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ONE
Tuesday Lessons
Homo sum: humani nihil a me alienum puto.
(I am human: I consider nothing human foreign to me.)
—Terence, Heauton Timoroumenos
(The Self-Tormentor) (163 B.C.)
The child’s attitude to its father is colored by a peculiar
ambivalence. —Sigmund Freud, The Future of an Illusion (1927)On October 13, 1885, a young man with a well-groomed beard and a foreigner’s heavy coat stepped out of the train and onto the busy platform at the Gare du Nord in Paris. Letting the other travelers hurry past him, he stood still for a moment, waiting for his ears and eyes to adjust to the strangeness of this foreign destination. Sigmund Freud was twenty-nine years old and had left everything behind, sensing with some strange certainty that his future would begin here, hundreds of miles away from his adored fiancée, Martha, and beautiful Vienna, with its familiar Kaffehaüser and imposing Ringstrasse. He could have remained at home and begun the predictable, respectable career that most young physicians longed for and that he would be required to pursue if he wished to marry. But instinctively he knew that he needed something that Vienna could not offer him. For there, in Paris, shone the great name of Charcot.
Who had not heard of the illustrious neurologist Jean-Martin Charcot, or of his famed Tuesday lessons? Each week at his Salpêtrière hospital, he presented for study his ailing patients, who these days were most often hysterical women. He discussed their symptoms—irrational ramblings and convulsive spasms, for example—before a rapt and eclectic audience of curious scientists, skeptical journalists, and chic socialites. Freud had heard tantalizing accounts of these sessions, of writhing bodies brought into submission under the piercing, all-seeing gaze of the great doctor. As a testament to the Frenchman’s considerable power and influence, he was even known as the “Emperor of the Salpêtrière.”
Yet for all these accolades, Charcot was also considered something of a maverick. He had been among the first to treat hysteria as a knowable neurological disorder, despite its vague symptoms that seemed to have no discernible physiological source and despite the fact that many of his contemporaries still dismissed such sufferers—often women—as malingerers. Such courage . . . such confidence—the young Freud was bowled over at the thought of such achievement. And so, hoping that with so innovative a teacher he would find the training and inspiration he needed to launch his own career, Sigmund Freud entered the swirling commotion of the French capital. “For years, I only dreamed of Paris,” he later recalled, “and the extreme happiness that I felt in posing my foot for the first time on these cobblestones seemed to me to guarantee the realization of my other desires.”
Freud’s first weeks in the City of Lights, however, proved disappointing and bewildering. He felt lazy and out of sorts, and, in letters home to his most intimate confidante, Martha, he fretted about the high prices and the exhausting, frenetic pace of Parisian life. His hotel in the fifth arrondissement was small and cramped. His accent and limited knowledge of the French language made the simplest conversation difficult. After failing to make a waiter at a café understand his request for du pain (“some bread”), Freud was too embarrassed to ever go back there. As he waited for his first meeting with the great Charcot, Freud restlessly toured the capital, seeking shelter among the antiquities of the Louvre from the city of strangers and from his own gawky foreignness. To stave off his mounting sense of inferiority, Freud savagely noted the symptoms of that pathology unique to the French: their “miserable megalomania,” which caused them to mount theater performances that lasted four hours and meals that lasted five or six, and bred a misplaced idealization of revolutionary activity. But there was something else, something about the city and its inhabitants that struck him as uncanny and alien. “I think they are all possessed by demons,” he confided to Martha. “The French are a people of psychical epidemics, of historical mass convulsions, and they have not changed since the time of Victor Hugo’s Notre-Dame de Paris.” Freud felt that great poet, who had died only a few months earlier, had captured something elemental and unsettled about the capital. At first glance Paris seemed to him like a city flush with possibility. Everywhere he looked, there was something to catch his eye, from the dance halls and cafés lining the grands boulevards, to the Luxor obelisk in the center of the place de la Concorde, or the impressive array of goods at the new department stores. People were whisked to and fro in the elaborate system of streetcars and omnibuses, and many were already talking with excitement about the centennial celebration of the French Revolution that would take place four years later at the Universal Exposition. But while Hugo had embraced the volatility of the capital, Freud was unnerved by it. Underneath the frenetic exuberance, one could just make out a dull throb of anxiety. Nor was he alone in thinking that something was afoot in Paris: specialists of the day only half-jokingly called Paris “the hysteria capital of the world.”
But as he slowly settled into a routine, Freud found himself warming to certain benefits of Parisian living: the coffee, he allowed, was excellent, as were the dramatic talents of the sublime Sarah Bernhardt. The cathedral of Notre Dame left the most lasting impression upon him. And a week after his first visiting the church, Freud breathlessly invoked it in another letter to Martha as a metaphor for his own evolving relationship with his new mentor, Jean-Martin Charcot, under whom he had begun studying:
I am now quite comfortably installed, and I think that I am changing greatly. I will tell you in great detail what is causing this change. Charcot, who is one of the greatest doctors and whose genius is only limited by his sanity, is quite simply in the process of demolishing my ideas and my plans. I leave his course as if I was leaving Notre-Dame, full of new ideas about perfection. But he exhausts me, and when I leave him, I no longer have any desire to do my own work, which seems so insignificant . . . Will the seed produce any fruit? I don’t know; but all that I do know is that no other man has ever had so much influence on me.
Like a man intent on heralding his own mythology, Jean-Martin Charcot enjoyed telling his students about his origins. They in turn would whisper these stories to one another before lectures or after making patient rounds, and in this way the contours of their teacher’s life and those of the scientific discipline that he was building became virtually indistinguishable.
He was born in Paris on November 29, 1825, to Simon-Pierre Charcot, a twenty-seven-year-old carriage builder and artisan, and Jeanne-Georgette Saussier, who was not quite seventeen. His first years occurred against the backdrop of the political turmoil of the final days of the Restoration and the revolts of 1830, most famously immortalized by Victor Hugo in Les Misérables. His family was of modest means, and Jean-Martin lived with his parents and three brothers in a lively section of Paris near the grands boulevards on the Right Bank. It was a pleasant childhood, marred only by the death of his mother when Jean-Martin was just fourteen years old. Yet he was a stern child, who already showed signs of that cold, taciturn disposition for which he would later become famous, preferring to spend his time alone reading and drawing than playing with friends. In 1843, when he was eighteen, he finished his secondary schooling and was faced with the prospect of choosing a career either in art or in medicine, ultimately deciding to become a physician, with its promise of greater economic and social advancement.
At the time, the field of medicine was enjoying a newfound prestige in light of doctors’ prominent role in the July Revolution of 1830 and in fighting the cholera epidemic in 1832. “No lifestyle that I know,” gushed the author of The French As Viewed by Themselves, a popular book published while Jean-Martin was in school, “is more varied, more complete, than that of the medical professor. To advance the interests of science and his own fortune, to have a clientele and an audience, to be obliged to reveal a thousand secrets in the name of art, but never breaching the trust of his patients . . . He sees all aspects of pain . . . a palace, and a leper asylum, this is his world.”
To be both master over and witness to the sick and diseased— this was what young Jean-Martin wanted for himself. And so he began his training at the School of Medicine in Paris, the Faculté, at the center of the city, off the rue de l’École de Médecine. A thin, pale young man, with long black hair and a small black mustache, Charcot spent most of his free time sketching scenes from the Latin Quarter rather than mingling with the other students, many of them fellow children of the lower and middle bourgeoisie who had enthusiastically embraced the credo of upward mobility captured in the exhortation of statesman François Guizot: “Enrich yourself!” In 1853 he presented his doctor’s thesis, in which he differentiated between the symptoms and lesions of gout and those of chronic rheumatism. For the next ten years, Charcot steadily and tirelessly worked his way up through the ranks of the medical hierarchy until he had built himself an impressive enough portfolio in teaching and research to earn a hospital post in 1862. At the age of thirty-seven, he was nominated to the Salpêtrière clinic in Paris, and he accepted a chaired position there in 1882.
Charcot had first entered the Salpêtrière as a student on January 1, 1852, passing through the great arched gateway that allowed the visitor, in a single glance, to take in the entire grand facade, along with its imposing dome, reminiscent of the Hôtel des Invalides. But behind this grand exterior lay a dark and grubby institutional history: originally built as an arsenal in 1634, the Salpêtrière had been transformed by a royal edict in 1656 into a public hospital or asylum to shelter destitute women and prostitutes. Treatment of the inmates ranged from neglectful to outright abusive: the most disturbed of its inmates—those restricted to the wing for insane women—often had their feet and hands bound by chains and their bodies confined in large iron rings affixed to the walls. Some were kept in pits, which, during winter, were invaded by rats. In September 1792 the Salpêtrière entered a gruesome chapter when a revolutionary mob notoriously stormed the gates and raped and massacred forty-five female prisoners and a few prison chaplains, whom the mob suspected of aiding a counterrevolutionary plot. It was not until 1800 that the inmates’ iron shackles were replaced with straitjackets. As the nineteenth century progressed, the Salpêtrière eventually became the largest asylum in Europe, housing anywhere from five to eight thousand inhabitants.
While most medical practitioners saw the Salpêtrière as a place to be avoided, a “Versailles of misery” rather than a site of scientific innovation, Charcot, who had by now turned exclusively to the study of neurological disorders, saw its large and diverse patient population as providing an excellent opportunity for the comparative study of disease. It was nothing less, he declared, than an immense “living pathological museum.” When Charcot returned to the Salpêtrière in 1862 as an attending physician, his first step, undertaken with his colleague Alfred Vulpian, was to attempt an inventory of the massive patient population, which was divided into two primary categories of inpatients. The psychiatric section contained the insane, les aliénés, who numbered between one and two thousand. Another three thousand patients, mostly elderly women suffering from chronic disorders of the nervous and musculoskeletal systems, were also housed there. He and Vulpian roamed the wards together, beginning the arduous task of compiling, for the first time in that institution’s history, detailed medical case histories, which would allow physicians to follow the patients and, upon death, relate their clinical record with autopsy findings. They heard stories of lifelong suffering and slow, painful decline; they saw hands gnarled into claws futilely grasping at the thin bed sheets, limbs akimbo. Surrounded by the disarray of a misunderstood and mislabeled population of Paris’s most diseased and crippled bodies, Charcot was determined to transform the hospital from a “a prison and an asylum of unwanted womanhood” into one of the great clinical research centers in the world. And he did.
To wrest order out of the chaos before him, Charcot turned the clinical observation of his patients into a kind of divining art form. Doctors at the School of Medicine in Paris had already begun, for the first time, to correlate clinical symptoms in living patients with anatomical lesions identified during postmortem examinations. In this way they were able to determine that jaundice pointed to an ailment of the liver, while frothy sputum was frequently a sign of cardiac or pulmonary distress. Charcot went one step further, placing primary importance on the close observation of his living subjects: “It is not on an inert corpse,” he wrote, “that one can chart the incessant movements that life, with its infinite variations of movements, impresses on all parts of the human body.” He called his method the “anatomo-clinical” method. Working under the supposition that each patient’s external symptoms related to some kind of internal state of deformation and degeneration in the form of anatomic lesions, Charcot concluded that these lesions were responsible for such previously enigmatic afflictions as epilepsy, multiple sclerosis, strokes, and other neurodegenerative conditions. His penetration of disease required the ability to comprehend, in a single glance, an essential image of the inner disorder from a variety of superficial appearances, a skill that he had honed during his earlier years as an aspiring artist. He was able to trace the origin of these disorders further still due to recent developments in cellular pathology. He used a new microscope developed by Rudolf Virchow, a German doctor who, in 1858, had advanced cell theory by demonstrating that tissues were composed of cells that maintained a normal order unless disrupted or destroyed by disease states. Over the years Charcot expanded the facilities of the Salpêtrière to facilitate his increasingly complex forays into neurological diseases, adding a laboratory with the latest microscopic equipment and both outpatient and inpatient services. There was also a museum of pathologic anatomy, with an attached studio for modeling and photography. All day, every day, doctors and interns in each of these departments threw themselves into documenting and cracking the code of unknown diseases that appeared daily as cruel and vengeful scourges on the bodies of their victims.
For Charcot, as for other men of science in his generation, the classification of disease—in his case, of les maladies nerveuses—was as important as its treatment. Their methods held out the tantalizing possibility of a complete knowledge of the human being, including mysteries of the brain and nervous system. Because these areas had previously been so shrouded in ignorance, Charcot’s zeal for applying new technologies and knowledge to the field resulted in its becoming one of the most dynamic areas of modern medicine in the 1870s and 1880s. His approach and dedication came to be seen as ultimate proof of the kind of insight medicine could bring to the human condition.
In the twenty years between his arrival at the Salpêtrière and his nomination as the first Professor of Diseases of the Nervous System at the Faculty of Medicine, the first position in the world to be devoted to clinical neurology, Charcot essentially founded the field of modern neurology. His reputation grew through the publication of a series of studies and his innovative teaching techniques. The general public was made aware of the medical breakthroughs occurring at the Salpêtrière in reviews such as Iconographie Photographique de la Salpêtrière and Nouvelle Iconographie de la Salpêtrière. In these journals, which were even discussed and debated in the newspapers and popular novels of the day, readers were presented with case histories of Charcot’s patients, ghoulish photographs of naked men and women with distended bellies, bulging joints, and spasmed limbs, feebly propped up with pedestals or umbrellas, juxtaposed with bland descriptions of the symptoms in the most current medical language.
It was into this heady world that Sigmund Freud ventured when he arrived in Paris to study with Charcot in the fall of 1885. He first caught a glimpse of the professor’s genius through his teaching courses and lectures. By the time Sigmund Freud had arrived in Paris, Charcot was in the habit of giving his weekly Friday clinical lecture in a cavernous lecture hall at the Salpêtrière, which could hold four hundred people. As visitors entered from the rear and walked past the wooden benches, their attention was instantly drawn to the low platform at the front, where they saw statues of patients in contorted, anguished poses, plaster casts of bulbous deformities, and multicolored anatomic drawings of brains and spinal cords, which were carefully laid out like so many altar icons. As a backdrop to this staging was a gigantic painting of Philippe Pinel breaking the irons from the wrists and ankles of the insane in 1795, a not-so-subtle reminder that the upcoming display was only the most recent step in a long and lofty history of noble medical liberation. The doors flung open and Charcot entered swiftly and resolutely, a force of nature. With his low forehead and pronounced jowls, his cold, penetrating gaze and stocky body, Charcot bore more than a passing resemblance to Napoléon. He was followed in formal procession by his entourage of physicians and interns who assisted him in running the school of the Salpêtrière. Staring out at the audience assembled before him, Charcot took a deep breath and immediately launched into his formal presentation of whatever specific neurological disease—Parkinson’s, hysteria, multiple sclerosis, or paralysis—was on the agenda. While most doctors who lectured at the time relied on knowing asides and rhetorical flourishes, Charcot’s lectures were stripped of all unnecessary affectation or ornament. He spoke precisely, carefully, as if to ensure that no one would misunderstand him. Freud, who had already been won over by the master’s energy and lively intellect, quickly stopped attending other doctors’ lectures, so convinced was he that they had little more to offer than “well-constructed rhetorical performances.” Charcot threw himself entirely into these talks, mimicking different clinical signs—the mask of facial paralysis, the spasmodic muscular rigidity of a patient suffering from Parkinson’s disease—or, when words began to fail him, turning to graphic diagrams, enlargements of microscopic examinations, statuettes, actual anatomical specimens, and the new technology of photography to make himself clear.
Freud found these lectures to be wholly absorbing, calling them “a little work of art in construction and composition,” particularly the way in which the great master would explain in vivid detail his train of thought. In thus revealing his doubts and hesitations, Charcot seemed to reduce the gulf between teacher and pupil. His lectures were based on exhaustive, interminable research—from the latest medical journals in French, German, and Italian, to clippings from newspapers or books that had caught his eye, to notes he made during his extensive readings in literature, art, and history. Patients were wheeled out onto the platform—sometimes alone, sometimes in groups—where they were questioned, examined briefly, and held up as examples of one disease or another. He liked to bring out groups of patients with slightly different problems to compare and contrast. Or sometimes he would bring in three or four examples of patients suffering from the same disease, in order to show the breadth of clinical expression for common disorders. Prognosis of the patient was usually discussed after he or she had left the room, or it was given in Latin. The medical advances accomplished in those lectures were truly breathtaking. Charcot and his students were working on the cutting edge of neurological research, foraying into diseases like multiple sclerosis, tabetic arthropathies, and amyotrophic lateral sclerosis (ALS)—all pathological conditions so recently identified that they were frequently ignored in the textbooks of the period. And the skill with which he diagnosed and distinguished specific neurological disorders recalled to Freud nothing less than Adam identifying and naming the animals.
In addition to these clinical lectures, Charcot began holding more informal lectures—the famed Tuesday lessons—in 1882, drawing on the most interesting cases from his outpatient service and aimed at initiating students into the difficulties of diagnosis and practice. By the time Freud had arrived in Paris, Charcot was increasingly devoting these public lectures to “hysterical” conditions like Parkinson’s and epilepsy, which could not be obviously linked to any specific anatomical lesion, and had therefore been relegated to the unidentified category of névroses: disorders that involved the nervous system but could not yet be classified. In the mid-1870s, the work on hysteria at the Salpêtrière first leaped to public notice with the publication of the first three volumes of Photographic Iconography of the Salpêtrière under the editorship of Charcot’s assistant, Désiré-Magloire Bourneville. These books drove the reality of hysteria home with their graphic pictures of those suffering from various neurological diseases and those in the throes of hysteric episodes. Accompanying the photos were various tables, graphs, and other statistics that conferred upon hysteria the status of objective disease, while its more prurient aspects—case studies with salacious sexual details and accounts of delirious fantasies—were delivered with a flair that recalled the newspaper faits divers that fed the baser, voyeuristic appetites of the general public.
Although one of the oldest identified mental disorders, with a recorded history going back to ancient Egypt and Greece, hysteria had been largely ignored by medical practitioners until the nineteenth century. However, in the final decades of that century, hysteria became a visible, if not notorious, affliction, and French men and women saw a rapid rise in the number of diagnosed hysterics: in Charcot’s clinic at the Salpêtrière, they were coming in at a rate of one a day. The victims of hysteria were predominantly working-class, young, unmarried women, who, it was widely believed, had acquired the disease hereditarily and were now experiencing outbreaks due to some sort of “dynamic lesion” or psychologically traumatic event that had acted as an agent provocateur. The chief symptoms of hysteria were convulsions, spasmodic seizures, and feelings of strangulation. Faintings and swoonings, paralysis, coughing, and trancelike states were also frequently involved. It was a particularly frustrating disease at a time when the practitioners of science were bent on classification and were more comfortable with the idea that each disease had fixed and identifiable defining marks. But Charcot, astoundingly and elegantly, subsumed the seemingly random symptoms under positive laws. He argued that, based on his attentive and repeated observations, the symptoms of hysterical attacks revealed themselves on a completely predictable basis. Charcot believed it to be a real and curable malady, the primary cause of which lay in hereditary degeneration of the nervous system.
These presentations were responsible for popularizing Charcot’s theories and for cementing his reputation in the larger public. While Charcot saw his work as making illness and disease more knowable, and hence more manageable, others were worried about the implications of what he was discovering. At the time, the relationship between the central nervous system and human behavior was increasingly being explored in literary, artistic, and legal circles as a growing number of laypeople began relying on a neurological vocabulary of hysteria, degeneration, and heredity to explain crime and social deviance for the nation as a whole. To many, these forces seemed to be overpowering the older values that had served as the backbone of Victorian sense and sensibility—family, religion, and social hierarchy—only to be replaced, or so announced the front pages of mass circulation newspapers, by divorce, the occult, and dangerous class warfare. Rapid industrialization and the rhythms of urban living were creating new stresses that now seemed to be overwhelming the nervous system. Doctors found themselves diagnosing more cases of “melancholy,” “neurasthenia,” and, of course, “hysteria,” which they declared a direct result of the cacophonous nature of urban life, while social reformers and politicians ominously warned of a variety of modern epidemics—of syphilis, of alcoholism, of delinquency—that seemed symptomatic of the nation’s rotten core. So it was unsurprising that the audience attending Charcot’s Tuesday lessons, along with Sigmund Freud and the other students and doctors, also included journalists and public officials, as well as hospital dignitaries and youthful interns, curious bourgeoisie and personalities from the stage. The philosopher Henri Bergson, the sociologist Émile Durkheim, the writers Guy de Maupassant and Edmond de Goncourt, the actress Sarah Bernhardt—all were frequent attendees at these star-studded presentations. There would also routinely be representatives from around the world—the United States, Germany, even Japan—all eager to witness for themselves the great doctor’s virtuosic gift for observation and analysis.
Laypeople watching the young women suffering from attacks—loss of consciousness, rigidity, foaming at the mouth, violent or tear-ridden outbursts, and delusions—found them chaotic and inexplicable, but Charcot and his colleagues underscored that they were as predictable and orderly in evolution as other diseases. He cut through everything that he deemed superficial or irrelevant to the diagnosis—often these were sordid details of emotional and physical abuse or painful personal history—and watched for signs of the physical elaboration of the four main periods of a hysterical attack: epileptic, “clown,” grands mouvements, and attitudes passionnelles.
It was thus, during one of his Tuesday lessons, on February 7, 1888, that he had a young woman suffering from hysteroepilepsy brought into the amphitheater on a stretcher. Having identified her three hysterogenic points—on her back, under her left breast, and on her leg—Charcot instructed the intern to touch one of them, immediately provoking an attack.
“Now, here we have the epileptoid phase,” Charcot calmly began, calling attention above his patient’s groans and squeals to her arched back.
“Now here comes the phase of emotional outbursts, which fuses with the back arching . . .” he continued, noting how, thus far, the attack resembled true epilepsy. In order to identify the attack as a truly hysterical one, Charcot instructed the intern to compress the ovarian region. The attack ceased and resumed again only when the compression was released.
As the young woman began contracting and contorting, Charcot turned to the audience and continued talking.
“Mother, I am frightened . . .” the female patient called out.
“Note the emotional outburst,” he continued. “If we let things go unabated, we will soon return to the epileptoid behavior.”
“Oh! Mother.”
“Again, note the screams,” Charcot steadily observed. “You could say it is a lot of noise over nothing,” he added drily. “True epilepsy is much more serious and also much more quiet.”
And with that he nodded quickly to an assistant, who swiftly and smoothly removed the quivering patient and brought out a new one.
These young hysterics and Charcot’s capacity to decipher their symptoms as they passed various dissociative twilight states of consciousness left an indelible impression on the young Freud and would have important implications for his own theory of the unconscious. He found the energy and intellectual excitement coiled within the sixty-year-old scientist electrifying, and he found himself daring to hope that some of this greatness might be passed on to him. Charcot’s antitheoretical streak—“Theory is fine,” he would growl, “but that doesn’t prevent facts from existing”—led the Frenchman to trust his careful observation of his patients over the opinions of experts or the abstract assumptions of medical textbooks. From the mid-1880s, when Charcot began to discuss “autosuggestion,” or self-hypnotism, as a mechanism for the mind-body interaction in hysteria, he incorporated a psychological dimension into what had originally been a purely somatic conception of the disease. It was Charcot’s use of hypnosis in an attempt to discover an organic basis for hysteria that stimulated Freud’s own interest in the psychological origins of neurosis. Freud recalled hearing him say that the greatest satisfaction a man could have was to see something new . . . to recognize it as new. By being willing to see hysteria as something real and new that could be treated by appealing to the laws of reason and the new technologies of science and medicine, Charcot had thrown the whole weight of his authority behind a disease that had, up to this point, been studiously ignored. In Freud’s mind this was nothing short of a smaller version of the “act of liberation” Pinel had committed when he freed the inmates of the Salpêtrière from their chains.
On January 19, 1886, Freud first attended one of Charcot’s famed soirées at his opulent mansion on the boulevard Saint-Germain, where the most fashionable and notable representatives of arts and letters, science and society, regularly gathered: the famed scientist Louis Pasteur, statesmen like Léon Gambetta and Pierre Waldeck-Rousseau, Charcot’s patient and friend the emperor of Brazil, and writers such as Alphonse Daudet, Théodore de Banville, Jules Claretie, Edmond de Goncourt, and Émile Zola, among others. Freud was so nervous that he devoted the entire day to preparing for his debut, spending fourteen francs on the barber and on new clothes for the occasion (white gloves, white tie, and even a new shirt). Wracked by anxiety, he even took a little cocaine to “untie my tongue” on his way out the door of his hotel room. When he arrived at his destination, Freud marveled at the elegantly appointed salon in Charcot’s home, which was like another world for him—the stained-glass windows and walls hung with heavy silken tapestries and exquisite artwork, the cabinets crammed with Hindu antiques and Chinese artifacts.
Although he could seem quite severe and imposing, Charcot was also a very social person and liked nothing better than to open up his home on Tuesday nights when, after a family dinner with a few select guests, the Charcots entertained with large receptions from October until May. It did not have the same formal function as some of the other salons, like the Daudets’ gatherings on Thursdays, where artistic and literary relationships—and even movements—were forged. But it allowed Charcot’s students to mix with their professors and other notable personalities, while sampling the delightful culinary offerings provided by Mme Charcot. The conversation was always sparkling and wide-ranging, tripping easily from science to art to politics. For Sigmund Freud these gatherings offered something entirely new and unexpected—most notably a fascinating glimpse at his mentor’s family and domestic life.
Jean-Martin Charcot had devoted the same determined energy to cultivating his domestic empire as he had to his professional life. In 1864, at the age of thirty-nine, Charcot had married Augustine Durvis, a twenty-seven-year-old widow with a seven-year-old child, Marie. Augustine was herself the daughter of a prominent and wealthy clothier in Paris who also collected paintings. She was a pleasant-looking woman, a skilled cook, and a talented painter and potter. She brought 450,000 francs to the marriage, as well as the prospect of inheriting all her father’s estate and a portion of her grandparents’ estate. Charcot, by contrast, only brought to the marriage 29,000 francs and a half-interest in a country house north of Paris. Mme Charcot was devoted to her husband and constructed a life around making sure he wanted for nothing. A year after they married, the Charcots welcomed a daughter, Jeanne, into the world; then, in 1867, came their son, Jean-Baptiste. The Charcot family was a close-knit unit. Jean-Martin doted on his children, frequently taking them on trips or going on long walks with them. He was a great animal lover, and there were always dogs of all sizes running about the Charcot home; for a while, Charcot even had a little monkey from South America, which had a place of her own near him at the dining table, where she would sit on a child’s high chair with a bib while the family enjoyed leisurely, sumptuous meals together. At night the Charcots often retired together to a workshop in the house, where Jean-Martin painted and his wife and the girls worked with clay, leather, metal, and glass. Mme Charcot was an avid artist and patron of the decorative arts whose work was also displayed in contemporary art exhibits.
Like any family, of course, they had their struggles. Jean-Baptiste, although devoted to his father, was a headstrong child who early on developed a fascination for all things maritime. Sailor suits, toy boats, and books about exploration and navigation were the supplies for his most ardent dreams. Jean-Martin initially chalked up such ideas to typical childlike enthusiasms. But as time passed, he witnessed his son’s interest in the sea intensifying, passing from mere fancy to a veritable obsession. Jean-Martin was strenuously opposed to his son’s youthful ambition to become a sailor—any son of his must follow in his footsteps and become a doctor, he frequently reminded Jean-Baptiste. And Jean-Baptiste knew in his heart of hearts that his father’s wishes would prevail. In any case, disobeying or disappointing his father was a thought Jean-Baptiste could scarcely fathom. But while Sigmund Freud was eagerly soaking up Charcot’s lessons, hardly able to believe his good fortune at being able to enter the great professor’s private circle, Jean-Baptiste took up his medical studies with some reluctance.
Among Charcot’s close friends—and patients—was the famous author Alphonse Daudet, whom Freud had an opportunity to meet at one of the soirées. “A magnificent face! . . . a resonant voice, and very lively in his movements,” Freud observed. Daudet was a great favorite of Charcot, who preferred ending his Tuesday evenings conversing exclusively with the writer as the doctor’s young disciples savored midnight chocolate and buttered toasts and attempted to eavesdrop on the lively exchange between the two friends. Yet Daudet was far from thriving; Charcot had taken over his care a short time earlier, having warned the author in May 1882 that he was most definitely sick with tertiary syphilis manifesting as tabes dorsalis, the result of the degeneration of nerve cells and fibers in the spinal cord. Gradually, patients suffering from this form of syphilis could expect to experience an increased inability to control their movements—one could pick out the victims of the disease by their distinctive shuffling walk—before general paralysis would set in. Alphonse was fifteen years younger than Charcot and had arrived in Paris at the age of seventeen, when Charcot was already well embarked on his medical career. They eventually became neighbors—the Charcots had lived since 1884 at 217, boulevard Saint-Germain and the Daudets since 1885 around the corner at 31, rue de Bellechasse—and the two families came together almost every Thursday, while Alphonse and his wife, Julia, would attend almost every Tuesday night salon hosted by the Charcots. Alphonse had attended Charcot’s class presentations at the Salpêtrière between 1882 and 1884, fascinated by the great doctor’s keen ability to analyze based on close observation. “A beautiful mind, respectful of literature. His analytic sense is close to mine,” Alphonse wrote of his physician and neighbor. Jean-Martin was no less fascinated by Alphonse, once telling the latter’s son Léon, “When I chat with Daudet, I feel like I’m under a microscope.” Yet Alphonse also felt an uneasy fellowship with Jean-Martin’s patients, felt drawn to the parade of human misery whose spasmodic trembling and grimaces of pain so closely echoed his own physical distress. From where he stood, it seemed as if his friend Jean-Martin and he existed on opposite ends of the continuum of health and disease.
The friendship between Jean-Martin Charcot and Alphonse Daudet trickled down to their sons Jean-Baptiste and Léon, who were inseparable from an early age. As a boy Léon often ran over to the Charcots’ home to play with Jean-Baptiste and Jeanne. The children chased each other from room to room, dashing through the anteroom where Charcot’s gaunt, ill patients waited to be seen. American millionaires and Polish princes were reduced by illness to the role of desperate supplicants. If the Charcot household “was hell for mental suffering,” Léon later remembered, “it was a paradise for youth.” While Léon was early on exposed to the dangers of illness, Jean-Baptiste Charcot grew up inculcated with the belief that illness could be contained or even mastered. Sigmund Freud was not the only one to be seduced by Jean-Martin Charcot’s seemingly limitless ability to recognize and understand disease. In so many ways, young Jean-Baptiste also came to look on his father’s abilities as nearly godlike. He spent his childhood surrounded by doctors, by his father’s reputation for being able to cure—not even the sight of his father’s patients, with their tears and spasms and disfigurations, could mar the harmonious interior of the Charcot family hôtel particulier. Jean-Martin bestowed order and reason on his son’s world, managing to keep the dangerous specter of irrationality and chaos at bay. For the rest of his life, Jean-Baptiste continued to believe in the supreme nobility of science and of the leading role his father had played in it.
For Léon, however, it was different. He felt considerable ambivalence, even suspicion, when confronted with tales of Charcot’s medical prowess—perhaps because he never felt entirely shielded from the threat of disease even in the great doctor’s presence. Like his father, he felt curiously aware of those on the receiving end of Charcot’s genius, remembering about his time playing with Jean-Baptiste:
Ataxics and melancholiacs squirmed on thirteenth-century Baroque prayer stools, those with muscular atrophy rested their scrawny arms on griffins, serpents, and gargoyles. Imagine Hell and all its suffering in an old antique shop, the spectrum of all pathological curses lodged in a setting from Victor Hugo. This spectacle along with our noisy games must have made the experience seem like a nightmare for those millionaires from Germany, Russia, America, Poland, England, and Turkey who came faithfully and humbly to obtain their prescription for bromide, strychnine, or a thermal cure at Lamalou from the king of neurologists . . .
And when Léon came home from playing with the Charcot children, he returned to the illness of his own father, whose struggle with nervous and muscular disorders associated with late-stage syphilis was a constant shadow over an otherwise happy family life for Léon and his two siblings. Subjected by Jean-Martin Charcot and an array of eminent doctors to a barrage of excruciating yet ultimately ineffective treatments—being suspended for a full minute by his chin and taking injections of fluid extracted from bull testicles were only two of the worst ones—Alphonse became obsessed with his own physical deterioration and began a journal of observations about his illness, which was published after his death as La Doulou (In the Land of Pain). Watching his father’s inexorable decline into a twilight of morphine and pain, the adolescent Léon developed his own obsession with heredity and degeneration and first had the idea that he himself would study medicine in the dual hope of trying to save his father and to avoid becoming him.
Had Léon admitted his anxieties to Professor Charcot, he would not have found much reassurance, for the professor was firmly in the camp of those who believed that neurological disorders were passed on within a family by hereditary transmission. Hysteria, epilepsy, a predisposition to alcoholism, retardation, or syphilis . . . each of these was a member of that dark famille névropathique and, thus, a form of degeneracy. Of course, he found that his patients usually attempted to deny this basic truth, which is why he placed such little stock in the family histories his patients attempted to present to him. “It is instinctive, almost a Darwinism,” he declared, “for families to hide from themselves and from others their neurological problems. They are the family blemishes. Man does not like fatality. Instinctively, he searches for another explanation, an accident or chance occurrence, rather than accept that this disease is passed on within his family by hereditary transmission.” If this view of human life guided by unforgivable rules seemed harsh, it was nonetheless a view that Charcot had found buttressed by his extensive research in philosophy and literature as well as in medicine. After a lifetime of work dedicated to unlocking the secrets of disease, of liberating men from ignorance about the human body, Charcot had come to the conclusion that our grim destinies were inescapable, already written onto our very cells and tissues. And he found himself continuing to return to a favorite quotation of his: “Man is in the hands of the gods, like a fly in the hands of children. They play with it until they crush it.”
In his focus on heredity and, specifically, in his belief that hysteria, along with most neurological and mental diseases and many other chronic diseases, was essentially the result of familial inheritance, Charcot was merely following in the footsteps of a school of thought that used the concept of degeneration to explain mental pathology and physical disease. The theory of degeneration was first introduced by a French psychiatrist named B. A. Morel in the 1840s and became a kind of catchall explanation for everything from criminality to genius. In Morel’s view, an organism may adapt to a pathological environment but would conceal this pathology as an aptitude or tendency. In subsequent generations, however, the pathology would reveal itself as a worsening physical or nervous disorder. The end result of degeneration was nothing less than sterility and, finally, death. Cesare Lombroso, an Italian criminologist and physician, furthered the discussion with the publication of his famous 1864 work Genius and Madness, followed by his Genius and Degeneration in 1887. Taking as examples such figures as Leopardi, Tasso, Byron, Napoléon, Zola, and Poe, Lombroso argued that the nervous sensibility could be so highly developed in geniuses that it was almost a kind of illness, that aesthetic production could, in fact, be stimulated by a kind of psychosis. The young psychiatrist and clinician Valentin Magnan, who had been trained at the Salpêtrière, was primarily responsible in France for the adaptation of organic theories of degenerative mental illness to the neurological science of the day. He even collaborated with Charcot on several publications. It was a powerful theory that only gained more ground as the 1880s progressed. But to a boy like Léon, anxiously watching his ailing father, such theories simply smacked of guilt by association.
With the lessons of Charcot still tumbling about in his brain and a photograph of Notre Dame tucked into his suitcase, Sigmund Freud left Paris on February 28, 1886 (just nine months after Victor Hugo’s death), knowing what the new century would require him to do. And on Easter Sunday, April 25, 1886, the Neue Freie Presse in Vienna ran a small announcement that would have a lasting impact on the century to come: “Herr Dr. Sigmund Freud, Docent for Nervous Diseases at the University, has returned from his study trip to Paris and Berlin and has consulting hours at [District] I, Rathhausstrasse No 7, from 1 to 2:30.”