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“Toujours La Chose Génitale”: Charcot, Freud, and the Etiology of Hysteria in the Late 19Th Century Medical History

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“Toujours La Chose Génitale”: Charcot, Freud, and the Etiology of Hysteria in the Late 19Th Century Medical History Medical History “Toujours la Chose Génitale”: Charcot, Freud, and the Etiology of Hysteria in the Late 19th Century Lucy C. Barker*, MD, Resident physician, Department of Psychiatry, University of Toronto *At the time of reasearch: Lucy C. Barker, Medical student, Faculty of Health Sciences, McMaster University and elective student, Department of History, University of Ottawa “I was almost paralyzed with amazement and said to myself Abstract ‘Well, but if he knows that, why does he never say so?’ But the In the late nineteenth century, Sigmund Freud stud- impression was soon forgotten”1 and Freud then returned to ied under Jean-Martin Charcot, a famed neurologist his studies in pathology and neurology. According to the story with a special interest in hysteria. After Charcot’s that Freud tells, it was not until several years later that he real- death, Freud published his seduction theory, which ized that sexuality – “la chose génitale” – was the root cause claimed that hysteria developed from memories of of hysteria and developed his seduction theory. childhood sexual abuse. Although Charcot is known Assuming that Freud’s eavesdropping was correct and that for his hereditary theory of hysteria, Freud later at- his memory did not alter the phrase between hearing it in the tributed Charcot with postulating a genital (sexual) winter of 1885/1886 and transcribing it in 1914, then we are etiology in the phrase “toujours la chose génitale”; left with what is for Charcot – who was adamant that all hys- this discrepancy is not well explained in the litera- teria was caused by heredity – a very peculiar phrase to utter. ture. This paper surveys concepts of hysteria before This paper will try to understand what Charcot might have Charcot and explains Charcot’s model of hysteria. It intended by it, and what Freud could have meant by attribut- then examines Freud’s interpretation of Charcot’s work, and what role Charcot potentially played in ing it to him. To do so, I will start by surveying concepts of the development of seduction theory. Based on the hysteria before Charcot, then look at how Charcot used this primary documents studied and on existing scholar- previous information and created his own model of hysteria, ship, there is no evidence that Charcot believed that and finally I will explore Freud’s interpretation of Charcot’s hysteria was sexual in origin. The paper concludes by work, and what role Charcot (and the famous phrase) might theorizing that Freud imagined, or at the very least have played in the development of seduction theory. misinterpreted, the famous “génitale” phrase. The concept of hysteria is first seen in an Egyptian text from 1900 BCE, entitled Kahun Papyrus.2 From what can be gathered from this and similar documents, hysterical symp- toms (including tonic-clonic seizures and the feeling of suf- he phrase is often repeated in the literature: “Mais, focation or imminent death)3 were attributed to a wandering dans des cas pareils c’est toujours la chose génitale, womb, and treatments consisted of using herbs and substanc- toujours… toujours… toujours” [But, in such cases, it T es to attract the womb back into place. The first mention of is always the genital thing, always, always… always]. Often the the word hysteria (derived from the word hystera, meaning story is told of Freud, a young physician, on a term abroad in th th Paris to study under Charcot, the famous neurologist. The uterus) appeared in Hippocratic texts in late 5 to 4 cen- young Freud, awed by his formidable teacher, is invited to one turies BCE. According to these texts, hysteria was primarily a of Charcot’s soirées. At the party, he overhears Charcot speak- disease of mature women who were deprived of sexual rela- ing to Brouardel, a forensic specialist. The two physicians are tions.4 Following in Egyptian tradition, the mainstay of treat- talking about a case where the husband was impotent and the ment through the Greco-Roman era was bringing the uterus wife severely hysteric. Many years later in 1914, in the “On the back to its correct location.5 Galen of Pergamon (129-199 CE) History of the Psycho-Analytic Movement,” Freud recounted then rejected the wandering womb hypothesis, and instead hearing the now-famous “la chose génitale” utterance and theorized that hysteria occurred in sexually deprived women seeing his teacher become lively while saying it. Freud wrote (and men) because of retention of fluids.6 The wandering womb hypothesis prevailed in medical communities, but Ga- len’s work is important as the first concrete example of male Corresponding Author: hysteria. Lucy C. Barker [email protected] In the late Middle Ages and Early Modern periods, with the rise of religious fervor and supernatural thinking, hyste- ria was linked to diabolic possession and exorcisms were used UTMJ • Volume 93, Number 1, December 2015 9 Medical History “Toujours la Chose Génitale”: Charcot, Freud, and the Etiology of Hysteria in the Late 19th Century against hysteric women. This persisted for centuries, with that in rare cases the brain could be affected by genital needs’ witch-hunts in Europe and colonial America occurring in not being met,19 this was not the rule. In analysis of women waves until the eighteenth century. Although various think- based on sexual activity he showed that hysteria overall was ers throughout this period had other theories about hysteric quite rare in nuns20 and much more common in servants, disorders, there was no overriding approach that took hold. who are neither deprived, nor overly sexually stimulated. He Despite Galen’s hypothesis that sperm retention could be found uncommonly high rates of hysteria among prostitutes, related to hysteria, the illness remained firmly in the women’s but saw it as a result of lifestyle and trauma as opposed to realm (and in the realm of the uterus) for millennia. In the sexual over-satisfaction: seventeenth century, Charles Lepois noted the presence of “La misère, les veilles, l’abus des boissons alcooliques, male hysteria as evidence against the wandering uterine the- les craintes continuelles des exigences de la police, ou des ory.7 In the eighteenth century, as medicine shifted into its mauvais traitements de la part des hommes avec lesquels modern scientific form, hysteria started to shift from a disease elles vivent, les séquestrations forcées qu’occasionnent les of the uterus to a disease of the brain. maladies qu’elles contractent, la jalousie effrénée et les pas- In the nineteenth century, there was increased curiosity in sions violentes qui les animent, expliquent assez chez elles hysteria and many physicians took up research in the area. Of la fréquence des accidents hystériques.”21 note in France are Paul Briquet and Charles Lasègue. Lasègue (1816-1883), a celebrated Parisian academic physician, had What Briquet describes in this passage would now be con- an interest in mental illnesses but restricted his research of sidered psychological trauma and he concluded that the hysteria to a small number of cases.8 Briquet (1796-1881), a most common moral cause of hysteria was maltreatment of hospital doctor of lower prestige, took a systematic approach children by their parents or women by their husbands.22 In to hysteria. His landmark work, Traité Clinique et Thérapeutique analyzing Briquet, however, it is easy to fall into a trap of pre- de l’Hystérie, published in 1859, drew on more than 400 cases sentism. As Ian Hacking points out, “whatever we find in Bri- of hysteria and took a statistical approach looking at etiology, quet’s book, it was not, and I think could not have been, read symptomatology, and treatments. in our way, in terms of child abuse, during his lifetime.”23 The Briquet’s interest in the etiology of hysteria is particularly concept of traumatisme morale as we understand it did not noteworthy for this paper. Several authors of treatises on hys- exist until Janet and Freud systematically employed it as an teria continued to uphold the belief that hysteria had a geni- etiology of hysteria. Although many themes that would even- tal origin (Briquet points to three among many physicians tually form modern views of psychological trauma and social publishing on the illness at the time)9 and Briquet reiterated determinants of health are present in Briquet’s work, he did that male hysteria disproved the Hippocratic uterine theory.10 not re-invent hysteria as a socially acquired disease. Instead, Instead, Briquet stated that women were more prone to hyste- Briquet’s 700-plus page traité is important because it was so ria (twenty times more prone by his calculation ) because of thorough, and can be seen as a triumph of large-scale popula- a special sensibilité that women are endowed with that allows tion analysis at a time when so much research was based on them to fulfill their roles of raising children, taking care of few cases. people, etc.12 He is quite clear that genitals are not the basis of The research conducted by Briquet found its way into womanhood (nor of hysteria) and illustrates cases of ‘normal’ much of the writing on hysteria in the late nineteenth century. women without uteruses.13 Charcot credited him “for having established in his excellent So if not wandering uteruses, then what? He wrote book, in a manner beyond dispute, that hysteria is governed, “L’impressionnabilité augmentée de l’élément affectif du in the same way as other morbid conditions, by rules and laws, système nerveux constitue le fond de la prédisposition à which attentive and sufficiently numerous observations always l’hystérie [the hypersensitivity of the emotional component permit us to establish.”24 The data Briquet collected shows of the nervous system is the basis for a predisposition for hys- up in Gilles de la Tourette’s Traité Clinique et Thérapeutique de teria]”14 and that this hypersensitivity had various contribut- l’Hystérie d’après l’Enseignement de la Salpêtrière,25 in which de ing factors.
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