Sites of the Unconscious: Hypnosis and the Emergence of the Psychoanalytic Setting

Andreas Mayer is a research scholar at the Max Planck Institute for the History of Science in Berlin.

The University of Chicago Press, Chicago 60637

The University of Chicago Press, Ltd., London

© 2013 by The University of Chicago

All rights reserved. Published 2013.

Printed in the United States of America

22  21  20  19  18  17  16  15  14  13       1  2  3  4  5

ISBN-13: 978-0-226-05795-8 (cloth)

ISBN-13: 978-0-226-05800-9 (e-book)

Originally published as Mikroskopie der Psyche: Die Anfänge der Psychoanalyse im Hypnose-Labor

© Wallstein, Göttingen, 2002

Translated by Christopher Barber, revised and expanded by the author

Library of Congress Cataloging-in-Publication Data

Mayer, Andreas, 1970–

Sites of the unconscious : hypnosis and the emergence of the psychoanalytic setting/Andreas Mayer.

pages.  cm.

Includes bibliographical references and index.

ISBN 978-0-226-05795-8 (cloth : alk. paper)—ISBN 978-0-226-05800-9 (e-book)

1. Hypnotism—History.    2. Psychotherapy—History.    3. Freud, Sigmund, 1856–1939.    4. Charcot, J. M. (Jean Martin), 1825–1893.    I. Title.

RC495.M34 2013

615.8'512—dc23

2013005919

This paper meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper).

Sites of the Unconscious

Hypnosis and the Emergence of the Psychoanalytic Setting

ANDREAS MAYER

The University of Chicago Press

Chicago and London

To the memory of Lydia Marinelli (1965–2008)

Contents

List of Abbreviations

Introduction

PART ONE. French Cultures of Hypnosis

1. Experimental Neuroses: Hypnotism at the Salpêtrière Hospital

2. The Controversy between Paris and Nancy over Hypnotic Suggestion

3. Amour expérimental: Facts and Fetishes at the Musée Charcot

4. The Question of Lay Hypnosis

PART TWO. The Emergence of the Psychoanalytic Setting

5. Paris–Vienna: A Problematic Transfer

6. Freud and the Vicissitudes of Private Practice

7. The Psychotherapeutic Private Practice between Clinic and Laboratory

8. Experimentalism without a Laboratory: The Psychoanalytic Setting

Conclusion

Notes

Acknowledgments

Bibliography

Index

Abbreviations

BF:

Letters from Eugen Bleuler to Sigmund Freud (1905–6). In Lydia Marinelli and Andreas Mayer. Dreaming by the Book: Freud’s The Interpretation of Dreams and the History of the Psychoanalytic Movement. Translated by Susan Fairfield. London: Other Press, [2002] 2003.

BH:

Bernheim, Hippolyte. Hypnotisme, suggestion, psychothérapie: Études nouvelles. Paris: Doin, 1891.

BS:

Bernheim, Hippolyte. De la suggestion et de ses applications a la thérapeutique. 2nd ed. Paris: Doin, [1886] 1888.

FF:

The Complete Letters of Sigmund Freud to Wilhelm Fliess 1887–1904. Edited and translated by Jeffrey Moussaieff Masson. Cambridge, MA: Belknap Press, 1985.

GW:

Freud, Sigmund. Gesammelte Werke. 18 vols. In colloboration with Marie Bonaparte, Prinzessin Georg von Griechenland. Edited by Anna Freud, Edward Bibring, Willi Hoffer, Ernst Kris, and Otto Isakower. London: Imago Publishing, 1939–52. Suppl. vol. edited by Angela Richards, and Ilse Grubrich-Simitis. Frankfurt: S. Fischer, 1987.

OC:

Charcot, Jean-Martin. Œuvres complètes. 9 vols. Paris: Bureaux du Progrès medical and Lecrosnier & Babé, 1888–94.

SA:

Freud, Sigmund. Studienausgabe. 10 vols. and suppl. vol. Edited by Alexander Mitscherlich, Angela Richards, and James Strachey. Frankfurt: Fischer Verlag, 1969–1975.

SE:

Freud, Sigmund. The Standard Edition of the Complete Psychological Works of Sigmund Freud. 24 vols. Edited and translated by James Strachey. London: The Hogarth Press, 1953–1974.

TD:

Freud, Sigmund. Die Traumdeutung. Leipzig: Deuticke, 1900.

Introduction

In the years 1877–78, several English physicians and scientists traveled to Paris to observe a number of astonishing phenomena at the Salpêtrière Hospital. The renowned French neurologist Jean-Martin Charcot was about to develop a new experimental approach to the study of the neuroses, in particular to one of its most elusive and enigmatic forms, hysteria. The striking phenomena demonstrated on his patients in a state of unconsciousness—the transfer of symptoms through the body by the use of magnets and metals, the ordering of the automatic execution of various physical and mental tasks—suggested that, in a daring fusion of older and rather suspect practices, derived from mesmerism, with the most recent cutting-edge laboratory apparatus, a new powerful experimental method had been created.

The integration of mesmeric practices into scientific medicine, performed by one of the most eminent neurologists of his day, provoked divided and passionate reactions. While some English observers noted the extreme rarity of Charcot’s cases,¹ others were outright skeptical about the facts presented, clinging to the old wisdom that hysterics were astute women well versed in the arts of deception. They raised the suspicion that Charcot, despite his great authority and reputation, may have been the prey of a few cunning simulators.² Other commentators in turn stood up to defend the neurologist and hailed his scientific stroke of genius for having taken these emotional and wretched women, these waste products thrown off in the evolution of the race in order to experiment with them as to produce results as clear, as true, and as pure as the chemist can obtain with the inanimate elements in the laboratory.³

By the mid-1880s, hypnotism counted as one of the most promising candidates for a new experimental science of the unconscious mind with the neurological clinic at its center. Not only in scientific circles, but also in a flourishing popular culture of novels, plays, and stage shows in which the social and political implications of hypnosis were played out, sometimes in satirical or grotesque fashion, Jean-Martin Charcot became its most emblematic representative. When, at the peak of the public interest in the Parisian hypnotic demonstrations, the French writer and anarchist Octave Mirbeau published a detailed description of his own visit to the Salpêtrière, he did not hesitate to proclaim the nineteenth century to be the century of nervous illnesses, from a double point of view: in the first place, because they will have been mistress and cause of all its events; and then, because it will have studied and known the secrets of their evil.⁴ In the coupling of the scientific hypnotist and his experimental subject, he recognized the rise of a new fundamental division of mankind into those who were dominated by their unconscious and a small elite of scientists, entitled to know and to rule. Convinced by the power of science to throw light on the mysteries of the human mind and to master them, Mirbeau crowned his appraisal with the prediction that this century might be remembered as neither the century of Victor Hugo, nor that of Napoleon, but as the century of Charcot.⁵

By the time of his death, in 1893, Charcot’s ambitious experimental program around hypnosis had already fallen apart, and a young Viennese doctor who had studied with him and acted as his German translator would recognize in him his master and soon the precursor of the new science of the unconscious that would appear, a few years later, under the name of psychoanalysis.⁶ With Sigmund Freud’s rise to fame in the twentieth century, Charcot then appeared for a long time as the figure whose research into hysteria had not done more than set the stage for the ultimate insights of psychoanalysis yet to come, namely that neuroses were caused by sexual repression, only to be lifted by the talking cure. Whereas Charcot was now featured as a kind of evil clinical genius, a seer, an arranger of scenes lacking both the adequate conceptual apparatus and forms of treatment, Freud could be presented as the exponent of a new theoretical and therapeutic approach who would, by delivering the keys of interpretation, make the strange and cruel theatre of the Salpêtrière at last intelligible.⁷ However, historiographies gravitating around the person of Freud, written either in the style of hagiographic appraisal or in a debunking vein, could not bypass the problem of where the actual rupture between hypnosis and psychoanalysis should be located. The fact that Freud started his own career as a nerve specialist, using various techniques of hypnosis and suggestion for at least a decade, from 1885 to 1895, has led his biographers to relegate this earlier period to a mere prelude to the true and momentous discovery of the unconscious in his famous self-analysis.⁸ Such heroic accounts, as they prevailed in the aftermath of Ernest Jones’s biography of Freud from the 1950s, were to be challenged by a number of historians who attempted to reinsert the history of psychoanalysis into the history of magnetism and hypnotism.

In 1970, the Swiss psychiatrist Henri F. Ellenberger published a bulky study of such a kind, claiming that shamanism, mesmerism, hypnosis, psychoanalysis, and other forms of psychotherapy were all elements in a long chain of what he proposed to term dynamic psychiatry.⁹ In contrast to biographical hero-worship, but also to an epistemologically oriented historiography emphasizing ruptures that characterized the work of many French historians and theorists,¹⁰ Ellenberger stressed the continuities between a vast array of seemingly heterogeneous traditions and realms of cultures. In the wake of Ellenberger’s work, the history of animal magnetism and hypnosis has been studied in greater detail by a number of historians and philosophers. The scholarship in the 1980s and 1990s can be roughly divided into three different currents: the first takes a critical stance vis-à-vis psychoanalysis and a positive one toward hypnosis, with the attempt to propose an alternative genealogy running from Anton Mesmer to Sigmund Freud and even beyond;¹¹ the second one, in contrast, aims to make sense of mesmerism, animal magnetism, and hypnosis as distinct cultural forms within various social and intellectual contexts;¹² the third one, mostly inspired by the work of Michel Foucault, looks at the historical transformations of diagnostic categories (such as hysteria or traumatic neurosis) and their potential effects on human subjects.¹³ The present study, while indebted to the cultural-historical and epistemological sensibilities of the second and third currents, shifts its focus from larger cultural or social contexts and the work of classification to the concrete sites of knowledge production. It suggests that the material setup of clinics, museums, laboratories, or consulting rooms played a critical role in the project of making hypnotism into an experimental science of the unconscious mind. In contrast to the person-centered and often polemical approaches to the history and prehistory of psychoanalysis, this book takes up lessons from ethnographic and historical studies of scientific laboratories,¹⁴ proposing a genealogy of the sites, practices, and inscription technologies particular to hypnotism.

Sites of the Unconscious analyzes the emergence of hypnotism in the late nineteenth century as a key episode in the experimentalization of the unconscious mind, retracing the historical process by which controlled procedures for producing knowledge of psychic phenomena were introduced, applied, and propagated throughout different clinical settings. By developing a symmetrical approach,¹⁵ this books attempts to elucidate how conflicts centered on the theories and experimental techniques of hypnosis paved the way for the familiar psychoanalytic setting established by Sigmund Freud in Vienna around 1900. In contrast to a person-centered historiography, as it prevails notably in the works devoted to Freud and psychoanalysis, it adopts a historical-sociological approach that takes a wider range of actors and processes into account. While language may appear today, to analysts and scholars alike, as the only stuff psychoanalytic practice has to deal with,¹⁶ the historical constitution of this practice can hardly be understood without taking into account its material and social components.¹⁷

The first part deals with the most comprehensive and influential attempt to install hypnotism as a new form of experimental research in France, Jean-Martin Charcot’s research program at his hospital service at La Salpêtrière in Paris and the controversies that ensued between his Paris school and the so-called Nancy school led by his antagonist, Hippolyte Bernheim. Whereas the received view presents Bernheim as the clear winner in this controversy, I suggest in the first two chapters that the perceived superiority of his demonstrations in themselves cannot account for his triumph over Charcot’s doctrine of grand hypnotism. Rather, I distinguish what I argue are two incompatible cultures of hypnotism, stressing their different emphases on the relation between clinical practice and knowledge, their different ways of deploying hypnosis (the one therapeutic, the other experimental), and the contrast between centralized hierarchies of knowledge constructed within the Salpêtrière school and the rather loosely structured group at Nancy. These differences were constitutive of the epistemological and political characteristics of the two competing cultures of hypnotism: Bernheim’s focus on the numbers of patients hypnotized and the suggestive group atmosphere facilitated mass hypnosis in contrast to the Charcot school’s emphasis on the individual patient as an exemplar of a rare type. Mobilizing an impressive apparatus of mechanical recording devices, Charcot and his team attempted to definitively exclude the possibility of patients’ simulation under hypnosis, an attempt Bernheim and his followers countered with an emphasis on the notion of the experimental subject’s imagination.

Chapter 3 singles out a decisive moment within the struggle between the two schools, namely the strategies associated with the Musée Charcot at the Salpêtrière and its heterogeneous collection of objects in contesting Bernheim’s debunking strategies. The young psychologist Alfred Binet and the doctor Charles Féré sought to ensure that their experimental protocols endorsed the assumption that the experimental subjects used at the Salpêtrière were no more than mere registration devices. The chapter displays the increasingly complex strategies developed in the face of the common and openly acknowledged problem of erotic relations existing between research subjects and experimenters. In the context of the hypnotic experiments as they were performed at the museum, Binet also coined the concept of fetishism in its new sexological meaning.

Chapter 4 contrasts methodically the responses of Charcot’s and Bernheim’s adherents to the question of lay hypnosis, with the Paris school insisting on the pathological character of the hypnotic state and the necessary medical expertise required to master it, whereas Bernheim and his followers were more open to the possibilities of stage magnetism and to a wider diffusion of the therapeutic technique of suggestion among nonmedical practitioners. Joseph Delbœuf, a Belgian philosopher, mathematician, and lay hypnotist who became actively involved in the debates about hypnosis, served as the control instrument for these two cultures. He demonstrated how the registers of academic experimentalism could be fused easily with the language of stage magnetism, and how his rapprochement of the theory of suggestion with normal dream activity fostered a practice of self-observation as a legitimate parallel investigation to hypnotic experiments on prepared subjects. However, Delbœuf’s conception of hypnotism, which tended to abolish the asymmetry, either epistemological or moral, between hypnotist and hypnotized, remained a marginal position.

The second part of the book reconstructs the reception of French hypnotism in the German-speaking countries in the years from 1880, arguing that Freud’s abandonment of hypnosis and development of the psychoanalytic setting was less a flash of singular genius than a fitful response to the problematics raised by the French controversies and the ensuing difficulties that a nerve specialist had to face in private practice.

Chapter 5 provides an account of how Freud’s attempt to transplant Charcot’s model of experimental hypnotism ran into difficulties. In Vienna, the question of hypnotism was hotly debated, in part around the familiar issue of simulation but, more interestingly, against the backdrop of debates about the closeness of the experimental hypnotist to the stage magnetists. The contrasting receptions given to hypnosis in Viennese psychiatry are brought out by examining the work of Theodor Meynert, exponent of a descriptive brain-psychiatry and suspicious of the therapeutic and experimental claims associated with hypnotism and suggestion, and the subsequent observational, experimental, and therapeutic approach of Richard von Krafft-Ebing, Meynert’s successor in 1892 in the chair of psychiatry. In an instructive and consequential debate in 1893, Krafft-Ebing was vigorously attacked by followers of the Salpêtrière school. The ensuing public scandal around Krafft-Ebing and his practice of the suggestion method cast a further shadow on hypnosis as an experimental and therapeutic approach.

Chapter 6 then details how the problems played out in public scandals about hypnotic suggestion were reflected on the microlevel of Breuer’s and Freud’s private practice. With his technical revisions, Freud gradually shifted away from hypnosis, initially still keeping up its semblance.

Reconstructing in minute detail the work of a number of German and Swiss doctors and scientists in the 1890s, chapter 7 charts the emergence of the private consulting room of hypnotherapists and a new literature promoting the redefinition of the hypnotic subject as a skilled self-observer. I look at one key episode, the establishment of what I propose to term introspective hypnotism by Freud’s exact contemporary Oskar Vogt, who aimed to solve the problem of simulation by subordinating all physical components of the hypnotic setting to the continuous verbal expression of the subject’s state of mind. A number of crucial features of the later psychoanalytic setting and the talking cure were, I suggest, first put into place by Vogt and his followers.

In chapter 8, I address the distinctive features of Freud’s psychoanalytic setting and their variations between 1900 and 1914, showing how differences between the Paris and Nancy schools resurface in this historical trajectory. Crucial here is the function of Freudian self-analysis, with the interpretation of dreams and slips of the tongue conceived not as reckless singular acts but as slow and collective processes that favor interactive practices of reading and writing over the stabilization of a special mental state during treatment—as was the case in hypnotic experimentation. In light of the uncertainty about the mental state of the hypnotic subject, Freud’s strategy allowed him to detach his technique from the situated character of his own practice and to elaborate a form of virtual analysis (initially often conducted in the form of correspondence). While Freud retained the claim of psychoanalysis performing an experimental situation, he set apart his own setting from the objectifying practices that had dominated hypnotism as an experimental and therapeutic endeavor. The specificity of the psychoanalytic setting emerges, I argue, not suddenly and of a piece but, rather, gradually, in response to investigators’ failure to establish laboratory-like conditions for the production of hypnotic states, a consequence of their inability to control their research subjects and to rule out the possibility of simulation.

I conclude with remarks about the development and future of psychoanalytic practice. With respect to the seemingly endless debates about its supposed scientificity, I argue that a detailed historical reconstruction of its genesis proposes a different outlook: the development of a knowledge about the unconscious in a relatively closed setting cannot be properly understood within a normative framework; rather, the emphasis on its local and situated character raises the question about the new places in which psychoanalytic knowledge is likely to flourish.

PART ONE

French Cultures of Hypnosis

1

Experimental Neuroses: Hypnotism at the Salpêtrière Hospital

When the young Viennese doctor Sigmund Freud received a travel stipend for Paris in winter 1885 to study neuropathology at Jean-Martin Charcot’s clinic at the Salpêtrière Hospital, he was only one of many curious and skeptical physicians and scientists who wanted to see the highly surprising findings of the famous neurologist with their own eyes.¹ Attempts to make hypnosis part of a new experimental approach to understanding the nature of nervous diseases had emerged and proliferated in French hospitals since the late 1870s, and they found their most ambitious representative in Charcot and his definition of grand hypnotism. Although it is widely acknowledged that Freud’s encounter with Charcot was a decisive moment for the future development of psychoanalysis, most historical accounts of the French research on hysteria and hypnotism tend to cast this episode as a mere prehistory of the Freudian enterprise. In his writings, Freud himself has largely contributed to a portrait of Charcot as a seer, a visuel, a genius of clinical observation, thereby fostering a historiography according to which the appeal of hypnotism as an experimental program was explained by the prestige and personal fascination exerted by a single great clinician.² Numerous contemporary and later accounts devoted to the artist Charcot speak of the same fascination, be it in a hagiographic or in a debunking key.³ This person-centered focus has led to a neglect of an essential factor in the attractiveness of experimental hypnotism, namely the promise of a new scientific psychology, grounded in the material and social surroundings of the neurological clinic. One of the major reasons (if not the most important one) for the short success of Charcot’s research project lay in the multiple facilities brought together in his clinic at the Salpêtrière, which he presented as a living pathological museum.⁴ His attempts to integrate the contested practices of animal magnetism into a laboratory setting were critically dependent on a material apparatus conceived to detach the action of hypnosis from the person of the hypnotist. Somewhat ironically, then, Charcot’s posthumous fame is largely attributed to a personal factor that he sought to eliminate once and for all from a new scientific psychology based on a novel form of clinical experimentation.⁵ In this chapter, I aim to specify the ways in which unconscious processes were made observable and manipulable within a geography of sites installed at Charcot’s clinic between 1877 and 1882, during the formulation of a new experimental program—grand hypnotisme—designed to elucidate one of the most elusive and problematic neuroses of the nineteenth century, hysteria.

The Clinical Geography of Charcot’s New Research Center

In the nineteenth century, the Salpêtrière numbered among the largest and most important hospitals in Paris. The neurologist Jean-Martin Charcot played a decisive role in the modernization of the hospital: during the course of his career, the clinic he headed developed from an institution primarily devoted to the accommodation of poor and elderly women into a world-famous neuropathological research center.⁶ In 1882 a professorship for nervous disorders was created especially for Charcot, allowing him to focus on the systematic teaching of neurological and psychological disorders. The seat of this new research and teaching center consisted of a building complex adjoining the existing clinic. It housed a number of facilities, including an autopsy ward, a physiological-chemical laboratory, an electrodiagnostic laboratory, ophthalmologic and otologic cabinets (for measuring visual and aural capacities), a photographic studio linked to a pathological-anatomical museum with a department for plaster and wax casts, and a large lecture hall equipped with the most modern projection devices. The German physician Ludwig Hirt, who visited the Salpêtrière in 1883, numbered the beds under Charcot’s supervision at between 600 and 650.⁷ With 250 beds, the ward for hystero-epileptic women was the hospital’s largest, whereby the parallel ward for men housed twenty beds. Such appellations show that the patient population had increasingly come to be differentiated according to specific disorders. Treatment in the hospital was free, whereby a small number of patients—the pensionnaires payantes—paid a modest fee entitling them to single rooms and additional meals. The patient population, which Charcot referred to as his material, generally originated from the lower classes, although a slowly increasing minority of patients came from the petite bourgeoisie.⁸ A hospital stay lasted at least three weeks, but usually months and often years, which allowed the doctors to observe individual cases over an extended period of time. To supplement the material gathered for research and teaching purposes with more mild cases and those of incipient gravity, an outpatient clinic was erected along the outer wall, where on each day of the week a different physician diagnosed all needy sufferers of nervous disorders.⁹

Charcot’s neuropathological service placed the head physician at its center: the cabinet de consultation, where he examined his patients, was located at the middle of a complex of buildings housing the laboratories, the museum, and the lecture hall. Thus the head physician’s daily rounds to the patients’ beds were replaced by a different form of examination: it was not the doctor who visited the patients, but rather the patients who were summoned to various sites where they served in the study or demonstration of clinical facts. As Hirt noted after his visit, Charcot personally examined and discussed hundreds of interesting and rare neurological cases each year before a small circle of privileged listeners in his consulting room during his daily three-hour morning visits to the Salpêtrière.¹⁰ Other guests at the clinic, such as the Russian mathematician Sofia Kovalevskaya, characterized Charcot as the sovereign ruler of this kingdom of neuroses.¹¹ By the 1880s, the neurologist had become a well-known public figure, particularly on account of his venture into hysteria research using the hypnotic techniques depicted in numerous popular accounts.¹²

Charcot’s famous Tuesday lectures—held at the policlinic beginning in 1881 and transcribed by his students—served a dual purpose.¹³ Firstly, by offering semipublic outpatient treatment the doctors were offering a free service, which in return provided them with cases not represented in the inpatient population. Thus the clinic’s access to patients was expanded to include mild and incipiently severe cases.¹⁴ Secondly, the lectures presented an audience of physicians in training with a cross section of examinations in which the doctor demonstrated how he reached a conclusive diagnosis when confronted with a specific symptomatology. In the lectures, one or more patients appeared before an audience as objects of comparison and generally received an instantaneous diagnosis.¹⁵ The object of these publicly performed examinations was not only to present a variety of typical cases, but also to demonstrate the steps to be taken by the physician in reaching an unequivocal diagnosis.¹⁶ However, the improvised character of these lectures emphasized by many visitors (including Freud)¹⁷ and some later authors has been exaggerated. Before the presentation, Charcot’s assistants examined the patients and carefully prepared an initial list of diagnoses with the greatest possible precision for their master. The list was presented to Charcot upon his arrival at the clinic, and from the cases deemed most interesting at first sight¹⁸ he selected the patients who would provide him with the material for his lecture. Once the lecture was over, the work was turned over to the chef de clinique, who, assisted by some externs, completed the consultation.

More generally, the Tuesday lectures served Charcot in demonstrating his mastery of the clinical art of observation, which often allowed him to track down the relevant symptoms at first glance. Most of the neurological conditions were deciphered in a differential diagnosis based on tiny characteristic signs that could be observed on the patient’s body (difficulties in walking, trembling hands, blinking eyes, paralysis of facial or other muscles etc.). When observation of the patient alone was not sufficient for reaching a decisive diagnosis, Charcot resorted to various instruments, such as Skoda’s percussion hammer for testing the reflexes. The use of such instruments reinforced the asymmetry between doctor and patient: it indicated the physician’s position of power, replacing the history of illness recounted by the patient and his or her family with a controlled medical semiology.¹⁹

In this semipublic forum, Charcot thus demonstrated how in uncovering symptoms the neurologist must refrain from forms of gaining evidence in which the patient and family members are treated as reliable witnesses. First of all, information obtained from patients is of dubious value for establishing a correct diagnosis, because they make up theories that are not, of course, always based on a correct grasp of the facts.²⁰ Thus, when patients describe their illnesses, their statements are generally translated into technical terminology by the physician, who at times disabuses them of their faulty thinking or silences them. For Charcot, the naive accounts provided by patients are occasionally of interest, but one must put them in order, since they are almost always formulated very haphazardly.²¹ Sometimes, the description itself becomes the indicator for the diagnosis: When a patient comes along with some sort of written account, saying, ‘I have put down some notes on my condition because I don’t want to take up too much of your time.’ They are all neurasthenics, particularly those of the sort with marked tendencies toward hypochondria.²² Hence the physician presents himself as the authority who is able to distinguish true symptoms from patients’ exaggerations and imprecisions.

And yet the main problem with the patient’s speech is not that it is imprecise and haphazard by the standards of clinical knowledge, but that it is potentially deceitful. Charcot even professes that most of the information provided by patients and their families is intended to lead the physician astray and keep him from discovering the true cause of the illness:

Among the family members there is a solidarity, a conspiracy of silence. To satisfy your questions they make up a tale based on lies, at times involuntary untruths. A dog was raging about in the countryside, the child was afraid, and so on. And sometimes you will hear the child himself repeat the story, believing it is true because he has heard it told so often. The physician, whose duty it is to get to the bottom of things and see them as they are, must not be duped by such babbling.²³

According to Charcot, then, the true cause of illness is commonly to be found in heredity. The histories narrated by patients and their relatives, which can become the oral tradition of a whole family, thus serve as a means to escape from the uncomfortable idea of a hereditary destiny.²⁴ Therefore, from the very beginning of the examination, the statements of the patient and his or her family are considered mendacious: for Charcot, they cannot serve as a point of departure in the scientific search for truth. The medical lecture functions as the public representation of a struggle in which the patient’s will to deceive the physician is subjugated to the doctor’s will to discover the truth. In his interrogation, Charcot separates witnesses belonging to the same family for the purpose of bringing to light family secrets: Plus il y a d’affection de famille et moins il y a de vérité pour le médécin.²⁵ Discarding the extravagant stories told by patients, the Salpêtrière physicians prefer the synoptic representational form of the family tree, in which they enter the illnesses of family members as revealed in the course of interrogation.²⁶

While the Tuesday lectures held at the outpatient clinic shaped the public image of Charcot and his theatrical, visually oriented style, another crucial site of his new research center has received little attention: the museum of pathological anatomy, known as the Musée Charcot, which was set up in the immediate vicinity of Charcot’s consulting room, and where demonstrations of clinical cases were frequently undertaken.²⁷ Summoning patients to this location facilitated comparison with pieces from the museum’s collections. It housed a large quantity of natural anatomical specimens, a collection of brains, a series of lifelike wax casts (busts as well as entire figures), and, as a special attraction, a large collection of images combining photographs of Salpêtrière patients (or engravings created after them) with reproductions of works by Rubens, Raphael, and other European masters.

The collection served several functions: on the one hand, it was an archive, providing evidence to substantiate the universality of the clinical pictures presented by Charcot. In this respect it embodied the program of retrospective medicine formulated by the positivists, in which the artistic testaments of earlier eras could be interpreted through a materialist semiotic (a sort of natural grammar of symptoms), thus confirming the factuality of the conditions diagnosed.²⁸ On the other hand, the objects and images preserved in the museum functioned as a supplement to the clinic. One might even assert that they served as its model, for Charcot proudly referred to his clinic as his living pathological museum.²⁹ The casts and