Hidden Minds (10 page)

Janet’s treatment was complete. Where every other method known to medical science had failed, he had produced a miraculous transformation. This rather curt summary of his methods, is complemented by a near pathologically modest assessment of his own achievement:

The young philosophy teacher continued to publish his results in the
Revue Philosophique.
He investigated several more of Dr Cibert’s patients and, as his work progressed, he become increasingly convinced that memories and ideas, outside of awareness, were the ultimate cause of mental illness. He coined his own term to describe this level of mind. He called it the
subconscious;
however, more importantly, he had demonstrated that hysterical symptoms could be cured, through the discovery and rebuilding of material in the subconscious. This process was much more sophisticated than what had gone before. Janet was not merely hypnotising patients and removing symptoms. Janet was uncovering and reshaping inaccessible memories.

Today, Janet’s special term ‘subconscious’ is used in exactly the same way as the more commonly used ‘unconscious’; however, Janet introduced the term subconscious for a very specific reason. He wished to make a clear distinction between the concept of the unconscious mind, as the source of mental illness, and the unconscious as described by philosophers – a more general concept still largely associated with romanticism. This was a useful distinction to make. Unfortunately, the term unconscious continued to be used indiscriminately by both doctors and philosophers.

Janet worked with patients in Le Havre from 1882 to 1888. Although he wrote several academic papers in which he recorded his experiments and findings, the ultimate destiny of much of this work was his thesis, on
psychological automatism.
The term psychological automatism was used to describe behaviour that occurs in the total or partial absence of awareness. At its most basic, psychological automatism could take the form of
absent-mindedness -
trivial actions executed largely while thinking about other things (for example, trying to put on a second pair of trousers). But psychological automatism could also take more complex forms. These forms of automatism were well documented among individuals suffering from a particular type of epileptic seizure. A patient might stop talking mid sentence and fail to respond to any verbal prompts, such as ‘What’s the matter?’ The patient might then finish drinking a cup of coffee, rise, and walk to the door. At that point, be or she might recover consciousness and look around, somewhat confused, wondering what had just happened, in certain individuals these
absence automatisms
can be sustained for a considerable period of time. The patient’s mind appears to be out of commission, but his or her body still manages to execute a limited repertoire of behaviours. Post-hypnotic suggestion and cases of multiple personality can be considered as even more complex examples of automatism. Both of these phenomena can be associated with the most sophisticated behaviours imaginable – for example holding a coherent and novel conversation – apparently without the consent (or participation) of the individual’s conscious mind. In his thesis Janet catalogued numerous examples of psychological automatism and attempted to classify them.

Janet’s most important work during his Le Havre years was, however, his exploration of hysteria. He had suggested that hysterical symptoms originated in parts of the mind that had been split off. These symptoms were, therefore, examples of psychological automatism. They were generated by parts of the mind that had become ‘detached’ and contained subconscious thoughts and memories. Janet believed that this ‘splitting’ was caused by the experience of trauma.

Janet did not include any of his experiments on telepathy in his thesis. A further notable omission was any reference to the possible therapeutic implications of his work. Janet was not, at that time, medically qualified, and he did not want to offend the sensitivities of the medical establishment. He was examined on 21 June 1889 at the Sorbonne. He passed without difficulty and was warmly congratulated for his achievement.

By 1889 Janet had completed the first major phase of his life’s work. That August, he attended the International Congress for Experimental and Therapeutic Hypnotism in Paris. He was a committee member and well respected by his peers. Over 300 delegates attended. Many were distinguished. They included Frederick Myers, Cesare Lombroso (one of the first criminologists), and William James (the psychologist and brother of Henry). One member was yet to make his mark on the world. In fact, it would be another four years before he published his first important paper on the psychological treatment of mental illness. He was a young neurologist from Vienna called Sigmund Freud. The man history would canonise as the father of psychotherapy.

Janet began his medical studies in November 1889; however, his time was still not fully his own. He was still pledged to undertake teaching duties and for a year occupied a post at the Lycée Louis-le-Grand before moving to the Collège Rollin. Fortunately, he was regarded as a special case and he was able to spend a considerable amount of time on Charcot’s wards at the Salpêtrière from 1890 onwards.

The Salpêtrière was, of course, a hospital. But to call it a hospital would fail to give a proper impression of its dimensions, for the Salpêtrière was not so much a large building designated for the care of the sick, as a city. Indeed, it was often described as a city within a city. The Salpêtrière housed thousands of patients (mostly women) in over forty buildings and covered over 125 acres of land.

Janet arrived at the Salpêtrière when Charcot’s career was at its zenith. If the Salpêtrière was a kingdom in miniature, then there was no doubting the identity of the demiurge who presided over its shadowy and labyrinthine corridors. Charcot was known as ‘The Napoleon of the neuroses’, and his colleagues and acquaintances were called – by envious rivals –
la charcoterie’.
Janet had already been noticed and praised by Charcot, so when he arrived at the Salpêtrière his place among
la charcoterie
was virtually guaranteed. As soon as Janet commenced his medical studies he resumed his psychological investigations. At the Salpêtrière, he was allowed to assess and treat hysterical patients. Indeed, Charcot often referred his own patients. It is very likely that Charcot recognised that Janet was not really a student; at least, not in the conventional sense. He had gained a considerable amount of clinical experience while ‘experimenting’ at Le Havre and was, in his own way, an expert.

In his writings, Janet began to refine his treatment methods. He believed that treatment depended on a thorough understanding of psychological problems. Symptoms should be carefully analysed. Moreover, the clinician should attempt to reconstruct the progress and development of the illness. Symptoms concealed stories.

In order to facilitate the detection of such stories, Janet established a number of guidelines for good clinical practice. Today, these would be regarded as routine; however, for a practitioner in the 1880s they were extremely thorough and systematic. Janet suggested that the clinician should be alone with the patient at the time of examination. He believed that an exact record of everything said in therapeutic sessions should be recorded. Finally, and most importantly, the clinician should obtain an entire life history and consider the effects of any prior treatment. An adage of Janet’s was that the clinician could never know enough about his patient. These recommendations show a strong inclination towards empiricism. Indeed, the collection of data, the formation of hypotheses – and experiment – were central to Janet’s method.

One of the first patients that Janet saw at the Salpêtrière was Marcelle, a twenty-year-old woman whose problems had begun in early adolescence. Her principal symptom was paralysis, most notably, difficulty moving her legs; however, she also suffered from disturbances of memory and thought. Janet noticed that habitual movements were accomplished without too much difficulty, whereas movements that were preceded by voluntary decisions were extremely difficult. When, for example, Marcelle decided to get up and walk, her thoughts became disturbed by what she described as ‘clouds’: the entry into awareness of muddled ideas and even hallucinations.

Marcelle’s memory problems were of an unusual nature. Her memory for events in her life up until the age of fifteen were good; from that age onwards her memories became intermittent or unclear. She could recall nothing of her life beyond the age of nineteen.

Janet began to piece together her personal history, which seemed to have considerable relevance to her symptoms. At the age of fourteen Marcelle had contracted typhoid. She became very ill and was unable to cope with life. Janet believed that at that point Marcelle had attempted to escape from her troubles by retreating into a world of daydreams and fantasy (a world, perhaps, of’clouds’). This tendency may have been amplified by her voracious appetite for ‘escapist’ literature. The following year Marcelle’s father – who had been paraplegic – died. The final telling event occurred when Marcelle was nineteen. An unsuccessful romantic involvement ended unhappily, and she became suicidal.

At first Janet tried to treat Marcelle by using the methods he had employed in Le Havre. He wanted to retrieve the ideas that Marcelle had formulated at various significant points in her life. To this end, he used hypnosis and automatic writing. Janet worked with the ideas and memories that became accessible; however, any improvement in Marcelle’s condition was only temporary. As one symptom disappeared, another would take its place.

When Janet used hypnosis and automatic writing on Marcelle she experienced ‘hysterical crises’, becoming severely disturbed. Nevertheless, Janet made two important observations. Firstly, Marcelle appeared to feel better immediately after a hysterical crisis had been induced and, secondly, the more severe these crises became, the more they released ideas that were formed earlier in life.

Janet began to work with these ideas in reverse order, working back from the most recently formed ideas to the most remote in time. He wrote:

Once these older ideas were retrieved and modified, Marcelle’s improvement was significant and lasting.

Janet’s account suggests a number of interesting points. To treat a patient properly, it is necessary to retrieve and modify the most fundamental and relevant ideas and memories from the unconscious. Retrieval of unconscious material is best achieved if the patient is placed in a heightened emotional state. Moreover, the most important material in the mind is revealed, as it were, by excavation: the upper strata contain fewer riches than those laid down at an earlier time. Systematic improvement will be associated with the dissolution of pernicious ideas and memories of increasing priority. In the same case history Janet wrote: ‘in the human mind, nothing ever gets lost’.

Janet’s reputation had begun to spread beyond the city within a city. The intellectual climate of the time favoured a general interest in the mind and its secrets. Inevitably, the literature of the day reflected this trend and began to explore psychological themes. Marcel Prévost, a famous contemporary writer, chose to make psychotherapy a principal feature of his 1893 novel
The Autumn of a Woman.
A central character in this work is Dr Daumier, a young neurologist practising at the Salpêtrière (who is also a gifted psychotherapist). The methods he employs to treat his patients borrow much from Janet. Moreover, his mannerisms and style of speech are believed to resemble Janet’s. In all likelihood, Dr Daumier
is
Janet. Regardless of his retiring nature, the Salpêtrière constituted too small a bushel to conceal Janet’s brilliance.

In the 1880s and 1890s becoming a doctor was a relatively undemanding business and, for Janet, required hardly any effort at all. On account of his prior academic training and experience, Janet was afforded many exemptions. Thus, he was able to sit his final examinations on 31 May 1893. He presented his MD thesis a few months later. Predictably, he graduated with honours. Moreover, Charcot (who was always interested in experimental psychology) created a laboratory at the Salpêtrière for the purpose of conducting psychological experiments. He gave it to Janet to run. In Charcot’s eyes, Janet had clearly lived up to all of his early promise. A remarkable achievement, given that it was only eight years earlier that Janet’s first major paper on Madame B was read at the Société de Psychologie Physiologique,

Janet’s theory of hysteria was detailed in several academic journals and in his MD thesis (which was published in 1893). In summary, he suggested the following: Hysterical symptoms were due to the presence of thoughts and memories in the unconscious and have a traumatic origin. The traumatic experience is perceived as so overwhelming that it cannot be integrated into the psyche. Memories of the traumatic experience are subsequently ‘split off* from awareness; sometimes to such a degree that months of a patient’s life are consigned to oblivion.

This splitting of the mind is sometimes technically described as
dissociation.
However, these split-off or dissociated portions of mind can still exercise an influence on everyday existence; they ‘return’, to haunt the body, like ghosts, producing inexplicable impulses, anaesthesiae, and re-enactments. With respect to the latter, the individual is like an actor who is driven to perform a scene in the absence of props or other members of the cast. However, these re-enactments might not always be literal. They could, for example, be symbolic. For Janet, the so-called ‘hysterical crisis’ was almost invariably a re-enactment of some kind, albeit a disguised re-enactment. Keeping traumatic memories at bay requires mental energy. Janet believed that this produced what he described as ‘a narrowing of consciousness’.