“*mockingbird of nosology”

From How the Brain Lost Its Mind by Allan H. Ropper, MD and Brian David Burrell, Copyright (c) 2019:

“…Freud idolized Charcot, but found him to be difficult, somewhat remote and inscrutable, his methods opaque. He either could not or would not say how he reached his conclusions, merely that after observing something long enough the nature of it would become clear. According to Pierre Marie (sitting third to Charcot’s right in Andre Brouillet’s painting, below):


“More than once his closest pupils heard him answer to their ‘Why?’ or to their ‘How?’ sometimes impatiently, because of his inability to better satisfy them: ‘Oh, why? I cannot tell you, but I know it is this disease, I can sense it.’”

…As another assistant, Pierre Janet, recalled, “Everything in his lectures was designed to attract attention and to capture the audience by means of visual and auditory impressions.”…

Charcot hired the artist-physician Paul Richer (first on his right in the painting, with a pencil and paper) to reproduce the poses of afflicted patients. Charcot also built a photography studio on the premises and hired the medical photographer Albert Londe (seated on the far left of the painting, wearing an apron and cap) to document exemplary cases. The resulting publication, in three volumes, the Iconographie Photographique de la Salpêtrière, may have greater claims to art than to science, but it was a major breakthrough in the classification and understanding of mental illness.

…the man portrayed in Brouillet’s A Clinical Lesson appears to be more concerned with symptoms than with people…the only man in the painting who is facing away from the patient…who seems more interested in what he is saying than in what is happening behind him. His assistant Joseph Babinski…stands center stage, ready to catch the swooning Blanche. Georges Gilles de la Tourette, an odd-looking duck by his own admission, is mercifully rendered in profile…Charcot himself…stands with his right hand extended in an odd gesture…of thumb and forefinger held out as if indicating a measurement of a few centimeters. According to a contemporary, Félix Platel, “…His gaze is oblique…surprising in a mask of Bonaparte. The Roman nose…is like the tip of the prow of a Roman galley, destined to cleave the waves, despite wind and tide.” It could also be the gaze of a man beginning to doubt what he is saying.

…Today, epilepsy has a set of diagnostic criteria backed by the technology of electroencephalograms, yet hysteria has only a generic and vague profile. In 1870, hysteria drove diagnosticians to distraction. One physician called it a “*mockingbird of nosology” because of its tendency to run the gamut from migraine to paralysis, numbness, fainting, sweats, difficulty in breathing, insomnia, and even nymphomania. No one could say whether it was real or imagined, structural or functional, all in the head or lurking in damaged tissue. Charcot decided to find out. At the end of a decade-long investigation involving scores of patients, he was ready to publish.

…The meaning of any work of art changes over time. Standing in front of Brouillet’s painting today, one finds it difficult to appreciate what it meant to viewers when it debuted. Charcot saw psychiatry and neurology as cooperative specialties. They should, he wrote, “philosophically speaking remain associated with each other by insoluble ties.” The painting marks the moment when that hope was dashed, and the two fell apart in the most confounding way, partly because of Charcot himself—his role in creating the very scene Brouillet depicted—and in a small yet significant way, partly because Brouillet chose to depict it at all. He unwittingly immortalized a catastrophic failure.

Charcot believed he could separate mind and brain by treating the human subject as an automaton, as a sensorimotor machine. Instead of visiting his patients on the wards, he had them brought to his office. Instead of interviewing them, he examined their bodies in silence. Instead of interacting with them, he let his assistants do it. Onstage, he treated them like servants, speaking freely as if they were not present and could not hear. Charcot thought he was removing any potential bias this way, and in doing so, he seems to have overlooked the mind entirely. Blanche Wittman and his other subjects heard everything, unconsciously processed it, and fed it back in a finely tuned performance.

Hypnosis does work as a short-term intervention. Hardly anyone uses it anymore in a hospital setting because it is paternalistic and exposes a subject’s vulnerability, although it remains popular in alternative medicine…Had Charcot used it strictly for the purpose of artificially producing symptoms of hysteria and epilepsy, had he not invested himself in what most of his contemporaries viewed as sideshow antics, he would command greater respect today.

But Brouillet’s painting, perhaps more than anything Charcot himself ever did, exposed him in flagrante, duping himself in front of a double audience—the one portrayed in the painting and the one viewing it. Had it been an isolated incident of a great scientist exceeding the bounds of the scientific method, the painting might not merit all that much attention. But there is more to be found in it, facts unknown to the viewers of 1887, and a crowning irony even Charcot overlooked. A real neurological disease did indeed lurk behind many of the hysterical symptoms he so painstakingly observed, and he missed it, even though all along it was right there under his Napoleonic nose…”

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