Charcot and the psychology of hysteria, with special reference to a never published final case history.

Abstract

Jean-Martin Charcot is perhaps best remembered for his contributions to organic neurology. However, his pursuit of hysteria, the most prevalent diagnosis in his hospital clinic, yielded no anatomical lesion to account for hysteria's plethora of somatic disorders assumed due to a purely functional or dynamic lesion in the cerebral cortex. This led Charcot to turn his attention to the psychology of hysteria. Taking advantage of institutional reforms at the Salpêtrière-notably, the establishment of his professorship in nervous diseases-Charcot from the early 1880s focused his teaching increasingly on case histories of hysteria in male as well as female patients. Already renown for his earlier dramatic public lessons on female hysteria, his lessons of the 1880s, of which two volumes were published at the end of the decade, elaborated the issue of psychology in terms of altered states of patient's suggestibility. By the decade's end, Charcot's worldwide reputation rested on the prospects of this work as acknowledged by numerous students, notably medical psychologists Pierre Janet and Sigmund Freud. Yet Charcot's views remained sketchy. They were discussed at length in his unpublished notes for a lesson intended for May 1893, just a few months before his sudden death. His unpublished notes reveal a detailed case for dreams as illustrating a psychological mechanism underlying hysteria in a 17-year-old Paris artisan. I conclude by considering why this significant climactic case of Charcot's might have been overlooked by his entourage.