Aux origines du cerveau moderne: Localisations, langage, et memoire dans l'oeuvre de Charcot (review)

On 10 June 1993, on the occasion of the centenary of his death, the Paris daily Le Figaro displayed a dramatic photograph of Jean-Martin Charcot emblazoned with the headline “Mental illness stems from brain lesions.” A commemorative poster also pictured Charcot with a giant neuron sprouting from his head. Both images, despite their anachronism, reflected a revisionist view of a figure who had previously been remembered largely as the mentor—and, in some respects (equally anachronistic), the precursor—of Sigmund Freud and psychoanalysis.

Jacques Gasser’s study, as its title indicates, comes down solidly on the hard-wired neurological side. For Gasser, Charcot’s work on cerebral localization provides the key to understanding his career and his enduring contribution to modern neuroscience. In this lucidly written and meticulously documented history of scientific ideas, Gasser guides the reader (lay readers will be instructed and challenged by an author who is both historian and neuropsychiatrist) through three connected, successive, and increasingly sophisticated stages of Charcot’s conceptual development: first the anatomo-clinical lectures on the cerebral localization of motor paralyses (1875–76), then similar investigations of aphasia and other aspects of language disorders (1883–84), and finally, more psychologically oriented work on amnesia in the last years of Charcot’s career.

Gasser convincingly lays to rest the notion fostered by the master himself of a resolutely antitheoretical Charcot. The neurologist invoked hypothetical cerebral cortical centers, such as a “center of ideation” linked with a complex of other centers constituting the “apparatus for word memory.” In considering disorders of double personality, he postulated unconscious psychological structures.

Nonetheless, Charcot refrained from systematic commitment to theory. His famous “bell” schema, a diagrammatic sketch to account for four types of sensory and motor aphasia, was never published in French, appearing only in Italian. Among his huge published output, there is but a single lesson on amnesia, and here the theoretical aperçus derive from students such as Pierre Janet and Alfred Binet. All in all, the statement attributed to Charcot by Freud—“la théorie est bon, mais ça n’empêche pas d’exister”—stands as his empiricist credo, despite Gasser’s nuance implying that the opening clause, “theory is fine,” should be taken seriously. Charcot’s primary contribution to cerebral localization, as elsewhere in neurology, remains his careful generalizations based on the study of individual clinical cases. Presented in lectures, these constituted the essence of Charcot’s epistemology, as Gasser skillfully illustrates with unpublished as well as published case histories.

This book is both more and less than a study of a seminal figure. More, in the sense that Gasser traces the intellectual background of Charcot’s study of brain localization by means of perceptive capsule accounts of predecessors, including Gall, Duchenne de Boulogne, Hughlings Jackson, Broca, and Ribot. Less, however, in that the overall contours and context of Charcot’s work are either neglected or subordinated to this theme. Hysteria—undoubtedly the main focus of Charcot’s energy during his final fifteen years, the principal source of his world reputation during that period, and, together with hypnotism, the subject he chose to emphasize among his credentials as a scientist in his bid for membership in the Academy of Sciences—is here referred to only in passing as source of clinical material for other theoretical pursuits.

Gasser has made a substantial and significant contribution to a neglected aspect of a figure who, perhaps because he has been hitherto perceived as a “mere clinician,” has been neglected by historians of science. The claim that the key to understanding Charcot’s contribution lies in cerebral localization falls prey at times to Whig history of ideas, especially when this problematic is projected backward as well as forward in time. Gasser resurrects speculation that Charcot was on the verge of carrying out a major theoretical revision of hysteria that would have unified organic with psychodynamic...