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Journal of the History of the Neurosciences, 15:22–30, 2006

Copyright © Taylor & Francis, LLC


ISSN: 0964-704X print / 1744-5213 online
DOI: 10.1080/096470490944707

Charcot in Contemporary Literature


1744-5213
0964-704X
NJHN
Journal of the History of the Neurosciences
Neurosciences, Vol. 15, No. 01, October 2005: pp. 0–0

CHRISTOPHER G. GOETZ
Charcot In Contemporary
Christopher G. Goetz Literature

Professor of Neurological Sciences, Professor of Pharmacology, Rush University


Medical Center

Charcot and his medical observations remain an enduring topic of scientific study in
neurology, but he is also the topic of modern literary works. This essay examines the
depiction of Jean-Martin Charcot (1825–1893) as a character in late-twentieth-cen-
tury literature as an index of the contemporary nonmedical literary public’s interest in
neurology and Charcot. It focuses on three contemporary works that involve Charcot
as a central figure with comparison between primary source documents and the ren-
dered context, character development, and plot lines of these literary works. The two
French novels [Slumbers of Indiscretion and Dr. Charcot of the Salpêtrière] and one
American play [Augustine (Big Hysteria)] approach Charcot and neurology with dif-
fering levels of historical accuracy. All create a figure of authority, each with a differ-
ent coloration of the balance between power and its abuse. Two focus almost
exclusively on his work with hysteria and inaccurately amplify Charcot’s concern with
symbolic sexual conflict as the origin of hysteria and fictionalize more extensive inter-
actions with Freud than historical documents support. The three works demonstrate
that Charcot retains an enduring fascination with an enigmatic personality, a contro-
versial career, and a pivotal role in the development of studies involving the brain and
behavior. Neurologists should not look to these works as replacements for more seri-
ously composed historical studies, but as enrichments anchored in the imaginative
possibilities of Charcot and his fin de siècle era.

Keywords Charcot, Jean-Martin, neurological history, history, clinicoanatomical


method, hysteria

Introduction
During his life, the French neurologist, Jean-Martin Charcot, developed an international
reputation as the premier clinical specialist of neurological disorders. Charcot’s contempo-
rary and lasting contributions form the basis of the modern neurological nosography that
correlates specific neurological signs with specific anatomical lesions. He developed a two-
part discipline known as the méthode anatomo-clinique whereby he first categorized
patients by their predominant neurological signs and then, after they died, he studied brain,
spinal cord, and nerve tissue to identify specific areas of degeneration, structural damage,
or inflammation (Goetz, 2000). Because Charcot had access to thousands of patients at the
Salpêtrière hospital, he was able to separate Parkinson’s disease from multiple sclerosis,
two entities previously confused with one another because both shared tremor. He sepa-
rated epilepsy from pseudo-epilepsy, myelepathies from neuropathies, and he graphically
described the trophic changes that occur in spinal and cerebral diseases. Charcot opened
new horizons for the study of direct relationships between clinical and anatomical

Address correspondence to Christopher G. Goetz, Rush University Medical Center, Chicago,


IL, 60612, USA. Tel: +1-312-942-8016. Fax: +1-312-563-2024. E-mail: cgoetz@rush.edu

22
Charcot In Contemporary Literature 23

pathological states and presented the revolutionary concept that a precise anatomic diagno-
sis could be made before death. Beginning in the early 1870s, Charcot added hysteria to his
research focus and made several pivotal contributions to the understanding of this neurop-
sychiatric condition. His work in hysteria was more controversial than his work with ana-
tomically confirmed neurological syndromes, and his studies of hysteria and hypnotism
brought him international attention but also severe scientific criticism (Widlocher, 1982).
In the intellectual atmosphere of fin de siècle Paris, Charcot was also a well-known
social figure, and his Salpêtrière teaching sessions gathered not only physicians, but also
artists, political figures, writers, and journalists. Rapid advancement of neurological
knowledge during the late nineteenth century, medical-legal interest in behavior with a
focus on its anatomical and physiological bases, and the artistic movements of realism and
naturalism contributed to a general public consciousness of neurology and its luminaries
(Goetz, Bonduelle, Gelfand, 1995).
As an international emblem of contemporary clinical neurology and medical author-
ity, Charcot was the subject of paintings and documentary essays, but he was also incorpo-
rated into several literary works of his own time and the years surrounding his death in
1893. The Norwegian novelist, H. E. Kinck developed a character in his novel Dr. Gabriel
Jahr (1902) who incessantly speaks of moving to Paris to study under Charcot. In his
semi-biographical novel, The Story of San Michele (1926), Axel Munthe evokes an
encounter with Charcot who fired him from the Salpêtrière service with accusations of
sexual indiscretions. When the Nobel Prize laureate, B. Björnson wrote the play Over
Ævne (1883), he cited Charcot’s lectures in a notation at the end of the printed play script,
and Alphonse Daudet dedicated his L’Evangéliste (1883) to Charcot, evoking medical ter-
minology: “To the eloquent and learned professor, J-M Charcot, physician of the
Salpêtrière, I dedicate this clinical case.”
Whereas Charcot’s influence on nineteenth century literature has been analyzed in
detail (Koehler, 2001), this study examines Charcot as a character figure in late-twentieth-
century literature. Over a century after his death, Charcot still exerts a level of literary fasci-
nation shared by no other neurologist in history. Three fictional works published in the
1990s present Charcot as a key focus: two French novels, Sommeils Indiscrets [Slumbers of
Indiscretion] (Meyer, 1990) and Monsieur Charcot de la Salpêtrière [Doctor Charcot of
the Salpêtrière] (Thuillier, 1993) and an American play, Augustine [Big Hysteria] (Furse,
1997). In rich detail and coloration, each evokes Charcot as a person and a physician, plac-
ing him in the context of an artistic rendering of neurological medicine. This study exam-
ines each text to evaluate the authors’ methods of presenting neurological material in a
fictional venue, the text’s neurological accuracy in regard to both clinical disease and Char-
cot, and the elements of Charcot’s personality that dominate the presentation. As a group,
they focus primarily on Charcot’s work on hysteria, rather than his neuroanatomical contri-
butions, painting him in varying degrees of dictatorial and chauvinist authority. Clearly
based on primary documents and archival sources, they all present material with some
accuracy, though the artistic liberties are often extensive. Most importantly, they demon-
strate that neurological issues of brain function and behavior continue to exert an influence
on public and artistic interests and that Charcot himself, in life such an elusive personality,
remains enigmatic in spite of artistic attempts to reconstruct him through fiction.

Slumbers of indiscretion
Sommeils Indiscrets (Slumbers of Indiscretion) by the French pharmacologist Philippe
Meyer (1990), is a historical novel with a young physician as narrator. He enters the
24 Christopher G. Goetz

Charcot service in 1880 and gradually is taken into the inner circle or cercle intime of the
Salpêtrière neurological unit. Arriving at the height of Charcot’s career, he adopts an atti-
tude of awe and reverence for his professor, but he evolves over time to end the novel in a
preoccupation of disillusionment, concern, and self-doubt at the moment of his professor’s
death:

No day had ever passed that spared his orders, his counsel, and his example.
Charcot had been the inspiration of my medical vocation, of my devotion to
this hospital which now embraced him for the last time and of my passion for
human brain function. Charcot had been my sun, my supreme being during
my journey into the ways of neurology. He had also been a devil, a magician,
a brilliant hoax who had taught me that one can construct a career out of sick-
ness and human misery. This extraordinary man was a master with two sides,
knowing how to make his students shiver with the ecstasy that successful
researches experience and also how to send them to despair by vile therapeutic
trickeries. (Meyer, 1990, p. 14)

These lines are likely derived from the essays of Léon Daudet, himself a student on the
Charcot service for a short period and a childhood friend of Charcot’s son. As a literary
and social commentator of the time, Daudet retained his bitterness towards the medical
academic hierarchy and was particularly harsh in his portraits of Charcot:

For one who already was endowed with great intelligence, authority, eco-
nomic wealth, and the priceless gift of clear insight, what possible added
pleasure could he have derived from playing the role of a tyrant? (Daudet,
1915, p. 17)

The novel accurately portrays Charcot’s centralist and controlling style, his doting on
special students, and his requirement of devotion and fidelity. The citation above from
Meyer however introduces the added element of deception that is incongruent with his
lifelong scientific approach. Though Charcot was indeed accused of unwittingly manipu-
lating his patients through his personality and enthusiasm for research, documentation of a
conscious falsification of medical observations extends scandalously beyond archival
sources. His human experiments with hysterical patients and hypnotism were celebrated
and highly publicized, but Charcot’s constant emphasis was on the description of these
behaviors and the search for physiological explanations underlying the exotic signs he
witnessed. Disillusionment and personal decline in enthusiasm haunted Charcot himself in
his late career, and he reportedly told his young assistant, Guinon, on his last night of
work: “Our entire system of hysteria needs revamping” (Guinon, 1925, p. 515). Archival
sources suggest that Charcot himself was indeed duped by hysteria and hypnosis, but that
rather than being a conscious manipulator or medical trickster, he mistakenly allowed
himself to be manipulated by his own preconceptions (see Goetz, Bonduelle, Gelfand,
1995).
The title, Slumbers of Indiscretion, is derived from an allusion to hypnosis that was
the primary experimental technique adopted by Charcot to examine the phases and pheno-
typic varieties of hysteria. Hypnosis allowed Charcot to induce and alter hysterical signs,
thereby providing an experimental means to study the condition and decompose its neuro-
logical elements. The novel vividly recreates several fictionalized sessions of hypnosis,
but incorrectly ascribes to Charcot a primary interest in superficial display: “Charcot was
Charcot In Contemporary Literature 25

only interested in the spectacle of hypnosis” (Meyer, 1990, p. 246). Charcot focused on the
phenomenological presentation of hysteria, just as he studied the tremors of Parkinson’s
disease and multiple sclerosis or the atrophy and contractions of amyotrophic lateral
sclerosis. His emphasis was on visual observation and dispassionate recording of clinical
signs. Though he occasionally presented hypnotized patients in his amphitheatre teaching
sessions, most of Charcot’s work with hypnosis was performed outside the lecture halls,
because such patients were affected by their environment. He repeated his hypnotic exper-
iments multiple times, because of his emphasis on observing precise details just as his
clinical-anatomical observations with disorders like tabes dorsalis, stroke, and other struc-
tural diseases needed numerous examples and longitudinal descriptions.
The novel further breaches medical accuracy in making many allusions to psychiatry
and Charcot. Psychiatry in Paris was a completely different discipline from neurology and
primarily dealt with issues related to insanity. Like other French hospitals, the Salpêtrière
had a separate psychiatric service with which Charcot barely interacted. Whereas Charcot
developed a psychology wing to his service that focused on anatomical and physiological
questions related to language and behavior, this division was never linked to medical psy-
chiatry. The allusion to Charcot’s “psychiatric lectures”(Meyer, 1990, p. 23) is a historical
misnomer that would have surely offended the professor, because Charcot’s fundamental
self-image and medical emphasis focused directly on neurological issues. Finally, sexual
themes quietly permeate the latter part of the text as well as the title. Though Freud and
others would later link sexual conflict to the origin of hysteria, Charcot was not part of this
polemic, and primary source documents give no indication that he ever considered sym-
bolic sexual conflict as the mechanism underlying hysterical symptoms. Passages with
these allusions as well as a scene of Charcot sitting on a patient’s bed, admiring her full-
breasted chest have no foundation in archival material and can only be considered as fic-
tional tidbits to enliven a lagging text. The author extends his artistic license even more
seriously by creating a greater bond between Freud and Charcot than available documents
support. Freud rotated at the Salpêtrière for only a few months, and neither Charcot’s
archives nor Freud’s letters indicate discussions about the contribution of sexual conflict
to hysteria (Freud, 1893). Charcot remained entrenched throughout his career in the purely
descriptive realm of hysteria and a search for an anatomical basis for the disorder, and
Freud’s theoretical constructs on the core role of sexual maladaptation date from well after
Charcot’s death.
Particularly strong attributes of this novel are the descriptions and rich coloration of
the lifestyle of the young doctors. In this area, the author’s heavy emphasis on textual
materials directly lifted from Charcot’s own writings give the novel sufficient credibility
to allow the reader to sense accurately the likely ambience of the Salpêtrière service. The
camaraderie, the very long hours, the never-ceasing and demanding expectations of the
professor are accurately depicted and well anchored in the writings of his own students
(Joffroy, 1893; Cornil, 1892). The internal resentment expressed by the narrator and his
remorse for the countless hours of invested devotion to the exclusion of having a private
life of quality and nourishment are literary extrapolations. The fears expressed by the
young physician who lived and worked in the halo of a powerful man and then found him-
self vulnerable when Charcot died are searingly accurate, as the Salpêtrière service was
dismantled in the wake of Charcot’s unexpected death, and his protégés fared poorly in the
next generation (Goetz, 1988). Babinski never received a faculty post, Pierre Marie was
relegated to the peripherally located Bicêtre hospital, and the junior trainees largely aban-
doned academic aspirations. In this sense, though melodramatic, the young physician’s
lament as he sits at Charcot’s funeral resonates with historical accuracy:
26 Christopher G. Goetz

His death was turning the last page of an adventure that would not be
repeated. Neurology would no longer be as creative as before, my passion for
brain disorders would necessarily wane and my life would become insignifi-
cant, I told myself my eyes closed and nested in the palms of my hands trying
to evade the future. (Meyer, 1990, p.15)

Monsieur Charcot de la Salpêtrière


Doctor Charcot of the Salpêtrière (1993) is written by the neuropsychiatrist Jean
Thuillier, who has also written a popular biography of Mesmer and several novels. The
author suggests that “by bringing Charcot to life in the medical and social context of his
era, by watching him in the framework of daily life and conversations and in the atmo-
sphere that he so well constructed, perhaps we will have the chance to unveil his true per-
sonality.” The goal fails, and the fictionalized rendition is largely a bland redrafting of
Georges Guillain’s eulogistic biography that was at largely based on recollections trans-
mitted by his teachers, Marie and Raymond (Guillain, 1959). The chronological organiza-
tion provides no thematic development, and though the author does not create dialogs for
Charcot in the manner of Sommeils Indiscrets, he invents actions (wiping feet, smiling,
looking at a watch, shrugging shoulders) to humanize his protagonist. He is careful to
remain in narrative third person without interpretive invasion into Charcot’s psyche, and
the quotations he provides for Charcot are taken largely from his transcribed lectures.
These texts, however were written with purposeful formality, and their introduction as
dialog in the context of routine experiences result in an awkward stiffness that enhances
rather than diminishes the image of Charcot as an archetypal figure. The other major
source materials for this novel are Léon Daudet’s extensive writings on Charcot, and these
essays, though based on first-hand contact with Charcot, are highly biased and cloaked
with personal bitterness (Daudet, 1915; Daudet, 1922).
Of the three works under study, this fictionalized biography portrays the balance of
Charcot’s career most faithfully without the primary focus being on hysteria and hypnosis.
The many years of exclusive attention to clinical-anatomical correlative research, the con-
tinuation of this effort even after 1870 when hysteria became a research focus at the
Salpêtrière, and the solid foundation of Charcot’s career in the study of chronic medical
illnesses are faithfully conveyed. His cool and distant demeanor, impenetrable face, and
penchant for privacy are effectively conveyed and enhanced by the third-person narrative
that does not engage Charcot other than through observation and recording of formal
speeches. Historically, this novel takes the least artistic liberty of the three, but also it is
the most tedious to read.

Augustine (Big Hysteria)


The third literary work under consideration, Augustine (Big Hysteria), is a late-twentieth-
century play (1997) of the feminist theatrical movement, written by A. Furse. The play
portrays Charcot, Sigmund Freud, and a young hysteric, named Augustine who was one of
the starring vedettes of Charcot’s large population of patients used for the study of hysteria
and hypnotism. Freud briefly studied with Charcot in 1885–1886, and Augustine was a
real patient on the Charcot wards. Beyond these details, dialogs and scenes are entirely
fictional, the author admitting in the introduction that she has taken historical liberties to
create her own artistic effect. Whereas the author researched the photographic and written
archival materials from the Salpêtrière to construct her story line and themes, her dialogs
Charcot In Contemporary Literature 27

compress time inaccurately and broach issues and conclusions that were never articulated
by Charcot. Freud’s reflections on stage are not based on primary source material from his
diaries of the time and only emerged in his writings several years after his Salpêtrière visit.
The three characters are clearly demarcated by a pyramid hierarchy that is based on
power and gender: Charcot, the male master clinician with uncontested authority, the
young male apprentice, already showing signs of independence, and though compassion-
ate towards the woman patient, nonetheless comfortable in his own power over her, and
the young, uneducated woman, who establishes her uniqueness through flamboyancy in
her hysterical spells or quiet coquettish behaviors. Within this geometry, the play also sets
up a triangle of three senses embodied by the characters, visual (Charcot), aural (Freud),
and vocal (Augustine). As the visuel, Charcot is portrayed as the impassive observer of
disease, a nosographer concerned with diagnostic descriptions but without concerns for
therapy. Freud is cast as an impressionable but ambitious youth who takes the time to lis-
ten to the patient but again focuses on the disease rather than the individual. And finally,
Augustine embodies the repressed woman, now lifted by the playwright from her histori-
cally emblematic and voiceless role at the Salpêtrière to a modern liberation on stage that
allows her to express herself as a person, specifically a woman, and not as a disease or
archetype of diagnosis.
Though the clash of these three characters is artistically effective, the toll on historical
accuracy is high, with the faults particularly focused on Charcot. First, though the author
is drawn to the power and authority of Charcot, she creates passages that evoke an image
of medical pomposity that primary source documents do not support. As only one exam-
ple, Furse presents Charcot boasting like a mountebank at a county fair: “And I repeat,
nothing, but nothing is incurable” (Furse, 1997, p. 18). Charcot’s authoritative presence is
very easy to document from direct archival materials covering his teaching lectures, but he
did not rely on sweeping statements or medical dogma. In fact, Charcot prided himself on
his dispassionate and positivistic reliance on facts and materialism. To contrast with the
fictional words of Charcot, his actual lecture material on the topic of medical cure
bespeaks his authority with a measured posture of positivist humility. In the direct tran-
scription of the Leçons du mardi, on February 28, 1888, as soon as his patient leaves the
amphitheatre, Charcot laments:

Yes, this man’s disease is implacable. No matter what is done, the bulbar dys-
function will progress relentlessly . . . It is sad to say, but it is true. However,
for the doctor, whether it is sad or not is not the issue; truth is the issue . . . Let
us keep looking, in spite of everything. Let us keep searching. It is indeed the
best method for finding, and perhaps, thanks to our efforts, tomorrow the ver-
dict we will give to such a patient will not be same as we must give today.”
(Charcot, 1887–1888)

A second artistic liberty that simplifies Charcot into an archetypal chauvinist involves
a series of sexual actions and innuendos throughout the play. The stage directions dictate
that Charcot “moves his hand generally over Augustine’s womb area”, a detail that is
inserted without ambiguous intent, and one that is seriously problematic from an historical
perspective. The Leçons du mardi recorded Charcot’s clinical presentations and categori-
cally indicate that Charcot did not touch his patients. Rather, except for unusual circum-
stances, he assigned his interns or assistants the task of tapping reflexes, checking
sensation, accessing pulse, and palpating hysterogenic zones, whether they involved the
nonsexual body regions or the breast, ovarian region, or genitals. The celebrated painting,
28 Christopher G. Goetz

A Clinical Lesson at the Salpêtrière, captures the protocol, Charcot standing apart as a
“photographer” to witness and describe the phenomena, the assistants performing the
tasks on command with the instruments of investigation lined up on a table to be utilized
by younger physicians upon demand by Charcot (Charcot, 1887–1888).
Further, to insert a sexual and abusive trait into Charcot’s character, the author pur-
posefully ascribes the name Carnot to Augustine’s childhood guardian and molester, forc-
ing a phonetic connection to Charcot himself. Accusations (and fascination) with a
perception of Charcot as misogynist have peppered feminist historical texts on several
occasions, though available primary documents do not support malice or sexual perversity
in Charcot’s character. In fact, Charcot was among the first professors to have a woman
intern on his service, and he was notable for fostering the progression of women’s access
into the medical hierarchy of the nineteenth century (Goetz, 1999). Though paternalistic
and demanding of deference, Charcot revealed these traits across gender lines. Whereas it
is true that most of his hysterical study subjects were women, these demographics related
to the hospital administrative structure, since the Salpêtrière was a woman’s hospital.
Charcot did not limit his consideration of hysteria to women, and in fact, one of his most
important contributions was his clear delineation of the disorder in men (Micale, 1990). A
direct quotation from one of his lectures reads:

Male hysteria is not at all rare, and just among us, if I can judge from what I
see each day, these cases are often unrecognized by even distinguished doc-
tors. One can concede that a young and effeminate man might develop hyster-
ical findings after experiencing significant stress, sorrow or deep emotions.
But that a strong and vital workman, for instance, a railway engineer, fully
integrated into the society and never prone to emotional instability before,
should become hysteric—just as a woman might—this seems to be beyond
imagination. And yet, it is a fact—one that we must get used to. Such was the
case with so many other ideas today so universally accepted because they are
founded on demonstrable evidence; but for so long, they met only skepticism
and sarcasm—it is only a matter of time. (Charcot 1887, p. 256 English)

Interest in Fictionalized Neurology


These two historical novels and feminist drama bring Charcot’s life out of the strictly aca-
demic enclosure reserved for physicians and historians interested in neurology to provide
exposure to a larger and wider readership. Capitalizing on the centenary of Charcot’s
death and the five year period honoring the bicentenary of the French Revolution, authors
and publishers in the early 1990s could count on a greater interest in French history.
Though none of the novels was a “best seller”, they were produced by standard publishing
houses, and Augustine (Big Hysteria) has been performed in repertory theatres in numer-
ous European and US cities. They are examples that can be set beside an array of
American and British fictional contributions dealing with neurological disease and
demonstrate a well-established public interest in brain diseases and behavior.
These works are distinct in focusing on a person and prioritizing his individual contri-
butions and personality into the broader issues of neurological discovery. Other luminar-
ies, J. Hughlings Jackson, Osler, Gowers, Hammond, or Mitchell have not received such
literary attention and do not carry the symbolic importance to neurology that Charcot held
during his career, lost in the generations after his death and has since regained. Because
source documents are limited, the goals of resculpting and humanizing Charcot are
Charcot In Contemporary Literature 29

necessarily extrapolations, but neurologists can glean from these works a clear indication of
a reading public’s interest in the foundations of a modern discipline and the contribution of
a dominant figure to its establishment. In this way, the three works serve the reading
public differently. Sommeils Indiscrets personalizes Charcot, rounds him with humanity,
penetrates his psyche through artistic license and uses Charcot and his young assistant as a
study of contrasts in power with linked destinies. Monsieur Charcot de la Salpêtrière is
more sternly anchored in biography with less fictionalized décor, offering a clear descrip-
tion of the medical field of neurology at the close of the nineteenth century and providing
general readers with factual material that formerly was recounted primarily in books,
essays, and journals largely confined to medical audiences. Dry in style and without origi-
nality, it is free of glaring fictionalization. Augustine is the most artistically interesting and
most historically inaccurate. Charcot’s emblematic aloof and patriarchal posture is ampli-
fied, rather than polished with nuance, and the dialogs are all created to set up a triangular
conflict of symbolic interest, rather than historical fidelity.
With these differing emphases, the three works are complementary rather than dupli-
cative. They all honor neurology as a field of interest to the general public, choosing dif-
ferent methods to attract their readership. Charcot’s central figure to all of them
demonstrates an enduring fascination with his personality, his success and controversial
career, his power and his discipline. Neurologists should not look to these works as
replacements for more seriously composed historical studies, but as enrichments anchored
in the imaginative possibilities of Charcot and his era.

Acknowledgement
French translations have been made by the author with advice from Madame Dominique
Knull.

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