4.4IdentifyingSymptom-RelatedAlterationsintheIntrinsic DynamicOrganisationofHysteriaPatients’Brains ....................................... 494
Introduction
Inearly2011,whilebrowsingtheinternet,Iaccidentallycameacrosstheonlineversion ofa NewYorkTimes articletitled“IsHysteriaReal?BrainImagesSayYes.”1 Atthatpoint, Itooheldtheviewthatcontinuestodominatethehumanitiesliterature.Accordingto thisview,hysteriawas“writtenoutofcurrentmedicine”duringthetwentiethcentury.2 Itthushadno“placeintheseriousreachesofcontemporaryscience.”3 ButErikaKinetz, theauthorofthearticlepublishedinSeptember2006,challengedthiswidelyaccepted view,claiminginsteadthathysteriawasstillamongus.Importantly,Kinetzpointed outalargelyneglectedfact—sincetheturnofthetwenty-firstcentury,therehasbeena resurgenceofmedicalstudiesthatuseimagestoinvestigatehysteria.Yet,interestingly enough,inthehumanities,theoldimageofhysteria,whichseesthisage-oldillness asameremyth,stillholds.Forexample,writingin2004,thearthistorianAmanda duPreezhasarguedthathysteria“manifestsexclusivelythroughvisualappearances andimagesandisreproducedinimitationsandrepresentations.Sinceitsaetiologyis fantasmatic,hysteriahasnoanatomicalorcorporealbasis.Asaresult,thecondition canbedescribedasasimulacrumofsymptoms.”4 Bycontrast,Kinetzofferedadifferent takeonhysteria.
Beforedevelopingthemainpointofherarticle,Kinetzsketchedaconcisemedical historyofhysteria.Shetoucheduponhysteria’soriginsinancientEgyptandGreeceas afemalemaladyattributedtoamisplacedwomb,abeliefthatbecameinscribedinto thedisorder’sveryname(i.e., hystera inGreekmeansuterus).Shethenemphasised theidentificationofthisdisorderwithdemonicpossessionduringtheMiddleAges. Afterthat,Kinetzforegroundedthescientificcontributionsofthenineteenth-century FrenchneurologistJean-MartinCharcotandhistwopupils,PierreJanetand“the now-unfashionable”Freud.5 Finally,shementionedthattheapparentdisappearance
1Kinetz,“IsHysteriaReal.”Accordingtothecommentatthebottomoftheonlinearticle,theprinted versionappearedintheNewYorkeditionof TheNewYorkTimes underthetitle“MindandBody.” Kinetz,n.p.Myfollowingdiscussionreferstotheonlineversionofthearticle.
2Hunter, FaceofMedicine,169.
3Kinetz,“IsHysteriaReal,”n.p.
4DuPreez,“PuttingonAppearances,”47.
5Kinetz,“IsHysteriaReal,”n.p.
ofhysteriahad“beenheralded”sincethe1960s.6 OnlyatthispointdidKinetzbeginto departfromthedominantnarrativeonhysteria.First,shequotedPatrikVuilleumier, aneurologistandneuroscientistattheUniversityofGeneve,whostatedthat,farfrom havingvanished,hystericalsymptoms“arestillcommonin[clinical]practice.”7 Kinetz thenreportedoncontemporaryresearcherswhohavestartedtousenovelfunctional neuroimagingtechnologiestovisualisehysteriapatients’brainactivity.Itisthesebrainimagingstudies,Kinetzsuggested,thathavestartedtoidentify“thephysicalevidence ofoneofthemostelusive,controversialandenduringillnesses.”8
Apartfrombeingaboutnewresearchintoadisorderthatmostpeoplebelieveno longerexists,fouraspectsofKinetz’sarticleareremarkable.First,untiltheendof 2019,Kinetz’swasoneofonlyahandfulofarticlesinthegeneralpresstomentionthe growingnumberoffunctionalneuroimagingstudiesonwhatpresent-dayresearchers claimarethesamehystericalsymptomsasinthenineteenthcentury.9 Searchingthe internet,Ihavemanagedtofindonlythreeotherarticlesthatdealtwiththistopicand wereaddressedtoageneralaudience.Theseappearedin TheTimes in2007, Newsweek in 2011,and Bloomberg in2014.10 Perhapsevenmoresurprisingly,notjustthegeneral pressbutalsotheacademicdiscussioninthehumanitiesandsocialscienceshave disregardedtheneuroimagingstudiesofcontemporarymanifestationsofhysteria.11 Consequently,theclaimsandimage-basedfindingsofthesestudieshaveremained confinedtoneuroscientificandneurologicalcirclesandalmostentirelydetachedfrom thebroaderpublicdiscourse.
Second,althoughthebrainimagesarementionedinthetitleandthusdeclared tobethetopicofthearticle,thereaderisleftinthedarkabouthowtheseimages look.Kinetzprovidednodescriptionofwhatexactlycanbeseenintheseimagesthat purportedly“enable[s]scientiststomonitorchangesinbrainactivity.”12 Arethesestatic ormovingimages?Aretheyblack-and-whiteorincolour?Dotheygiveresearchers real-time,near-instantaneousaccesstowhatisgoingoninthepatients’brains?Is thevisualisedbrainactivityimmediatelyrecognisableeventoanon-expert,ordoes workingwiththeseimagesrequireaspecialkindofvisualexpertise?Notonlydid allthesequestionsremainunaddressed,butthearticlealsodidnotincludeasingle reproductionofhysteriapatients’brainscans.Thiswasallthemoresurprisingsince
6Kinetz,n.p.
7Kinetz,n.p.
8Kinetz,n.p.
9See,e.g.,Bègueetal.“Metacognition,”251–52.
10SeeBee,“CalmDown”;Schwartz,“Hysteria”;andGale,“Freud’sHysteria.”Mysearchwaslimitedto English-speakingsourcesandgeneral-interestnewspapers.Ihave,therefore,disregardedseveral articlesthatappearedinpopularsciencemagazines,whichspecificallyaddressascientifically mindedaudience.
11OnerecentexceptionisanarticleauthoredbytheAmericannovelistandessayistSiriHustvedt. Interestingly,althoughthearticlewaswrittenfromthehumanitiesperspective,itwaspublished inamedicaljournal.SeeHustvedt,“IWeptforFourYears.”Seealsomyfiverecentlypublished articles:Muhr“EpistemicProductivity”;Muhr,“FramingtheHystericalBody”;Muhr,“Hypnotised Brain”;Muhr,“RecentTrajectory”;andMuhr,“DieUnsichtbarkeitenderHysterie.”
12Kinetz,“IsHysteriaReal,”n.p.
Kinetzclaimedthatbrainscansofferedphysicalevidencefortherealityofthiselusive disorder.Kinetzremainedtacitabouttheomissionofbrainimagesfromherarticle, whichwecanonlypresumewasdeliberate.If,forwhateverreason,shechosenotto illustratetheimagesshewaswritingabout,whynotatleastexplainherdecisiontothe reader?Couldthereasonforherdecisionnottoincludebrainscansinherarticlebe thattheevidentialstatus,whichsheattributedtotheseimages,wasnotimmediately apparenttoanon-expertviewer?
Third,andevenmorecuriously,theillustrationplacedprominentlyatthetopof theonlineversionofthe NewYorkTimes articlewasaslightlycroppedreproductionofa paintingbyAndréBrouillet,titled UneleçoncliniqueàlaSalpêtrière.Thispainting,initially unveiledatthe1887SaloninParis,depictsthenineteenth-centuryFrenchneurologist Jean-MartinCharcotholdingaclinicallectureonhysteriaathisfamousParisian hospitallaSalpêtrière.ThemedicalhistorianMarkS.Micalefittinglydubbedthis image“themostfamousiconinthehistoryofhysteria.”13 Whatundoubtedlyfurther reinforcedtheiconicstatusofBrouillet’spaintingisthatadownsizedlithographic reproductionofithungfamouslyinFreud’sconsultingroom,firstinViennaandthen inLondon.14
Paintedinthetraditionofmonumentalgroupportraits, Uneleçoncliniqueàla Salpêtrière showsCharcotandaswooningfemalehysteriapatientsurroundedbyalarge entourageofmedical,artistic,andpoliticalluminariesofthetime,allofwhomwere men.15 TheexplicitintentionbehindBrouillet’spaintingwastocreate“aneloquent symbolofCharcot’spromotionoftheSalpêtrièreschool.”16 Atthatpoint,theschool’s highlypublicisedresearchonhysteria,whichreliedontheextensiveuseofphotography andothernovelvisualisationmethods,reachedalevelofinternationalfamethat turneditinto“amedical-culturalphenomenon.”17 Uneleçonclinique was“aproductof hysteria’sheyday,”18 capturinginintentionallyheroicvisualtermsthemomentwhen thisdisorderreachedtheapexofitsmedicalandculturalvisibility.Yet,inthecourseof thetwentiethcentury,theintendedheroicmeaningofthispaintinggraduallyeroded andwasdisplacedbyafarlessflatteringone.
Inparticular,sincethe1980s,followingthepublicationoftheFrencharthistorian Didi-Huberman’sinfluentialbook InventionofHysteria,acontinuallygrowingnumberof
13Micale, HystericalMen,2.
14Fordetailsaboutthishanging,seeMorlock,“PrimalScene,”130–31,140–44.
15Apartfromthepatient,theonlyotherfemalefiguresinthepaintingweretwonurses.Although theclinicallessondepictedinthepaintingwasnotareproductionofanactualevent,allthe individualsrepresentedinthisfictionalgroupingwerewell-knownhistoricalpersonalities,who wererecognisabletothevisitorsofthe1887Salon.Forthepainting’sfavourablecriticalreception attheSalon,seeHunter, FaceofMedicine,166–67,177.Fortheexhaustivelistoftheindividuals depictedinthepainting,seeGoetz,Bonduelle,andGelfand, Charcot,92–93.Forasuccinctaccount of Uneleçonclinique’sindebtednesstothegenresofportraitureandhistorypainting,seeMorlock, “PrimalScene,”134–35.Foramoredetailedaccountonthistopic,seeHunter, FaceofMedicine
16Goetz,Bonduelle,andGelfand, Charcot, 238.
17Goetz,Bonduelle,andGelfand,239.Interestingly,thepaintingwasneithercommissionednor boughtbyCharcot.Hunter, FaceofMedicine,177.
18Hunter, FaceofMedicine,167.
humanities-basedstudieshaveemergedthatcriticallydiscussCharcot’simage-based hysteriaresearch.19 ThebroadconsensusisthatCharcotunscientificallyusedimages toillustratehispre-existing,biasedviewsofhysteria,notsomuchinvestigatingbut insteadinventingthisdisorder.InthecontextofthiscriticalreappraisalofCharcot’s work,Brouillet’spaintinghasacquiredanewmeaning.Inpresent-daypublications, thispaintingistypicallyusedtoillustratetheclaimsthatCharcotandhisteamhad fraudulentlytrainedtheirfemalepatients“howtoappearasahysteric.”20 Forexample, thisviewwasemphaticallyexpressedbythearthistorianSigridSchade:“Hysteriahad thecharacterofanimaginaryfigurativecontract:thedoctor’sinterestinthepatient wasmaintainedaslongassheperformedtheexpectedalphabetofpassionategestures withherbody.”21 Hence,Brouillet’sdepictionofCharcot’sclinicallessonhasbeen reinterpretedintoasymbolofunscientificuseofimagesinhysteriaresearch.
Itisbewilderingthat,inherarticle,Kinetzmadenomentionofthecurrentcriticism levelledatCharcot’sresearch.Instead,inthecaptionaccompanyingthereproduction ofBrouillet’spainting,shestatedthatCharcothad“helpedlaythegroundworkfor contemporaryresearch.”22 Giventhatshedidnotfurtherqualifythisstatement,it remainedunclearhowexactlysheregardedCharcot’shighlycontestedresearchtobe relatedtothepresent-dayneuroimagingstudiesofhysteria.Whatwasevenlessclear iswhetherKinetzwasoblivioustothecurrentnegativeconnotationsofBrouillet’s paintingandthegeneraldismissalofCharcot’sresearch,orif,forsomeundisclosed reasons,shechosetoignorethem.Ineachcase,her(orhereditor’s)decisiontousethe reproductionofBrouillet’spaintingtoillustratethearticlethatdiscussedneuroimaging studiesofhystericalsymptomsinexclusivelyfavourabletermsappearstomeill-advised andhighlyconfusing.ItisnotthelinkingbetweenCharcotandthecontemporary imagingstudiesthatIfindproblematic,butthatKinetzfailedtoeithercontextualise orexplainit.Asaresult,thosereadersofherarticlewhoarefamiliarwiththecritical literatureonCharcotmightdismisstheneuroimagingstudiesofhystericalsymptoms withoutanyfurtherthought.
Fourth,inadditiontoneithertellingnorshowingherreaderswhatfunctionalbrain imageslooklike,Kinetzalsoprovidedalmostnoinformationabouttheirexactrolein theneuroimagingstudiesofthepresent-dayhystericalsymptoms.Inavaguestatement thatobscuredmorethanitrevealedabouttheseimages,thereaderwasmerelytold thatthey“allowscientiststoseedisruptionsinbrainfunction.”23 Kinetzsimplyleft itatthat.Buthowexactlyisthis‘seeing’mediatedthroughbrainimages?Basedon whichoftheimages’visualfeaturescanscientistsrecognisewhatKinetzreferredto asthedisruptioninbrainfunction?Howmuchtimeandworkdoscientistshaveto putintotheprocessofproducingfunctionalbrainimages?Towhatextentistheimage productionautomatedandatwhichpointscanscientistsinfluencethisprocessthrough
19Didi-Huberman, InventionofHysteria.Seealso,e.g.,Borch-Jacobsen, MakingMindsandMadness; Bronfen, KnottedSubject;Gilman,“ImageoftheHysteric”;andShowalter, FemaleMalady
20Gilman,“ImageoftheHysteric,”346.
21Schade,“CharcotandtheSpectacle,”509.
22Kinetz,“IsHysteriaReal,”n.p.
23Kinetz,n.p.
theirdecisions?Whatisthenatureofthereferentialrelationshipbetweentheseimages andtheactualactivebrains,basedonwhichscientistscanusetheimagestomake judgmentsaboutthepatients’brainfunction?Finally,arefunctionalbrainimagesmere illustrationsofexperimentalfindingsandthusextraneoustothem?Ordotheseimages playconstitutiverolesingeneratingpotentialinsightsintothepresumeddysfunction ofhysteriapatients’brains?
Kinetz’sarticle,tomyknowledge,wasthefirsttodrawthegeneralpublic’sattention tothearguablyimportantyetlargelyneglectedfunctionalneuroimagingstudiesof present-dayhystericalsymptoms.Yetitraisedmorequestionsthanitanswers.Taking thecuefromKinetz’sarticle,myenquiryinthisbooksetsouttoanswerthequestions Ihavelistedabove.Morespecifically,thisbookexamineshowdifferenttypesofimages wereusedinconcrete,historicallysituatedresearchpracticesinordertoproducenew medicalinsightsintohysteria.Throughout,Iwillanalysewhatkindsofinsightsinto hysteriawereproducedusingparticularimages,underwhichepistemicconditions, andwithwhichepistemicconsequencesforthebroadermedicaldiscourseonthis elusivedisorder.Consequently,thefocusofmyenquirywillnotbelimitedtofunctional neuroimagingstudiesbutwillalsoentailadetailedre-examinationofCharcot’simagebasedresearchintothisdisorder.
Mygoaltherebyistwofold.Ontheonehand,Iaimtodrawattentiontothe epistemicimportance,complexityandinnovativenessofthecurrentneuroimaging researchonhysteria,whichhasthusfarbeenunjustifiablyneglectedinthehumanities context.Iwillarguethatalthoughthisresearchisstillrelativelynew,ithas neverthelessalreadygeneratednewinsightsthataregraduallystartingtoreshape thecurrentmedicalunderstandingofcontemporarymanifestationsofhysteria.As such,neuroimagingresearchonhysteriadeservestobetakenseriously,andits epistemicimplicationsneedtobeanalysedindetail.Ontheotherhand,Iintend tochallengetheexceedinglynegativeimageofCharcot’shysteriaresearchthathas emergedfromthecontinuallygrowinghumanitiesscholarshiponthistopicoverthe lastfourdecades.24 Themajorityofthemostcriticalaccountshavefocusedexplicitly ondeconstructingwhathasbeensummarilydesignatedasCharcot’sunscientificuse ofimagesinhishysteriaresearch.25 Asopposedtothedominantview,Iwillargue thatfarfromenticinghispatientstoenacthisprefabricatedvisionofhysteria,Charcot
24See,e.g.,Baer, SpectralEvidence;Bronfen, KnottedSubject;Didi-Huberman, InventionofHysteria; duPreez,“PuttingonAppearances”;Gilman,“ImageoftheHysteric”;Gilman, SeeingtheInsane; Gunning,“InYourFace”;Harrington, CureWithin;Holl, Cinema,Trance,Cybernetics; Hunter, Face ofMedicine;Lamott, DievermesseneFrau;Marshall, PerformingNeurology;McCarren,“Symptomatic Act”;Rose, FieldofVision;Schade,“CharcotandtheSpectacle”;Scull, Hysteria;Shorter, FromParalysis toFatigue;andShowalter, FemaleMalady
25VeryfewanalysesofCharcot’shysteriaresearchlackovertlydismissiveovertones.See,e.g., GauchetandSwain, LevraiCharcot;Goetz,Bonduelle,andGelfand, Charcot;Micale“HysteriaMale/ HysteriaFemale”;andMicale, HystericalMen.Interestingly,onthewhole,thelesscriticalaccounts haveremainedconspicuouslytacitaboutCharcot’suseofimages.Someauthors,suchasMicale andGunthert,haveevenarguedthatphotographyandothervisualisationmethodshadafarless significantfunctioninCharcot’shysteriaresearchthansuggestedbymorecriticalstudies.See Micale,“HysteriaMale/HysteriaFemale,”229n16;andGunthert,“KlinikdesSehens,”27–31.
usedimagesasinvestigationtoolswithwhichhegeneratednewinsightsintothe neurologicalbasisofthisdisorder.Moreover,IwillshowthatsomeofCharcot’sinsights, whichwereconsiderederroneousformorethanacentury,arecurrentlyreceiving partialconfirmationthroughneuroimagingstudies.BothmyanalysisofCharcot’s andthepresent-dayneuroimagingresearchintohysteriawilldrawontheburgeoning humanitiesscholarshipthathighlightstheconstitutiverolesofimagesinproducing newscientificknowledge.26 Thisbookis,therefore,conceivedasaninterdisciplinary enquirysituatedattheintersectionofscienceandtechnologystudies(STS),historical epistemology,visualstudies,mediastudies,andhistoryofscienceandmedicine.
Duetothespecificfocusofmyenquiry,thoseperiodsinhysteria’slongmedical historyinwhichimageswereofnosignificanceintheresearchcontextwillbemostly disregardedinmyenquiry.27 Forexample,despiteitsundeniableprominenceinthe generalhistoryofhysteria,Freud,whoseresearchwasdecisivelyinformedbytheuse ofspokenlanguage,willonlybemarginallyaddressedinthisbookandwithaparticular purpose.Specifically,IwillarguethatbychallengingCharcot’sviewsontheneurological natureofhystericalsymptoms,Freuddirectlycontributedtothepurgingofimages fromhysteriaresearchand,laterandmoreindirectly,totheapparentdisappearanceof thisdisorderasamedicalcategory.Hence,onlythoseaspectsofFreud’sengagement withhysteriathatwillhelpmemakethisargumentwillbediscussedinthisbook. Thisbringsustoahighlycontestedpointregardinghysteria’spresent-dayexistence asanactualmedicalcondition.Addressingthispointiscrucialformyenquiry.This isbecauseIamnotdealingherewithhysteriainthecolloquialsenseoftheword, asapejorativedesignationforemotionallyexcessivebehaviour,stillpredominantly attributedtowomen.Iamalsonotfocusinghereonhysteriaasabroadersociocultural phenomenonthat,assomefeministscholarshavesuggested,shouldbeunderstoodas asymbolicallyencodedenactmentofpersonaldiscontent.28 Instead,Iamenquiring intohowimageshavebeenusedasproductiveepistemictoolsinthecontextof systematicandsustainedmedicalresearchonhysteriawithinthelastthreedecades ofthenineteenthandthefirsttwodecadesofthetwenty-firstcenturies.Anattentive readermightaskatthispointhowsuchanenquiryisevenpossibleifhysteriaceased toexistasamedicalentitybeforethebeginningofthetwenty-firstcentury.
Admittedly,asIwilldiscussinchapter2,theterm‘hysteria’wasindeedexpunged fromtheofficialmedicalnosologyinthe1980sandreplacedbymultiplenewlabelsthat havebeenchangingeversince.Yet,notwithstandingthesestillongoingfluctuationsin terminology,whathasremainedconstantsincethenineteenthcenturyarethephysical characteristicsofthepatients’symptoms.This,atleast,iswhataconsiderablenumber
26See,e.g.,Alac, DigitalBrains;Beaulieu,“Notthe(Only)Truth”;DastonandGalison, Objectivity; Dumit, PicturingPersonhood;Krämer,“OperativeBildlichkeit”;Latour,“MoreManipulation”;Latour, “VisualizationandCognition”;Lynch,“RepresentationinFormation”;Mersch,“PictorialThinking”; andRheinberger, HistoryofEpistemicThings
27Forapertinentandsuccinctoverviewofhysteria’smedicalhistory,seeMicale, ApproachingHysteria, 19–29.
28SeeBronfen, KnottedSubject,xii–xiii,40–42.Similarly,JulietMitchellhasarguedthathysteria“is nolongeradisease,itisamodeofbehaviourandalifestory,”“aparticularresponsetoaspectsof thehumancondition.”Mitchell, MadMenandMedusas,17,19.
ofcontemporaryneurologistsargue,manyofwhomhaveauthoredthefunctional neuroimagingstudiesIwillanalyseindetailinchapters3and4.29 Inchapter2,I willdiscusstheevidenceputforthbytheseneurologiststosupporttheirargument thathystericalsymptomshaveremainedunchangedsincethenineteenthcentury.Yet alreadyatthispoint,itisimportanttoemphasisethatIhavenointentiontochallenge thisview.Firstofall,fromtheperspectiveofmyenquiry,itisnotsignificantifthis claimisvalidornot.Moreover,strictlyspeaking,duetothelackofmedicalexpertise andaccesstoactualpatients,Ihavenowayofdirectlytestingthevalidityofthis claim.Whatmatters,however,isthattheclaimofhysteria’scontinuedexistenceis explicitlyandrepeatedlyinvokedinthepresent-daymedicalcontext,particularlyinthe neuroimagingstudiesIwilldiscussinthecourseofthisenquiry.Hence,inthisbook, theviewthathysteriastillexistswillbetreatedasanaxiomaticclaimthatsubstantially informscurrentneuroimagingstudiesofthesesymptoms.
AnothercrucialpointisthatIhavechosentoretainthetermhysteriawhen referringnotonlytoCharcot’sresearchbutalsotothepresent-daystudies.Onthe onehand,Ihavedonethistoemphasisetheneuroimagingstudies’underlyingidea ofthehistoricalcontinuityofhystericalsymptoms.Ontheotherhand,inretaining theterm‘hysteria,’Iaimtoavoidtheterminologicalconfusionthathasdominatedthe currentresearchintothisdisorderduetothecontinuallyshiftingnomenclatureover thepasttwodecades.30 Myintentionisnottonaivelyimplytheexistenceofasingle, homogeneous,orhistoricallyunchangingdiseaseentity.Instead,Iusethetermhysteria asadescriptive,summarydesignationforasetofhighlyheterogeneoussymptomsthat wereoncethefocusofCharcot’simage-basedresearchandhavenowonceagainbecome theobjectoffunctionalneuroimagingstudies.Thesesymptomsincludelimbparalysis, convulsivefits,contractures,anaesthesia(i.e.,lossofsensitivity),pain,mutism,and disturbancesofvision.Whilemyuseofthetermforegroundstheassumedconstancy ofthesymptoms’physicalfeaturesacrosscenturies,itneverthelessacknowledgesthe undeniablehistoricalcontingencyandinstabilityofhysteriaasanosologicalcategory. Thisinstabilityisreflectedinhysteria’sshiftingdefinitions,diagnosticcriteria,and presumedaetiology,whichIwilldiscussinchapter2.Toputitmoreexplicitly,the viewthatwillunderpinmyanalysisinthisbookisthatwhiletheclinicalfeatures ofthesymptomsmayhaveremainedthesame,theirmedicalperceptionhasvaried considerablyacrossthespecifichistoricalperiodswewilldiscusshere.
Importantly,IshouldalsoaddthatIamwellawarethatmydecisiontocontinue tousethetermhysteriawhendiscussingcontemporarystudiesmightraiseafew eyebrows.Admittedly,thistermiscurrentlyviewedbymanyashavingpejorative connotations,mainlyduetoitsetymologicalassociationwiththefemalereproductive organ.BynomeansdoIwishtooffendanyofthesufferers.Yet,Iamunconvincedthat
29See,e.g.,Bègueetal.“Metacognition,”251–52;Vuilleumieretal.,“SensorimotorLoss,”1077–78;and Wegrzyketal.,“FunctionalConnectivity,”163.
30Forexample,duringthisperiod,thesamesymptomhasbeendesignatedacrossdifferent functionalneuroimagingstudiesashysterical,conversion,orfunctionalparalysis.Compare,e.g., Marshalletal.,“HystericalParalysis,”B1;deLange,Roelofs,andToni,“Self-Monitoring,”2051;and Diezetal.,“Fast-Tracking,”929.
itwouldbringmuchtoreverttoalternativetermscurrentlyusedinthemedicalcontext, suchasconversion,psychogenic,functional,somatoform,ormedicallyunexplained symptoms.31 First,asIwilldiscussinchapter2,noneofthesealternativelabels isneutral.Second,allthesealternativelabelstendtoobscureanddisownhysteria’s windinghistoryasanenduringmedicalmysterythathasmoreoftenthannotbeen moreorlessexplicitlyviewedaseitheranexclusivelyor,atleast,predominantlyfemale disorder.32 Ignoringthishistorydoesnotchangeit.
Havingsaidthis,however,myenquirywillhaveverylittletoaddtotherich scholarshipthathasexaminedtheundoubtedlysignificantroleofgenderinmedical researchonhysteria.33 Thereasonforthisisthatmyfocuslieselsewhere.WhenI examineCharcot’sresearchandthepresent-dayneuroimagingstudies,Iamprimarily concernedwithdiscussingtherolesofimagesinthemedicalinvestigationofhysteriaas aneurological,ormoreprecisely,brain-baseddisorder.ThismeansthatIamanalysing howparticularkindsofimagesareproduced,used,andinterpretedinthemedical contextwithadistinctaimofdirectlyorindirectlylinkinghysteriatoapotentialbrain dysfunction.Simplyput,myenquiryfocusesonthemedium-specificandepistemic aspectsofimage-basedhysteriaresearch.Fromthisparticularperspective,gender issuesneitherhadanypriorityforCharcot’shysteriaresearchnorhavetheybeen ofanyexplicitinteresttotheauthorsofthefunctionalneuroimagingstudiesatthe centreofmyenquiry.Admittedly,justasduringCharcot’stime,alsotoday,hysterical symptomscontinuetobediagnosedmoreofteninfemalethanmalepatients.34 Yet, thisdiagnosticprevalence,whichmaybeaninadvertentconsequenceofimplicitgender bias,remainswithoutanyaetiologicalexplanationandisnotatopicaddressedbythe functionalneuroimagingstudiesanalysedhere.Instead,asIwillshowinchapter3, thefunctionalneuroimagingresearchintohysteriawithinthefirsttwodecadesof thetwenty-firstcenturyhasbeeninformedbyatacitassumptionthatsharedneural mechanismsunderpinhystericalsymptomsinbothmenandwomen.Theverysame assumptionexplicitlyinformedCharcot’simage-basedhysteriaresearchmorethana centuryearlier.35 Forthesereasons,thisenquirywilllargelyignoregenderissues.36
31Iamconcernedwithherehowtodesignatethesymptomswhendiscussingtheminthe humanities-basedcontext.Idonotpresumetopossesstheauthoritytoinfluencehowthese symptomsshouldbenamedinthemedicalcontext.
32Forfeministaccountsofhysteria,see,e.g.,Bronfen, KnottedSubject;Evans, FitsandStarts;Mitchell, MadMenandMedusas;Showalter, FemaleMalady;Showalter,“Hysteria,Feminism,andGender”;and Smith-Rosenberg,“HystericalWoman.”
33Forasuccinctoverviewoffeministanalysesofhysteria,seeMicale, ApproachingHysteria,66–88. Ontheroleofthefemalegender,see,e.g.,Bronfen, KnottedSubject;Showalter, FemaleMalady;and Showalter,“Hysteria,Feminism,andGender.”Foradiscussionoftheconstructionandtreatmentof themalegenderinCharcot’shysteriaresearch,see,inparticular,Micale, HystericalMen;andMicale, “HysteriaintheMale.”ForcomparativeanalysesofthefemaleandmalegendersinCharcot’s research,seeGilman,“ImageoftheHysteric”;Holschbach,“K(l)eineDifferenzen”;andMicale “HysteriaMale/HysteriaFemale.”
34See,e.g.,APA, DSM-5,312.
35See,e.g.,Charcot,“Lecture18:SixCases,”220.
36However,thereareindicationsthat,inthenearfuture,gendermightbecomeatopicofconcernin functionalneuroimagingresearchonhysteria.Thisshiftisreflectedintwoperspectivearticles
Specifically,thisbookaimstoshowthatbothinCharcot’sresearchandthecurrent functionalneuroimagingstudies,images,thoughadmittedlyofverydifferentkinds, wereconstitutiveofproducingnewmedicalinsightsintohysteria.Whetherornotthese insightswithstood—orinthecaseofcurrentstudies,willwithstand—thetestoftime regardingtheirscientificvalidityisbesidethepointformyenquiry.Whatmattersis thattheseinsights,asIwillclaim,effectuatedshiftsinthemedicalunderstandingof hysteriaatthegivenhistoricalmomentsand,inCharcot’scase,alsohadadirectimpact onhowthesymptomswerediagnosedandtreated.Myaimisnotlimitedtomerely outliningtherespectivechangesintheunderstandingofhysteriainthelatenineteenth andearlytwenty-firstcenturies.Instead,Iammainlyinterestedinuncoveringhow theseshiftswerefacilitatedthroughtheuseofimages.Iwilltherebyarguethatin neitherofthesecontextswereimagesdeployedasmereillustrationsofscientific findings.Rather,imageswereandarebeingdeployedasactivetoolsforexploring hysteriapatients’bodiesandbrains,searchingfortheassumedneurophysiologicalbasis ofhystericalsymptoms.Moreover,Iwillalsoclaimthatbyproducing,manipulating, interactingwith,makingsenseof,andinterpretingimages,bothCharcotandthe authorsofcontemporaryneuroimagingstudieshavemanagedto,atleasttentatively, linktheelusivehystericalsymptomstoavisualisableandthusanalysabledysfunction ofthebrain.
Inthecourseofthisenquiry,wewillencounterawiderangeofdifferentkinds ofimages.Forexample,whenanalysingCharcot’simage-basedhysteriaresearch,we willdiscusshisuseofphotographs,sketches,schematicdrawings,synoptictables,selfinscribingcurves,linegraphs,andbodymaps.Wewillalsoexaminecontemporary neuroimagingstudiesandseethatso-calledfunctionalbrainmapscomprisean essentialpartofeachpublishedarticle.Suchmapsaretypicallyvisualisedascolourful blobssuperimposedeitherupongrey-scalebrainsectionsor3Dbrainrenderings.ButI willalsoshowthat,inadditiontobrainmaps,present-dayscientistsproduceandwork withahostofdifferentintermediaryimages.ForreasonsIwilldiscussinchapter3, suchintermediaryimagesremainconfinedtolaboratoryspacesandspecialistcircles andarethusunfamiliartonon-expertaudiences.Nevertheless,Iwillarguethatworking withsuchintermediaryimagescruciallyshapestheresearchprocess,bothfosteringand limitingthekindsofinsightsthatscientistscanproduceabouthystericalsymptoms whenusingfunctionalneuroimagingtechnologies.
Strictlyspeaking,myanalysiswillbelimitedtoimagesinthesenseofpurposemadevisualartefactsor,touseBrunoLatour’sterm,inscriptions.37 Suchinscriptions
publishedinlate2020andearly2021,whichhaveproposedanewresearchagendaforthe neuroimaginginvestigationofhysteria.Theauthorsofbotharticleshaverecommendedthat despitethesharedneuralmechanismsacrossgenders,potentialneurophysiologicaldifferences betweenmaleandfemalepatients—andhowsuchdifferencesmightbeinfluencedbygenetic, hormonal,socialandculturalfactors—shouldbeexploredbyfuturestudies.SeeDraneetal., “Framework,”6;andPerezetal.,“StateoftheField,”11,article102623.Whenstudiesinformed bythisnewresearchagendastartappearinginmedicaljournals,itwillbethetaskofhumanities scholarstoexaminehowgenderisbeingframedintheongoingfunctionalneuroimagingresearch onhysteria.
37Latour,“MoreManipulation,”347;andLatour, Pandora’sHope,306–7.
areproducedthroughtheprocessofvisualisationthat“includesthearrangementsof materials,instruments,andtheiroutputs.”38 Despitethediversityofkindsofimages thatIwilldiscusshere—someanalogueandothersdigital—myintentionisnotto clarifytheconceptofthe‘image.’Althoughinthecurrentvisualstudiesdiscoursethere areapluralityofcoexistingdefinitionsregardingthenatureofimages,myenquirydoes notaimtoparticipateinthisparticulardiscourse.39 Tobemorespecific,thequestion Iamaddressinghereisnotwhatanimageisingeneral.Instead,myfocusisonhow differentkindsofimageswereandarebeingusedoperatively,i.e.,as“instrumentsof reflection”andexploration,inconcrete,historicallysituatedscientificpracticeswhose goalwastoelucidatetheneurophysiologicalbasisofhysteria.40 Thus,myenquiry isalignedwithandaimstoexpandthepractice-orientedapproachesoutlinedin thecontributionsrecentlypublishedinthevolume RepresentationinScientificPractice Revisited. 41
Methodologically,myanalysisisinformedbySybilleKrämer’sconceptofoperative iconicity(“operativeBildlichkeit”).42 AccordingtoKrämer,epistemicallyproductive imagescanbeunderstoodasspacesforaction(“Operationsraum”).43 Putdifferently,their
38Lynch,“RepresentationinFormation,”325.
39Howtodefinethe‘image’remainsamatterofintensedebate.Forasuccinctoverview,seeEder andKlonk,“Introduction,”9–11.Onepertinentdefinitionthatisnotmentionedinthisoverview butdeservestobepointedoutisNelsonGoodman’s.Writinginthe1970s,Goodmanbroadly definedimagesaspictorialsignswhosevisualpropertieshaveadistinctlyreferentialrelationto theobjectstheyvisualise.Goodman, LanguagesofArt,9.Heinsistedthatnodegreeofresemblance betweentheimageandtheobjectwasrequiredtoestablishthereferentialrelation.Thisis becausetheprocessofproducinganimage,insteadofpassivelycopyingapre-existingreality, actively“participatesinmakingwhatistobe”visualised.Goodman,32.Forrecentaccountsthat attemptedtodefinetheconceptoftheimage,see,e.g.,Mersch,“PictorialThinking”;andPurgar, “WhatIsNotanImage.”Moreradically,IngridHoelzlhasarguedthatthe“conceptof‘image’ [is]dissolvingundertheassaultofneuroscientificmodellingandadvancesinmachinevision.” Hoelzl,“Postimage,”361.AccordingtoHoelzl,theimagecouldnolongerbedefinedasafixed representationalformbutinsteadasaninfinitelymalleablealgorithmicconfiguration.Hoelzl thusproposesa“verylargedefinitionoftheimageastherelationofdataandofalgorithmsthat areengagedinanoperation,whichinvolvesvisualdataordatavisualization.”Hoelzl,361.Atfirst glance,itmightappearthatmanyofthedistinctlynon-mimeticdigitalimagesIwilldiscussin chapters3and4defymoreclassicalnotionsofimages,suchasGoodman’s,andfitmoreclosely theredefinitionoftheimageproposedbyHoelzl.However,mydetailedanalysisinchapter3 willshowthatfarfrombeingentirelyarbitraryandunstablealgorithmicconfigurations,various digitalimageswithwhichscientistsworkinthecourseofafunctionalneuroimagingstudyhavea distinctlyreferentialrelationtoactualsubjects’activebrains.Despitetheirtechnologicalnovelty, fromtheperspectiveoftheirconcreteuseinthescientificcontext,theseimagesaremoreclosely alignedwithGoodman’sthanwithHoelzl’sdefinitionofimages.
40Krämer,“OperativeBildlichkeit,”104(mytranslation).
41SeeCoopmansetal., RepresentationRevisited.SeealsoHinterwaldnerandBuschhaus, Picture’s Image;andPauwels, VisualCulturesofScience
42Krämer,“OperativeBildlichkeit,”104.
43Krämer,“DiagrammatischeInskriptionen,”236.Itshouldbenotedthatwhileanalysingthe functionsofimagesacrossdifferentcontexts,otherscholarshaveintroducedalternativeconcepts ofimageoperativity.Forinstance,HarunFarockidevelopedhisinfluentialconceptofoperative imageswhilediscussinghowimagesareusedasinstrumentsinthecontextsofwarfarewith
abilitytobothshowandtellsomethingofinterestaboutthephenomenatheyreferto dependsonhowtheirusersinteractwiththem.44 Itisthroughsuchinteractionsthat imagesfulfiltheirfunctionsasinvestigationtoolsinthescientificcontext.Generally speaking,myanalysiswillfocusontwokeytypesofinteractionswithimagesthatcanbe identifiedbothinCharcot’sresearchandinthecontemporaryfunctionalneuroimaging studiesofhysteria—howresearcherswork on imagesand with images.
First,Iwillfocusonhowresearcherswork on images,inthesenseofintentionally producingthemintargetedwaysthroughlong“cascadesoftransformations.”45 Wewill seethatthetrajectoriesofsuchcascadesoftransformationsareinpartdetermined bytheparticularvisualisationtechnology(i.e.,themedium)researchershadchosen todeploy.AspointedoutbyBrunoLatour,inscientificpractice,thereferential qualityoftheresultingimages,i.e.,their“abilitytoreachtheobjectsinaccessible otherwise,”isinextricablylinkedtoaseriesoftargetedmanipulationsthatwentinto theproductionoftheimages.46 Tounderstandtherolesofimagesingenerating newmedicalinsights,bothinCharcot’sresearchandthecontemporaryneuroimaging studiesofhysteria,wehavetopaycloseattentiontothemedium-specificprocesses throughwhichtheseimageswerepurposefullyconstructed.Itmaybefairtowarnmy readersthatinchapter3,whendiscussingfunctionalneuroimagingstudies,Iwillgo intoconsiderabletechnicalandmathematicaldetailregardingtheunderlyingprocesses ofimageproduction.Yet,Ikindlyaskthoseofmyreaderswhoarelessinterested
intelligentweapons.Hence,inFarocki’sdefinition,operativeimagesare“madeneitherto entertainnortoinform”but“tomonitoraprocess.”Farocki,“PhantomImages,”17,18.Moreover, Farockihasunderscoredthenon-representationalcharacterofsuchimages,arguingthatthey aremadebymachinesandformachines,thuslargelybypassingthehumanuser.Farocki,17. Morerecently,whilediscussingthefunctionsofimagesinthedynamicsofcontemporarypolitical conflicts,JensEderandCharlotteKlonkhaveintroducedtheconceptof‘imageoperations’to designatetheabilityofimages“toaugmentandcreatesignificantevents.”EderandKlonk, “Introduction,”3.Aimingtoexaminevariouspoliticalimageoperations,EderandKlonkprimarily focusontheuncontrollableeventsthatimagestrigger“bothinthevirtualandthephysicalworld, [and]thatoftengobeyondtheintentionsoftheirproducersandsometimesevenagainstthem.” EderandKlonk,4.Foradiscussionofadditionalapproachestoimageoperativity,seeHoel, “OperativeImages.”Duetomyfocusonexaminingepistemicfunctionsofimagesinscientific research,IdrawonKrämer’sconceptofoperativeiconicity,whichshedevelopedbyexplicitly foregroundingtheknowledge-producingpotentialofimages.SeeKrämer,“OperativeBildlichkeit,” 94–96,98,104.
44SeeKrämer,“OperativeBildlichkeit,”116–17;andKrämer,“Mind’sEye,”277,286.Admittedly, Krämerintroducedtheconceptofoperativeiconicityinthecontextofwhatshereferredtoas diagrammaticinscriptions,suchasgraphs,tables,andmaps.AccordingtoKrämer,the“lowest commondenominator”ofsuchdiagrammaticartefacts“istheinscribedplanethatemergesfrom theinteractionofpoint,lineandplane,”afeaturethatshedesignatesasgraphism.Krämer,“Mind’s Eye,”276.SomeimagesthatIwillanalysehere(e.g.,photographs)donotpossessthefeatureof graphism.Nevertheless,Ihopetoshowthattheconceptofoperativeiconicitycanbefruitfully appliedtocharacterisetheiruseasepistemictoolsinhysteriaresearch.Inotherwords,Iwill expandtheconceptofoperativeiconicitybyarguingthatitisnotdeterminedbythevisualfeatures oftheimages,suchasgraphism,butinsteadconstitutedprimarilythroughtheirparticularuseas epistemictools.
45Latour,“MoreManipulation,”347.
46Latour,347.
intechnicalaspectsoffunctionalneuroimagingtoneverthelessbearwithme.Inmy analysis,Iwillnevergobeyondthelevelofdetailnecessarytoallowmetomakeclaims abouttheepistemicfunctionsoftheresultingimagesinhysteriaresearch.
Second,theotherkeytypeofinteractionofinteresttothisenquiryishow researcherswork with imagesasoutputsoftheprocessofvisualisation.Twocrucial aspectsofworkingwithimagesareofprimaryconcern,bothinregardtoCharcot’s researchandtothepresent-dayfunctionalneuroimagingstudies.Ontheonehand, Iwillanalysehowresearchersmakesenseofimagesintermsofhowtheyextract informationofinterestfromthem.Ontheotherhand,Iwilldelineatehowresearchers usetheinformationtheyextractedfromtheimagestomakejudgmentsaboutthe hysteriapatients’physicalbodies(inCharcot’sresearch)andaboutthepatients’active brains(inneuroimagingstudies).Althoughthesetwoaspectsofworkingwithimages arecloselyinterlinkedinactualpractice,myanalysiswillprythemaparttoclarifytheir distinctrolesintheprocessofproducingnewmedicalinsightsintohysteria.
Thefirstaspectofworkingwithimages,Iwillargue,requiresahighlyspecific kindofvisualexpertisethatallowsmembersofaparticularresearchcommunityto identifyinapurposefullyconstruedimagesomethingwhichisnotnecessarilyevident toanon-expert.Iwillinsistthatthisapplieseventoimageswhosevisualcontentmay otherwiseappearstraightforwardorself-evident,suchasthewell-knownphotographs ofCharcot’shysteriapatients.Whatisatstakeisnotwhattheseimagesappeartodepict toanuntrainednon-specialisteye,buthowscientistsinteractwiththemtoobtainnew informationaboutthephenomenonunderinvestigation.Iwillshowthattoidentifythe informationofinterestintheimages,researchersdonotviewthemasvisualdepictions, asnon-expertswould.Instead,researchersengagewithimagesinadistinctivewaythat isbestdescribedbywhatSybilleKrämertermed‘reading.’47 Krämer’sdesignationof readingispertinentbecauseitemphasisesthattomakethemyieldtheinformationof interest,researchersapproachimagesakintovisualtexts.Or,touseDieterMersch’s term,researcherstreatimagesas“iconictextures,”48 whichtheyneedtodecipher.In doingso,researchersmustmakeexpertdecisionswhichoftheimages’visualfeatures shouldbeoverlookedasirrelevantfortheirpurposesandwhicharesalientandshould, therefore,receiveagreatdealofattention.49 Insuchtargetedreadingoftheimage, knowingwhichvisualdetailstoignoreisjustasimportantasbeingabletorecognise thosethatcarrytheinformationofinterest.50
47Krämer,“OperativeBildlichkeit,”101–3.
48Mersch,“PictorialThinking,”162.SimilarlytoKrämer,Merscharguesthatvarious‘iconictextures’ thatareusedinthecontextofscienceandtechnology“cannotsimplybesubsumedunderthe categoryofthepictorial,astheyaremuchclosertowritingswhichhavetobe‘read’thantoimages whichhavetobeviewed.”Ibid.
49Mersch,162.Forarelatedaccount,whichpositsthatscientificimagesarenotmerelyviewedbut mustbeactivelyreadbecausetheyareoftenaccompaniedbyadditionalcontextualinformation andalsorequirecertainbackgroundknowledgeontheuser’spart,seeMerz,“DesignedforTravel.”
50Importantly,drawingontheconceptofreading,inchapter3,Iwilladditionallyarguethatsome oftheintermediaryimageswithwhichauthorsoffunctionalneuroimagingstudiesworkremain illegibleeventotheseexperts.Wewillseethatthisillegibilityisduetothefactthatalthough theinformationofinterestisencodedintotheseimages,itisneverthelessnotdirectlyaccessible.
Crucially,theselectiveseeingthatunderliestheprocessofreadingimagesinthe scientificcontextisnotarbitrary.Instead,asIwillshow,itisgroundedinthesetof assumptionsandconventionsthataresharedbyaparticularcommunityofresearchers atagivenmoment.Putdifferently,therearerulesamongresearchersaboutwhich aspectsoftheimagestheyworkwitharesalientandwhichareaccidental.However, suchrulesandconventionsarenotnecessarilyexplicitlyformulated.Hence,knowing howtoreadparticularimagesinordertoobtainfromthemtheinformationofinterest entailswhatMichaelPolanyihastermedtacitknowledge,i.e.,thekindofknowledge “thatcannotbeputintowords.”51 Membersoftheresearchcommunity,therefore, havetoacquirethistacitknowledgethroughthepracticeofworkingwithimages.Just asimportantly,wewillalsoseethatsomeoftheimplicitruleswhichgovernhowa particularcommunityofresearchersreadscertainimagesarehistoricallycontingent andthussubjecttochange.Thisisallthemorereasonwhy,whendiscussingthe epistemicrolesofimagesinCharcot’sresearchandincontemporaryneuroimaging studiesofhysteria,wemustunpacktheassumptionsthathavedeterminedhow differentkindsofimageswereandarebeingreadinthesespecifichistoricalcontexts.
Finally,itisnotonlyvitalforustounderstandwhatscientistsseeintheimages whendeployingtheminhysteriaresearchtoobtainnewinformationaboutthe functioningofpatients’bodiesandbrains.Itisequallyimportantforourdiscussion how,inthenextstep,scientistsattributesymbolicmeaningstotheinformationthus obtained.Inotherwords,weneedtoanalyticallydifferentiatebetween,ontheone hand,whatIhavedefinedaboveastheoperationof‘reading’imagesand,ontheother hand,thesubsequentoperationthroughwhichtheimages’meaningsareconstituted andwhichIwillcall‘interpretation.’
Idonotmeantoimplythattheoperationofreadingtheimages(inthesense ofobtainingtheinformationofinterest)issemanticallyneutral.52 Imerelywantto emphasisethat‘reading’isdistinctfromtheprocessofinterpretation,which,inturn, isunderstoodhereasanactiveascriptionofmedicalmeaning.Infact,Iwillargue thatitisultimatelythislatterprocessthat,intheend,enablesresearcherstouse imagesoperativelyinthemedicalcontext.Forinstance,itenablesthemtomoreorless reliablydifferentiatebetweenactualpatientsandsimulators,ortomakeclaimsabout thehystericalsymptoms’underlyingneuralmechanisms.Touncoverhowparticular
Hence,Iwillusethetermillegibletodenoteimagesthatareimpossibletoread(inthesense ofaccessingtheinformationofinterest)evenforanexpertbecausetheseimagesarenotclear enough.Simplyput,inmyterminology,illegibleimagesarevisuallyopaque.Conversely,Iwill claimthatimageslegibletoanexpertareneverthelesspotentiallyunreadabletoanuntrained viewer,wholacksthebackgroundknowledgerequiredtoreadsuchimagesinaninformedway. Suchdifferentiationintermsmayappearfastidious,butitwillenablemetodelineatewhichusers underwhichconditionsandfromwhatkindsofimagescanextracttheinformationofinterest.The specificwayIapplytheterms‘illegible’and‘unreadable’toimagesinthecontextofthisenquiry isderivedfromthesemanticallydistinctwaysinwhichthesetwoadjectivesareusedtoreferto writtenorprintedtexts.See,e.g.,UniversityofChicagoPress, ChicagoManualofStyle,335.
51Polanyi, TacitDimension,4.
52Seemyclaimabovethattheprocessofreadingisinformedbyaresearchcommunity’sshared conventionsandrequirestobelearnt.
medicallyoperativemeaningsofimageshavebeengeneratedinhysteriaresearchat thegivenhistoricalmoments,itisnecessarytogobeyondtheimagesthemselvesandto analysethebroaderconceptualframeworkswithinwhichtherespectiveinterpretations areembedded.ThisaspectofmyanalysiswillbeinformedbyLudwigJäger’sconceptof ‘transcriptivity.’53 Jägerintroducedthistermtodenotethe“semiologicalproceduresof inter-andintramedialreferences”that“organizetheproductionandtransformationof meaning”acrossallcommunicativemedia(i.e.,speech,writing,analogue,anddigital images).54
IdrawonJägerfortwospecificreasons.First,hisconceptoftranscriptivity willallowmetozoominontheproceduralaspectsofhowmeaningisgenerated inimage-basedhysteriaresearchthroughsymbolicoperationsofrelatingimagesto otherimagesandtexts,andthroughthemtomoreabstractconcepts,suchaswill, agency,orintention.Second,byintroducingtheconceptoftranscriptivity,Jägerhas definedmeaningindynamicterms,asatemporaryandintrinsicallyunstableeffectof therelationsestablishedamongdifferentmediasystemsunderparticulardiscursive conditions.Crucially,accordingtoJäger,thevalidityofthesemanticeffectsthus generatedcanalwaysbecalledintoquestionbysubsequent,alternativeinterpretations thatestablishadifferentsetofintermedialandintramedialreferences.55 Hence,Jäger’s conceptoftransciptivitywillenablemetoforegroundthehistoricalsituatedness, contingency,andfragilityoftheattributionofoperativemeaningstoimagesbothin Charcot’sresearchandinthefunctionalneuroimagingstudiesofhysteria.Moreover, itwillpermitmetoexaminetheepistemicconditionsthatmadeusingimagesas investigationtoolsinhysteriaresearchpossibleatthegivenhistoricalmoments.Finally, itwillallowmetoanalysehowtheseimagestheninducedshiftsinthebroader conceptualframeworksthathadinitiallyenabledtheirimplementation.
Significantly,myanalysiswillstrictlyfocusonthedynamicprocessesofmeaning attributionwithinthemedicalcontexts.Iwilltherebydisregardthesemanticpotential oftheseimagestoprovokeuncontrollableeffectswhencirculatingamongnon-experts. Becausetheylackthevisualcompetencenecessarytoreadtheimagesintheintended ways,non-expertsmightinteractwiththeminalessinformedmannerthanthe scientistswhousethemasinvestigationtools.Intheprocess,non-expertuserscan thusgenerateunforeseensemanticeffects.56 Howeversignificanttheresultingbroader socioculturaleffectsoftheseimagesmighthavebeenor,inthecaseoffunctional brainscans,couldturnouttobe,theyarenottheobjectofmyenquiry.Andalthough mythematicfocusislimitedtothemedicalinvestigationofhysteria,myanalytical approachandtheconclusionsIdrawabouttheepistemicfunctionsofimagesin theresearchpracticecanbeappliedtoothersubjectareas.Itisconceivablethata
53SeeJäger,“TranscriptivityMatters,”49.
54Jäger,“EpistemologyofDisruptions,”72.
55Jäger,82–84.
56Foranincisiveaccount,whichusestheexamplestakenfromvariousareasofpoliticalconflictto delineatetheunforeseenandunintendedsocioculturaleffectsthatimagescandeveloponcethey startcirculatingamongthegeneralpublic,seeEderandKlonk,“Introduction,”1–7.
comparableapproachcouldbefruitfulwhenanalysingneuroimagingingeneral,aswell asotherareasofnaturalsciencesthatuseimagesasepistemictools.
Thisbook’scentralquestionofhowresearchersworkedandareworkingonandwith differentkindsofimagestoproducenewmedicalinsightsintohysteriaattheendof thenineteenthandbeginningofthetwenty-firstcenturiesisaddressedsystematically acrossfourchapters,followedbyashortconclusion.Chapter1examinesindetailthe epistemicusesofawidevarietyofimagesacrosstwodecadesofmedicalresearch intohysteriathatCharcotandhisteamconductedattheSalpêtrière.Doingsowill shiftthefocusfromthe(in)famousphotographsoffemalepatientsinthethroesof hystericalattacks,whichhavebeenatthecentreofthemajorityofhumanities-based accountsthathavedismissedCharcot’shysteriaresearchasnon-scientific.57 Although Iwillalsodiscussthesephotographs,Iwillconsidertheminconjunctionwiththeother typesofimagesthatfeaturedprominentlyinCharcot’sresearch.Moreover,Iwillalso examinetherelationsbetweentheimagesandthebroaderconceptualframeworksin whichtheproduction,reading,andinterpretationoftheseimageswereembedded. Iwilltherebyarguethatimageswereconstitutiveofproducingnewinsightsintoa rangeofhystericalsymptoms.TheyenabledCharcottodevelopnoveldiagnostictools andtreatments,aswellastoconceptualisehysteriaasabraindisorderbypositingits underlyingneurophysiologicalmechanism.
Whereaschapter1takesacloselookathowimageswereusedinaparticular historicallysituatedresearchpractice,chapter2introducesachangeofperspective. Itoffersadiachronicviewoftheepistemologicalshiftsthattookplacefromthemid1880stothepresentday.Ihopetoshowthattheseshiftsplayedacrucialrole,first,inthe dismissalofimagesasepistemictoolsinhysteriaresearch;second,inthesubsequent apparentdisappearanceofhysteriaitself;andthird,inthere-emergenceofanimagebasedinvestigationofthiselusivedisorder.Aswewillsee,theemergenceofnew medicalresearchonhysteriahasbeencloselytiedtotheuseofnovelneuroimaging technologies,suchasfunctionalmagneticresonanceimaging(fMRI).Havingcharted thesedevelopments,thechapterthendelineateshow,bothdirectlyandindirectly, thecurrentfMRI-basedresearchhasbeguntoreshapethemedicalunderstandingof hysteriabycontributingtoitsrenewedconceptualisationasabraindisorder.Chapter 2thuslaysthegroundworkforthesubsequenttwochapters,eachofwhichexamines fromadifferentperspectivehowthecurrentlyongoingmedicalreconceptualisationof hystericalsymptomsiseffectuatedthroughtheuseoffunctionalbrainimages.
Chapter3offersadetailedanalysisofhowpresent-dayresearchersworkwithfMRI toproducenewinsightsintothepathologicalfunctioningofthehysteriapatients’ brains,whichispresumedtounderpinthedisorder’sbafflingsymptoms.Usingthe exampleoftwomutuallyrelatedfMRIstudies,thechapterexaminestheoperations researchersperformandthejudgmentstheymakewhileproducing,reading,and interpretingfunctionalbrainimages.58 Ihavechosenthetwoparticularcasestudies becauseoftheprecisionwithwhichtheirauthorsformulatedtheresearchquestions
57See,e.g.,Didi-Huberman, InventionofHysteria;Scull, Hysteria;andShowalter, FemaleMalady 58SeedeLange,Roelofs,andToni,“Self-Monitoring”;anddeLange,Toni,andRoelofs,“Altered Connectivity.”
andthecomplexityoftheirexperimentaldesigns.Thesetwoaspects,asIintendto show,arerepresentativeofthegraduallyincreasingrefinementofthecurrentfMRIbasedinvestigationofhysteria.Moreover,followingLatourandJäger,inthischapter, Idevelopanewmethodologicalapproachtoanalysingtheepistemicfunctionsof digitalscientificimagesthatvisualisepreviouslyinaccessibleandessentiallyinvisible neurophysiologicalphenomena.Idosobyintroducingthekeyanalyticaldistinction between‘(il)legible’and‘(un)readable’images.Thisapproachallowsmetoanalysethe medium-specificstep-by-stepoperationsthroughwhichfMRI-basedfindingsandtheir medicalmeaningsareconstructedinthecurrenthysteriaresearch.
Drawingonthisanalysis,chapter4thenexpandsthefocustoofferanoverviewof thekindsofinsightsthatthefunctionalneuroimagingstudiesofhysteria,onthewhole, havegeneratedinthefirsttwodecadesofthetwenty-firstcentury.Ontheonehand, thechapterdelineatesandexaminesasetofempiricalandtheoretical“action-guiding concepts”thathaveinformedfMRIstudiesduringthisperiod.59 Ontheotherhand, thechapterchartshowtheimage-basedfindingsofthefMRIstudieshavefacilitated thegradualarticulationand,insomecases,arevisionofthepreliminaryconceptsthat informedthesefindings.Intheprocess,Iargue,thefMRIstudieshavegeneratednew, thoughstilltentative,insightsintohystericalsymptoms’underlyingneurophysiological mechanisms.Chapter4isstructuredaroundaseriesofcasestudiesspecificallychosen tohelpdelineatethisprocess.
TheconclusionsummarisestheepistemicimportofthefMRIstudiesofhysteria fromthefirsttwodecadesofthetwenty-firstcentury,examinestheirrelationto Charcot’sresearch,andconsiderspossiblefuturedevelopments.Finally,itprovides anoverviewofthevariousepistemicfunctionsofimagesinthemedicalresearch onhysteriadiscussedinthisbookandsuggeststheimplicationsforabroader understandingofimage-basedknowledgeproductioninhistoricallysituatedscientific research.
59Steinle, ExploratoryExperiments,321.