Mad Doctors as Scientists

In this valuable study Lilian R. Furst makes available (in her own translations) certain significant or representative papers in the history of modern psychiatry. These case histories, most of them hitherto virtually inaccessible, were written by five psychologists, neurologists, and physicians in the closing decades of the nineteenth century: George Miller Beard, an American; Jean-Martin Charcot and Pierre Janet, both Frenchmen; and Richard von Krafft-Ebing and Arthur Schnitzler, both Viennese. In a brief preface Professor Furst declares that her aim in this “rescue operation” is to establish the historical context in which the “originality” of Freud can be appreciated. And in her excellent introduction—“Demons, Lesions, and Neuroses”—she identifies the questions she intends to answer: “What kind of questions did they see? How did they envisage the etiology of ‘nervous’ afflictions? What hopes did they hold for remediation, and what methods did they regard as potentially effective?” Many readers, I think, will find the cicerone more interesting than the museum of oddities through which she guides us.

Lilian Furst writes without jargon or pedantry. In her prefatory headnotes she offers subtle rhetorical analysis of the case histories she has selected and tells us what we need to know in order to imagine what the effects on readers of the day must have been. Freud’s forerunners were all committed to this diagnostic principle: “Look to the lesion!” There must be a physical reason for any mental disturbance, whether mild or outlandish. When no lesion could be found, the first thought was that newer, more powerful microscopes would reveal what they knew was there.

The malady known as hysteria presented a fascinating challenge because the lesion was elusive. Patients suffered amnesia or terror or listlessness, together with, perhaps, vomiting, diarrhea, or loss of feeling in the limbs. They were mostly women, and the favored cure was pregnancy or, failing that, horseback riding! The cause—the lesion—was still held to be the “wandering womb,” a diagnosis dating from antiquity, as the etymology underscores. Mesmerism had been supplanted by the more respectable hypnosis; Charcot’s dramatic demonstrations of an hysteric’s recovery under hypnosis (usually temporary) won him international recognition—and brought Freud to Charcot’s clinic to study the master’s procedures. Charcot’s colleagues were shocked when he established clearly that men also could suffer hysteria. (As Frenchmen perhaps they were not acquainted with Shakespeare, or they would have remembered that Lear knew where to place the blame for his oncoming madness: “Hysterica passio! Down, thou climbing sorrow! / Thy element’s below!”) Charcot nevertheless proceeded to palpate the male abdomen in pursuit of the wandering nonwomb, a veritable emblem of Derrida’s absent presence.

Failure to acknowledge the psychological character of hysteria was, of course, the logical consequence of commitment to the lesion theory. Charcot came close to admitting psychology into physics when he speculated that hysterics suffered a psychic trauma as a result of a physical trauma. Another placeholder for the lesion while they were waiting for the better microscope was heredity. That was the theory favored by Krafft-Ebing, a neurologist who had no interest in remediation. His case histories trace psychopathic manifestations in the patient’s family. (Look to the loonies?) His findings and the descriptions of the resultant aberrations were drawn up in excruciating detail with a sobriety that at times converts the genre of the case history to that of the comic sketch. Some friends of mine used to read aloud from Psychopathia Sexualis for laughs. My guess is that James Joyce would gladly have joined in the fun; at least he was amused by the name, writing in Finnegans Wake of a man whose “Kraft [strength] was ebbing.”

As it gradually became clear that psychology was inescapable when it came to diagnosing mental illness, these scientists resorted to renaming or to using neologisms. Problem-solving by means of terminology is endemic in the social sciences and psycholinguistics. (If defining and conceptualizing meaning is troublesome, then...