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6. Trance and Trauma: Functional Nervous Disorders and the Subconscious Mind

[Figure 22] Franz Anton Mesmer (1734-1815) [see figure 22] was born in the German town of Iznang. At the age of 32, he completed his medical training at the University of Vienna with a dissertation on the influence of the planets on human disease. In 1773, a twenty-seven year old patient, Fräulein Oesterlin, came to Mesmer suffering from a variety of recurring physical ailments. In the spirit of his dissertation, Mesmer set about trying to relate the periodicity of Fräulein Oesterlin's symptom manifestations to tidal fluctuations and, in the course of this effort, decided to see whether he could induce an artificial tide in his patient.

On the 28th of July, 1774, he asked the fräulein to swallow a solution containing iron and affixed magnets to her stomach and legs. The results of this treatment were to change the course of Mesmer's life. As Fräulein Oesterlin felt a mysterious fluid coursing throughout her body, her symptoms started to disappear. With continued treatment, she recovered completely, and Mesmer's fame began to spread. Unfortunately, however, controversy over the effectiveness of his techniques spread as well; and in 1777, under somewhat dubious circumstances, Mesmer left Vienna for Paris. There he established a lucrative practice in magnetic healing and completed the Mémoire sur la découverte du magnétisme animal [19]. Influenced by physical theories of gravitational force and by the work of Franklin and others on electricity, Mesmer developed what was for the period a reasonable explanation of magnetic cure.

[Figure 23] Hypothesizing the existence of a physical magnetic fluid interconnecting every element of the universe, including human bodies, Mesmer argued that disease resulted from a disequilibrium of this fluid within the body. Cure required the redirection of the fluid through the intervention of the physician who served as a kind of conduit by which animal magnetism could be channeled out of the universe at large and into the patient's body via "magnetic passes" of the physician's hands [see figure 23]. In the process of treatment, patients experienced a magnetic "crisis," something akin to an electric shock, from which they recovered cured. In imitation of electrical theory, Mesmer thought of magnetic fluid as polarized, conductible, and able to be discharged and accumulated. Indeed, ever the entrepreneur, he developed the baquet, a device for concentrating magnetic fluid in the manner of a Leyden jar. The baquet enabled him to treat as many as twenty patients at a time, each patient connected to the fluid through contact with an iron rod

Mesmer's fall was as meteoric as his rise. About 1785, after several spectacular therapeutic failures and the publication of the Rapport des Commissaires chargés par le Roy de l'examen du magnétisme animal (Bailly, 1784) which concluded that the evidence in favor of the existence of mesmeric fluid was inadequate, Mesmer left Paris under a cloud and lived the remainder of his life in relative obscurity, dying in 1815 near the place of his birth.

[Figure 24] If Mesmer the man disappeared from public view, his ideas did not. By far the most important of Mesmer's disciples was Armand-Marie-Jacques de Chastenet, Marquis de Puységur (1751-1825), a wealthy aristocrat and landowner who had begun, even before Mesmer's fall, to experiment with magnetic healing. If anyone can justifiably be said to be the founder of modern psychotherapy, it is Puységur. Working with Victor Race, a young peasant on the family estate near Soissons [see figure 24], the Marquis discovered the "perfect crisis," a somnambulistic sleep state in which patients carried out the commands of the magnetizer and upon reawakening exhibited no memory for having done so. When Victor, who would never normally have dared to confide his personal problems to the lord of the manor, admitted in magnetic sleep that he was disturbed by a quarrel that he had had with his sister, Puységur suggested that he act to resolve the quarrel; and, upon reawakening, without memory for Puységur's words, Victor acted on the Marquis' suggestion.

From these experiences, Puységur gradually arrived at the recognition that magnetic effects depend on the force of the magnetizer's personal belief in the efficacy of magnetic cure, will to cure, and rapport with the patient. In 1784, Puységur embodied these ideas in his Mémoires pour servir a l'histoire et a l'établissement du magnétisme animal [20], a work which can be considered the point of origin of modern psychotherapy. It is of more than passing interest that as early as 1784, right from the inception of psychotherapeutic procedure, it was recognized that belief in the efficacy of cure, desire to cure, and the nature of the relationship between patient and therapist are fundamental factors in psychotherapeutic success.

With the technique developed by Puységur (but often with the accompanying explanation of Mesmer), Mesmerism spread rapidly. In the United States it arrived from France with Charles Poyen de Saint Sauveur [see 52] and became allied briefly with phrenology and more extensively with spiritualism, eventuating in the New Thought movement that exerted an impact on William James [see 61].

In Europe, mesmerism continued to develop at the hands of a number of major figures such as the Abbé José Custodio de Faria, Général François Joseph Noizet, Étienne Félix, Baron d'Hénin de Cuvillers, and Alexandre Bertrand. Faria, in his De la cause du sommeil lucide (1819), developed the modern trance induction ("fixation") technique, emphasized the importance of the will of the subject rather than that of the magnetizer, recognized the existence of individual differences in susceptibility to somnambulistic sleep, and first articulated the principle of suggestion, which he believed to be effective not only in magnetic sleep but in the waking state as well. In 1820, Noizet, in a Mémoire sur le somnambulisme presented to the Berlin Royal Academy but only published in 1854, and Hénin de Cuvillers, in his Le magnétisme éclairé, presented more extended accounts of mesmeric effects in terms of suggestion and belief; while Bertrand's Traité du somnambulisme (1823) was the first systematic scientific study of magnetic phenomena.

[Figure 25] The year 1843 marked an important turning point in the way in which mesmeric effects were conceptualized. In that year James Braid (ca. 1795- 1860) published Neurypnology; or, the Rationale of Nervous Sleep, Considered in Relation with Animal Magnetism [21]. Born in Fifeshire about 1795 and educated at the University of Edinburgh, Braid moved to Manchester early in his career. There, as he describes it in the Neurypnology, a visit to a stage demonstration by the Swiss mesmerist, Charles Lafontaine, convinced him of the reality of the physical phenomena induced by mesmerism. After several days of private experiment, Braid came to the conclusion that these physical effects were produced by "a peculiar condition of the nervous system, induced by a fixed and abstracted attention ..." (p. 94) and not through the mediation of any special agency passing from the body of the operator to that of the patient. To distinguish his views sharply from those of mesmerism, he named the state of nervous sleep "hypnotism" [see figure 25], and substituted fixation of a luminous object, a variant of Faria's old induction technique, for the mesmerists' "magnetic passes."

Braid's linking hypnotic phenomena to brain physiology, development of a straightforward, less mystical induction technique, and introduction of a terminology that was more acceptable to the medical and scientific establishment, helped prepare the way for the eventual use of hypnosis in research on psychopathology. That this effect was by no means immediate, however, is hardly surprising in light of the fact that between 1848 and 1875 magnetic healing became increasingly involved with mediumistic spiritualism, on the one hand, and stage demonstrations, on the other. Indeed, when Braid died in 1860, "magnetism and hypnotism," as Ellenberger (1970) points out, "had fallen into such disrepute that a physician working with these methods would irretrievably have compromised his scientific career and lost his medical practice" (p. 85).

Yet, even in this climate of opinion, there were a few who continued to work therapeutically with hypnosis. One of these was Auguste Ambroise Liébeault (1823-1904), a physician in rural Pont-Saint-Vincent, a French village in the region of Nancy. In 1866, Liébeault published his Du sommeil et des états analogues considérés surtout au point de vue de l'action du moral sur le physique[22]. In the Du sommeil, Liébeault argued that concentration of attention on the idea of sleep induces the hypnotic state through the power of suggestion and that the therapeutic effects of hypnosis are, in effect, suggestive phenomena. While neither of these ideas were original with Liébeault, who derived them from the Mémoire sur le somnambulisme et le magnétisme animal (1854) of Noizet, it was through Liébeault that they captured the attention of Hippolyte Bernheim and became the cardinal principles of the Nancy school of suggestive therapeutics to which we shall momentarily return.

Before techniques of hypnotic induction could come to serve as a tool for research on functional nervous disorders, however, they had first to be rescued from the domain of pseudoscience to which they had been consigned. Credit for such rescue is generally given to Charles Richet, a young French physiologist whose "Du somnambulisme provoqué"(1875) led to a revival of interest in the scientific use of hypnosis, especially through the work of Jean- Martin Charcot (1825-1893).

Charcot was born and received his medical education in Paris. Awarded the M.D. in 1853, he worked largely as a private physician until 1862, when he was appointed resident doctor at the Salpêtrière. There he created what was to become the world's most influential center for research in neurology. Placed in charge of a ward containing women1 suffering from convulsions, Charcot set out to distinguish between convulsions that were epileptic in origin and those that were hysterical (hystero-epilepsy), to clarify the hemianaesthetic and hyperaesthetic symptomatology of hystero-epilepsy, and to differentiate between hystero-epilepsy and non-convulsive cases of hysteria.

The first important summary of the conclusions that Charcot drew from this work was presented in Volume I of his Leçons sur les maladies du système nerveux faites à la Salpêtrière [23], published in parts between 1872 and 1873. Following Briquet, whose Traité clinique de thérapeutique de l'hysterie (1859) is considered to be the first systematic, objective study of hysteria, Charcot conceptualized hysteria as a neurosis of the brain typically brought on in hereditarily predisposed individuals by psychic trauma. In 1878, under the influence of Richet, Charcot began to employ hypnosis in the study of hysteria and discovered that, under hypnosis, he could reproduce not only hysterical symptomatology (amnesias, mutism, anaesthesias) but even post-traumatic phenomena such as the paralyses sometimes occasioned by railway accidents. This led him to group together hypnotic, hysterical, and post-traumatic phenomena, to distinguish these dynamic phenomena from those organic symptoms that arise from lesions in the nervous system, and to suggest the existence of unconscious "idée fixes" at the core of certain neuroses, a notion that exerted a considerable influence on Janet and Freud.

In keeping with his generally physicalistic orientation, Charcot also attempted to describe the somatic phenomena associated with hypnotic induction. This process, he believed, occurred in three successive phases: a) catalepsy with anaesthesia and neuromuscular plasticity; b) lethargy with neuromuscular hyperexcitability; and c) somnambulism. Furthermore, on the basis of work by students, he went on to assert that these somatic manifestations could be transferred from one side of the body to the other by means of magnets.

[Figure 26] Unfortunately, and despite his numerous important contributions and generally pivotal role, it is for the errors of the three stages and magnetic transfer that Charcot is sometimes best remembered. As the Belgian psychophysicist, Joseph Remi Leopold Delboeuf (1886), suggested in a pointed attack on Charcot's work, the effect of suggestion passes not only from hypnotist to subject but from subject to hypnotist. A particularly striking patient can create expectations in the therapist about the forms that hypnotic manifestations will take. These can then unwittingly be transmitted as suggestions to future patients who will act so as to confirm the therapist's expectations. Such, indeed, seems to have been the case at the Salpêtrière, where patients, most notably the famous Blanche Wittmann [see figure 26], students, collaborators, and Charcot himself, fell victim to the fatal force of mutual expectation.

At Nancy, a group working under the leadership of Hippolyte Bernheim (1840-1919), committed to the view that hypnotic effects were obtained through the power of suggestion, was particularly well situated to recognize the flaw inherent in Charcot's work. Bernheim was born in Mulhouse, France and received part of his medical education at Strasbourg. Upon receiving his agrégation, he accepted a professorship at the Faculté de Médicine at Nancy. In 1882, when he had already become well-established, Bernheim heard of a country physician named Liébeault who was rumored to be treating patients effectively using artificial somnambulism.

Following visits to Liébeault in which he became convinced of the therapeutic effectiveness of hypnosis, Bernheim published De la suggestion dans l'état hypnotique et dans l'état de veille (1884) [24] in which he reintroduced Liébeault's neglected view that the effects of hypnosis reflect the power of mental suggestion. Here and in the expanded 1886 edition, Bernheim conceptualized hypnotic phenomena as manifestations of ideomotor suggestibility, a universal human ability to transform an idea directly into an act. Indeed, for Bernheim, hypnosis was simply a state of heightened, prolonged, and artificially induced suggestibility.

Taken by themselves, these views alone would have led Bernheim into conflict with Charcot; but Bernheim and his colleagues at Nancy went much further. Criticizing Charcot's claim that hypnosis is a pathological nervous condition allied to hysteria, Bernheim rejected Charcot's description of the three phases of hypnotism and derided the idea that symptoms could be transferred laterally with magnets. Picking up on the criticisms of Delboeuf, Bernheim asserted that the phenomena discovered by Charcot were simply artifacts of the suggestibility of his patients, the exercise of poor experimental control by his students, and, by implication, Charcot's own suggestibility as well. Indeed, so convinced were they of the suggestive nature of hypnotic therapeutics that, as time passed, the members of the Nancy school abandoned hypnotic induction entirely for direct suggestion in the waking state, a technique they termed "psychotherapeutics."

[Figure 27] While the debate raged between Nancy and the Salpêtrière, Pierre Janet (1859-1947) [see figure 27] was at work at Le Havre gathering clinical observations on which to base his dissertation. Born in Paris, Janet entered the École Normale Supérieure in 1879, placing second in the extremely competitive examinations of the agrégation. Shortly thereafter he took up a professorial position in philosophy at the Lyceum in Le Havre where he remained until the acceptance of his dissertation. Upon receipt of the degree, he moved to Paris to study medicine and pursue clinical research under Charcot at the Salpêtrière.

Janet's dissertation, L'automatisme psychologique [25] brought together a wealth of related clinical information on a variety of abnormal mental states related to hysteria and psychosis. Dividing such states into total (involving the whole personality) and partial (part of the personality split from awareness and following its own psychological existence) automatisms, Janet employed automatic writing and hypnosis to identify the traumatic origins and explore the nature of automatism. Syncope, catalepsy, and artificial somnambulism with post-hypnotic amnesia and memory for prior hypnotic states were analyzed as total automatisms. Multiple personalities, which Janet called "successive existences," partial catalepsy, absent-mindedness, phenomena of automatic writing, post-hypnotic suggestion, use of the divining rod, mediumistic trance, obsessions, fixed ideas, and the experience of possession were treated as partial automatisms.

Most importantly, Janet brought all of these phenomena together within an analytic framework that emphasized the ideomotor relationship between consciousness and action, employed a dynamic metaphor of psychic force and weakness, and stressed the concept of "field of consciousness" and its narrowing as a result of depletion of psychic force. Within this framework, Janet analyzed the peculiar fixation of the patient on the therapist in rapport in terms of the distortion of the patient's perception, and related hysterical symptomatology to the autonomous power of "idées fixes" split off from the conscious personality and submerged in the subconscious. Although careful to avoid direct discussion of the therapeutic implications of his work in a non- medical dissertation, Janet laid the foundations for his own and Freud's later therapeutic approaches through his demonstration of the origins of splitting in psychic traumas in the patient's past history.

Indeed, it was but a short leap from the work of Charcot, Bernheim, and Janet to that of Josef Breuer (1842-1925) and Sigmund Freud (1856-1939). In 1893, Breuer and Freud published a short preliminary communication, "Ueber den psychischen Mechanismus hysterische Phänomene" in the Neurologische Centralblatt [26]. The origin of the Breuer and Freud paper lay in Breuer's work with the famous patient Anna O.

Although actual details of the case of Anna O. as described by Breuer, who undoubtedly took pains to disguise his patient, and many years later by Jones (1953/1957) are at considerable variance with one another and probably with the actual facts of the case (see Ellenberger, 1970), it is known that the alleviation of Anna O's symptoms occurred only as the patient, under hypnosis, provided Breuer in reverse chronological order with an account of the exact circumstances under which each symptom appeared. Only when she had traced the final symptom back to the traumatic circumstances of its occurrence was she cured. Anna O's cure by this "cathartic" method, which involved bringing the trauma to consciousness and allowing it to discharge through affect, words, and guided associations, has often been seen, and was thought by Freud, to be the starting point for psychoanalysis.

In the seminal work of Janet and in the critical transitional paper of Breuer and Freud, we see the culmination of developments that had begun with Puységur's elaboration of the doctrines of Mesmer. In a little over a hundred years, a huge corpus of evidence and related neurological and psychological theory had led irrevocably to the belief that mental events -- mesmeric trance states, rapport, the therapist's will to cure, the concentration of attention, mental suggestion, psychic trauma, the dissociation of consciousness, and catharsis -- could effect radical alterations in the state of the body. No psychologist writing in the 1890s could afford to ignore this rich material and its implications for conceptualization of the nature of the mind/body relationship. William James, as we shall see, was no exception.

The Rise of Experimental Psychology

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Wozniak, Robert H. "Mind and Body: Rene Déscartes to William James";
Bryn Mawr College, Serendip 1995
Originally published in 1992 at Bethesda, MD & Washington, DC by the National Library of Medicine and the American Psychological Association.

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