Comment la photographie a-t-elle impacté la dimension d’archive et pédagogique des études de Charcot sur l’hystérie à la Salpêtrière ?
How Did Photography Shape the Archival and Pedagogical Dimensions of Charcot’s Studies on Hysteria at the Salpêtrière?
Adriana Gonzalez – March 21, 2023
Medical Photography
Medical photography was introduced in the nineteenth century, a few years after photography itself. Its main purpose was to use photographs to assist patient care, teaching, and future research. Early uses in the 1850s included Hermann Wolff Berend and Hugh Welch Diamond, who photographed orthopaedic patients to track the evolution of treatment. As a psychiatrist, Diamond also began to photograph patients considered insane.
In France, Charcot started photographing patients and showing the images to his students. He believed photography was an objective method that could capture all patient activity at the Salpêtrière hospital. To record every movement — such as epileptic seizures — patients were photographed even in bed. Charcot captured numerous moments that helped him deepen his studies, but at what cost?
Unfortunately, medical photography was not used objectively. It led to multiple misinterpretations of patients, most of them women. There was an obvious lack of privacy: women’s faces appear clearly in many images. Being in a psychiatric hospital, these women had no choice over whether to be photographed. Most of the photographs were published without patient consent. In addition to being women, many belonged to lower social classes, further diminishing their voice and power.
Hysteria at the Salpêtrière
Jean-Martin Charcot was a French neurologist who became particularly interested in the disease known as hysteria. This condition was considered a mental disorder that manifested through physical bodily reactions. More specifically, Charcot believed the illness was hereditary. With his experience and influence in neurology, he had a major impact on the study of mental illness. Given how frequent hysterical symptoms were in nineteenth-century Europe, Charcot had ample opportunity to study both patients and their disorders.
One of the most important tools for his research was photography. The images below show some of the women he photographed and studied at the Salpêtrière hospital in Paris.
Photography served as a tool to validate Charcot’s thinking and his studies on hysteria. By capturing each movement of his patients at the Salpêtrière, he amassed material to present in lectures. However, it is important to note that many photographs were staged. The need for visual evidence to support Charcot’s ideas about hysteria led to women being photographed in strange positions, wearing specific dresses and making particular facial expressions.
Why was this problematic? To satisfy Charcot’s needs, patients gave him exactly what he wanted, and he used this as proof that his theories were correct. The women received special status among other patients for their hysterical performances, but they risked losing that status if they refused to pose during supposed hysterical episodes. Today, it is clear that these images did not capture authentic behaviours or movements. Instead, they show a strategy Charcot used to establish himself as a leading physician of the nineteenth century.
One of Charcot’s most famous patients was Augustine. She became very well known; many of her attacks were included in the Iconographie photographique de la Salpêtrière. As a result, she was favoured by Charcot and received special attention. She is the subject of some of the photographs discussed below.
Muscular Hyperexcitability
Charcot, Jean-Martin. Iconographie photographique de la Salpêtrière (1877–1880)
This photograph shows a woman in the midst of a hysterical episode. Her entire body is covered except for her face and hands. She lies across two chairs, arched upward. Her face is not visible to the viewer. The photograph demonstrates her “muscular hyperexcitability.”
Several elements highlight her condition:
Her body is in an abnormal posture, her head tilted upward in both plates. In Plate XIV, her body appears to float. She is supported by two chairs, but the dark tones of the image, especially the chairs, make her seem suspended in mid-air.
Her clothing completely covers her body. There is a stark colour contrast between her white cap and long skirt and the rest of the scene, which is mostly black. Her white skirt becomes the focal point, drawing the viewer’s eye to her unusual position. As in other images, only her face and hands are visible. Her head is in the same position in both plates, tilted back with eyes seemingly closed. Her hands, however, change position: in Plate XIV they rest on her belly; in Plate XV they grasp her neck. This change suggests that she may be undergoing an episode in Plate XV.
No one else appears in the frame. In Plate XV, there are no chairs either. It looks as if the woman is standing, but her feet are not visible as they are in Plate XIV. The two plates are also differently oriented: Plate XIV is horizontal, Plate XV vertical. If the images were identical, there would be little or no difference in her posture.
Knowing that Augustine is the patient in these particular plates, it is difficult for viewers to determine how much of the photograph is genuine and how much staged. Charcot’s credibility as a physician can be seriously questioned here. Plate XIV, with its very unusual pose over the chairs, suggests that this is one of the images Charcot used to “prove” his theories, even though it looks artificial. In a sense, Augustine gave him exactly what he wanted.
Lethargy
Charcot, Jean-Martin. “Léthargie,” Iconographie photographique de la Salpêtrière (1880)
This photograph shows a woman’s facial muscles contracting. The woman is in the lethargic phase, when neuromuscular hyperexcitability reaches its peak. A doctor’s hand can be seen touching her face with an instrument to trigger a muscular response. The muscle contracts.
There are three different images of the same woman. In each, she is seated in the same position. This allows the viewer to see how her posture and expression change. Her clothes are entirely black, and no other colour appears in any of the photos.
Her eyes are closed, suggesting she is in the middle of an episode. In the first photograph, her head faces forward. In the second, it begins to turn; in the third, it is fully turned to the side. Her facial expressions are particularly interesting: Plate XI shows her smiling. Her body appears more relaxed than in the other two images; she is looser, with her hands no longer tightly clasped. There is almost no visible movement in this image, and her hands are less blurred than in Plates XXXIX and XXXVIII.
The doctor’s hand is visible, using an instrument to highlight parts of her face. However, he never touches her directly. Why? Given the many misconceptions surrounding the women of the Salpêtrière, it is clear she is being used as an object of study. The doctor’s hand always points to a specific area of her face or neck. Even if other parts of her body, like her hands, are also moving, only her face is singled out. This is another example of how Charcot uses photography to underscore his studies and lend them credibility. He explicitly tells the viewer what to focus on—presumably because that is what supports his claims.
The woman is fully clothed, and only her face and hands are visible, as in the previous image. This helps the viewer concentrate on her facial expressions and hand movements. Looking across the three photographs, we see that she lets go in the last one: she smiles and her hands are no longer clasped.
Cerebral Atrophy: Partial Epilepsy
Regnard, Paul-Marie-Léon. “Atrophie cérébrale: épilepsie partielle hémiplégie gauche,” Iconographie photographique de la Salpêtrière (1878)
This portrait shows a woman seated and facing the camera. Both hands rest on her knees; one hand is clenched. She wears a white cap. Only her face and arms are visible; the rest of her body is covered.
This is the first image where her eyes are open, looking straight ahead. Her face shows a frown, highlighted by wrinkles around her mouth.
As in the previous photos, she is seated, and only her face and arms are uncovered. The emphasis on face and hands is again apparent. Here, this framing can be interpreted as a way of analysing women’s behaviour and how it relates to their mental state. Both arms are visible, but her left arm is in an unusual position. This emphasises the effects of epilepsy: the left hand is turned inward. Having both arms in view allows the viewer to compare them and clearly see the anomaly in the left arm.
No doctor is visible. The drapery in the background suggests that this image was taken in a studio rather than in the hospital.
Her dark dress merges with the other elements of the image. The white cap, however, stands out because of its light tone and central position, drawing immediate attention to her face.
This photograph clearly illustrates women’s lack of privacy when photographed. Her facial expression conveys discomfort and disapproval. Her clothing might be read as a sign that she belongs to a lower social class. As a result, she has no authority to refuse being photographed.
Beginning of the Attack
Regnard, Paul-Marie-Léon. “Début de l’attaque (cri),” Iconographie photographique de la Salpêtrière (1878)
This image shows a side view of a woman lying on a bed, her head resting on a pillow. Her arms appear to be extended along the sides of the bed, and her mouth is open. Her face is the only clearly visible part of her body. A belt can be seen around her abdomen.
This is the first image we see of a woman lying on a hospital bed. It conveys much stronger emotions than the previous photos because she seems to be in distress. This can be inferred from her facial expression, particularly her open mouth. The woman appears to be lying flat. The photograph does not show her arms, which had been visible in all the other images. By not showing specific body parts such as her arms, the photographer limits what the viewer can deduce about her position.
The decision not to show her arms is important. The arms are extended but seem to be pulled down or restrained. Taken together — her hidden arms and her obvious distress — this may explain why she appears to be suffering.
The image seems to have been taken in a hospital. Even though the focus is on the woman and the background is empty, the bed and pillow match the hospital gown she is wearing. It is striking, however, that no doctor appears in the picture.
One of the most interesting and important elements is the belt around her abdomen. Its very dark colour contrasts sharply with her light clothing and draws the viewer’s attention. It is possible that the belt delivers electrical shocks. Based on her invisible arms and evident distress, it seems that she is having a seizure.
This is another photograph of Augustine. Her facial expression is extremely exaggerated, with her mouth wide open. Knowing that she is the subject, it is difficult to determine whether this attack is genuine. It is notable that the image is centred on her. Was Charcot in the room, telling her what to do? The attack itself is hard to validate because so little is visible to the viewer.
Charcot and the Salpêtrière Hospital
Brouillet, Pierre-André. “A Clinical Lesson with Doctor Charcot at the Salpêtrière” (1887)
This image shows Charcot teaching other doctors and scientists at the Salpêtrière. He is demonstrating what hysteria looks like using one of his patients. All the doctors are men.
Unlike the previous images, which focus on a single individual, this one contains many figures. The left side of the image centres on the woman, who seems to be having an episode. She is accompanied by Charcot, two other women, and a man. The right side is populated exclusively by men: doctors, scholars, and students.
Even though the image is not in colour, the right side appears darker, causing the figures to blend together. This suggests they share similar goals and that nothing truly sets them apart. By contrast, the left side is lighter; in particular, the woman being studied is lit by a ray of light pointing toward her chest.
It is clear that Charcot intervened in his patients’ real reactions and seizures. As viewers, it is very difficult to know whether this is a “true” response. There are many men in the room. Given the power held by Charcot and the other men, the patient must behave in a certain way. The goal is always to support Charcot and his status, not to show an authentic reaction.
Conclusion
Each woman in the photographs above had her own personal story. However, because of Charcot’s choices about what to show and what to hide, it is clear that he was mainly interested in visible bodily movements. The women’s feelings remain largely unreadable.
Even though we cannot deny Charcot’s impact on the study of mental illness and hysteria, his studies were narrow. Focusing on women in the Salpêtrière hospital allowed him to control his subjects, but studying only women in a psychiatric setting severely limited the possibility of comparison and nuance.
As we continue to examine mental illness and the role of photography in capturing moments, it is essential that research broaden its scope and include a wider range of subjects. Photography had a major impact on Charcot’s studies on hysteria. Specific instants and movements were frozen in time, which helped popularise his work in Europe and beyond from the nineteenth century onward.
Although the photographs Charcot used as evidence were highly precise, we cannot know whether they were authentic. Once we understand patient behaviour and the social consequences of doing — or not doing — what he wanted to capture on camera, it seems unlikely that these images show the women’s real behaviours. Today, the term hysteria has very negative connotations. Given Charcot’s role in using his patients for his own research and reputation, that may be one reason why.