The Charcot-Bouchard controversy

Charles Bouchard, an ambitious and industrious man, was one of Jean Martin Charcot's first pupils. With his mentor's support, he rapidly ascended the academic ladder and became a full professor at the school of medicine in Paris. After Bouchard attained professorship, his relationship with Charcot gradually deteriorated. Their strong personalities, their ambition to have schools of their own, and their competition to become the most influential man in the medical school resulted in antagonism between them. The most tragic consequence of this antagonism took place in 1892 when Bouchard presided over the competitive examinations for agrégation, in which Joseph Babinski, one of Charcot's youngest pupils, was a candidate. Charcot wanted his pupil to be nominated but Bouchard eliminated him in order to nominate his own pupils. The nominations were appealed but finally Bouchard's decision was upheld. Babinski did not retake the examination and never became a professor at the medical school.     

Marcel Proust's lifelong tour of the Parisian Neurological Intelligentsia: from Brissaud and Dejerine to Sollier and Babinski

In Search of Lost Time, the main novel of Marcel Proust (1871-1922) gives prominence to medicine, especially to neurology. Proust possessed excellent medical knowledge and maintained lifelong contact with neurologists. From 1881 onward, he experienced recurrent attacks of asthma, a condition which, at the time, was considered belonging to 'neurasthenia'. Marcel's father, Adrien Proust, was a famous physician who had written papers on stroke, aphasia, hysteria and neurasthenia, and who introduced his son to Charcot's pupil, Edouard Brissaud, the founder of the Revue Neurologique. Three years later, Brissaud published a landmark book on asthma with a preface by Adrien Proust. In 1905, when Proust intended to undergo a 'cure' in order to improve his asthma and other symptoms, he first considered treatment by Jules Dejerine, who was to become Charcot's second successor. He also considered two Swiss physicians who had studied with Charcot and Vulpian: Henry Auguste Widmer, founder of the Clinique Valmont above Montreux, and Paul Dubois, a schoolmate of Dejerine, who practiced in Berne. Brissaud recommended Paul Sollier, under whose care Proust followed a 6-week 'isolation cure'; Sollier, along with Babinski, was considered the cleverest of Charcot's followers. He had studied memory extensively, in particular affective memory, which caused him to reject Bergson's theories and now makes his work a major precursor. Sollier attempted to trigger 'emotional revivals' (reviviscences), 'reproducing the entire state of the personality of the subject at the time of the initial experience'. This concept was integrated by Proust into his novel, with emphasis on 'involuntary memory'. Proust's last neurologist was Joseph Babinski, whom he consulted repeatedly because he feared becoming aphasic, like his mother. Proust's unusual life journey with the most celebrated neurologists of his time highlights aspects of his literary work and also provides a unique perspective on the neurological intelligentsia at the turn of the 19th century.     

Alfred Vulpian and Jean-Martin Charcot in each other's shadow? From Castor and Pollux at La Salpêtrière to neurology forever

While Alfred Vulpian (1826-1887) is not completely forgotten, he cannot match the uninterrupted celebrity which Jean-Martin Charcot (1825-1893) still enjoys today. After becoming interne (residents) at the same institute in 1848, both were involved in shaping the cradle of what would become modern neurology. Both started work as chiefs at a La Salpêtrière service on January 1, 1862, making common rounds and studies, with several common publications. While their friendship remained 'for life', as stated by Charcot at Vulpian's funeral, their career paths differed. Vulpian progressed quicker and higher, being appointed full professor and elected at the Académie Nationale de Médecine and the Académie des Sciences several years before Charcot, as well as becoming dean of the Paris Faculty of Medicine. These positions also enabled him to support his friend Charcot in getting appointed full clinical professor and becoming the first holder of the chair of Clinique des Maladies du Système Nerveux in 1882. Before studying medicine, Vulpian had worked in physiology with Pierre Flourens, and his career always remained balanced between physiology and neurology, with remarkable papers. He introduced Charcot to optic microscopy during their La Salpêtrière years, indirectly helping him to become his successor to the chair of pathological anatomy in 1872. While Vulpian succeeded so well in local medical affairs, Charcot spent his time building up a huge clinical service and a teaching 'school' at La Salpêtrière, which he never left for over 31 years until his death. This 'school' progressively became synonymous with clinical neurology itself and perpetuated the master's memory for decades. Vulpian never had such support, although Jules Déjerine was his pupil and Joseph Babinski was his interne before becoming Charcot's chef de clinique (chief of staff) in 1885. This unusual switch in Parisian medicine contributed to Charcot's unaltered celebrity over more than a century, while Vulpian was progressively relegated to the studies of historians. However, Vulpian and Charcot remain inseparable in the memory of a lifelong friendship which gave birth to neurology.     

Charcot and Brazil

OBJECTIVE: To describe the relationship between Professor Charcot and Brazil. BACKGROUND: During the XIX century, French Neurology and its most prominent figure, Professor Charcot, dominated the area of nervous system diseases in the world. METHOD: We have reviewed some of the main publications about Charcot's life, the biography of Dom Pedro II, Emperor of Brazil and the development of Neurology in Brazil. RESULTS: Among the most important patients in Charcot's practice was the Emperor of Brazil. Dom Pedro II became a close friend of Charcot and he was a distinguished guest at Charcot's house, particularly at Tuesday soirées on boulevard St. Germain. In 1887, during the visit of Dom Pedro II to France, Charcot evaluated him and made the diagnosis of surmenage. In 1889, Dom Pedro II was disposed and went to Paris, where he lived until his death in 1891. Charcot signed the death certificate and gave the diagnosis of pneumonitis. Charcot had a passionate affection for animals, a feeling shared by Dom Pedro II. Dom Pedro II was affiliated to the French Society for the Protection of Animals. It is conceivable that Charcot's little monkey, from South America, was given to him by Dom Pedro II. The Brazilian Neurological School was founded by Professor A. Austregésilo in 1911, in Rio de Janeiro. At the time, of Charcot's death in 1893, his influence was still very important in the whole world. He and his pupils played a major role in the development of Brazilian Neurology. CONCLUSION: Professor Charcot had a close relationship with the Emperor of Brazil, Dom Pedro II. He was his private physician and they were close friends. The neurological school, created by professor Charcot, contributed significantly, albeit in an indirect way, to the development of Brazilian Neurology, starting in 1911, in Rio de Janeiro, by Professor A. Austregésilo.     

The debate over "hysteria"]

The debate on hysteria at the "Société de Neurologie" in 1908 signed the official death certificate for Charcot's hysteria, which even in his day had started to come under attack. The article by Babinski in 1901 had delivered the "coup de grace". The debate paints an astonishing picture of the medical world of the day, and also of hysteria, which would never again present the spectacular clinical picture seen up to that point. Babinski, dominating the debate with his strong personality, prevented a discussion on the mental basis for hysteria, requested by several participants, in favour of pithiatism, which in his view offered an acceptable definition of hysteria. It is surprising that more was not made of the contradiction in terms in the expression "auto-suggestion", and of the fact that Babinski was begging the question when he asserted that it could not be asserted that a patient had been subject to suggestion! This debate effectively banished hysteria from the columns of the neurological press, whose pages it had tended to overburden. It cannot however be blamed for not having made a positive contribution to our understanding of this neurosis which, even today, remains enigmatic. It does our Society credit to have ruled out "for ethical reasons" the hypothesis of simulation.     

Moreno als Erzieher

Trying to find baselines for education according to Morenos thinking, at first the pupil as the object of the educational process has to be thought about. We understand him in his dual dependency on stable relationships and worldly wisdom: attachment and exploration, safeness and freedom, footing and space??however we call the poles, he needs them both. The educating person first and foremost is a counterpart to the pupil, because attention and real encounter are indispensible conditions for successful education. The quality of this offer of encounter as well as its ambivalence and paradoxes will be brought up as subjects in a second step. After noticing the mutual relationship between educator and pupil it is possible to look at essential matters of the educational process. In a psychodramatic sight those matters are active learning, concentration on exemplary situations, relation oriented approaches, the meaning of emotions for sustained success in learning and creativity and democratic capability as central goals of the educational process.     

Freud and the mighty warrior

This essay traces a prominent facet of Freud's personality, his being a "mighty warrior" throughout his life. This aspect of his character evolved as a reaction formation against his submissive father and as an identification with his more aggressive mother. He first tried it out in his highly ambivalent relationship to his nephew John, who was one year older. In his childhood play, Freud identified with certain military heroes, such mighty warriors as Napoleon, Hannibal, Alexander the Great, and Massena. As he grew older he shifted from military heroes to other great men including Goethe, Shakespeare, and finally Moses. He substituted these men as ego ideals in place of his father about whose stature he felt disillusioned. He far surpassed his father in his life achievements and yet managed to maintain an even-handed, respectable relationship with him until he died in 1896. His mother all but worshipped Sigmund but also demanded that he achieved the maximum in whatever he did. He had to earn her love by an outstanding performance but always wanted to feel unconditionally loved. His mighty warrior attitude developed into an important part of its personality. It protected him from feelings of helplessness and inadequacy and made him into an outstanding leader of the psychoanalytic movement.     

Charcot and art: from a hobby to science

Jean-Martin Charcot not only was one of the founders of modern neurology, but he displayed an exceptionally developed visual perception and memory, with special artistic gifts, which he used first as a hobby and subsequently as a tool in his profession. Previously unpublished drawings emphasize Charcot's talents in caricature, including autoderision. One of the best achievements of Charcot in correlating the clinic with art includes his thorough study of artistic representations of "possessed states", which allowed him to refine his work on hysteria. The artist and the scientist are two unique facets of Charcot, whose permanent coexistence help to understand his legacy.     

Freud's relevance to hypnosis: a reevaluation.

In this paper we examine Freud's life and thinking, based on his collected works, and reevaluate some of his ideas in the light of various aspects of contemporary hypnosis research. Although Freud has often been blamed for simplistic thinking about hypnosis and for its eclipse during the opening decades of this century, his writings reveal a rich theory of hypnosis and a frank acknowledgement of the debt psychoanalytic theory and practice owe to it. Even though he abandoned hypnosis as a clinical tool, Freud maintained a theoretical interest in the subject and in many respects anticipated issues in current research. Whereas his emphasis on the hypnotist's skill may have been exaggerated, his insights concerning attention, social expectations, group dynamics, reality testing, and the relationship between hypnosis and sleep have been borne out by empirical investigations.     

Phenomenology of genius and psychopathology.

The relationship between genius and madness has been a subject of interest since the beginning of critical and philosophical thinking. Thus, Aristotle, in the Book XXX of the Problemata, asks himself "why are all extraordinary men in the fields of philosophy, politics, poetry and art melancholic?, adding afterwards: "...and some of them in such a way that they may suffer from pathologic manifestations whose origin is in the black bile". In the past decades the German author Tellenbach studied the personalities of several geniuses, both from fiction, such as Hamlet, and from reality, such as the writer von Kleist, concluding that they suffered from a specific form of depression that he called "Schwermut" (melancholy), which was supposedly different from the narrowly defined illness of depression. Other work done on this subject is the extensive study by the North American author Kay Jamison, who, after researching the biography and the tree of a long list of writers, composers and musicians, concluded that all of them had suffered to some degree from a bipolar disorder. This author strives to carry out a phenomenology of genius, and he finds that, together with other essential features, the geniuses always show forms of experiencing and/or of behaving which do not fall within the range that is considered normal, although they can not always be classified as pathological. His study is based on the analysis of the life and the work of three men whose genius could not be doubted: the naturalist Alexander von Humboldt, the philosopher Soeren Kierkegaard and the poet Rainer Maria Rilke. This author specially focuses on the last named, since in his later work he explicitly meditated on the suffering that has meant for him his condition of genius and what he considered the only way to overcome them: to be faithful to the work of art, whose fulfilment was imposed on him--to a certain degree from the endogenous--as an unavoidable imperative.     

Babinski's clinical differentiation of organic paralysis from hysterical paralysis: effect on US neurology

BACKGROUND: The formalized neurological examination developed near the end of the 19th century, and clinicians searched for signs to differentiate weakness due to structural lesions of the central nervous system (organic paralysis) from weakness caused by hysteria. Joseph F. F. Babinski worked in the shadow of his mentor, Jean M. Charcot, until 1893, but then developed independent studies to examine patients with both types of weakness. OBJECTIVES: To elucidate the role of Babinski in differentiating organic paralysis from hysterical paralysis and to describe his influence on 2 US neurologists, Charles Gilbert Chaddock and Charles Franklin Hoover. DESIGN: Primary and secondary sources were studied to outline the discoveries of Babinski and to determine his influence on US neurology. RESULTS: Babinski described toe extension in cases of organic paralysis and specifically stated that this sign did not occur in cases of hysterical paralysis. Chaddock and Hoover were influenced by the work of Babinski and disseminated his discoveries to US neurologists, each developing additional techniques to differentiate the 2 forms of paralysis. Each considered his technique superior to the Babinski toe sign. CONCLUSIONS: Although Babinski was only modestly appreciated by his contemporary peers of French neurology, his influence on US neurology was substantial. The Babinski, Chaddock, and Hoover signs that demonstrate whether structurally related upper motor neuron weakness exists continue to be useful maneuvers in separating these forms of paralysis from psychogenic weakness.     

Amyotrophic lateral sclerosis: early contributions of Jean-Martin Charcot

Amyotrophic lateral sclerosis is historically an important entity because its manifestations involve distinct signs that can be correlated with gray and white matter lesions at specific sites within the central nervous system. Working at the end of the nineteenth century, the celebrated neurologist, Jean-Martin Charcot, used this disorder as a prototypic example of the power of his research method, termed "méthode anatomoclinique." Using clinical cases and autopsy material, he showed how anatomical lesions in the nervous system could be accurately determined by the presence of carefully analyzed clinical signs. Charcot's work on amyotrophic lateral sclerosis brought together neurological entities formerly considered as disparate disorders, primary amyotrophy and primary lateral sclerosis. In addition, these studies contributed to the understanding of spinal cord and brain stem anatomy and the organization of the normal nervous system. Because of Charcot's fundamental contributions, the eponym "Charcot's disease" has been used internationally in association with amyotrophic lateral sclerosis.     

De la monstruosité du matricide à l’élaboration d’un altruisme délirant

The authors propose to study two matricide cases: two young men passed to the act and killed their mother in order to put an end to the unbearable aspect of the jouissance. This crime which could have been the solution was considered as an altruist act by Pierre Rivière in 1835, but it did not salve him as he had expected. On the contrary, he brusquely appeared as monster on the world scene, and from that time he just wanted to die as he could not assume this identification. As far as Louis is concerned, the psychoanalytic work under transference enabled him to build altruism as an interpretation. It also allowed him to accept the subjective responsibility of his crime. Therefore, we will examine what the exact function of altruism is in these two delirious cases. We will also study if the historic category is valid or not to give an account of what really happened for these two subjects.     

Le parricide de Pierre Rivière comme échec du processus d’adolescence

At the beginning of the 19th century, a young farmer from Normandy, age 20, killed his mother, his younger sister and his youngest brother. After wandering for one month in the woods, he turned himself in to the police. When he was interrogated by the judge, he admitted his crime and explained it in a statement of case, written in prison at the judge's demand, as a way of protecting his father whom he considered to be threatened by his wife and pushed by her to commit suicide. The analysis of this statement of case reveals a failure in the adolescent process of Pierre Rivière, which led him into a fatal narcissistic shutting up, both for himself and for his victims.     

Robert Schumann

Robert Schumann, one of the giants of early romantic music, was born in Saxony in 1810 and died in an asylum shortly after his 46th birthday. Early in life, he demonstrated extraordinary skills in both music and journalism; he remained active in both areas until his final illness. His marriage to the remarkable pianist, Clara Wieck, provided him with both much-needed emotional support and a highly effective champion of his music throughout her lengthy career. Schumann's plans to be a concert pianist were thwarted at least partially by an injury to his right hand, the nature of which has been the subject of much speculation. After considering what few facts are available, the author concludes that this may have represented focal dystonia. His compositional output waxed and waned dramatically over his professional life, reflecting to some degree his emotional state. It is considered most likely that he suffered from a major affective disorder, bipolar type. This ultimately led to a suicide attempt in February 1854, and to his eventual death in July 1856. Despite wide-spread and reasonable suspicion that he may have died from neurosyphilis, severe malnutrition from self-starvation seems more likely.