Human Traces Read online

  Jacques smiled and picked up his notes again. He would not repeat his little diversion when he read his paper to the psychiatrists of Vienna, but he hoped it had served to rekindle the interest of the stout lady to whom he had been speaking.

  ‘Before I share with you, ladies and gentlemen, the nature of my discovery, I would like to show you that what I am proposing is in medical terms not at all revolutionary. You may think it strange for a scientist who is claiming a new theory to say that it is not particularly original, but I believe my work has a better chance of being appreciated if I show how naturally it arises as a synthesis of the innovations and discoveries already in the public domain.

  ‘Let us take the hypnotists. The function of hypnosis in this century has been far greater than merely to illustrate the mental component in hysteria. You will be familiar with the name of FranzAnton Mesmer, who proposed that humans were joined to one another and to the heavens by an invisible fluid. Good health depended on the individual’s having the right balance of this fluid, which could, by magnetism, be redistributed between different people. Mesmer’s successor, the Marquis de Puységur, was able by magnetism to introduce “artificial somnambulism” in patients, with good therapeutic results. The relevant state of mind was subsequently christened “hypnotism” by a physician from England called James Braid. Well, we know that there was no Mesmeric fluid as such and we no longer think magnets are of much use; but these people had discovered something important, and that was that the certain rapport which existed between magnetiser or hypnotist on one side and patient on the other could provide a path into the patient’s unconscious mind. And all this is quite old history, as you see.

  ‘Hypnotism fell into disrepute until rescued by a doctor called Hippolyte Bernheim, who worked at Nancy, developing the techniques of his master, the physician Liébeault. I have studied under Bernheim myself and have witnessed at first hand his ability to hypnotise all but the most recalcitrant of subjects and have seen the therapeutic benefits that result. Patients have been able to disclose the root causes of their symptoms, to partake in their cure and even to foretell the day of its completion.

  ‘I have touched on Charcot’s immense contribution already, particularly his distinction between, on the one hand, “dynamic” paralysis – caused by hysteria, trauma or hypnotism – and, on the other hand, “organic”paralyses caused by a static lesion of the nervous system. Charcot also distinguished organic from dynamic amnesia. In the first, memory is utterly lost; in the second, it can be recovered under hypnosis. The mechanism of this recovery is a serious consideration for us. In his famous lecture of 1882, Charcot re-established the respectability of hypnotism, but he went further: he showed how “fixed ideas”, held outside normal mental function, could be the base of certain neuroses.

  ‘All hypnotisers have been struck by what their process reveals about the working of the human mind in general. Two years ago, in Leipzig, Max Dessoir published a book called The Double Ego, which reflected the feeling that the mind appeared to be divided into conscious and unconscious parts. The latter was accessible only under hypnosis. Others believed the split went many ways and that we are all an assemblage, or chorus, of personalities. However, it is the split into two which intrigues Janet, and on which I am relying. A long time ago, in 1846, the leading psychologist Carl Gustav Carus wrote: “The key to the knowledge of the soul’s conscious life lies in the realm of the unconscious.” In Carus’s view, psychology is the science of the soul’s development from the unconscious to the conscious. Truly, ladies and gentlemen, I offer you nothing new: Carus wrote almost half a century ago. In 1869, Eduard von Hartmann’s celebrated book Philosophy of the Unconscious saw a kind of universal unconscious as the lowest stratum, then a physiological unconscious which is at work in the evolution of all beings and last, at the highest level, a psychological unconscious which underlies your mental life and mine.

  ‘For decades the truth has been all about us. The work of such men as Fechner and Bachofen is in the library in the town. You may go and read it. Even the great Wilhelm Griesinger, who is known as the “somatic” psychiatrist because he insisted that mental illness is a bodily disease of the brain, was aware of the role of the unconscious. He wrote: “Almost all fixed ideas are essentially expressions of a frustration or a gratification of one’s own emotional interest.” And if Griesinger is not famous enough for you, there is always Nietzsche, who wrote about the mind’s quantities of dynamic energy, and how the conflicting drives within it can inhibit or suppress desires, driving them down into what Janet calls the “subconscious”.

  ‘The name of Janet comes happily at this point. He is not yet as famous as I am sure he will become, but I had the pleasure of knowing him when he began his work at the Salpêtrière in 1889. Before that time he had practised as a doctor at Le Havre, and it was here that he made some astounding discoveries, the details of which were published by him three years ago in Paris. A nineteen-year-old girl called Marie was brought to him, apparently raving mad. She had hysteria with severe menstrual complications. Every month, she had contractures of the arms and the muscles between the ribs; she had partial loss of feeling; she went blind in one eye and she vomited blood. Janet discovered that on the occasion of Marie’s first menstruation at the age of thirteen, she had been so ashamed that she had plunged herself into a large barrel of freezing water to stop the bleeding. She did arrest the flow, but contracted a violent fever. Under hypnosis, Janet took Marie back to the age of thirteen, convinced her by suggestion that her menstruation had not been interrupted by the cold immersion but had painlessly completed its natural course. As for the blindness in Marie’s left eye, this had arisen at the age of six, when she slept with a girl who had impetigo and subsequently contracted a partial anaesthesia of the left side of her own face. Janet took her back through hypnosis to the night in question, suggested that the other girl was quite well, without infection, and that Marie had passed a pleasant night asleep close to her. All of Marie’s symptoms disappeared and her menstruation returned to normal.

  ‘Janet had further successes of this kind at the Salpêtrière with a young woman called Marcelle, whom he helped to walk again by removing in reverse order the fixed ideas that had lodged hysterically in her mind and, only last year, with a patient of Charcot’s called Madame D, whose complete amnesia he cured by making her relive the trauma that had caused it. Janet used Madame D’s dreams to unearth her hidden memories; he also asked her to indulge in “automatic talking”, whereby she said anything that came into her head. This is a development of “automatic writing” done by those under hypnosis and by spirit mediums.

  ‘Janet has many other compelling cases, but my time is short tonight. The important conclusion he drew is that “in the human mind nothing ever gets lost”. A subconsciously fixed idea persists because it is a kind of congealed emotion of which the patient remains unaware, but which may lead to physical symptoms as extreme as paralysis. It is our task to find what has been mislaid, or hidden. The ways of finding it are many. Some of the symptoms – one thinks of the girl Marie, with the arrested menstruation, vomiting blood – appear to be symbolic. In the case of Madame D, it was her dreams that allowed Janet a window on to her unconscious.

  ‘In Vienna, the great neurologist Moritz Benedikt has recently described what he calls the “second life”, by which he means the important existence of a secret life in many unwell people, which contains a “pathogenic secret”, almost invariably of a sexual nature. He has given many examples of patients with hysterical symptoms, almost all of them women, who have been rapidly cured by confessing their secrets. The interesting point about Benedikt is that he has always claimed, since 1864, that hysteria does not depend on organic disorders. He has presented four cases of male hysterics with no heredity and no physical trauma or accident. He contends that the root of their problem is mistreatment in childhood. This is very important.

  ‘Do you see where we are going, ladies and gentlemen? I ho
pe so, because we have almost arrived. I hope also that I have not wearied you with the mention of so many names and the descriptions of what these men discovered or believed. They may sound strange to you, but to me they are as well-known as the names of my old classmates at school; their work is as familiar to me as the unformed handwriting of those little boys long ago. I have mentioned so many only to assure you that what I am proposing is firmly based on work already published.

  ‘Before I conclude, I would like to tell you very briefly why I believe the study and interpretation of dreams may be one of the most powerful weapons in our new cures of madness and distress. First, I must make a small confession. It was a dream of my own, a remarkable one, that first led me to wonder whether there might be some therapeutic value in the analysis of dreams. I shall of course not share that dream with you; it would be both unscientific and tedious – there being perhaps no worse manners on earth than telling others of your dreams. My analysis of my own dream, however, gave me a much fuller understanding than I would otherwise have had of the state of my affections and profoundly relieved a distress of which I had been only half aware.

  ‘I was wary at first of this line of thought, because it seemed to be medieval, or older, in its assumptions; there was something of the shaman about it. However, it was not long before a search of the relevant libraries in Paris led me to a different view. Now it is true that many great German psychologists have seen dreams as little more than the side-effects of chemical activity in the brain – a sort of neural waste matter. But there exists a large and equally respectable school of thought to the contrary.

  ‘In my own language there is the example of the Marquis Hervey de Saint-Denys whose rare book Dreams and the Means to Direct Them I was fortunate enough to be lent by a benefactor in Paris. This charming work is mostly about the author’s attempts to direct his own dreams, but part of his analysis was suggestive to me. He showed that many apparently novel or unexplained images that occurred in dreams turned out, on closer inspection, to be enactments of things he had forgotten. Our compatriot Alfred Maury’s book Sleep and Dreams confirmed this phenomenon. Saint-Denys also showed how one quality could be abstracted from an image in a dream and projected on to another. He had no theory to expound; this was simple autobiography.

  ‘In Germany, in 1861, Karl Albert Scherner’s book The Life of the Dream did have a thesis to propose: that dreams are a language of symbols, which can be interpreted. He showed that the symbolism was mostly related to the physical condition of the patient, so that dreams of flying, for instance, occurred to those with temporarily increased lung function. However, he also maintained that some symbols existed regardless of the patient’s health. A house always represents the human body. Over the space of ten or more pages, Scherner listed such things as pipes, towers and clarinets as emblems of the male, while the female is represented by staircases or narrow courtyards.

  ‘A few years later, another highly respected German philosopher, F. W. Hildebrandt, wrote of how dreams could be the materialisation of a suppressed immoral thought. I think we can perhaps all think of an instance in our own lives where this may have been the case. Then, just three years ago, under the nom-de-plume Lynkeus, the German Josef Popper developed this idea to the crucial point by suggesting that unresolved conflict in the dreamer, between conscious and unconscious levels, finds expression in puzzling or coded dreams.

  ‘From the basis of what all these scholars have written, it is not difficult for us to move one step further and suppose that dreams are a necessary mental function; that far from being mere “neural waste”, these images are those thoughts with which the conscious mind has not been able to deal. In dreams they come to us, these troubling ideas, sometimes in heavy disguise. They come as beggars, mendicants to our door, asking either to be understood or else discharged for ever. They constitute our best guides into the unconscious; they are Virgil to our Dante, as we descend into that dark region.

  ‘Ladies and gentlemen, I must now draw to a close. It is probably clear to you that I have devoted many hundreds of hours to this subject. I began with an orthodox study of an apparently orthodox neurological illness, hysteria. It proved a hard nut to crack, or as people in the village where I was brought up used to say, “a hard oyster to open”. The fault-line or crack in the closed shell, however, was clearly the mental element. By following Professor Charcot’s preliminary examinations and Monsieur Janet’s subsequent remarkable case studies, I have been driven into an extremely delicate area of neurophysiology.

  ‘From there, I widened my researches, particularly in the German psychological literature, a glimpse of which I have given you in the last few minutes. The important ideas and phrases often seemed to lie, oddly enough, in the footnotes or the obiter dicta. I remind you of Janet’s words: “The idea, like a virus, develops in a corner of the personality inaccessible to the subject, works subconsciously, and brings about all disorders of hysteria and mental disease.” Not just hysteria in his view, you will note, but all mental disease.

  ‘I kept returning in my mind to Charcot’s concept of “dynamic amnesia”. It was not something he had time to investigate fully himself; it was by way of something thrown out by the continuous activity of that great brain. Surely, however, the idea that some amnesia could be unlocked by suggestion was highly significant.

  ‘And then there was Moritz Benedikt, a neurologist second in renown perhaps only to the great Charcot, who pointed out almost in passing that the mechanism for forming a pathogenic secret might exist universally, independent of any specific pathology. It might exist in healthy people too.

  ‘Benedikt also gave me leave to explore the possibility that hysteria might not depend on an organic neurological pathology. I am not ready to abandon Charcot’s elegant description of the disease; nor should any doctor do so while hysterical patients present themselves by the score in his consulting rooms. However, Benedikt’s suggestion prompted me to examine the way in which an entire psychology might be based on some of the key principles we developed in studying one complex hereditary disease.

  ‘I have not reached my destination yet, but I am well on the way, I believe, in a personal journey which began some years ago in the dissection of eels and crayfish, and has moved on, step by scientific step, to the threshold of something of rather greater importance: the meeting point between thought and flesh.

  ‘I have yet to find an entirely satisfactory name for the new therapeutic technique that attaches to these discoveries. I had wanted to call it ‘psychosomatic resolution’, but it has been pointed out to me that many people do not understand the meaning of the word ‘psychosomatic’. It truly means ‘existing in mind and body’, and is often used of physical symptoms whose cause is in the mind; it suggests a double existence. I believe that a common misunderstanding of the word, however, has it as little more than a synonym for ‘imagined’; that in many people’s minds, far from meaning dually existent or doubly real, it means unreal or non-existent! Well, alas, one cannot deal only with what words truly mean, one must deal also with words as they are used or abused. For the time being, I am calling the process ‘psychophysical resolution’, and I hope in due course, little by little, we may shed the ugly adjective and call it simply by the more attractive noun, with all its beautiful connotations of healing and calm: resolution.

  ‘Enough of philology. Ladies and gentlemen, I leave you with the firm hope and the modest belief that my discovery, when it is complete, should be nothing less than – and here I permit myself to borrow a phrase once used by my colleague Dr Midwinter, though it may have lost a little of its elegance in translation from his original, indeed highly original, French – “the way in which functions the mind of the human”.’

  Jacques swept up his notes and levelled off their edges; he had no chief of clinic to hand them to, no one to instruct to prepare them for publication, but there was in his manner something of the Napoleon of the neuroses, of Charcot himself, as he strode from t
he stage.

  XI

  ONE OF SONIA’S responsibilities at the schloss was overseeing the diet of those patients undergoing the rest cure, and the cornerstone of it was raw beef soup. The prescription was strict: to one pound of chopped beef she was to add a pint of water and five drops of hydrochloric acid; the mixture was left in a bottle on ice overnight, then, in the morning, boiled for two hours at 110 degrees. The warm filtrate was given to the patients in three portions daily in addition to their regular meals.

  In the first week of their confinement, the rest-cure patients took all meals in their room, beginning at eight o’clock with a plate of oatmeal porridge and cream, followed by dried ham, white rolls, scrambled eggs and cheese. This was preceded by the beef soup and followed by a pear and half an ounce of cod-liver oil; cascara was prescribed for those who needed it.

  Lunch might be a leg and loin of venison, one of Frau Egger’s staples, finished with red wine and half a pint of sour cream and served on a hillock of buttered noodles. This was preceded by the beef soup and might be followed by fruit loaf, chocolate sausage or cream cheese pastries with a pint of milk.

  The number of patients and the volume of food required meant that Sonia and Frau Egger had to decide on the menus a week in advance so that the tradesmen knew what to deliver and on which day. In the summer, when the kitchen gardens of the schloss were at their most fruitful, rumours began to circulate among the patients that tonight would see one of Frau Egger’s strawberry soufflés. These could be served only in the main dining room, not in the patients’ bedrooms, but Frau Egger never failed to make them rise, the secret, apparently, being a refusal to inspect them until some native instinct told her they were ready, at which moment they would be carried through in triumph.