Art and Images in Psychiatry
May 2005

A Clinical Lesson at the Salpêtrière

Author Affiliations



Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Gen Psychiatry. 2005;62(5):470-472. doi:10.1001/archpsyc.62.5.470

Hysteria has its laws, its determination, precisely like a nervous ailment with a material lesion. Its anatomical lesion still eludes our means of investigation . . .—Jean-Martin Charcot, 18901(p77),2(p208)

In June 1870, Jean-Martin Charcot (1825-1893) delivered his first lecture on hysteria, a lesson on hysterical contractures, at the Salpêtrière in Paris, France.2 His lecture emphasized a scientific approach to hysteria and focused on not only the physical features but also the psychological aspects. Thus, he expressed doubt about reports of miraculous religious cures and likened them to the sudden recovery of hysterical patients. Charcot was influenced by the work of Pierre Briquet (1776-1881),3,4 who in 1859, based on clinical assessments, published a systematic epidemiologic study describing 430 cases of hysteria seen over a 10-year period. Briquet considered “hysteria as the product of suffering of the part of the brain destined to receive affective impressions and feelings,”4(p60)suggested a role for heredity, proposed a predisposing temperament, and identified male cases but noted that they were far less common than female cases. The previous July, Charcot attended the British Medical Society meeting in Leeds, England, where Russell Reynolds delivered a paper that had intrigued him, “Paralysis, and other disorders of motion and sensation, dependent on idea.”5 Reynolds wrote “that some of the most serious disorders of the nervous system, such as paralysis, spasm, pain, and otherwise altered sensations, may depend upon a morbid condition of emotion, of idea and emotion, or of idea alone . . . they sometimes associate themselves with distinct and definite diseases of the nervous centres, so that it becomes very important to know how much a given case is due to an organic lesion, and how much to morbid ideation.”5(p483)

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