CHARCOT, JEAN-MARTIN (1825- 93)

Charcot, regarded as the founder of clinical neurology, was born in Paris and received his medical degree from that city’s university. In 1860 he became professor of pathological medicine at the university’s Faculty of Medicine, and in 1862 was appointed head of the Salpetriere Hospital, where he developed a world famous laboratory and clinic for the study of neurological diseases.Between 1862 and 1870 Charcot successfully identified causes of cerebral hemorrhage, noted the effects of spinal cord injury, gave the first accurate description of multiple sclerosis, differentiated rheumatism from a disorder which became known as Charcot’s joints (due to wasting of the spinal cord), and showed that poliomyelitis was related to other forms of muscular atrophy. Between 1870 and 1880 he concentrated on the functions of the cerebrum, and his findings greatly influenced Jackson, Horsley and other members of the English school of neurology. In 1882 the French government established the world’s first Chair of Medical Diseases of the Nervous System specifically for Charcot.In the later years of his career, Charcot entered upon a study of hypnosis and hysteria that eventually resulted in a fuller understanding of the psychoneuroses. He established what has become known as the Salpetriere school of hypnosis, and sought to put this technique on a firm scientific footing by describing the successive stages of hypnosis (lethargy, catalepsy, somnambulism), and by showing that changes take place in the nervous system when an individual is hypnotized —for example, changes in reflex action, neuromuscular excitability, and sensory functions. After examining his experimental findings, Charcot concluded that hysteria and hypnosis are due to the same activities of the nervous system, and mistakenly claimed that only hysterics could be hypnotized.Before Charcot, hypnosis was in disrepute due largely to the questionable practices of Mesmer and his followers. The Academie des Sciences had even condemned all research on “animal magnetism.” But when Charcot presented his views “on diverse nervous states determined by the hypnotization of hysterics,” the Academie felt his work was unrelated to animal magnetism and accepted his findings. In the words of Charcot’s successor, Janet, the new interpretation “broke a dam and let in a tide which was ready to rush.” Soon physicians from the world over came to Salpetriere to hear Charcot’s lectures on hysteria and to witness his demonstration of both the production and removal of hysterical symptoms by hypnosis. Among the most distinguished of these visitors was Sigmund Freud.Though impressed by Charcot’s demonstrations, Freud could not accept his emphasis on the neurological basis of hypnosis or his organic interpretation of hysteria. Charcot had noted that hysteria was often accompanied by convulsions, and harked back to the traditional theory that the ovaries were involved in the attack. He apparently did not believe that emotions had anything to do with these convulsive states. However, he was aware that external suggestion and autosuggestion could produce some hysterical symptoms, and he also spoke at times of the significance of postural changes as reflections of emotional states. Nevertheless, his neurological orientation prevented him from doing full justice to the psychological aspects of the disorder.Another group of investigators, sometimes referred to as the Nancy School, did recognize these factors. A. A. Lie- beault (1823-1904), a French country doctor, published a book in 1866 in which he reported that he could put 20 per cent of his patients under hypnosis simply through sleep suggestion. He converted Hippolyte Bernheim (1837— 1919) to his point of view when he cured a hysterical patient of Bemheim’s through this technique. Bernheim then proposed the theory that hypnosis was merely an intensification of normal suggestion, and that with rare exceptions anyone could be hypnotized. He pointed out that persuasion is actually a form of suggestion, and that various socializing agencies (mother, teacher, state) use suggestion as a means of education and control. In his view, hypnosis is simply a dramatic form of suggestion which utilizes rapport between the hypnotist and the subject in bringing about a restriction of attention and a limitation of the senses to the commands of the hypnotist. He also argued that the neuromuscular and other symptoms obtained at the Salpetriere were actually a product of the suggestions made by the hypnotist. These observations helped to bridge the gap between abnormal conditions and normal behavior, and furthered the use of hypnotic suggestion as a therapeutic tool.Even more important, Bemheim’s emphasis on suggestion and his psychological interpretation of hysterical symptoms began to focus attention on a psychogenic approach to behavior, in contradistinction to the attempts of Charcot and others to explain all types of reactions in physiological and genetic terms. Bernheim himself contributed to this trend by making a special study of criminal behavior in which he presented the view that suggestion plays a role in almost every crime. He sagaciously pointed out that many ordinary acts are not of conscious origin, but are imposed in subtle and obscure ways because people are naturally suggestible and imitative. He therefore was on the brink of a recognition of unconscious factors and the complexity of man’s hidden motivations. It should not be surprising, therefore, that Freud was far more influenced by Bernheim than by Charcot. See HYPNOSIS, CONVERSION REACTION.