From Alienism to the Birth of Modern Psychiatry: A Neurological Story?

Abstract

The interactions between developing neurology and psychiatry in Paris are of interest, in a city which was the main center for studies on the nervous system and its disorders during the nineteenth century. Contrary to a common view, and in spite of an established tradition for mental diseases, emerging neurology had a much stronger influence on psychiatry (‘alienism’) than the reverse. This was largely due to the school built up by Jean-Martin Charcot, which was organized around the study and management of hysteria. Although Charcot himself always claimed his disinterest in mental medicine, he stimulated the development of an original scientific approach to nervous system conditions, along with a structured academic teaching, while alienism paradoxically remained stuck in organicism, after Antoine Bayle’s report in 1822 of ‘arachnitis’ as the substratum of general paresis of the insane. Contrary to alienism, the young neurological school was able of self-criticism, and progressively underscored mental factors in hysteria. This led to the paradox that neurologists were active in a disease with a recognized lack of organic lesion, while alienists were postulating brain lesions in all mental disorders. The neurological activity thus indirectly and involuntarily led to the first developments of psychodynamic concepts in mental diseases. The academic evolution led to the launch of a faculty chair of mental and brain diseases in 1875, which was taken over for nearly half a century by direct pupils of Charcot: Benjamin Ball, Alix Joffroy, and Gilbert Ballet held the position until 1916, supporting the development of modern psychiatry in general hospitals, while alienism progressively disappeared at the turn of the century.

Historical sketches of the beginnings of the academic "Mental and Nervous Diseases" in Brazil, and European influences

“…A chair of Clinical Diseases of the Nervous System (1882) was established at the School of Medicine in Paris and occupied by Charcot. Previously (1875), a chair for Clinic of Mental Illness and Diseases of the Brain was devised, in the same School of Medicine, under Charcot's influence 1 . However, the unity of Charcot's School took place around the study of hysteria, as hysterical women with somatic manifestations were commonly admitted to La Salpêtrière.…”

“…Conversely, the influent School lead by Wilhelm Griesinger (1817-1868) carried out research based on anatomoclinical method [2][3][4][5] . Moreover, another group guided by Benedict-Augustin Morel (1809-1873) combined anatomoclinical (not obvious anatomical lesion) and philosophical methods to propose a degenerative theory for mental disorders 1,3 . The proximity of neurologists and modern psychiatrists led to the emergence of "neuropsychiatrists" from the nineteenth century until at least two-thirds of the twentieth century 1 .…”

“…Moreover, another group guided by Benedict-Augustin Morel (1809-1873) combined anatomoclinical (not obvious anatomical lesion) and philosophical methods to propose a degenerative theory for mental disorders 1,3 . The proximity of neurologists and modern psychiatrists led to the emergence of "neuropsychiatrists" from the nineteenth century until at least two-thirds of the twentieth century 1 . At the beginning of the twentieth century, Sigmund Freud (1856-1939) promoted the theory of psychoanalysis and helped to define the modern concept of neurosis 2 .…”

“…However, on academic grounds as a chair, it was linked to psychiatry. Antonio Austregesilo Rodrigues de Lima, the first to hold a chair of neurology in Brazil, was strongly attached to the Brazilian psychiatric school 8 , in opposition to Charcot who had absolutely no connection with mental alienation ("psychiatry") tradition and school 1 . Despite their different profile, the "neurological-looking" clinical manifestations of the hysterical patients impressed Charcot 1 and, in the same way, Austregesilo.…”

Alfred Vulpian and Jean-Martin Charcot in Each Other’s Shadow? From Castor and Pollux at La Salpêtrière to Neurology Forever

“…1) is considered the father of modern neurology [1] as well as the main instigator of the evolution of alienism into modern psychiatry [2]. His lifelong best friend in the field of medicine was (Edmé Félix) Alfred Vulpian (1826–1887; fig.…”