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Psychiatry

Jean-Martin Charcot and the pathologisation of ecstasy

Extase_Iconographie-e1369328952903One of the things I want to argue in my next book is that ecstatic experiences have been pathologised in the secular west, to our detriment. People still experience ecstasy – by which I mean moments where we go beyond the self and feel connected to something bigger than us, usually a spirit but also sometimes another individual or group – but we lack the framework to make sense of such experiences. And, as Aldous Huxley said, ‘if you have these experiences, you keep your mouth shut for fear of being told to go to a psychoanalyst’ – or, in our day, a psychiatrist.

The medicalisation and pathologisation of ecstasy happened slowly over the last four centuries – it is a key shift in the emergence of secular society. Before the 17th century, if you had an ecstatic experience, you might either be canonized or demonized. Either way your experience was carefully defined and controlled by the Church, which has always been wary of unbridled ecstasy, particularly in women (see Monsignor Ronald Knox’s misogynistic Enthusiasm (1950) for a recent example – Knox writes ‘the history of enthusiasm is largely the history of female emancipation…and it is not a reassuring one’).

Then, from the 17th century on, cases of both ecstasy and possession were viewed not as spiritual encounters but as disorders of our mechanical body, the product of diseased nerves, or an over-heated brain, or ‘animal spirits’, or ‘the vapours’. In the 19th century, unstable women were increasingly diagnosed with ‘hysteria’, a disease which Egyptians suggested, back in 1900 BC, was caused by a ‘wandering womb’ (supposedly the womb could be lured back to its proper position by holding scented objects near the affected woman’s vagina).

220px-Jean-Martin_CharcotThe understanding of hysteria didn’t advance much in the 4000 years to 1856, when Charcot was made head of the Salpetriere hospital in Paris. Salpetriere was the biggest hospital for women in Europe, and a ‘grand asylum of human misery’, as Charcot put it. He and his team carried out ground-breaking research into several neurological conditions – Parkinson’s, Tourette’s, Multiple Sclerosis, Lou Gehrig’s syndrome – but it was his work on hysteria that made Charcot globally famous.

Hysteria was a notoriously loose and imprecise diagnosis, so Charcot attempted to classify it, and discover the physical cause of it. He insisted that hysterical fits followed four clearly-defined stages – 1) epileptoid fits, 2) ‘the period of contortions and grand movements’, 3) ‘passionate attitudes’, and 4) final delirium.

He claimed that, although hysteria was a physical disease caused by a lesion on the brain, one could artificially induce these four stages through hypnosis. To prove this, he used photography to capture the four stages of hysteria, and circulated the evidence through the Iconographie Photographique de la Salpetriere. Photography was still a new, somewhat magical science – rather like neuro-imaging today – and these photos ‘did much to fix the image of hysteria in the public mind’, according to the medical historian Andrew Scull.

Augustine vogue-ing in the Iconographie
Augustine vogue-ing in the Iconographie

Charcot also put on public displays, every Thursday, where he hypnotized female patients and provoked hysterical fits for the fascinated male public, which included everyone from Sigmund Freud to Emile Durkheim. Both in the photographs and in the public displays, Charcot had ‘star patients’ who were particularly good at performing the four stages of hysteria, including a pretty teenager called Augustine, and a devout woman called Genevieve.

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These ladies expertly performed religious poses which Charcot’s team defined as ‘ecstasy’. And the team insisted that their work proved that all the religious ecstatics and demoniacs of yesteryear were suffering from hysteria. Joan of Arc, St Theresa, St Paul, Jesus himself were all evidently hysterics. By a happy coincidence, Genevieve – who suffered from particularly violent fits – came from Loudun, the scene of a mass demonic possession of nuns in the 17th century. Charcot had an extensive gallery of religious art, and displayed the drawings and photos of his hysterics next to this art – were they not one and the same condition?

An illustration of a fit of Genevieve's (right) next to an illustration by Rubens
An illustration of a fit of Genevieve’s (right) next to an illustration by Rubens

This equation of ecstasy with degenerative hysteria served a political purpose. Charcot and his disciples (particularly his main disciple, Desire-Magloire Bourneville) were closely affiliated with the Third Republic, which was virulently anti-monarchist and anti-clerical. Charcot and Bourneville were involved in the campaign to secularize medicine, and to replace nun-nurses with secular nurses. Each proof of the hysterical pathology of religious ecstasy was a broadside in this wider war.

Yet the irony, as several historians of hysteria have noted, is that in many ways the secular diagnosis of hysteria recalled the medieval Inquisition. Of course, none of the hysterics were burned – although they could be subject to physical punishments including mustard baths and ‘ovarian compression’. But they were made to follow and perform a cultural script defined and directed by a male power system, for the prurient consumption of a fascinated male public.

Again and again, the women would be made to perform hysteria, just as the poor nuns of Loudun were wheeled out, over and over, to go through their demonic antics. They would literally be fixed into poses, like ‘automatons’ or ‘statues’ as Charcot’s disciples put it, and then the poses were used as evidence for the pathology of ecstasy. This script advanced the career ambitions and political agenda of the men in charge, as it did in the Inquisition.

As with the Inquisition, it sounds like a form of pornographic cabaret masquerading as a public service. The Iconographie looks like a porn catalogue, with the photos of the sexy teenager Augustine interspersed with accounts of her sexual reveries. And the Thursday shows sound like something from the Moulin Rouge – the women are hypnotized by a gong or a tom-tom drum, the approach of the hysterical fit announced by the shaking of the feathers in their hats, before they fall to the floor clutching their vaginas as the male audience applaud.

Jane_Avril_by_Toulouse-LautrecIndeed, one of the star-hysterics of the Salpetriere went on to become Jane Avril, a lead-dancer at the Moulin Rouge who was painted by Toulouse-Latrec. She claimed she was cured when she learned to dance, which goes back to the ancient Greek idea that the best cure for anxiety and phobia, particularly in women, is the ‘Dionysiac cure’ of dancing. Augustine, meanwhile, finally escaped from Salpetriere, dressed as a man, while Genevieve was offended one day by Charcot and refused to be hypnotized anymore.

Was this the diagnosis of hysteria or, as Charcot’s critics insisted, its cultivation? Was this merely an ‘absurd farce’? It didn’t help that something like 500 hypnosis vaudeville shows sprang up around Paris in the 1880s, some featuring women fresh from their debut at the Salpetriere.

Charcot’s search for a materialist cause for hysteria ultimately failed, and the consensus grew that his fantastic shows were merely the result of suggestion. But a few in the audience – including Sigmund Freud and Frederick Myers – still thought he had hit on something important.

If nothing else, Charcot’s use of hypnosis showed the profound connection between mind and body – his hypnotized patients felt no pain, and their physical symptoms could sometimes be cured by hypnosis and suggestion. His work suggested the existence of what Myers called a ‘subliminal self’, which could be brought to the surface under hypnosis. And it suggested a connection between spirituality, sexuality and subliminal or hypnotic states.

However, Charcot – and, later, Freud – defined hysteria purely as a symptom of female sexual disorder, when it could be argued it was just as much a product of male sexual disorder. Many of the hysterics had been raped as children or teenagers, and were struggling in a society dominated by men with few opportunities for female liberty. Performing sexual hysteria for a titillated male public was one opportunity for approval, expression and a sort of fame.

Frederick Myers, founder of the Society of Psychical Research and gifted writer on psychology (alas all his works are now out-of-print)
Frederick Myers, founder of the Society of Psychical Research and gifted writer on psychology (alas all his works are now out-of-print)

Frederick Myers and William James, meanwhile, accepted the idea that spirituality might be connected to sexuality, to hypnotic or subliminal states, and to nervous instability. But they insisted it wasn’t necessarily pathological or degenerative – many of the geniuses of human culture were ecstatics, much of our culture is the product of ecstasy. Perhaps, wrote Myers, ‘ecstasy is to hysteria somewhat as genius is to insanity’.

In fact, as Asti Hustvedt argues in her excellent Medical Muses: Hysteria in 19th Century Paris, in seeking to pathologize ecstasy, Charcot ended up spiritualizing medicine. He used the language of religion – ecstasy, stigmata, possession – and also some of the ritual and performance of religion. He and his disciples explored how hypnotized women seemed to exhibit miraculous powers of telepathy (a word Myers later coined).

By the end of his career, Charcot, like William James, came to recognize that religious ritual could be powerfully healing, even if the mechanism that healed was really ‘just’ suggestion. His last work, an article on ‘the faith cure’, suggests the miracle cures at Lourdes and elsewhere are real, but simply the result of suggestion. James and Myers went further, speculating that the hypnotized self might also be more open to spiritual forces.

We still don’t know. Hustvedt notes that, while ‘the hysterics of yesteryear’ have disappeared, a new batch of poorly-understood and possibly psychosomatic illnesses have proliferated – chronic fatigue syndrome, ME, post-viral fatigue, cutting, anorexia, conversion disorder, depression, psychogenic non-epileptic seizures, mass psychogenic illness – the prevalence of which is higher, sometimes much higher, in women than in men.

Are these real or invented? Physical or mental? Pathological or spiritual or both? We still don’t know. We don’t yet understand the relationship between mind and body, between mind and gender, between your mind and my mind, and between our minds and nature / God / Super-consciousness.

One last item in this bizarre and fascinating history: the vibrator was invented in the late 19th century as a result of the ancient theory that female orgasm (or ‘paroxysms’) helped to cure hysteria. Doctors would bring patients to paroxysm by manipulation, but complained their hands got cramp, so one bright spark invented an electric dildo. Meanwhile the first electrically-vibrating bed was actually developed as part of an 18th-century sexual-religious-health show called the Temple of Health and Hymen – where the star-performer was the delectable Emma Hamilton.

Don’t you think this would all make a brilliant musical?

Gods, voice-hearing and the bicameral mind

A few months back I was giving a philosophy workshop in a mental health charity. It was one of my less popular events – only one person turned up, a Romanian man who had recently moved to the UK and was finding it tough. We talked about Socratic philosophy, about the idea of engaging your inner voice in a rational dialogue, and the man (let’s call him Anghel) quietly told me that he heard voices.

Anghel heard one particular voice, and wondered who or what it was. He’d gone online, to an app called God Picker, and in very postmodern fashion picked a God – he’d chosen an ancient Mediterranean fish goddess called Atargatis – and made it his personal deity. Things went OK for him, he said, as long as he obeyed the commands of Atargatis. He was nervous about telling the local authorities about the fish-goddess, in case they locked him up and put him under heavy medication. I suggested he contact the Hearing Voices Network instead, to find support from other voice-hearers.

I thought about Anghel this week, as I was reading an extraordinary book called The Origin of Consciousness in the Breakdown of the Bicameral Mind, by a Princeton psychologist called Julian Jaynes.

The book was a big hit when it came out in 1976, and has an unusually diverse roster of fans – Daniel Dennett was influenced by its theory of consciousness, David Bowie picked it as one of his 100 must-read books, Terence McKenna thought it was ‘a most provocative book’, while Philip K Dick thought it was a ‘stunning theory’. Richard Dawkins spoke for many when he said (in The God Delusion): ‘it’s one of those books that is either complete rubbish or consummate genius’.

Jaynes’ thesis, baldly stated, is this: human consciousness (which Jaynes defines as self-conscious introspection) only emerged around 3000 years ago. Before that, everyone heard voices and saw visions, which they took as the commands of the gods, and obeyed unquestioningly. These voices or commands came from the right hemisphere of the brain, which ‘bicameral man’ experienced as alien or Other.

Achilles: the lights are on but nobody’s home

This, says Jaynes, is the world we meet in the Iliad. Homer’s heroes have no inner world, no capacity of introspection. The gods appear to them at various points and tell them what to do, and they do it. They don’t have free will in the modern sense, rather they are ‘noble automatons’. They are, in effect, a different species – not homo sapiens but rather ‘bicameral man’.

Jaynes’ astonishing hypothesis is that you can have a whole civilization operating without consciousness, that’s to say, without introspection or free will. A zombie civilization. You can see why the theory appealed to Daniel Dennett and Philip K. Dick.

He speculates that voice-hearing developed as a form of social hierarchical control. When we’re near the chief, we can hear his commands. But when we’re further away and out of the chief’s presence, we can still hear commands from our inner chief, so to speak.

Then, sometime in the second or first millennium BC, subjective consciousness emerged. Jaynes thinks this happened through the expansion of metaphor – our minds became able to make analogies, to link like with like, to imagine time as stretching forwards and backwards, to imagine ourselves as narrative heroes with a variety of choices (what he calls ‘the analog I’). As metaphors connect, like synapses, homo sapiens generated a rippling field of metaphoric consciousness.

With the emergence of subjective consciousness, the ‘bicameral mind’ breaks down – or rather, the external voices become integrated into internal consciousness. The gods are no longer heard so often, except in moments of extreme stress. Instead, we internalize their commands as the voice of conscience. We notice the gods speak to us less, and we miss their guidance and fear their wrath. We wonder what we did wrong, to make the gods go silent.

Michelangelo’s Jeremiah, waiting for a call

Another of Jaynes’ astonishing hypotheses is that the great organized religions emerged out of a ‘nostalgic anguish’ for the lost voices / departed gods. In one remarkable chapter, he uses the Bible as evidence for this departure. In the beginning, Elohim (the Mighty Ones) spoke to us all the time. Then came the Fall – the emergence of subjective consciousness. After that, the Mighty Ones only appear to certain chosen prophets, like Moses, and are organized into one entity, called Jehovah, to which we must be monogamously faithful, or else.

Instead of the constant presence of the Mighty Ones, we have instead the poor substitute of Deuteronomic priestcraft and scripture. The Bible is indeed filled with anguish at the silence of the Divine (like Psalm 35: ‘Do not stay silent, do not abandon me oh Lord’). But at moments of stress, like the exodus from Egypt or the fall of Jerusalem, the voices return to prophets (just as, for Anghel and many other immigrants, voice-hearing may emerge as a response to the stress of immigration).

Although humans evolved into a higher state of subjective consciousness, vestiges of the bicameral mind still remain, most obviously in voice-hearing. As much as 10% of the population hear voices at some point in their lives, much higher than the clinical incidence of schizophrenia (1%). For many people, voice-hearing is not debilitating and can be positive and encouraging.

Sensing a voice or presence often emerges in stressful situations – anecdotally, it’s relatively common for the dying to see the spirits of dead loved ones, likewise as many as 35% of people who have recently lost a loved one say they have a sense of the departed’s continued presence. Mountaineers in extreme conditions often report a sensed presence guiding them (known as the Third Man Factor).

A bear of very little brain (roughly 50%, to be exact)

And around 65% of children say they have had ‘imaginary friends’ or toys that play a sort of guardian-angel role in their lives – Jaynes thought children evolve from bicameral to conscious, much as Piaget thought young children are by nature animist (ie they attribute consciousness to things, and may attribute special consciousness to favourite toy-companions, like Winnie the Pooh or Sheriff Andy).

These are all vestiges of the bicameral mind, according to Jaynes, as is our capacity to be hypnotized (our hypnagogic openness to external commands is a remnant of the bicameral mind’s obedience to social hierarchy) and our love of poetry, which seems to come to poets from Parnassus or some other Beyond.

Such is Jaynes’ remarkable theory. Alas, he never wrote another book, but his magnum opus is increasingly popular, not least because some recent brain-imaging studies confirm his ideas about brain-function lateralisation and the origin of auditory hallucinations in the right hemisphere.

His book is similar in some respects to Iain McGilchrist’s recent work, The Master and his Emissary, which also uses the bicameral mind for a Grand Historical Theory. But McGilchrist thinks the two hemispheres have become progressively less integrated, rather than more, and this is why the gods have gone silent. He thinks we need to bring the right hemisphere back into the game, through poetry or religious practices, while Jaynes is much less concerned with returning to some bicameral utopia. Indeed, like Max Weber he warns we should resist the nostalgic desire for the right hemisphere’s charismatic certainty.

Genius or bonkers?

What can we say about Jaynes’ theory? Well, it’s refreshingly bold. But as a theory of consciousness it doesn’t really solve the ‘hard problem’ of how mind comes from matter. Even if Achilles isn’t self-consciously introspective, he is still experiencing mental events.

Jaynes’ theory that auditory hallucinations are a form of social control doesn’t sound quite right, either. Look at how many voice-hearers have resisted and destabilized social control, from Moses to Socrates to Jesus to Joan of Arc.

Jaynes doesn’t have much evidence for his contention that everyone used to hear voices and lack introspection – his main evidence is the Iliad. But the characters in that are special, they are heroes, with a special relationship to the divine. If the gods spoke to everyone, why are prophets like Cassandra remarkable or different? Why the need for divination in the Iliad, if the gods are constantly telling people what to do?

And is Jaynes saying that schizophrenics or voice-hearers today lack conscious introspection and free will, that they are automatons? Better to say that they have the capacity to question and not obey their voices, it’s just that often they choose to follow their voices’ commands because they are terrified of them. Some voice-hearers learn a more flexible and egalitarian relationship to their voices. (Marcel Kuijsten, who has edited Jaynes’ work, tells me Jaynes did not equate schizophrenia with bicameral man – in schizophrenics subjective consciousness has emerged).

Those are some of my reservations about the theory. What I like about it is the suggestion that subjective consciousness emerged at a particular moment, and this moment was quite recent. I think, in fact, that fifth-century BC Athens was one of the moments when modern consciousness was born.

Suddenly, in fifth-century BC Athens, many people stopped hearing or believing in the gods, and some sophists insisted that the only real authority was Public Opinion. As a result, rhetoric, or the art of seeming, is born. This was taken as a profound heresy by bicameral minds like Sophocles, the inspired tragedian, who insisted we must honour the intuitive and god-hearing part of us rather than denigrate it or try to leave it behind. What you see in Sophocles’ last two tragedies (Philoctetes and Oedipus at Colonus) is a last-ditch attempt to marry together the splitting parts of the Athenian soul – the worldly and the other-worldly.

Oedipus (right) and Theseus, the intuitive and the pragmatic…
…and Philoctetes (right) and Neoptolemus, also representing the marriage of the intuitive and the pragmatic

And at this moment of the birth of modern consciousness, there stands Socrates, with one foot in each era. He insists that we must bring our unexamined beliefs into consciousness and ask if they make sense. He is the midwife of subjective consciousness. And yet he also has a daemon who gives him moral commands, and he insists he has been sent on a mission to humanity by the Gods. I love these two figures – Sophocles and Socrates – because they are trying to integrate the two eras, to marry the two hemispheres.

Jaynes and the Hearing Voices Network

Perhaps the most impressive practical consequence of Jaynes’ book was the establishment of the Hearing Voices Networks, and the beginning of a more enlightened approach to voice-hearing.

In the 1980s, a Dutch psychiatrist called Marius Romme was treating a 30-year-old voice-hearer called Patsy Hague. She was on tranquilizers, which failed to stop the voices and made it difficult for her to think. She became suicidal. Then Romme happened to lend her a copy of Jaynes’ book. It made her think perhaps she was not ill so much as ‘living in the wrong century’, and also gave her confidence that her voices were ‘real’, or as real as the invisible God that Romme and others believed in. Hague told Romme: ‘You believe in a God we never see or hear, so why shouldn’t you believe in the voices I really do hear?” Why not listen to what the voices had to say, rather than dismissing them as meaningless pathological symptoms?

Romme set up a meeting between Hague and other voice-hearers, who enthusiastically swapped stories and shared their sense of helplessness, vulnerability and alienation from their society. A sort of peer-led support network emerged, and has continued to blossom since then.

Today, the voice-hearers network is increasingly challenging the traditional theory that auditory hallucinations are sufficient for a diagnosis of psychosis or schizophrenia, which should be treated with anti-psychotics without any regard for the content of the messages. More and more healthy and high-functioning adults are ‘coming out’ as people who have occasionally or frequently heard voices. I personally heard a voice once, during that near-death experience in 2001, although I’ve never heard one since.

I’m particularly interested in the link between voice-hearing, dissociation and creativity, and in the incidence of voice-hearing among creative individuals like novelists Marilynne Robinson (who occasionally hears a voice inspiring her novels), comedians Graham Linehan and Jonny Vegas (both of whom hear or have heard voices), and musicians like Lady Gaga and David Bowie (the former says she heard voices and started to act them out as personae, while the latter likewise embodied and acted out radically different personalities and has a history of schizophrenia in his family).

Not to mention the dissociative capacity of gifted actors to become other people (Le Carre called Alec Guinness’ ability to become someone else a ‘complete self-enchantment, a controlled schizophrenia’); or all the many poets and song-writers who say their poems came to them from a voice / presence / spirit / muse.

What Jaynes fails to address, I’d suggest, is the value of these ‘vestiges of the bicameral mind’. When we seem to feel or hear messages from the beyond, it’s not just a primitive throwback to Homeric times. These messages sometimes tell us something useful, beautiful and wise, something our ordinary consciousness does not know. They are often sources of moral inspiration or consolation. I’d suggest the right hemisphere is still not entirely accessible to our ordinary consciousness, and there is a value in learning how to access it through things like meditation, trance states or techniques of ecstasy (though of course there are risks as well, particularly if you end up with an inflated or Messianic sense of self).

To go a step further into the mystical, if we do receive inspiration through the right hemisphere, does that mean the origin is definitely purely material or neurochemical? Could we not consider William James’ hypothesis that the right hemisphere / unconscious is the door through which the divine speaks to us? Such has been the suggestion of various spiritual critics of Jaynes’ theory, from Owen Barfield to Philip K. Dick.

Still, the voice-hearing network is fascinating, from a theological perspective, because in some ways it suggests a very modern attitude to the gods. We hear their commands, and yet we don’t have to obey unquestioningly. We relate to them less as a child to their all-powerful father, and more like a friend to their equal, rather like Lyra’s friendship with her daemon, Pantalaimon, in Philip Pullman’s Dark Materials. Happiness, then, is eudaimonia: having a friendly daemon to keep one company in life and through death.

Very well, says my daemon, looking over my shoulder as I write. But who made the daemons?