Return to Equinoxes, Issue 5: Printemps/Eté 2005
Article ©2005, Nadia Mamelouk
In the highly charged international political atmosphere of the late nineteenth century the health of the nation was of primary importance, and as the representative “head” of the state, capital cities became symbolic battlegrounds for the medical establishment to exercise its frequently anti-modernist rhetoric. 1Medico-legal literature of the late nineteenth century presents the reader with a series of highly specialized responses to the perceived problems of a newly urbanized Europe. 2Repeatedly, medical theorists of the period such as B.A. Morel, Ambroise Tardieu, and Jean-Martin Charcot bemoaned the deleterious effects of an industrialized society on the health of the nation. At the same time, however, large cities were quickly becoming the locations of the most advanced medical and scientific research in Europe. By the 1880s, Paris above all had developed into the premiere city for research concerning health and illness. With the accession of Dr. Jean-Martin Charcot to its directorship, the Salpêtrière hospital for the mentally ill became the European center for the study of all areas of neuropathology, even attracting a young Sigmund Freud to be trained under the tutelage of the esteemed Dr. Charcot. Thus, as the location of both Europe's most advanced medical research facility and one of Europe's most industrialized (and therefore pathologized) cities, Paris was an ideal representation of the discursive incongruities of nineteenth-century medico-legal discourse concerning the city. Using Mary Douglas' symbolic system of “purity and danger” as a lens, this essay will argue that with the growth of Paris as a metropolitan city the incorporation of the hospital patient into the social body of the capital collapsed the boundary between the healthy citizen and the diseased “other.” Furthermore, as urban growth prevented the physical distancing of the patient (as the early psychiatric profession frequently did) the collapse of the geographical boundary necessitated a restructuring of the symbolic boundary by distancing the “other” through language particular to Paris' metropolitan flâneurs . In short, the symbolic distancing of the mentally ill could no longer be achieved through casting them out beyond the city walls; consequently they were reinvented as commodified spectacles for urban mass consumption.
The relationship between Paris and those of its citizenry that were “diseased” is both a literal and a figurative construction of Mary Douglas' anthropological system of ritual purity and danger. In Douglas' conception, we maintain a coherent sense of self by categorizing matter and experience; however, these ordered systems of thought can only exist through a process of abjection in which anything that contravenes our classificatory system of matter or experience becomes rejected, ignored, or made to fit within our preconceived orderly categories (36-38). In other words, the creation of a coherent identity relies on a categorical system of symbols that organizes experience, creating a symbolic “pure inside” and “dangerous outside.” The boundary between these symbolic locations is wholly defined by the figure of the abject – that which does not fit into our preconceived “pure inside.” Building on this theoretical framework, both Sander Gilman and Susan Sontag emphasize the maintenance of these symbolic borders through the means of projection, or creating a symbolic geographical distance between the pure “self” and a diseased “other.” 3In Sontag's words, “there is a link between imagining disease and imagining foreignness. It lies perhaps in the very concept of wrong, which is archaically identical with the non-us, the alien. A polluting person is always wrong […and] a person judged to be wrong is regarded as, at least potentially, a source of pollution” (136). It is no coincidence that early French psychiatric professionals referred to mentally diseased individuals as aliénés. 4Following this construction, then, by the late nineteenth century Paris had become both “inside” and “outside” – the representative European city for art, culture, commerce, and science, but also the site of the largest community of aliénés whose close proximity to the Parisian population was a constant reminder of modernity's potential for individual dissolution.
As early as the 1850s, the city provided medical theorists with a conundrum. Expressed in terms of the dominant medical trope of the period, theorists questioned whether national degeneration – or hereditary atavism – was a regressive problem separate from progress, or whether “the city, progress, civilization, and modernity were paradoxically the very agents of decline” (Pick 106). The dominant theorist of degeneration, the doctor Bénédict Augustin Morel, argued that one's social milieu had as much to do with one's physical and mental state as heredity. In his major work, Traité des dégénérescences physiques, intellectuelles et morales de l'espèce humaine et des causes qui produisent ces variétés maladives (1857), Morel often made this argument in terms of the degenerative effects of industrial centers. According to Morel, “habitation in overpopulated or unsanitary areas submits an organism to new causes of decline and consequently of degeneration” (50). 5Paris was no exception to this statement, as Morel found that in “almost all the large cities, I have found that vagabondage bears the same fruit…the young detainee of Manchester and Edinburgh resembles that of Paris” (660). For Morel, these “overpopulated or unsanitary areas” were breeding grounds for the abuse of alcohol, venereal excess, and malnutrition (albeit, apparently only among the “poorer classes”), and consequently, the asylums for the city's aliénés were nothing “if not the concentration of the principal degenerations of the human species” (77). While the city was considered a source of possible contamination, the integrity of the city as a representative of the social body was restored by the removal and “concentration” of various “degenerates” in a controlled asylum that, in the case of Paris, was beyond the city limits. The physical removal of the aliénés from the city was a striking illustration of the symbolic abjection of urban “impurities” writ large.
The means of maintenance of the boundaries between pure and impure was not limited to incarceration. Many of the prescribed treatments for various ailments required removal to the country as a type of vacation. As opposed to Morel's emphasis on fixing the social environment, these prescriptions focused more on the separation of the afflicted from the temptations of urban life in an attempt to cure the individual, while still removing them from the city so as not to “infect” the social body. For example, in order to treat a condition called “satyriasis” – a malady characterized by male hypersexuality – Dr. Ambroise Tardieu, a professor on the Faculté de médecine of Paris, prescribed in his Manuel de pathologie et de clinique médicales (1873) “the most absolute calm, the most complete repose, study, manual labor […] life in the country to correct, by a proper life, the deregulation of the imagination and the loss of the senses that engenders satyriasis” (577). The manual gives similar prescriptions for a number of ailments including nymphomania and hysteria (577-598). Tardieu does not specifically warn of the dangers of the city in his manual, but by prescribing vacations to the country the reader's implicit assumption is that only urban residents succumb to such afflictions (which was considered especially true of sexually-based disorders, as the city offered numerous “temptations” in that regard). For patients, the bucolic countryside provided a necessary reprieve from the pressures of urban life and at the same time served once again to purify the social body of the city.
By the 1880s, the physical removal of the aliénés from Paris proper became increasingly difficult. During Napoleon III's Second Empire, the city of Paris expanded immensely incorporating several of the outlying communes in a massive urban reconstruction headed by the Emperor's Prefect of the Seine, Baron Georges Haussmann. 6The Salpêtrière was now within the purview of Paris, the embodiment of French power and affluence, and the seat of nineteenth-century European culture. A massive institution of over five thousand relatively permanent denizens, as Mark Micale has described it, the Salpêtrière had become a “city-within-a-city” (714). For Micale, this characterization of the locality of mental illness signals a shift in the conception of the nineteenth-century hospital. Whereas once the Salpêtrière was located in the bucolic countryside surrounding Paris, safely distant from the “social body” of the nation's capital, the gradual encroachment of the growing city brought the hospital within the city limits, and consequently ushered in “an incomparably more public conception of the hospital” (722). While the hospital may have been “publicized” by this shift, the symbolic distance between the diseased inhabitants of the Salpêtrière and the healthy citizens of Paris was ritually maintained, if no longer by physical distance, then by rhetorical transformation.
As Diana Fuss and others have argued, at the same time that the abjected other helps create a boundary between “inside” and “out,” the continual fear of the other “concentrates and codifies the very real possibility and ever-present threat of a collapse of boundaries, an effacing of limits, and a radical confusion of identities” (6). While these symbolic boundaries are susceptible to transgression, Fuss argues that these borders and the hierarchical relations they represent also tend toward reestablishment (6). As Fuss states, “Such retrenchments often happen at the very moment of the supposed transgression, since every transgression, to establish itself as such, must simultaneously resecure that which it sought to eclipse” (6). In the case of the physical distance of the diseased other in nineteenth-century Paris, this reiteration of a hierarchical relationship did not occur without a radical transformation of the terms with which this fear of subversion was expressed. Fuss asks in her essay “Inside/Out”: “Why is institutionalization overwritten as ‘bad' and anti-institutionalization coded as ‘good'? Does inhabiting the inside always imply cooptation? […] And does inhabiting the outside always and everywhere imply radicality?” (5). With the new conception of the “public hospital” these questions became increasingly important for a society already concerned with national degeneration. Now that the aliénés were physically both inside and outside of the city, in order to maintain the symbolic separation of the national body from its diseased citizens, Parisian doctors reinvented the language of the hospital. Medical rhetoric transformed the hospital and its inhabitants into another boulevard attraction, akin to the numerous grands magasins , museums, and panoramas that appealed to the urban flâneur . The urban hospital could then fit with the conception of Paris as, in Walter Benjamin's phrase, “the capital of the nineteenth century.”
As Micale has argued, the Salpêtrière in this period is “unthinkable without Paris during the fin-de-siècle period,” in that the changes in the urban hospital mirrored the cultural changes taking place in Paris in the fin-de-siècle (723). Along with the emergence of a mass consumer society in Paris, according to Micale, the idea of the hospital shifted from a “distant and dreaded institution” to an institution that relied heavily upon social interaction in order to accomplish its rehabilitative goals (724). In this view, attitudes toward the sick were tempered by the increasing involvement of non-professionals in the medical sciences, most notably through Charcot's public lectures at the Salpêtrière, reflecting the consumer-driven boulevard culture of the Parisian streets where quotidian life was presented as popular spectacle. For Micale,
“Absorption into a large and imposing metropolitan area, accompanied by new therapeutic imperatives, economic motives, and financial resources, allowed the hospital to turn outward for many new features of its development. The capital city itself effectively became the ultimate institutional model. Confronted at one time by these multifarious forces, the hospital attempted to adapt by increasing its public accessibility and transforming itself into the image of the city at large” (724).
Micale admits that this transformation was ultimately unsuccessful, as the mentally ill “continued to arouse in Parisians, if not the outright horror of earlier times, at least considerable anxiety” (725). Micale does not offer an explanation for this effect, but following from Douglas, Sontag, and Fuss, I would argue that this new publicly-accessible hospital was only “public” in so much as the inhabitants of the Salpêtrière were rhetorically commodified in an attempt to maintain the (no longer physical) distance between the Parisian flâneur and the diseased other, thereby reiterating the seemingly collapsed boundary between purity and danger. As both inside and out, the Parisian hospital represented itself as a part of the cultural capital of Europe in its scientific accomplishments, but also as a “spectacular reality” (to use Vanessa Schwartz's term) to be consumed by the Parisian public. In effect, the Salpêtrière became a free public theater whose inhabitants were the players, safely viewed from a distance by the Parisian audience. In this, the hospital mirrors other developments of early mass culture, like the Paris city morgue, where “the allegedly serious business of identifying anonymous corpses,” or in the case of the hospital of helping psychiatric patients, was transformed “into a spectacle – one eagerly attended by a large and diverse crowd” (Schwartz 47).
This commodification was accomplished in several ways, most effectively by Charcot's public lectures. Upon the opening of the newly expanded facilities of the Salpêtrière (including the public lecture hall), Charcot extolled upon the virtues of having such a large and diverse population with which to study the diseases of the nervous system. 7“The clinical types of disease which come under observation are illustrated by such numerous examples that we are enabled to take at one time a comprehensive view of an affection,” he proclaimed. “In other words, we are in possession of a sort of living pathological museum whose resources are almost inexhaustible” (3). 8At once underscoring the privileged scientific position of the Parisian facility and the consequent spectacularization of the hospital's inhabitants, Charcot's reference to his patients as a “living pathological museum” dramatically demonstrates the necessary transmutation of the mentally ill in a “public” hospital from human beings to pathological displays meant for consumption by, but not incorporation in, the social body of Paris.
Charcot's lectures frequently included any of a number of sensationalized stories, reflecting the concurrent emergence of a sensational mass daily Parisian press. 9For example, in the midst of a lecture on hysterical mutism in men, Charcot interjects an anecdote about Hélène G--, a 24-year-old woman who mailed to a priest a parcel labeled “cheese,” which in fact turned out to be a dead baby (369-370). Only loosely linked with the topic he was lecturing on, Charcot apologized for the digression. Such anecdotes, however, were not infrequent, as they were often the story of the very person being discussed in the lecture. The public demonstration of the case of a 13-year-old Russian boy offers one example. Charcot began the presentation as if the boy's case were a tabloid human-interest story. “The father [of the boy],” Charcot tells us, “who loves his son to distraction, undertook the voyage, came to Paris, and brought him to us fifteen days ago, imploring us to give him the means of cure, which he had been unable to attain in his own country. From the very first interview, we were able to give him hope” (80). Such anecdotes further lent to the appeal of the public lecture as a sensationalized spectacle for the masses, while at the same time emphasizing the role of Paris in the world of medical science. As a curative measure (for such was the stated purpose of these demonstrations), according to Charcot, the patient understood that “the more minutely and the more thoroughly they [were] investigated, so much the greater [was] the chance of their cure or alleviation,” and the public understood that curing mental illness was spectacular entertainment (4).
To be sure, Charcot still deeply felt the potential for the modern city to adversely affect the health of the populace. 10The solution, however, was no longer removal from the city. In the case of Paris, by the 1880s this was literally impossible because of the asylum's physical location within the city. Concurrently, Charcot looked down upon provincial France as being in the periphery of scientific advance. Charcot would still prescribe isolation for his patients, but it was no longer isolation from the city. As he explains in one of his public lectures,
“In Paris, during the last fifteen years, establishments of hydrotherapy take patients who are so disposed in hand with much success. In the provinces, Isolation is more difficult to effect, because conveniently arranged establishments are more frequently wanting. One can, no doubt, create artificial private asylums, but it may be readily understood that the arrangements are often seriously defective” (210).
The city, and especially Paris, was the place to go for help, and “isolation” did not include separation from the general populace.
Over the course of the latter half of the nineteenth century the relationship of the medical community to the city, and to Paris in particular, shifted dramatically. From the identification of the city as the source of degeneration to the invention of Paris as the premiere center for curing mental illness, the symbolic structure of purity maintained itself through the transformation of the cultural language of Paris. As Paris became the cultural capital of Europe, the new metropolitan concept of the city allowed for the rhetorical transformation of the abjected other. No longer able to be physically removed from the Parisian city limits, the Salpêtrière and its medical personnel rhetorically reinvented its afflicted inhabitants as public spectacles, museum displays, and sensationalized news stories so that the abject could be safely observed from the symbolic “inside,” while still maintaining the integrity of the boundary between pure and impure. Ensconced in this cultural position, the mentally ill as a symbol of national and individual dissolution could be safely located as both “inside” and “out,” making Paris simultaneously the symbolic embodiment of both absolute purity and absolute danger.
Jason Cavallari is a doctoral candidate in the Department of History at Boston College. His research interests include 19th and 20th century French cultural history, the history of sexuality, and the history of deviance. He is currently working on his dissertation on the relationship between medical discourse and popular representations of deviance in fin-de-siècle French culture.
1 For more on the intersection of international politics and medico-legal discourse see Daniel Pick, Faces of degeneration and Robert Nye, Crime, Madness, & Politics in Modern France .
2 While this essay will be primarily concerned with psychiatric and neuropathological discourses, the term “medico-legal discourse” is meant to include any of a number of newly professionalized fields of the nineteenth century including, but not limited to, criminal anthropology, psychiatry, psychology, sexology, and legal medicine.
3 See Sander L. Gilman, Disease and Representation and Susan Sontag, Illness as Metaphor .
4 See Jan Goldstein, Console and Classify as well as any number of primary source materials including B.A. Morel, Traité des dégénérescences , and Y a-t-il plus d'aliénés aujourd'hui qu'autrefois? as well as Ambroise Tardieu, Manuel de pathologie .
5 All translations are mine, except where otherwise noted.
6 For more on the reconstruction of Paris under Haussmann's prefecture see Michel Carmona, Haussmann: His Life and Times .
7 For Charcot, as for many of his contemporaries, mental diseases like hysteria were thought to have physical causes.
8 Italics are in original.
9 For more on the emergence of the French press after the 1881 “freedom of the press law,” see Claude Bellanger, et al., Histoire générale de la presse française and René de Livois, Histoire de la presse française . For the sensationalization of the French press and its relationship to fin-de-siècle mass culture, see Eugen Weber, France, Fin de Siècle , 42 and Vanessa Schwartz, Spectacular Realities , 26-44.
10 See Ruth Harris' introduction to Charcot's Clinical Lectures .
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