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Thursday, April 16, 2015

The Discovery of the Unconscious By Henri F. Ellenberger (1970): Summary of Chapter Two

Chapter Two: The Emergence of Dynamic Psychiatry

1.     The emergence of dynamic psychiatry can be traced to the year 1775 when the physician Mesmer clashed with the exorcist Gassner. Father Johann Joseph Gassner (1727-1779) was a very famous healer and his exorcisms were carefully recorded. In 1774 he published a pamphlet explaining his method.
a.     There are two kinds of illnesses: natural ones which require a physician and preternatural ones (e.g. imitation of illness caused by devil, effect of sorcery, or diabolical possession)  which required exorcism. 
b.     He entreated the demon to manifest the symptoms of the disease. If the symptoms were produced he concluded that it was the work of the devil. If they were not produced he sent the patient to a physician.
2.     Gassner had many supporters but many adversaries as well. His opponents included Catholic and Protestant theologians but mainly representatives of the Enlightenment. There were inquiry commissions established to investigate his authenticity. One such commission invited a Dr. Mesmer, who had claimed to discover the new principle of "animal magnetism" which enabled him to perform cures. He was reportedly able to elicit in patience the appearance and disappearance of various symptoms. This was essentially Gassner's approach without the theological backdrop of exorcism. This demonstration essentially ended Gassner's career and began a new stage in the development of dynamic psychiatry.
3.     Franz Anton Mesmer (1734-1815) was forty-years old (1774) when he discovered his new treatment approach. He was working with a twenty-seven year old patient, Fraulein Oesterlin. He studied the periodicity of her symptoms and became able to predict their reoccurrence. At the time some English physicians were treating certain diseases with magnets. He attempted to provoke an artificial crises in his patient by means attaching magnets to her body. She reported that she felt a mysterious fluid running through her body and she was cured after several hours. He viewed the magnets on her body as an auxiliary means of reinforcing and directing his own innate magnetism. Hence the term "animal magnetism". Eventually he dispensed with the use of magnets.
4.     Using this method he was able to affect many marvelous cures and gained fame and high acclaim. He was nevertheless met with resistance from the medical establishment in Vienna. He moved to Paris where he privately magnetized patients.  There, in 1779, he expounded his system of healing, which can be summarized as follows:
a.     A subtle physical fluid fills the universe and forms a connecting medium between man, earth, the heavenly bodies and between man and man.
b.     Disease originates from the unequal distribution of this fluid in the human body; recovery is achieved when the equilibrium is restored
c.     With the help of certain techniques, this fluid can be channeled, stored and conveyed to other persons
d.     In this manner, "crises" can be provoked in patients and diseases cured
5.     While Mesmer's private practice thrived and he established a society and disciples to spread  his teachings he was never accepted in the scientific and medical world. Like Gassner, commissions consisting of world-class scientists and personalities (one included Benjamin Franklin) were formed to investigate Mesmer's theory. Possible therapeutic effects were not denied, but were ascribed to "imagination," not a mysterious physical fluid. Mesmer was also disturbed by his disciples developing magnetism in ways that he did not intend. Mesmer was an extremely charismatic and authoritative personality who was convinced of the epoch importance of his discovery and sought to control his "intellectual property" [compare to Freud].
6.     Although Animal Magnetism seems world away from dynamic psychiatry, there are many similarities:
a.     The therapeutic agent of the cures is the magnetizer himself
b.     To make healing possible the magnetizer must establish "rapport," a tuning-in with his patient
c.     Healing occurs through crises — manifestation of latent diseases produced artificially by the magnetizer
d.     It is better to produce several weaker ones than one severe crises
7.     Mesmer's most important disciple was Marquis de Puységur (1751-1825). One of his first patients was a 23 year old peasant by the name of Victor Race. Victor was suffering from a mild respiratory disease and Puységur magnetized him. Unlike Mesmer's patients he did not have convulsions or disorderly movements. Rather, he fell into a deep sleep in which he appeared to be more awake and higher functioning than his normal waking state. Puységur found that while in this state Victor was able to diagnose his disease, foresee its course and prescribe treatments. Upon awaking from this state of  "perfect crises" the patient did not remember it. Demand for Puységur's treatment was so great that he organized collective treatment around magnetized trees. It was reported that within one month he cured 62 out of 300 patients using his collective treatment. Puységur organized a society in Strasbourg to train magnetizers, which was successful, and they published case histories.
8.     Based on his clinical experience Puységur conceptually diverged from Mesmer:
a.     Most important, Puységur rejected Mesmer's "physical fluid theory" and adopted a psychological theory. The primary agent of magnetism was the magnetism's commands
b.     He also simplified Mesmer's techniques
c.     The "perfect crises" seemed remarkably similar to "somnambulism" and was thus called "artificial somnambulism". Later this would be renamed "hypnotism"
d.     Patients, like Victor, would be more comfortable telling secrets when in magnetic sleep
9.     Charles Richet considered Puységur the true founder of Mesmerism and stated that the "new" discoveries in hypnosis in the mid-to-late 19th century was already contained in Puységur's writings. Following Puységur, around 1812, new concepts and methods were introduced to magnetism.
a.     Abbé Faria, a Portuguese priest who came from India, taught that certain individuals were more susceptible to magnetization. His technique consisted of seating his patients in a comfortable chair and fixate on his raised hand after which he commanded "sleep!" Once the patients were in a magnetic sleep he would produce visions in them as well as posthypnotic suggestions. Janet viewed Faria as the ancestor of the Nancy school (see below)
b.     Deleuze was successful in spreading magnetism in France. He published a textbook on the subject and warned against potential dangers. Alexandre Betrand sought to study magnetism in a scientific manner and convinced Noizet of the fallacy of the fluidist theory of magnetism. They both emphasized that the human mind conceives of thoughts of which we are unaware and which can only be recognized through their effects. Other French students of magnetism (Charpignon, Teste, Gauthier, Lafontaine, Despine, Dupotet, Durand) emphasized the role of rapport — the reciprocal influence between the magnetizer and the patient — as the central component in magnetism. Despite the clinical experience and scientific approach used by these magnetizers, the French scientific authorities did not accept magnetism. 
10. The situation in Germany was quite different. The German mesmerists included men of intellectual distinction. The German Romanticists were attracted to Mesmer's theory of a universal fluid since they viewed the world as a living organism. They were also excited about the "sixth sense" or extra-lucidity of magnetic somnambulism since it provided a way for the human mind to communicate with the World Soul. Thus, magnetism, for the Germans, was experimental metaphysics.
a.     Kluge, in his textbook on animal magnetism, proposed a phenomenology of magnetic somnambulism, including six degrees: 1) The Waking State, with a sensation of warmth, 2) Half-sleep, 3) Inner Darkness, referring to sleep and insensitivity, 4) Inner Clarity, which includes lucid perception and consciousness of one's body, 5) Self-contemplation, where the patient is able to perceive with greater accuracy the interior of one's own body and that of those with whom he is put into rapport, and 6) Universal Clarity, where the veils of time and space are removed. There were many extraordinary subjects in Germany during this time who displayed paranormal phenomenon. Among the most famous were Katharina Emmerich and Friedericke Hauffe. The latter was made famous by the poet-physician Justinius Kerner (incidentally, who also influenced the Rorschach tests) and aroused enormous interest among the German elite (e.g. Shelling and Schleiermacher) and masses.
11. Magnetism was met with resistance in England until 1840-1850. It reached the United States early on through the French city of New Orleans. One American adherent, Phineas Parkhurst Quimby, understood that the true agent of healing was suggestion and practiced "mind cure." One of his patients, Mary Baker Eddy, became the founder of Christian Science.
12. The history of Magnetism went through successive stages of positive and negative phases. The first phase took place during Mesmer's activity in Paris from 1777-1785). The second phase began in 1815 into the early 1820's. The third phase was from 1840-1850. Braid coined the term "hypnosis" in 1843. Following 1850 Positivism and scientific rationalism dominated and Magnetism fell into disrepute. Between 1860-1880 a physician would end his career by openly practicing magnetism and hypnosis.
13. At the same time, though, there was a huge interest in Spiritism and parapsychology, beginning in the 1850's and continuing to the end of the century (the Society for Psychical Research was founded in 1882 by Fredrick Myers and Edmund Gurney, in England). The study of mediumship led to new techniques with which to study the unconscious (e.g. automatic writing, divining rods).
14. Auguste Ambroise Liébeault (1823-1904) was among the few physicians who openly hypnotized patients during this time. He lived near the city of Nancy and his school of therapy was known as the Nancy School. He maintained that hypnotic sleep is no different than normal sleep except that the former is induced by suggestion of the hypnotizer. His method of inducing hypnotic sleep was to look into the eyes of the patient while suggesting that he was getting sleepy. While hypnotized he would suggest that the patient was cured of his symptoms. Although tales of medical miracles circulated, Liébeault was considered a quack by the medical establishment. This changed when Hippolyte Bernheim (1840-1919), a renowned professor who lived in Nancy, met Liébeault in 1882. He viewed himself as Liébeault's pupil and friend and introduced his ideas and methods to the medical world. In 1886 he published a textbook on hypnosis.
a.     Bernheim believed that hypnosis was easier to induce in people who are used to passive obedience. He had poorer results with people of the upper class.
b.     Bernheim maintained that hypnosis was the product of suggestion. He defined suggestion as "the aptitude to transform an idea into an act."
c.     Unlike Liébeault, Bernheim only utilized hypnosis when he thought it had a good chance of success. Eventually, Bernheim limited his use of hypnosis and maintained that the same effects could generally obtained by suggestion in the waking state. This was called "psychotherapeutics" by the Nancy School.
15. The Nancy School consisted of a loose group of psychiatrists and it had a vast international influence (e.g. Mortin Prince in America). By 1900 Bernheim was considered by many to be Europe's greatest psychotherapist (but by 1910 he was almost forgotten). Among those who visited Bernheim and Liébeault were Auguste Forel, who was the director of the Burghölzli mental hospital (where Jung would work for nine years) and Freud. Freud was particularly interested in Bernheim's belief that posthypnotic amnesia was not as complete as assumed and the patient could remember what occurred during hypnosis.
16. However, Bernheim's assertion that hypnosis was not a pathological condition unique to hysterics was the cause of a long struggle between himself and the greatest neurologist of the time, Jean-Martin Charcot (1835-1893). Bernheim also denied Charcot's theory of hysteria.

17. Charcot was the chief physician of the massive Salpêtriére hospital. The hospital houses four to five thousand women. In the years 1862-1870 he made the discoveries that made him the foremost neurologist of his time. However, beginning in 1870 Charcot began investigating hysterical patients who, like epileptic patients, displayed convulsions. He gave a description of a full-blown hysterical crises (grande hystérie) which will be described in detail later.  In 1878 he began exploring hypnosis and experimented with hysterical patients. He found that they developed the hypnotic condition through three stages of "lethargy," "catalepsy," and "somnambulism." Charcot read his findings in 1882 to the Académie des Sciences, giving hypnotism a new prominence in the established scientific world. However, Bernheim and Janet disputed the three stages of hypnosis. In 1884-5 Charcot investigated traumatic paralyses, which he replicated using hypnosis. Thus, Charcot grouped hysterical, post traumatic and hypnotic paralyses under "dynamic paralyses" as opposed to "organic paralyses." Likewise, in 1892 he distinguished "dynamic amnesia" from "organic amnesia." Charcot as nicknamed "Napoleon of Neuroses" and his public lectures attracted laymen, physicians and foreign visitors (included Sigmund Frued between 1885-6).  

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