The neurological advances of the nineteenth century are vast and historically important to the current understanding of both clinical and laboratory science. On the other hand, the recounting of these labor-intensive advances, slow in most instances, and accomplished by studious, often lackluster, personalities working in humble hospitals or primitive laboratories, does not make very interesting reading for most audiences. In contrast to these drabber histories on neurological development, the saga of hysteria has attracted a continual and hard to sate fascination. Asti Hustvedt‘s Medical Muses is the 2011 contribution to this list.
Readers who have followed the study of hysteria, its analysis and re-analysis, will recognize such titles as Console and Classify (1987), Murders and Madness (1989), Ventriloquized Bodies (2001), Mad Men and Medusas (2001), Invention of Hysteria (2004), and Hysteria, the Biography (2009), among many others. The natural question is whether we need another historical examination of this condition or are we simply perpetuating a tiresome re-telling of the same story?
In fact, I found this book a refreshing and surprisingly balanced view of hysteria and of the very knotty medical and social contexts of its study in the nineteenth century. The author chooses four central characters in this history — a celebrated physician and three individual patients on whom there are substantive records. At the center of this and all of the books cited above, Jean-Martin Charcot, the premier clinical neurologist of the nineteenth century, is the neurological luminary. Charcot (1825-1893) worked at the Salpêtrière Hospital in Paris throughout his career, and though he can be credited with major clinical-anatomical discoveries that continue to anchor modern clinical neurology, he also placed a particular emphasis on hysteria during the latter part of his career.
Hustvedt summarizes his career and his work on hysteria accurately and further concentrates on three premier stars among the array of hysterics at the Salpêtrière: Blanche Wittman, Augustine Gleizes, and Genevève Legrand. These three women were real patients with longstanding stays in the Salpêtrière and extensive medical records.
Whereas most other books dealing with Charcot and hysteria drift into a comfortable and aggressive focus on power and manipulation, this author finds an interesting balance that she describes at the beginning of the book and explores throughout the text: “I began writing with a preconceived notion: the hysterics were victims of not only their home lives, but of a misogynist institution led by the tyrannical Charcot. I would rescue them from that narrative and tell their stories, from their perspective. Despite my intention, the more I read, the more I found myself admiring Charcot‘s brilliance. I also became a reluctant fan of some — not all — of the members of his coterie, a group of physicians who worked with him at the Salpêtrière…. Instead of a clear-cut world of exploited women and exploiting men, I entered something far more nuanced. Blanche, Augustine, and Geneviève were undeniably victimized, both inside and outside the hospital. That said, they also participated in a hospital culture that was in many ways less oppressive than the world beyond it. The Salpêtrière provided a language — the language of hysteria — that allowed them to articulate their distress. Blanche, Augustine, and Geneviève mastered its vocabulary and were rewarded.
The primary essays of the text are the stories of the three patients. Within each woman‘s story, the author recounts the various experiments that the Charcot team conducted on hysteria, many of them involving hypnosis. With each chapter, the author covers the overall themes of this research effort to find a systematic series of neurological and medical signs that characterized hysteria, just as tremor, bradykinesia and rigidity defined Parkinson disease. In the presentations, the author uses the extensive clinical descriptions of the three women from publications of the time to provide a personal story of three nineteenth century women as well.
In aiming to provide a medical and personal story, the author admirably stays close to her primary sources and unveils the women‘s lives and their rise in the patient hierarchy as they contributed to the neurological study of hysteria. Largely based on their hysterical demonstrations, Charcot and his entourage proposed the diagnostic elements of hysteria, studied its association with hypnosis, and proposed treatments.
Whereas these women have appeared in a remarkable array of fictional accounts, including novels such as Sommeils Indiscrets (1990) and plays like Augustine: big hysteria (1997), the author has not brought personalities to them outside the documents available for study. Blanche Wittman was the most celebrated, because she was the central figure (besides Charcot) in the famed group portrait by Pierre Andre Brouillet, showing Charcot teaching while she is supported in the arms of Babinski. Augustine Gleizes was the victim of elaborate and disabling hallucinations, and even after a longstanding recovery, she continued to work at the Salpêtrière as a maid and participated in further hypnotic experiments in her uniform. Finally, Geneviève Legrand served to dispel religious bias of demonic possession, and her case allowed a medical model for dealing with entities that would previously been handled by the Catholic Church. For each woman, we have information on childhood experiences, early development, their arrival in destitution to the Salpêtrière, their care and work within the sheltered environment, and the medical and social outcomes relative to their hysteria.
The overriding theme of Hustvedt‘s study is the true sickness of these women. Although they expressed their illness in a manner recognized by their treating physicians, patients in the modern era have the same illness, but likely fall into different diagnostic categories in the modern nosology, eating disorders, bipolar illness, and schizophrenia, among others. Emphasizing that disease may be universal but diagnoses are culturally-based, Hustvedt shows empathically that these women were treated by physicians who thought they understood the diagnosis and were vested in studying it physiologically through hypnosis and clinically by testing therapies, often admittedly bizarre by modern standards.
In the end, perhaps the patients fared better than their physicians, because they were at least housed and protected, whereas Charcot largely lost his scientific credibility through these studies and the next generation of his students floundered in the backlash against their mentor after his death. Major errors were made as Charcot drifted away from the clinical-anatomical anchor of his earlier research successes in other domains of neurology, and, though there are allusions to his recognition of needing to revamp his fundamental thinking, he died unexpectedly at age 67.
Similar to Charcot, the author also finds herself drifting in the large amount of information and fascinating material. Some of the book is disjointed and off the central theme as if Hustvedt‘s passion compelled her to “stuff” it all in. Nonetheless, the arguments are human and medically sound in the context of the nineteenth century, and, therefore, the book is worth reading for those interested in a balanced examination of hysteria in the larger medical and social context of the period.
The only major deficit in terms of historical accuracy is the exclusive concentration on women. In fact, Charcot‘s most important contribution to the study of hysteria was his recognition of the disorder in men. Extensive case material exists on these men, and though the author‘s interest is in women‘s disease in the context of their society, a fourth case study of a man would have provided a fuller picture of Charcot‘s broader contributions. He stressed: “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.”
Finally, if readers purchase the book, I suggest that they buy the real book and not an electronic version. The book itself is admirably produced with good quality paper that is good to touch, a distinctive, if predictable, cover jacket, many pictures and a very helpful series of notes at the back of the book that the reader will want to turn to quickly throughout the reading.
Dr. Goetz is professor of neurological sciences and pharmacology and director of the Parkinson and Movement Disorders program at Rush University Medical Center in Chicago.
Charcot J-M, A propos de lChystérie chez lhhomme. Oeuvres Complètes, t.3. (pp. 253-280). 1887. Paris, Bureaux du Progrès Médical. In English: Charcot, J-M, Concerning six cases of hysteria in the male. Clinical Lectures on Diseases of the Nervous System, v. 3. (pp. 220-243), transl. T. Savill. 1890, London, New Sydenham Society.
©2011 American Academy of Neurology