CHARCOT, JEAN MARTIN (1825-1893)

Jean Martin Charcot was born in Paris in 1825, the son of a coach builder, and died of a heart attack near Lake Settons (Nièvre) on August 16, 1893. He was a physician with the Hôpitaux de Paris, a professor of clinical medicine for nervous disorders, and a member of the Académie de Médicine.

He was appointed a physician with the Hôpitaux de Paris in 1856, associate professor of medicine in 1860, senior physician at the Salpêtrière in 1862, professor of pathological anatomy in the School of Medicine at the University of Paris in 1872 (succeeding Alfred Vulpian), and in 1882 was appointed to the first chair of neurology, a position created for him at the request of Léon Gambetta, as professor of diseases of the nervous system. He was made a member of the Académie de Médicine in 1873 and the Académie des Sciences in 1883,

Charcot had an impressive career and received numerous academic honors, but the accuracy of his theories on hysteria, which he began working on in 1865 after the "department of epilepsy" was placed under his supervision, had begun to be seriously questioned at the time of his death. The work of his student, the neurologist Joseph Babinski; the rise of Pierre Janet's dynamic psychology; and especially the success of psychoanalysis all contributed to bringing down a theoretical structure that had nurtured these developments at the beginning of the twentieth century.

Charcot was an attentive observer, which helped establish methods of neurological description and classification still in use (Charcot's disease, Charcot-Bouchard aneurysm, and so on), and possessed an almost magical talent as a speaker. He attracted a diverse group of personalities to his presentations: his public "Leçons Cliniques," held on Wednesdays, and his "Grandes Leçons," held on Fridays. His patients, it was learned after his death, had to some extent been prompted to exhibit to the audience the typical "hysterical crises" that the Master expected of them. He was particularly interested in paralysis, anesthesia, and other symptoms considered to be "hysterical," and attempted to demonstrate their "functional"—rather than anatomical—origin, a belief that contradicted a number of other practitioners, who were proponents of the surgical removal of their patients' ovaries.

He succeeded in isolating a clinical entity he referred to as the "grande hystérie" or "hystero-epilepsy." He described a crisis, or "attack," as occurring in four successive phases: the epileptiform phase, clonic spasms, emotional "acting out," and terminal delirium. In addition to these attacks patients exhibited "stigmata" (narrowing of the visual field, anesthesia)—conditions that could only exist if there were some form of "diathesis," that is, a predisposition to hereditary degeneration.

To demonstrate his ideas, Charcot publicly performed hypnosis to provoke or eliminate such symptoms, which proved they were not connected to organic lesions, unlike true neurological disorders. This was a step toward a "psychological" conception of the origin of hysterical symptoms, but Charcot wrote in 1887, "What I call psychology is the rational physiology of the cerebral cortex." He gave encouragement to the new field with the creation, in 1890, of the Laboratory of Psychology at the hospital, with Pierre Janet as its head. He supported Janet in his work on his dissertation, "L'État mental des hystériques" (The Mental State of Hysterics; 1893), and ensured publication of the work of Sigmund Freud in French medical reviews.

Freud's work with Charcot at the Salpêtrière contributed greatly to Freud's later work and the birth of psychoanalysis. Arriving in Paris on October 13, 1885, with the help of a grant from the School of Medicine of the University of Vienna to study anatomic pathology, he was introduced to hysteria and its "psychological" etiology, which had a decisive influence on his decision to treat patients privately, which he did when he returned to Vienna in the spring of 1886.

A month after his arrival in Paris, on November 24, 1885, he wrote to his fiancée, "Charcot, who is one of the greatest of physicians and a man whose common sense borders on genius, is simply wrecking all my aims and opinions. I sometimes come out of his lectures as from out of Nôtre Dame, with an entirely new idea about perfection. . . . Whether the seed will ever bear fruit, I don't know; but what I do know is that no other human being has ever affected me in the same way." Before he left Paris at the end of February 1886, Freud obtained Charcot's approval to translate his Leçons cliniques into German. He took with him a number of expressions that proved useful to him later on: "theory is good, but that doesn't prevent its existence," "in those cases, it's always genital," "the wonderful indifference of hysterics," "the refusal of the sexual is enormous, like a house."

Freud and Charcot maintained their relationship through correspondence, even though the personal comments Freud added to the Poliklinische Vorträge (1892-1894a), his translations of the Leçons du mardi, left a somewhat bittersweet residue (Mijolla). Although Charcot was not interested in the cathartic method Freud had spoken to him about, Freud left the hospital with a draft for an article on hysterical paralysis that took him seven years to complete, but when published in French in the Archives de neurologie (1893c), represented the first "psychoanalytic" approach to the phenomenon. Freud named his first son Jean Martin, and throughout his life kept a reproduction of André Brouillet's painting Une leçon cliniqueà la Salpêtrière.

In his homage to Charcot at the time of his death, Freud confirmed his rejection of Charcot's theories but at the same time expressed his gratitude: "He was not a reflective man, not a thinker: he had the nature of an artist—he was, as he himself said, a 'visuel,'—a man who sees" (1893e). In February 1924, at the request of the review Le Disque vert, he wrote, "Of the many lessons lavished upon me in the past (1885-6) by the great Charcot at the Salpêtrière, two left me with a deep impression: that one should never tire of considering the same phenomena again and again (or of submitting to their effects), and that one should not mind meeting with contradiction on every side provided one has worked sincerely" (1924a).

Alain de Mijolla

See also: Bernheim, Hippolyte; Cäcilie M., case of;

Bibliography

Didi-Huberman, Georges. (2003). The invention of hysteria: Charcot and the photographic iconography of the Salpêtrière (Alisa Hartz, Trans.). Cambridge: MIT Press.

Ellenberger, Henri F. (1970). The discovery of the unconscious. The history and evolution of dynamic psychiatry. New York: Basic Books.

Freud, Sigmund. (1893e). Charcot. SE, 3: 7-23.

——. (1924a). Letter to "Le Disque Vert," SE, 19: 290-290.

Gauchet, Marcel, and Swain, Gladys. (1997). Le Vrai Char-cot. Paris: Calmann-Lévy.

Mijolla, Alain de. (1988). Les lettres de Jean-Martin Charcot à Sigmund Freud, 1886-1893. Le crépuscule d'un dieu. Revue française de psychanalyse, 52 (3), 703-726.

Charcot, Jean Martin

WORKS BY CHARCOT

SUPPLEMENTARY BIBLIOGRAPHY

Jean Martin Charcot (1825–1893), specialist in neurology and hypnosis, was born in Paris in modest circumstances, the son of a carriage builder. Finishing secondary school at 19, he entered the medical school of the University of Paris. He served his internship at the Salpêtrière, a very large Parisian hospital for patients of all ages with chronic, incurable diseases, particularly those of the nervous system. The Salpêtrière had been one of the first hospitals to accept Philippe Pinel’s beginning steps toward the reform of mental hospitals. In 1793, at the Bicêtre, another part of the Parisian medical service, Pinel had stopped the practice of keeping psychotic patients in chains, and the Salpêtrière had followed this example a few years later.

Charcot’s connection with the Salpêtrière lasted throughout his life. In 1862, at the age of 37, he became a senior physician there. Up to that time, although he had been a competent physician and had published several papers, his work had been in no way remarkable nor had he shown any particular interest in the nervous system. Yet in the following eight years he produced what were to become the classic descriptions of multiple sclerosis, amyotrophic lateral sclerosis, and the localization of lesions of the spinal cord. It is said that in those eight years he founded the field of modern neurology (Guillain [1955] 1959, pp. 10–11). His method of diagnosis is, in its broad outlines, the one still being used. His appointment as professor of diseases of the nervous system at the University of Paris in 1882 represents the first recognition of neurology as a specialty in its own right.

Charcot was known for his ability as a clinician. Before him, no clinician could unequivocally recognize a given neurological disease in a living person, although the presence of such disease entities had been established by post-mortem study. Charcot was especially adroit at relating observable clinical signs and symptoms to the underlying neurological damage visible in a post-mortem examination. He was able to delineate the symptomatology of each disease in the living patient and to differentiate each syndrome from closely related disorders. Moreover, he succeeded in correlating each clinical picture with the post-mortem establishment of a set of lesions, thus founding what he called the clinical-anatomical method.

Although austere and reserved, Charcot was able to teach his diagnostic skill to his pupils by examining patients in their presence. These demonstrations were spectacular displays for which he soon became celebrated. Students came to him from all over the world, among them Pierre Janet and Sigmund Freud.

Charcot also made contributions to cerebral physiology. The doctrine that the cerebrum of the brain functions homogeneously, advocated by Pierre Flourens, a French physiologist, dominated medical science through the 1860s. Charcot, among others, did much to demonstrate that some functions of the cerebrum are localized in specific regions (1875).

Although Charcot maintained his interest in neurology, in the 1880s he began to devote considerable time to the study of hysteria and hypnosis. Hysterical patients show a host of bewildering symptoms: amnesia, paralysis, anesthesia, contractures, and spasms. Charcot studied these patients intensively, using hypnosis as one technique of investigation. Although his work with hysterics and his exploration of hypnosis were interrelated, it is necessary to consider them separately.

Charcot considered neuroses, including hysteria, to be diseases of the nervous system, but ones with no known organic lesions ([1872–1887] 1877–1889, vol. 3, pp. 13–14). Significantly, he believed, not that they are a separate class of nervous diseases but, rather, that they are governed by the same physiological laws as the “common” organically based neural diseases. He laid considerable stress on the importance of organic factors in causing neuroses, although he admitted the presence of functional components, notably in his conception of traumatic ideas.

Traumatic ideas, although dissociated from the consciousness of the patient and forgotten, continue to exert an influence on the patient and to determine the nature of his hysterical symptoms. A weakness, probably of a hereditary constitutional origin, would make some individuals subject to this hysterical dissociation. Charcot considered trauma, either physical or psychological, to be the precipitating etiological factor bringing on the dissociative process.

Conventional medical opinion held that hypnotism was at best a theatrical stunt and at worst sheer charlatanism. Consequently, Charcot was moving against medical opinion when he decided to employ hypnosis. He had read widely in psychology (Guillain 1955) and had familiarized himself with earlier work on hypnosis. A physiologist, Charles Richet, and a psychologist, Théodule Ribot, whose opinions Charcot respected, had upheld the scientific validity of hypnotic phenomena.

Hypnotism came to be his preferred method of investigating hysteria. Integral to his conception of hysteria was his belief that only hysterical persons can be hypnotized and that hypnosis itself is a manifestation of hysteria. To Charcot, the hypnotic trance and the hysterical crisis constituted essentially the same kind of alteration of personality. The trance, however, could be induced by the operator and could therefore be used for the study of hysteria.

Charcot distinguished three progressive stages in the depth of hypnosis, namely: lethargy (drowsiness), catalepsy (in which isolated suggestions are accepted without question since they can be acted upon without interference from other ideas), and somnambulism (the ability to carry out complicated activities with no recollection afterward, so that there is a splitting of personality by dissociation).

Charcot has been accused of being uncritical about the influence of suggestion, and it has been charged that he was duped by overzealous assistants (Guillain 1955). However, his writings show that he did appreciate the significance of both suggestion and malingering in hypnosis as well as in hysterical manifestations, although it is probable he underestimated the importance of their effects.

Charcot’s contention that hypnosis is a psychopathological phenomenon was even then being disputed by the Nancy school of hypnosis, in the persons of Ambroise-Auguste Liébeault and Hippolyte Bernheim. The Nancy school argued that hypnosis is a normal behavioral experience arising from suggestion which can be induced in practically anyone and is continuous with waking behavior. Later findings support the position of the Nancy school, not that of the Salpêtrière school.

Although wrong in particulars, Charcot did much to make the study of hypnosis respectable (Wechsler 1953). He found that hypnosis can restore forgotten memories. He demonstrated so thoroughly that hysteria can occur in the male that after a few years such a statement was no longer seriously questioned. Freud, for example, who had worked under Charcot in 1885–1886 and referred to him later as “my master” ([1914] 1938, p. 943), was so impressed with Charcot’s demonstrations of cases of male hysteria that he insisted on lecturing on this subject when he returned to Vienna. He was received with ridicule. In Vienna, medical authorities still held the view that hysteria was somehow due to a “wandering womb,” and, consequently, male hysteria was a contradiction in terms. These lectures added to Freud’s disrepute among Viennese medical men. It was a casual remark of Charcot’s that reinforced Freud’s later firmly established belief in the primacy of sexual difficulties as an etiological factor. According to Freud, on one social occasion Charcot insisted that a certain female patient’s difficulties arose from the impotence of her husband.

Charcot prepared the way for much other fruitful psychological–medical collaboration. Above all, he contributed to the establishment of neurology as a scientifically based medical specialty.

Robert I. Watson

[For the historical context of Charcot’s work, see the biographies ofBroca; Mesmer. For the subsequent development of his ideas, seeHypnosis; Hysteria; Mental disorders, articles onOrganic Aspectsandbiological aspects; Mental disorders, treatment of, article OnSomatic treatment; Nervous system, article onstructure and function of the brain; and the biographies ofFlourens; Freud; Janet.]

WORKS BY CHARCOT

(1872–1887) 1877–1889 Lectures on the Diseases of the Nervous System. 3 vols. London: New Sydenham Society. → First published in French.

(1875) 1878 Lectures on Localization in Diseases of the Brain. New York: Wood. → First published in French.

SUPPLEMENTARY BIBLIOGRAPHY

Freud, Sigmund (1914) 1938 On the History of the Psycho-analytic Movement. Pages 933–977 in A. A. Brill (editor), The Basic Writings of Sigmund Freud. New York: Random House.

Guillain, Georges (1955) 1959 J-M Charcot, 1825–1893: His Life, His Work. New York: Hoeber. → First published in French.

Wechsler, I. S. 1953 Jean-Martin Charcot. Pages 266–269 in Webb Haymaker (editor), Founders of Neurology. Springfield, III.: Thomas.

Jean Martin Charcot

1825-1893

French Physician, Neurologist and Teacher

Jean-Martin Charcot was a pioneer of modern neurology and psychotherapy. Psychologists remember him for his investigations of hypnosis and hysteria, and his influence on Sigmund Freud (1856-1939). Among his contemporaries Charcot was highly respected as a teacher at La Salpêtrière and the creator of a unique neurological clinic. A prolific author and indefatigable researcher, he published many important clinical descriptions of nervous disorders and histological observations of lesions associated with various disorders.

Charcot was born in Paris, where he studied medicine and established an international reputation as a clinician, neurologist, and teacher. Although Charcot failed the competitive examinations in 1847, he became an Interne at the Salpêtrière, a major Parisian hospital and mental asylum, the next year. In 1853 he was awarded his M.D. for a thesis based on studies that differentiated rheumatoid arthritis from gout and other diseases of the joints. His mentor was French physician G. B. A. Duchenne de Boulongne (1806-1875). In 1859 Charcot published a study of intermittent claudication in humans. He was among the first to report on this phenomenon. Although Charcot is mainly remembered for his work in neurology, he remained interested in the degenerative diseases of the joints. He also described various aspects of liver and thyroid disease. In 1863 Charcot and André Victor Cornil published important observations of the renal lesions in gout. Five years later Charcot published a detailed description of a form of arthritis associated with the form of neurosyphilis known as tabes dorsalis. The condition is now known by his name, and tabetic joints are known as "Charcot's joints."

When Charcot joined the staff of the Salpêtrière he began a systematic clinical study of the unclassified, unknown chronic conditions that afflicted many of the hospital's long-term patients. He also performed painstaking postmortem examinations in order to correlate lesions found at death with the clinical symptoms observed in patients. This research program resulted in classical descriptions of diseases such as cerebral hemorrhage, diseases of the aged, chronic diseases, Menière's syndrome (a form of vertigo), multiple sclerosis, amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease, tabes dorsalis (neurosyphilis), infantile paralysis, and hysteria. Despite his dedication to pathological research, Charcot was generally opposed to animal experimentation. Nevertheless, he was not a rigid antivivisectionist and he defended Louis Pasteur's experiments with rabies vaccinations. In 1872 Charcot was appointed Professor of Pathologic Anatomy at the Sorbonne. Ten years later he became the first Professor of Disease of the Nervous System at Paris. His landmark work Lectures on the Diseases of the Nervous System was published in 1877. His published lectures provide an invaluable overview of his work, thought, and approach to teaching.

Like his contemporaries J. Hughlings Jackson (1835-1911) and Paul Broca (1824-1880), Charcot was intrigued by the problem of cerebral localization and aphasia. Charcot and Jean Albert Pitres published a series of papers that provided rigorous proof of the existence of the cortical motor center in human beings. Charcot differentiated between Aran-Duchenne type muscular atrophy and amyotrophic lateral sclerosis, now known as Lou Gehrigs's Disease, but previous called Charcot's disease. In 1886 Pierre Marie (1853-1940) and Charcot published the first description of the form of muscular atrophy now known as Charcot-Marie-Tooth disease.

Although his use of hypnotism and his dramatic demonstrations of hysteria were greeted with some skepticism, including the possibility that Charcot had suggested or provoked the "crises" and symptoms in their patients, his basic ideas about hysteria provided fruitful insights into the psychopathology of traumatic experiences. Charcot thought that hysteria was a progressive, irreversible mental disease that might be caused by a weak neurological system and triggered by traumatic events. According to Charcot, only hysterics could be hypnotized, because the condition was itself similar to an attack of hysteria. Ultimately, even though many of his most distinguished students concluded that hypnosis was a psychological phenomenon rather than a neurological condition, his methods and ideas had a profound impact on the development of psychoanalysis.

Charcot was a talented artist and caricaturist as well as an outstanding scientist. Many of his drawings were preserved at the Salpêtrière. Charcot collaborated with Paul Marie Louis Pierre Richer, an artist at the Salpêtrière, in the development of books on disease and deformity as portrayed by artists. These books had a significant influence on subsequent studies of the relationship between medicine and art. Charcot's complete works were published in nine volumes between 1888 and 1894.

LOIS N. MAGNER

Jean Martin Charcot

1825-1893
French psychiatrist who specialized in the study of hysteria, using hypnosis as a basis for treatment.

Jean Martin Charcot was born in Paris on Nov. 29, 1825, the son of a carriage maker. He took his medical degree at the University of Paris in 1853 and was appointed professor of pathological anatomy there in 1860. In 1862 he was appointed senior physician at the Salpêtrière, a hospital for the treatment of the mentally ill. It became a center for psychiatric training and psychiatric care, for Charcot had a flair for theatrics in addition to his reputation for sound science, and his lectures and demonstrations attracted students from all over Europe.

Charcot's contributions fall largely into three categories. First, he studied the etiology and cure of hysterical disorders (psychoneuroses). These disorders involve what appear to be physiological disturbances such as convulsions, paralyses, blindness, deafness, anesthesias, and amnesias. However, there is no evidence of physiological abnormalities in psychoneuroses since the root of the problem is psychological. In Charcot's time hysteria was thought to be a disorder found only in women (the Greek word hystera means uterus), but his demonstrations were eventually influential in correcting this idea. Charcot, however, continued to think of hysteria as a female disorder. Freud was later to associate hysterical symptoms with sexual problems.

Charcot's second area of contribution was the correlation of various behavioral symptoms with physiological abnormalities of the nervous system . One of the major problems for early psychiatry was that of determining whether certain behavioral abnormalities had their origins

in psychological or in physiological disturbances and, if physiological, where in the central nervous system the abnormality might be located. Charcot became noted for his ability to diagnose and locate the physiological disturbances of nervous system functioning.

Finally, Charcot made popular the use of hypnosis as a part of diagnosis and therapy. Hypnosis, known at the time as "mesmerism" (named for Franz Anton Mesmer), was regarded by the medical profession as charlatanism. Charcot found hypnotism useful in distinguishing true psychoneurotics from fakers and, like Mesmer, found that hysterical symptoms could be relieved through its use. In the hypnotic state the patient falls into an apparent sleep . While in this condition, the patient can sometimes recall events in his life which are not recalled in the waking state, and he is susceptible to the suggestions of the therapist. In 1882 Charcot presented a summary of his findings to the French Academy of Sciences, where they were favorably received. Scientific psychiatry was thus well on its way to being accepted by the medical profession. Charcot died on Aug. 16, 1893.

Further Reading

Guillian, Georges. J.M. Charcot, 1825-1893: his life-his work. trans. 1959.

Garrison, Fielding H. An introduction to the history of medicine. 1913. 4th ed. 1929.

Goetz, Christopher G. Charcot. New York: Oxford University Press, 1995.

Jean Martin Charcot

The French psychiatrist Jean Martin Charcot (1825-1893) specialized in the study of hysteria, using hypnosis as a basis for treatment.

Jean Martin Charcot was born in Paris on Nov. 29, 1825, the son of a carriage maker. He took his medical degree at the University of Paris in 1853 and was appointed professor of pathological anatomy there in 1860. In 1862 he was appointed senior physician at the Salpêtrière, a hospital for the treatment of the mentally ill. It became a center for psychiatric training and psychiatric care, for Charcot had a flair for theatrics in addition to his reputation for sound science, and his lectures and demonstrations attracted students from all over Europe.

Charcot's contributions fall largely into three categories. First, he studied the etiology and cure of hysterical disorders (psychoneuroses). These disorders involve what appear to be physiological disturbances such as convulsions, paralyses, blindness, deafness, anesthesias, and amnesias. However, there is no evidence of physiological abnormalities in psychoneuroses since the root of the problem is psychological. In Charcot's time hysteria was thought to be a disorder found only in women (the Greek word hysterameans uterus), but his demonstrations were eventually influential in correcting this idea. Charcot, however, continued to think of hysteria as a female disorder. Freud was later to associate hysterical symptoms with sexual problems.

Charcot's second area of contribution was the correlation of various behavioral symptoms with physiological abnormalities of the nervous system. One of the major problems for early psychiatry was that of determining whether certain behavioral abnormalities had their origins in psychological or in physiological disturbances and, if physiological, where in the central nervous system the abnormality might be located. Charcot became noted for his ability to diagnose and locate the physiological disturbances of nervous system functioning.

Finally, Charcot made popular the use of hypnotism as a part of diagnosis and therapy. Hypnotism, known at the time as "mesmerism" (named for Franz Anton Mesmer), was regarded by the medical profession as charlatanism. Charcot found hypnotism useful in distinguishing true psychoneurotics from fakers and, like Mesmer, found that hysterical symptoms could be relieved through its use. In the hypnotic state the patient falls into an apparent sleep. While in this condition, the patient can sometimes recall events in his life which are not recalled in the waking state, and he is susceptible to the suggestions of the therapist. In 1882 Charcot presented a summary of his findings to the French Academy of Sciences, where they were favorably received. Scientific psychiatry was thus well on its way to being accepted by the medical profession. Charcot died on Aug. 16, 1893.

Further Reading

A biography of Charcot is Georges Guillian, I-M Charcot, 1825-1893: His Life-His Work (trans. 1959). For general background material see Fielding H. Garrison, An Introduction to the History of Medicine (1913; 4th ed. 1929).

Additional Sources

Goetz, Christopher G., Charcot, New York: Oxford University Press, 1995. □