the most famous student of Charcot, felt deep admiration for him, and named one of his sons as Jean-Martin3 3 When he left his supervised practice in Paris, on February 2, 1886, Freud took with him a picture where Charcot was impotently posing (Scull, 2009). This fact seems to show both the importance of photography by that time, and the importance of Charcot to Freud. . (Freud, 1893/1996Freud, S. (1996b). Charcot. In S. Freud, Obras completas de Sigmund Freud (L. L. B. y de Torres, trad., tomo I, p. x-x). Madrid, España: Biblioteca Nueva. (Trabalho original publicado em 1893)) says:

Charcot was not a thinker, but a nature of artistic gifts or, as he used to say, a “visual”. About his working method, one day he told us: sometimes he used to carefully consider what was not known and, in this way, strengthen day after day his impression about it, until he suddenly understood it. Before his spiritual view, chaos was then ordered, pretended by the constant return of the same symptoms, emerging new pathological conditions characterized by the continued linking of some groups of syndromes. (Our translation, p. 31)

When Charcot joined the Hospital Salpêtrière (exclusively for female patients) in 1862, hysteria was not part of the usual vocabulary of the institute and of the French psychopathology in general, as says (Didi-Huberman, 2003). Still according to the author, at a given moment one building of the Salpêtrière had to be refurbished. Then, the hospital management could separate women considered to be psychotic from the non-psychotic ones.

As both the patients further called as hysterical and the epileptic patients (i.e., all non-psychotic patients) presented seizures, they found logical to put them together. Then, the special division named “Simple Epilepsy Division” (Didi-Huberman, 2003) was created in the hospital. In this service Charcot was in charge of the administration and, therefore, was surrounded by hysteria.

When also [Charcot] names it ‘the great emporium of human misery’, this is to add that, thanks to himself, a catalogue was designed and the emporium, the depot, had become the ‘center of really useful theoretical and clinical education’ in his hands. (Our translation, Didi-Huberman, 2003, p. 20)

In fact, according to the French context by that time as briefly described above, photography was highly considered as the “disclosure of reality” in Salpêtrière, as well. In fact, the hospital had a whole department exclusively devoted to photography. It was coordinated by Albert Londe, a scientist that considered this form of technology as the “true retina” of scientists (Didi-Huberman, 2003).

Charcot used photography as a lab tool to the experimental procedure, a scientific file to the museology procedure and a transmission tool for education. Therefore, there was trust and enthusiasm in relation to this technology, making it the tool that would ensure objectivity to methods and observation. According to (Didi-Huberman, 2003):

Charcot has effectively rediscovered hysteria (and, in this sense, his work is pioneer - but exactly in what has he been pioneer? That is the question). He named hysteria. He differentiated particularly from epilepsy and the remainder mental detachments. In brief, he isolated hysteria as a pure object of nosology. (Our translation, p. 23, highlights by the author).

Charcot made history firstly for having rediscovered (or reinvented, as we wish) hysteria. This nosological creation was greatly assisted by the tableaux4 4 It is worth paying attention to the ambiguity of this term that can mean “picture” and “table”. According to (Didi-Huberman, 2003) Charcot’s iconography has evidently artistic traits and, therefore, hysteria in the 19th century could be thought even as a chapter in the history of arts. , built from the detailing of patients’ behaviors. Many times the body expressions of patients were depicted in drawings, in an attempt to build the perfect portrait of the disease to compare and classify cases.

Many thinkers by that time were using this resource. Landouzy, for example, a physician that also worked on hysteria, prepared several tables on the disease. On one of these, he describes all secretions he found in the body of his female patients, including saliva, blood, urine, tears and “uterine or vaginal hypersecretion” (Didi-Huberman, 2003, p. 265).

Although being concerned about aspects that would be typical among patients, he concentrated more deeply on few patients, mainly one named Augustine, to whom Charcot developed a classificatory scheme. Augustine’s crises were very regular (both in terms of time and in the physical aspect). Then, Charcot thought to have discovered a sequence of stages underwent by all patients. According to (Scull, 2009Scull, A. (2009). Hysteria: the biography. Oxford, England: Oxford University.):

Charcot said that hysteria had four different stages “four periods (that) happed throughout a full seizure, with a regularity of mechanism”. Firstly, there was the “epileptoid” period where patient had seizures. In the next stage, the “period of contortions and grand mouvements” the patient, as the name says, presented drastic physical demonstrations, many times followed by cries and screams, sometimes culminating in the adoption of the position arc-en-cercle, where the patient bent backwards in an apparently impossible contortion, with only the back part of the head and the heel touching the floor. Charcot also referred to these episodes as clownisme. So, mainly the female patients had the phase of attitudes passionelles, where they posed like as if they were crucified or about to have an orgasm. (Our translation, p. 115)

Photography was decisive to the invention of hysteria, since all the aforementioned stages were photographed and, later, pictures were exhibited as evidence of the truth of the diagnosis. The iconography, i.e., collection of pictures, was disseminated in Paris to an audience that not always had a place in the Salpêtrière’s show - the presentation of hysterical patients. Both because of photography and for his own authority, Charcot disseminated his diagnosis (his discovery). Images fixed on the audience’s minds the existence of hysteria and, subliminally suggested the concept of being a neutral and natural evidence of what would be an organic disease of the nervous system. According to (Freud, 1893/1996Freud, S. (1996b). Charcot. In S. Freud, Obras completas de Sigmund Freud (L. L. B. y de Torres, trad., tomo I, p. x-x). Madrid, España: Biblioteca Nueva. (Trabalho original publicado em 1893)):

Students that visited with him the rooms of Salpêtrière, museums made up by clinical facts whose names and peculiarities had been mostly elaborated by him [Charcot] resembled Cuvier, the great expert and describer of the zoological world, where he presented his statue of the Jardín des Plantes surrounded by different figures of animals, or thought about the myth of Adam, which should intensively enjoy that intellectual pleasure, so much praised by Charcot, when God assigned him the task of differentiating and naming all beings in Heaven. (Our translation, p. 31)

Our understanding refers more to an intervention of the nosological category of “hysteria” than to its “disclosure” by God or the camera. To antirealism, there would be no way of accessing an alleged natural world (external to the human mind), which the human being had been tasked only to describe and label. In the case of hysteria, a new category was appraised mostly thanks to Charcot’s efforts towards defending his methods and techniques. He says: “This is not a novel: hysteria has its own laws. And hysteria abides by them! I can ensure it has the ‘regularity of a mechanism’. (Italic added) (Free translation of Charcot apud Didi-Huberman, 2003, p. 78).

Regarding the characteristics of hysterics, Charcot also said “these are valid for all countries, all times, all races and, therefore, are universal” (our translation, Charcot apud Scull, 2009Scull, A. (2009). Hysteria: the biography. Oxford, England: Oxford University., p. 115-116). The desire of this physician and artist towards fitting his thoughts into the rules of a natural and positive science is evident, because he sought for laws to ensure the objective and experimental nature.

We should recall that even before Charcot, Pierre Briquet published in 1850 his Traité clinique et thérapeutique de l’hystérie, where he used this diagnosis differently from how Greeks used it5 5 Even English authors in the 17th century, like Thomas Sydenham (1624 – 1689) and Thomas Willis (1621 – 1675), referred to “hysteria”, but in a different way than that used by Charcot. . Therefore, the term “Briquet’s syndrome” was used many times to designate what could be understood as hysteria today. Many times Charcot recognized his debt to Briquet (Scull, 2009Scull, A. (2009). Hysteria: the biography. Oxford, England: Oxford University.), but also added original concepts. According to (Didi-Huberman, 2003):

[Charcot] said that epileptic women had “seizures” and the hysterical had “attacks”. He compared the respective seriousness of symptoms. He said that epilepsy was “truer” (because it was more “serious”) than hysteria. And he had even a model established: hysteria imitates epilepsy, as he could observe every day in his work at Salpêtrière. (Free translation, p. 78).

Charcot then started talking about “hysterical-epilepsy” or greater hysteria. This new category was thought in the organic light, including supposing some kind of hysterical lesion: “a lesion of the cortex rather than of the center, a “dynamic lesion” he [Charcot] used to say, physiological and not anatomic, ‘ephemeral, instable, always prone to disappear’” (Free translation, Didi-Huberman, 2003, p. 79).

One of the biggest enigmas of hysteria comes about in this context. It is basically the divide between organic and psychical. Charcot and many physicians (up to these days) sought for likely organic causes in these psychopathological conditions. Freud, for example, took on a different theoretical risk, developing the concept of “conversion”. Although Charcot stated that “these cases are always about the genital thing - always, always, always” (apud Didi-Huberman, 2003, p. 160), something that has certainly influenced psychoanalysis, these were different understandings.

In anyway, Freud made own of Charcot’s concept of hysteria, however in a different light of etiology. In other words, he thought hysteria as an isolated and natural concept. As we could observe, this was a reconstruction of Charcot in the 19th century. According to (Didi-Huberman, 2003): “Freud was a confused witness of the huge chamber of hysteria and of image construction. His confusion influenced on the initial stages of psychoanalysis” (Free translation, p. 5). (Novaes, 2008Nietzsche, F. (1975). Beyond good and evil: prelude to a philosophy of the future. Middlesex, England: Penguin Books.) develops some concepts in this regard:

In Freud’s view, image is associated with nature, and world is associated with convention. In this light that still remains among social scientists, we never notice to which extent image is structured by rules and conventions of different cultures.... In this separation, nature has always been perceived as something objective, biological, universal, while convention is something social, cultural, regional or local. (Free translation of p. 457).

Undoubtedly we are not here to criticize past authors in current lights; but we believe it is worth thinking over the concepts of influent authors. Freud’s way of understanding images was decisive to build one of the most influencing theories in the 20th century. After his staying in France, Freud returned to Vienna to work with hysterical individuals. By that time, he published Studies on Hysteria (1895) jointly with Joseph Breuer.

In fact, Freud has largely advanced the psychopathological knowledge after his supervised practice. Reflecting on these results would demand many other articles (also including the hypnosis techniques used by Charcot in the Leçons du Mardi [Tuesday classes] at Salpêtrière). However, the main issue here is the concept that hysteria was invented rather than just discovered. And this goes far beyond a mere semantic issue.

Images, knowledge and interest

Scientific theories rigorously result from the collection of experience data through observation and experiment. Science is based on what we can see, hear, touch, etc. There is no place for personal opinions or preferences and speculative assumptions in science. Science is objective. Scientific knowledge is reliable because it is objectively proven.

(Chalmers)

The quote above describes a common sense-based concept of science. We can find the realism underlying this way of understanding, because it supposes a reality apart from human mind, and scientists should use the proper methods and instruments to reach it. (Chalmers, 1993Berrios, G. E. (2008). Classificações em psiquiatria: uma história conceitual. Revista de Psiquiatria Clínica, 35(3), 113-127.) names this concept as “naïve inductivism”. Through a series of argumentations, the author defends the logical, experimental and probabilistic impossibility of the idea that science starts by observation and, if it is right, to provide safe grounds for knowledge.

The invention of hysteria in the 19th century, for example, did not happen with a neutral observer taking pictures and further ‘discovering’ something. Scientists already had in mind many assumptions and expectations by the time of observing and photographing. As we could notice, these were in line with the views of the world and human nature by that time.

Psychology as a science frequently takes on inductivist and realist assumptions. Many of its concepts are perceived as natural representations and as the result of accurate observations of reality. This kind of understanding entails several consequences. One is that the concepts and institutions, after being created, “start being perceived as above humanity, having a sort of independent life” (Duarte Júnior, 1988Duarte Júnior, J.-F. (1988). O que é realidade. São Paulo, SP: Brasiliense., p. 42) and are no longer perceived as a human creation, being perceived as a natural reality. According to (Duarte Júnior, 1988Duarte Júnior, J.-F. (1988). O que é realidade. São Paulo, SP: Brasiliense.):

This phenomenon is known as reification - a name derived from the Latin word res that means “thing”. The socially constructed reality always undergoes reification, i.e., is “thingificated”: it acquires the same status of natural things, physical objects. It is in this sense that institutionalization, the ground for reality, bears social control: when perceived as something given, established, it prevents individuals from trying to change it. (Free translation, p. 42-43).

To many, hysteria would have been discovered and hold undeniable existence in a world external to the human mind. Therefore, accusing or even belittling those who do not work with this concept in psychopathology is a frequent consequence. It is like as if hysteria were part of an undeniable reality and whoever fails to recognize it is blind or, at least, superficial. However, on the other hand, those who do not use this concept can also call on the “objective reality” and clinical observation as guarantees to their concepts.

One should always bear in mind the existence of intentions and interests behind the apparently objective classifications of reality, like the belief of objectivity of instruments and methods. Even before photography, for example, Daguerre already stated in an article to attract investors that his invention granted nature with the power of reproducing itself (Sontag, 2004Sontag, S. (2004). Sobre fotografia. São Paulo, SP: Companhia das Letras., p. 204). In other words, the glorification of the daguerreotype possibilities in this case clearly served a personal financial interest. Considering our thoughts about photography and technical images in general, we can analyze the following Barrios’ (2008) quote:

the potential role of pharmaceutical industries and medical insurers in the “selection” of clinical classes (like in the DSM-IV6 6 The DSM (Diagnostic and Statistical Manual of Mental Disorders) is in its 5th edition (launched in May 2013). As most of the clinical classes in the DSM IV remains in the DSM V, Berrios’ thinking is also valid to this latest edition. ) is becoming clearer. One could also forecast that genetics and neuroimaging industries will soon play a similar role: new ‘diseases’ will be defined in terms of these techniques, and there will be pressure to include them in the further classifications. Although prima facie it happens to the benefit of patients, there is little doubt that the forensic obligation of diagnosing what is in the official classifications will push psychiatric centers to buy the required equipment. (Free translation, p. 125)

The ideas above came from a British consultant to the DSM-IV and professor of psychiatry at the University of Cambridge, and seem worthy of consideration. The question is pertinent, as it is characterized as a contemporary version of the weight that images produced by devices still have in science and in the common sense view. If in the past photography was greatly reliable to psycho-pathologists and the society at large, today neuroimages seem to have taken this place. A realist concept allied to a naive inductivism still hinders seeing other possibilities of understanding.

It is amazing perceiving in the quote above, allied to the reflections made up to then, how we manipulate reality when we create concepts. The categories of classification handbooks guide scientific research and the society at large towards some directions, just like the creation of human races have also biased (and still bias) our thinking. By creating a vocabulary we also create conventions and, therefore, other realities.

When we observe nature - either with naked eye, camera or neuroimaging devices - we never see an objectiveworld, but only pre-existing concepts.

This does not hinder the resulting knowledge from being extremely important to human life, but surely is not the only right interpretation of reality. In fact, concepts suffered changes and innovations along time (although not in a linear evolution). However, even the “new” always bears traits of the sociocultural context that surrounds it. It is not about denying reality through a naive relativism. It is about considering in our analyses the aspects of human interests when we interpret reality.

Therefore, there are several problems inherent to the appeal of an objective reality when we advocate for a given concept. The most serious one, in our view, is the weakening of dialogue. Considering this is a multidisciplinary field, psychopathology only loses when representatives of different sorts of knowledge that makes it up enclose themselves in an ivory tower. Seen something in an alleged objective reality is not enough to reify concepts and classifications or to reject other ways of understanding. As (Sontag, 2004Sontag, S. (2004). Sobre fotografia. São Paulo, SP: Companhia das Letras.) says, “nothing has ever been understood from a picture” (free translation, p. 33). The same is true to the other instruments, images and scientific concepts, because reality needs a human being to interpret and give sense to it.

When there is reification, there is also a search for social control. It happens both when we try to validate new knowledge using this resource, and when we try to protect it from criticisms. However, if we can challenge the ultimate fundamentals of our knowledge, accepting the incompleteness of our understanding about reality, we are typically more prone towards accepting the validity of different types of knowledge, even with radical alterity.

The possibility of having different perspectives dialoguing can be determinant to a successful psychic treatment. And, in this regard, we must ask: should the commitment of mental health professionals be with some specific research tradition or with the psychic suffering itself? Since this is a clearly rhetorical question, we think that sustaining an intellectual openness allied to the possibility of self-criticism is crucial. If this is important to analyze the constructing of Brazil and plants, it seems even more important when pathos is the objective of study.

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  • 1
    The translation of the references in this article were made by the author and revised by a translator.
  • 2
    As should be made clear throughout the text, the work Invention de l’hystérie: Charcot et l’Iconographie photographique de la Salpêtrière by Georges Didi-Huberman was crucial for us. In our view, the originality of his work remains little explored in the field of psychopathology.
  • 3
    When he left his supervised practice in Paris, on February 2, 1886, Freud took with him a picture where Charcot was impotently posing (Scull, 2009Scull, A. (2009). Hysteria: the biography. Oxford, England: Oxford University.). This fact seems to show both the importance of photography by that time, and the importance of Charcot to Freud.
  • 4
    It is worth paying attention to the ambiguity of this term that can mean “picture” and “table”. According to (Didi-Huberman, 2003) Charcot’s iconography has evidently artistic traits and, therefore, hysteria in the 19th century could be thought even as a chapter in the history of arts.
  • 5
    Even English authors in the 17th century, like Thomas Sydenham (1624 – 1689) and Thomas Willis (1621 – 1675), referred to “hysteria”, but in a different way than that used by Charcot.
  • 6
    The DSM (Diagnostic and Statistical Manual of Mental Disorders) is in its 5th edition (launched in May 2013). As most of the clinical classes in the DSM IV remains in the DSM V, Berrios’ thinking is also valid to this latest edition.

Publication Dates

  • Publication in this collection
    Sep-Dec 2016

History

  • Received
    10 Aug 2014
  • Reviewed
    25 Aug 2015
  • Accepted
    09 Nov 2015
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