Charcot has attracted interest from scholars of many disciplines, bringing to bear many different methodologies. He has been variously characterised as one of the great men of progressive medicine, an embodiment of patriarchal misogyny in his treatment of hysterical female patients, a figure whose work was deeply imbedded in debates about the relationship between art and science, or those associated with photographic documentation, as well as being an important precursor to the “discovery of the Unconscious” by his former student Sigmund Freud (see Micale, 1989, 1990:1 & 1995; Showalter, 1997; Ellenberger, 1970; Didi-Huberman, 1982). One issue overlooked in these wide-ranging analyses, however, is that of theatrical representation and performativity. Charcot’s demonstrations clearly constituted a form of theatre in their public staging of disease, pain and suffering for the purposes of pedagogy and diagnosis. Perhaps more significantly, an analysis of Charcot’s work as whole shows that performative signs, their proper interpretation, and their manipulation, lay at the heart of much of Charcot’s diagnostic and therapeutic practice.

Charcot’s work was intimately associated with the Salpêtrière Women’s Hospice in Paris. He was appointed general physician to the Salpêtrière infirmary in 1862 and in 1882 he became France’s first professor of neurology, presenting lectures on diseases of the nervous system and pathological anatomy at the hospice until his death in 1893. In 1656, the former gunpowder manufactory of the Salpêtrière had been transformed into a royally-patronised charitable institution by the foundation of the hôpitaux généraux—the “Great Confinement,” in the phrase of Foucault (1965), when mendicants and other destitute populations were gathered into state-run medical and psychiatric institutions.

Jules Clarétie, a journalist for Le temps, the administrator of la Comédie Française and a friend of Charcot, evoked in his account of the old royal complex the Shakespearean metaphor of the theatrum mundi (the “theatre of the world” or “microcosmos”). Clarétie described the crumbling edifice of the Salpêtrière as a “little town which is, at the same time, a world,” its courtyards “silent, picturesque and admirable like a theatre set, fullyequipped” for such melancholy dramatisations as those which Charcot framed and directed (1903: 179-180). In Clarétie’s novel, The Loves of an Intern, moreover, he related that within the “bare walls” of the decaying hospice “lives … a special population: old men, poor women, resting on a bench as they await death … There it is like the Versailles of pain” (Clarétie (1902)). Throughout the fin-de-siècle period, the Salpêtrière was widely acknowledged as a common setting for the staging of the melancholy spectacle of pain, suffering and disease as described in newspapers, books, fiction and medical studies.

It was not only lay audiences of Third Republic Paris who gazed with horrified curiosity at the actors of the Salpêtrière. Charcot was one of the most prominent advocates of the anatomoclinical technique, a procedure pioneered in Paris by such renowned anatomists as Jean-Baptiste Bouilliard, and Charcot’s predecessors at the Salpêtrière, Jean Cruveilhier and Pierre Paul Broca (see Hannaway & La Berge (1998)). In this technique, symptoms, which the living patient presented within the clinical environment, were systematically related to pathological signs visible in postmortem investigation, allowing the identification of which lesions or other gross and microscopic deformations of tissue caused which functional disorders. The high morbidity and mortality of the predominantly geriatric population of the Salpêtrière provided Charcot with a wealth of clinical cases from which to garner such data, enabling him to significantly clarify the nature of such conditions as sclerosis in plaques (multiple sclerosis), locomotor ataxia (tabes) and amyotrophic lateral sclerosis, as well as diseases of the kidneys, cardiovascular illnesses and more (as summarised by Goetz Bonduelle & Gelfand (1995)).

Charcot’s particular specialty presented certain problems for anatomoclinical investigation. Firstly, neuropathology as a discipline was particularly concerned with disorders of movement. The primary symptomatic clusters which Charcot investigated included epilepsy, chorea, and Tourette’s syndrome amongst others. These were disease manifestations which could only be fully described through the performance of the living patient.

Charcot’s methodology reflected an ambivalent dialectic between the pull of the living, phenomenologically-present sufferer and other forms of documentation or representation. Charcot emphasised to his students that his own groundbreaking work in distinguishing gout from rheumatism and arthritis had only been made possible by the wide range of clinical cases available at the Salpêtrière:

Although pioneering many alternative representations of the pathological body, Charcot insisted that one had to return to the living case materials literally present within the lectures as the primary authority upon which medical knowledge was based. As Freud (1893) and others observed, Charcot’s professional status was almost entirely attributable to his role as a first-person orator and multi-media dramaturg, with even his published Tuesday Lessons carefully transcribed to include descriptions of stage directions and actions, quoted speech laid out as in a playscript, and so on (Charcot (1887-1888)). Knowledge was to be created either through clinical examination or by pedagogic display. All other forms of representation acted as important props to these primary theatrical devices.

The famous lesson cited by Féré above was one in which Charcot distinguished Parkinson’s disease (then known as paralysis agitans) from other tremulous disorders by fixing feathers to the heads of his demonstration subjects. When the torso of a Parkinson’s sufferer was held by one of the assistants, the feathers remained still, showing the way in which the disease was marked by reduced flexibility of the spine and neck, and hence that the characteristic head tremor of Parkinson’s sufferers was in fact a product of vibrations which emanated in the trunk. Through such performative methods, Charcot made illness dramaturgically comprehensible.

In addition to Charcot’s construction of dramaturgy for pedagogic purposes, his diagnoses themselves were also produced through the staging of disease. The lighting and relative position of the audience to the spectacle in both Charcot’s specially built 1882 rectangular lecture hall (the “amphithéâtre”), and his rooms where he saw patients, was essentially the same. The subject appeared before the audience members, with light directed parallel to their gaze, away from the seating and towards the patient. Commentators observed of Charcot’s office that “The entire room and its furnishings were painted black,” like a contemporary photographic studio, thus minimising any bounce of light from adjacent surfaces (Guillain, 1959: 51-52). Charcot himself “sits before the window, from which light falls on the faces of the two or three patients … occupying chairs in front of him” (Withington, 1893: 207). After entering, the subject was ordered to strip and typically performed various diagnostically significant movements such as walking or raising a glass to the mouth. While these actions were carried out and the case notes read aloud to Charcot by his chef de clinique, the neurologist’s eyes would “fix the patient with an extraordinary penetrative force” (Peugniez, 1893: 4). Charcot’s gaze was almost surgical in the way it helped him to precisely relate anatomical structure to observed behaviour.

A similar situation in which well-lit spectacle highlighted performative signs, also provided the basis for Charcot’s lectures. The New York physician and former student of Charcot, Moses Allen Starr, noted that, in the demonstration theatre: “After the audience had gathered, dark shutters were closed at the windows, the footlights were turned up, and the clinic began,” adding that “sometimes, when a particular feature had to be demonstrated, a calcium”–catalysed, gas-fuelled light—also known as a limelight—”was turned on the patient, whose figure” became “the chief point of light in the darkness” and consequently “could always be perfectly seen by all” (Starr, 1926: 11-12).

Subjects caught in the glare of this intense lighting took on a harsh, bleached aspect, leaping forward within the viewer’s depth of field, and casting the pathological body into stark, high-contrast relief (Platel, 1878: 386). This use of light within the lectures also worked to assimilate the living, moving body represented on stage with the various other representations which Charcot integrated into his demonstrations, such as sculptures or slides and photographs brightly cast on a screen using an early electronic projection system (Gilles de la Tourette, 1893: 248). Georges Guillain, a later successor to Charcot, summarised the neurologist’s innovative use of audiovisual dramaturgy as follows:

Charcot thus framed and disseminated medical knowledge through dramaturgical performances, which were, in turn, imperfectly represented within the published lectures and photographs. The Iconographie photographique de la Salpêtrière in particular resembled a flip-book of predominantly sequential images taken from the complicated fits exhibited by partial epileptics, full epileptics and hysterioepileptics. The layout of these materials closely reflected the development of “chronophotography” or stop-motion cinematography by Charcot’s major collaborators Albert Londe, Paul Richer, and Étienne-Jules Marey (see Dagognet (1992)). Charcot’s work shared with theatre, dance and cinema not only a fascination with the body in movement. His practice also reflected a more subterranean concern of theatrical performance: that of the body in pain.

Both literal pain and its indirect manifestation through other forms of suffering constituted a basic characteristic of disease. Pain however—like movement—had particular significance for neurology. Pain in and of itself, its autonomous generation within the tissues of the nervous system, marked and helped identify different forms of neuropathology. Pain in this context could represent actual degeneration or harm caused to non-nervous tissues, such as in the paralytic deformations and breaks of the limbs found in the condition which still bears the neurologist’s name, Charcot’s joints. Pain could also, though, be purely neurological, its very existence indicative of dysfunction specifically located within nervous tissue itself. While certain conditions were defined predominantly by a reduction in sensitivity to pain, other disorders were characterised by hyper-sensitivity to pain.

This complicated wax and wane of pain provided one of the key diagnostic issues for the illnesses which Charcot helped to define. This challenge presented by the pathological body was particularly pronounced in the case of hysterioepilepsy. Charcot’s work in the field of hysteria has received exhaustive treatment in the historiography—an emphasis which is not entirely justified by the subject’s place within the neuropathologist’s practice. Hysterioepilepsy was nevertheless one of the most important diseases which Charcot investigated and it was certainly the one which drew the greatest attention from non-medical audiences. Unlike Freud’s later patients, Charcot’s subjects were almost entirely lower class women, many of whom had spent a considerable period of their lives in paid employment before their internment at the Salpêtrière. Although Charcot’s most famous demonstration subjects tended to be younger, more charismatic patients, women forty years and over were nevertheless statistically dominant amongst the hysterical population overall.

Charcot himself saw hysterioepilepsy as an essentially physical illness with secondary psychological symptoms, unlike both the ‘moral therapists’ who proceeded him (such as the Salpêtrière’s Philippe Pinel or Jean-Étienne Dominique Esquirol) and the psychologists who succeeded him (Freud or Pierre Janet, both of whom studied under Charcot). Charcot’s neologism of hysterioepilepsy reflected this emphasis on physiological attributes, in which the primary diagnostic feature of this disorder was the exhibition of complicated, systematic fitting “la grande attaque de la hystérie.”

Charcot did not, moreover, see any necessary connection between hysterical sexuality or gender and the disease itself. He insisted that hysteria could affect individuals as diverse as elderly female domestics and vigorous young male railway workers. Although unconventional sexual behaviours or delusions were extremely common amongst Charcot’s patients, this was seen by the neurologist as an essentially secondary and somewhat arbitrary symptom of hysterioepileptic psychophysiology (see also Micale (1990: 34 & 1991)).

The hysterical body was, in Charcot’s construction, one profoundly disordered in its performative manifestation of life processes. The neurologist’s interest in the disease was partly prompted by the fact that hysterioepilepsy was resistant to the anatomoclinical method which he had so successfully employed in other contexts. He claimed on more than one occasion that, together with paralysis agitans:

Charcot’s approach to hysterioepilepsy should not, however, be seen as distinct from the rest of the neuropathologist’s practice. Charcot adapted and extended here the same anatomoclinical procedures which he applied in other contexts. Throughout, Charcot attempted to map in an ever more precise way the physiological behaviours of the living body onto their origins in the palpable structures of the tissues. This applied to almost all areas of psychophysiology. Charcot hoped, for example, to go beyond even Paul Broca in identifying not just the area within the brain which was responsible for language functions (as Broca had done), but also to find those distinct subdivisions which governed the separate comprehension of heard speech, spoken language, and reading and writing (1888-1894, vol. 3, pp. 154-191 & vol. 12, pp. 258-283). In such a fashion, the neurologist hoped to relate everything, from the acquisition of language to the choreography of epilepsy, to their localised sources in the body. The over-riding principle of Charcot’s practice was therefore involving the somatic localisation of that which was, in many cases, paradoxically manifest through movement within the body or through other intangible, mobile characteristics of the organism such as pain.

This partly explains why Charcot retained within his own methodology one of most ancient proofs of Catholic inquisitorial practice: that of the needle test. Even in non-hysterical cases, Charcot frequently applied a needle to the skin or a probe to the soft tissues of mouth, vagina and rectum, in order to map the degree of sensitivity to pain and other stimuli. In the case of hysterioepilepsy however the needle test not only served to help establish the identity of the disorder, but the representational nature of the condition itself.

The Salpêtrière school’s definition of hysterioepilepsy was developed partly for polemical purposes, bolstering the largely positivist, Republican medical profession in countering the influence of Catholicism in both medicine and in public life generally (Goldstein, 1987). Charcot’s senior collaborator, editor and publisher, Désiré Magloire-Bourneville championed the replacement of untrained religious sisters by medically-trained lay professionals at all state-run medical institutions. The Salpêtrière school also challenged the authority of nineteenth century miracle sites, like the relatively new Lourdes—though Charcot himself appears to have tolerated appeals to the faith of devout believers where he felt this could have alleviated otherwise chronic cases (Micale, 1995: 263-279).

Catholic inquisitors had formerly pricked their charges in order to determine the reality or otherwise of the subject’s demonological possession. In an essentially scientific fashion, inquisitors determined that possession was ‘real’—that is to say, attributable to demonic causes—if the subject proved to be impervious to pain or did not bleed. Neither natural causes nor simulation on the part of subject were deemed to be able to generate such responses, which were therefore the product of either demonological or divine forces. Charcot’s use of the needle test in cases of hysterioepilepsy, however, constituted a strategic inversion of the logic of this proof. Charcot and his associates contended that the natural, non-demonological condition of hysterioepilepsy was itself characterised by physiologically ‘real’ anaesthesia. The needle test here functioned not only to discount Catholic doctrine by demonstrating the apparent banality of such allegedly unnatural responses, but also to prove that hysterioepilepsy was itself ‘real’ and not the product of simulation. In both cases, anaesthesia or the absence of pain was used to performatively exhibit an absence of simulation or performative falsehood. Pain in the neuropathological body could therefore both demonstrate representational reality (fitting, general symptoms, etc) and unreality (imperfect simulation of anaesthesia).

Hysterioepilepsy thus constituted an intensification or heightening of Charcot’s general demonstrative and diagnostic principles. Charcot conceded that such “Sphinx”-like diseases as hysteria remained problematic within the materialist medical nosology which he had developed because of the lack of any clearly identifiable causative lesion with which disease behaviour could be associated. The neurologist nevertheless insisted that eventually the specific, somatic dysfunction of the tissues responsible would be identified in each case. Charcot was indeed confirmed in his assumptions in several instances during the years following his death.

In the meantime, Charcot deductively applied those definitive neurophysiological associations, which had already been made to such other situations as hysterioepilepsy, the latter having so far appeared devoid of determinate postmortem clinical signs. The ‘reality’ of such conditions was therefore both problematic and conditional, as they lacked the fixed, incontrovertible evidence of postmortem signs which had become the standard of nosological authority during the late nineteenth century. Charcot indeed described hysterioepilepsy as “that great simulator,” noting that an appropriate alternate title for the disease was “neuromimesis” (1888-1894, vol. 13, p. 489 & vol. 3, p. 16). Hysterical and other post-traumatic conditions closely resembled many other illnesses caused by substantive neurophysiological damage. In the case of hysterioepilepsy however, this damage was purely functional. Hysterical manifestations of paralysis, for example, was typically caused by a “localised shock. Most often, the contusion … provokes the idea” and the sensation ”of heaviness, of powerlessness, sometimes [of] the absence of the limb as well” (1888-1894, vol. 12, p. 383).

Hysterioepilepsy was therefore functionally equivalent to hypnotic suggestion. Indeed, Charcot and his associates contended that only those predisposed to hysteria could in fact be hypnotised. Hysterioepilepsy as a disease was therefore inextricably associated with art and representation, the hysterical neurophysiology functioning as a fleshy machine for the generation of deceptive representations and performances of other, somatic illnesses. Charcot claimed, for example, that the neurophysiological hyper-responsiveness of lethargy meant that it “became possible” for him “to experimentally intervene in cases of this type,” creating “in all its simplicity, the machine man dreamed of by la Mettrie, which we [now] have before our eyes” (1888-1894, vol. 3, pp. 336-337). External manual or electrical stimulation of the muscles and tendons of such subjects enabled Charcot and his assistants to generate various “plastic poses” in their demonstrations (1888-1894, vol. 9, p. 399). Through such techniques, Charcot could produce at will performances of experimental paralyses in hysterioepileptic hypnotic subjects, whose symptoms he could then remove with a counter-suggestion. He opined on one occasion, for example, that hysterics had both “the taste and the aptitude for simulation” (1888-1894, vol. 9, p. 224).

Charcot’s clinical lectures thus consisted of a wealth of differential diagnoses in which the neuropathologist isolated the original organic illness which had caused this underlying degenerative physiology to become manifest. Summarising the Salpêtrière school’s characterisation of hysterioepilepsy, Paul Richer described hysteria as a veritable:

The Tuesday Lectures, for example, dryly recorded that, during one lecture of 1888, Charcot said: “(To the patient): Give me your left arm. (Using a pin, M. CHARCOT pricks at different points the arm and the hand…).” Charcot followed this performance with another test, explaining to the audience as he did so that: “You see that I am pulling the patient’s finger, even a little brutally perhaps, without her suffering at all [sans qu’elle éprouve rien]…” Turning to his subject, he asked: “What am I doing to you?” She replied: “I feel nothing”” (1888-1894, vol. 12, pp. 225-227). The reality and authority of Charcot’s lecture demonstrations was largely guaranteed by the fact that they unfolded in real time before the audience.

In light of these contradictions enfolded within Charcot’s pedagogic and diagnostic method, one can appreciate the sense of horror, titillation, and wonder which drew such spectators as authors and playwrights Léon and Alphonse Daudet, Paul Arène, Émile Zola, Guy de Maupassant and Edmond de Goncourt as well as Hippolyte Taine, Emile Durkheim, Henri Bergson and others—not excluding the many physicians who always comprised the chief, intended audience of Charcot’s performances. Power and pain, diagnosis and implicit sadism, embodiment and psychology, body and spectacle, all danced within the multiple allusions which Charcot’s presentations evoked, often overcoming the own neuropathologist’s attempt to banish such allusions through his systematic framing and his self-conscious use of dry, almost boring scientific language.

For all of Charcot’s laboured attempts to dramaturgically render the victory of materialist science over superstition, mysticism and religion, the melodramatic subject matter of his displays frequently overwhelmed his own cool, rational analytic exegesis. This was particularly true of hysterioepilepsy. By merit of hysteria’s highly various psychological and physical manifestations, the great variety of physical poses within the choreography of fitting which Charcot and Richer endeavoured to fully describe, and the sheer imaginative excess of the hallucinations exhibited by the patients in the final stages of any single attack, hysterioepilepsy became, in the words of Georges Didi-Huberman (1982: 4-5), an illness in which the suffering, pathological body “partakes of the prodigious…it surpasses the imagination, and even ‘all hope’… It is all there,” in these performances, “poses, crises, cries, ‘attitudes passionnelles [passionate attitudes],’ ‘crucifixions,’ ‘ecstasies,’ all the postures of delirium… theatrical qualities of bodies.”

The pained excess and indeterminacy of hysterioepileptic demonstration subjects could be seen, for example, in how they moved rapidly from violent, physical convulsions to beatific hallucinations of intimate, sexual and religious encounters with “a well-loved, imaginary being” (Richer, 1881: 206-207). After observing a young woman shifting with disconcerting speed between such psychophysical states of pain and pleasure, one reporter recorded that the patient “cries hot tears and laughs from time to time: she does not remember any more and she asks what are these pricks and lines which dot her arms” (X, 1885). The prominent female avant-garde poet and mystic, Berthe de Courrière, responded by comparing Charcot’s medical dramatisation of pain to both the violently repressive, inquisitorial Avignonese Pope as well as the Emperor Nero, claiming that Charcot had “invented scientific Sadism” (1893: 144-146), while an author from the radical, feminist La revue scientifique des femmes similarly argued that he practised:

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