Charcot, Jean-Martin

   (1825–1893)

   Often incorrectly identified as a psychiatrist, Charcot was an internist and neurologist whose contributions to psychiatry were largely limited to his doctrine of hysteria. Born in Paris into the family of a wagonmaker, Charcot began his internship in the Paris hospitals in 1848, a protegé of the internist Pierre François Olive Rayer (1793–1867). After his M.D. thesis on gout in 1853, he soon became a ward chief (médecin des hôpitaux) in charge of a service at Lourcine hospital. Passing his Agrégation in 1860 on the second try—the Agrégation is a major exam that qualifies one to teach at university level—and now eligible for a teaching post, in 1862 he chose that vast warehouse of elderly, invalid, ailing, and insane women, the Salpêtrière hospice, where he became chief physician of the infirmary. He evidently selected the hospice because it gave him an opportunity to follow patients over the long term and then to link the postmortem findings to signs and symptoms seen antemortem. In this manner, in the 1860s he made a number of important discoveries in neurology, including—from 1868 on—differentiating multiple sclerosis from Parkinson’s disease. For these accomplishments in internal and neurological medicine, Charcot became much celebrated.

   As Charcot received the chair of clinical pathology in 1872, he was already involved with hysteria, a condition that had come to interest him in the early 1860s. His interest intensified in 1870 as he received a ward of "hysterics" as part of his service. Hysteria meant roughly pseudoepilepsy in those days, but Charcot considerably expanded the definition to include what he called hysteria minor (la pétite hystérie) and hysteria major (la grande hystérie). Both were constitutional (inborn) lifelong diseases that affected mainly but not just women. Hysteria minor was characterized by various "stigmata," such as constricted peripheral vision and hypnotizability; hysteria major involved various "phases" of behavior through which the patient would supposedly migrate. In retrospect, almost all of this was artifactual behavior induced in the patients by the physicians’ expectations. Yet, Charcot had become so renowned that his flights of fancy were accepted by his medical colleagues as the iron laws of hysteria. At the height of his career, as the president of France in 1882 created a clinical chair for him in nervous diseases, Charcot’s hysteria had become a psychiatric doctrine that widely appeared in international textbooks. After his death in 1893, the house of cards fell in, and Charcot’s hysteria vanished from the scene. His views were published in the late 1880s in his Tuesday Lectures at the Salpêtrière (Leçons du mardi à la Salpêtrière).