Doubling of the Personality
IT WAS “in the spring of 1875, in the course of a conversation on the bizarreries of memory,” that Eugène Azam first told the story of the classic French double, Félida X. Somnambulism had been a topic for medical expertise and folklore for millennia. There had been trickles of interest in double consciousness and spontaneous somnambulism throughout the nineteenth century. But there was never any systematic study of multiple personality before Azam.1
Allow me to make you acquainted with Félida. She is a very remarkable personage who has played a rather important part in the history of ideas. Do not forget that this humble person was the educator of Taine and Ribot. Her history was the great argument of which the positivist psychologists made use at the time of the heroic struggles against the spiritualistic dogmatism of Cousin’s school. But for Félida, it is not certain that there would be a professorship at the Collège de France and that I should be here speaking to you of the mental state of hystericals. It is a physician of Bordeaux who has attached his name to the history of Félida: Azam reported this astonishing history first at the “Society of Surgery,” then at the “Academy of Medicine” in January 1860. He entitled his communication “Note on Nervous Sleep or Hypnotism,” and spoke of this case in connection with the discussion of the existence of an abnormal sleep in which it would be possible to operate without pain. And this communication, thus incidentally made, was to revolutionize psychology in fifty years.2
Those are the words of Pierre Janet, lecturing at Harvard in 1906. Janet held that chair of psychology at the Collège de France, the most prestigious academic site in France. There is only one thing wrong with this story. Azam did not tell the world about Félida’s double personality in his 1860 paper. He mentioned the woman, but not by name, and one can make out that she spontaneously went into something like a hypnotic trance. He also stated that he would write more about Félida, but he never did, until 1876. In 1860 she simply did not fit into any possible discourse, except hypnotism. In the spring of 1875 she began to fit into an entirely new discourse, the emerging sciences of memory. It was not until 1876 that this humble person burst upon the French world of psychology and psychiatry.
Eugène Azam (1822–1899) was a leading figure of the Bordeaux region, a dignified local booster, key to the establishment of a university in Bordeaux, and central in organizing the fight against the phylloxera that was annihilating the vineyards. He was a notable local archaeologist in one of the oldest inhabited regions of Europe, and a substantial collector of paintings. One has the impression that there was hardly a literary or scientific society in Bordeaux of which he was not sometime president. Yet he would barely be remembered in little volumes of local history today were it not for Félida. He was, perhaps, fated for the role, because he was one of the first French students of Braid’s scientific hypnotism. That was what he reported in 1860, not multiplicity. But hypnotism, along with hysteria, was to become one of the essential ingredients for the French era of multiple personality.
Azam tried out almost every imaginable name for Félida’s disorder; to take only titles from his papers about her, we have: Névrose extraordinaire, doublement de la vie (14 January 1876). Amnésie périodique, ou dédoublement de la vie (6 May 1876). Amnésie périodique, ou doublement de la vie (20 May 1876). La double conscience (23 August 1876). Le dédoublement de la personnalité (6 September 1876). We also have La double personnalité on 8 March 1879.3 Azam’s publisher encouraged him to use double conscience, the French translation of the English name. Azam did not much care for that. He preferred dédoublement de la personnalité. It can be translated as dividing, doubling, or splitting of the personality, and doubtless contributed to our expression “split personality,” which gets confused with the split brain of schizophrenia. Notice that no longer is it consciousness, a rather passive thing, that is doubled. It is life, personality, all that is active in the human soul.
Azam took pride in being the first man to introduce scientific hypnotism to France. (There are at least two other claimants to that honor, but no matter.) His father had been a surgeon and alienist in Bordeaux. The son in due course became chief surgeon at the asylum for women. In June 1858 he was called in to care for “a young woman of the people.” She was thought to be mad; she exhibited curious phenomena of spontaneous catalepsy, anesthesia, and hyperesthesia. “In addition she presented with an interesting lesion of the memory, to which I shall return.” This was Félida, but Azam never did write the memoir he intended. He displayed the woman to numerous colleagues, some of whom thought that the morbid phenomena were a sham but others of whom encouraged him. His boss told him of an encyclopedia article in an English encyclopedia about sleep, in which it was reported that Braid could produce artificially the very phenomena which Azam noticed in Félida. Thus it was Félida who led Azam to hypnotism, not the other way about.
Braid’s book at his side, it took Azam one minute to hypnotize Félida and create the symptoms that also occurred spontaneously. This did not prove hypnotism, because the symptoms occurred naturally. So he turned to another woman who happened to be living in the same house. This was a perfectly healthy twenty-two-year-old who worked for a jewelry manufacturer. Azam quickly produced all the phenomena of hypnotism that he had read about. He became convinced that although Braid exaggerated on many issues, and greatly overestimated the healing power of hypnotism, Braid was correct in his basic points. Azam was a friend of Broca, now remembered for the localization of language in what is called Broca’s region of the right hemisphere of the brain. Azam told Broca about hypnotism during a visit to Paris in 1859, and Broca was intrigued. Would it anesthetize during surgery? The two men hypnotized a woman with a terrible abscess and lanced it, and she felt no pain. Broca at once informed tout Paris. Azam was briefly famous. But to most doctors, hypnotism meant magnetizers—charlatans. No matter how hard Azam tried to distance himself, he was tainted. Hypnotism was not reliable for anesthetic surgery, and chloroform was almost universally in use by 1860. After a brief fad the French medical world left hypnotism to the masses and the stage magnetizers. Only in 1878, after Azam’s Félida had become celebrated for other reasons, was Charcot to give a “decisive demonstration of hypnotism” (to quote Babinski’s authorized version of the events).4 Azam was always rather peeved that he did not get full recognition for having introduced scientific hypnotism to France.
Notice that Félida, unlike Janet’s Léonie and a host of others, did not develop her dédoublement only after she had been hypnotized. Azam did not even know about hypnotism when he met Félida; he experimented with her first because she spontaneously dissociated. As soon as he discovered that he could hypnotize her, he turned to a healthy woman to try his newfound skill. He continued his hypnotic experiments with other subjects precisely because Félida was already a spontaneous somnambule. He did continue to hypnotize Félida in the hope of curing her, but without success, and he eventually abandoned the project. She seemed to get somewhat better toward the end of 1859. Azam did not see her again for sixteen years.
Hypnotism was central to the new French wave of multiples, and that is one way in which they differ from British instances of double consciousness. I am not making the tired suggestion that the patients were made multiple by hypnotism. That is rubbish. We know that Félida had an alternative personality before her physician had even heard of Braid’s scientific hypnotism. What is true is that all the individuals with doubling of the personality lived in a milieu that became fascinated by hypnotism, and where their behavior would be compared to that of hypnotized subjects.
There was an even more profound difference between double consciousness and the new era of Félida after 1875. Most cases of dédoublement had grotesque bodily ailments. The most dramatic of these were anesthesias over part of the body, hyperesthesia (oversensitivity), partial paralysis, spasms, tremors, and abnormalities of the senses, such as restrictions of the field of vision and loss of taste or smell. Often there was unexplained bleeding in the stomach or from the mouth, nose, or rectum; there were terrible headaches and vertigo. Tuberculosis was mimicked by pulmonary congestions. These complaints, which often were awful, had no known organic, physical, or neurological cause. We now call them conversion symptoms. I tend to avoid that expression, because it is too dismissive, too sanitized. It makes us forget the appalling pain that many of these patients experienced. I will presently describe Félida’s own horrible suffering.
At the time of Félida, these symptoms were standardly associated with the diagnosis of hysteria. Every French case of dédoublement was described as hysteric. This does not immediately distinguish dédoublement from double consciousness, for cases of the latter—Crichton Browne’s prototypical J. H., for example—were also tagged with hysteria. But hysteria itself had changed. I do not know when people first started calling hysteria protean, meaning that it could take indefinitely many forms; certainly Sauvages calls it protean in his classic 1768 Nosologia Methodica. The topic of hysteria in history serves many a book unto itself. I shall not touch on the marvelous studies of hysteria made by a generation of feminist historians.5 The variety of gross things done to women diagnosed with hysteria is almost as loathsome as the burnings of their sisters during the witch craze. Here I wish only to emphasize how radically the prototype of hysteria changed in the course of European medicine.
Two psychiatrists have made a statistical survey of four hundred years of hysteria. These men state that until the middle of the nineteenth century, the emphasis in medical textbooks and reports was on depression (as that term is now used in clinical practice). Then came a radical increase in symptomatology. Their graph of the frequency of items mentioned in articles shows a high plateau in the “expansion of the overall concept” roughly 1850–1910. “No one wrote more about the hysterical personality than Janet…. Janet’s items comprised the common features of depression, fearfulness, emotionality, lability and excitement, but also included exaggeration, suggestibility, deficient judgement, poor self-control, vivid imagination, erotic problems, self-destructive tendencies, regression, shame and diminution of the field of consciousness and dual personality.”6 These items were certainly used by doctors to describe their women patients. Yet the survey barely mentions all those anesthesias, hyperesthesias, spasms, paralyses, bleedings, and above all pains that were particularly prevalent in France in the era of Félida X.
Hypnotism and hysteria were two aspects of the matrix where the new French dédoublement was conceived. Philosophy also had an important role, and not only in the sense that throughout most of the nineteenth century psychology was a branch of philosophy. For much of that time, the dominant French style of philosophy was inspired by Victor Cousin (1792–1867). It was called eclectic spiritualism—or “spiritualist dogmatism” by people like Janet who did not like it. It was deeply entrenched in the school system. The hegemony of Cousin’s ideas was seriously challenged only in the Third Republic, established after the 1870 war with Prussia.
Cousin argued that the spiritual substances—God, the soul, ideas—were real, objective, independent, and autonomous of what anyone thinks. Philosophy should proceed by what he called the “psychological method” of inspecting our immediate ideas: the truly French method of Descartes and Condillac. Cousin and his followers regarded their work as empirical and scientific, since it began with introspection of actual ideas. They rejected biological reduction of psychological data and resisted any type of determinism in matters of human thought or behavior. In short, they were in every way opposed to the positivist school founded by Auguste Comte (1798–1857). Positivism began to flourish in the Third Republic. One of the roots of multiple personality is republican positivism.
The connection is absolutely explicit. Hippolyte Taine (1828–1893), along with Renan, is commonly regarded as one of the two dominant intellectual figures of France during the last third of the nineteenth century. Both were positivists, advocating a scientific worldview. Taine’s one major philosophical work was De l’intelligence (1870). Taine was no routine, fact-gathering, antitheory, anticausation positivist of the sort that played an important role in parts of French medicine. His was a positivism modulated by an immersion in Hegel. I cannot here say what he was for, but can note one thing that he was against. He was against the autonomous, freestanding self or soul of the eclectic spiritualists, against the “I or me, unique, persisting, always the same [and which] is something distinct from my sensations, memories, images, ideas, perceptions, conceptions, which are diverse and transient.”7 The I, the me, together with the faculties or powers that they are supposed to possess, “are metaphysical beings, pure phantasms, engendered by words, which vanish when one examines scrupulously the means of the words.” He was against the Kantian solution of the problem of free will, where the “I” is a noumenal self not subject to the causal laws of the phenomenal world. He thought of the self as a Hegelian being with a history; he thought of the self as a Lockean person constituted by a complex of consciousness, sensation, and memory. Hence he was delighted when doubled personality hit the headlines in 1876. In the next edition of his book, 1878, he cited these cases with intense fascination.8 For here were two selves alternating in one body, each defined (thought Taine) by its awareness and chains of memories. There was no transcendental soul here, no noumenal self. Instead there were two distinct selves, and the self was made by its memories.
Taine’s lesson of 1870 was not lost on his readers. The great French lexicographer Emile Littré had founded the Revue de philosophie positive in 1867 and edited it almost until his death. Early in 1875 he used it to publish a small piece on double consciousness, grouping together what we now count as distinct phenomena. There were references back to the British students of double consciousness—hence the title of his essay, “La double conscience.” He was more interested in the sensation of being doubled, hearing oneself speak, observing oneself act, or feeling that one is literally not oneself. Littré cited fourteen chiefly German variants of what we would tend nowadays to call depersonalization rather than dissociation. He concluded that the person is far from being “a primordial principle from which the other psychic properties flow.” Consciousness and self-identity result from a complex of experiences recorded in the brain, in “cerebral modifications.” Despite his title he was inclined to discuss “personality” rather than “consciousness” as the key idea. He denounced eclectic spiritualism and its ilk. “Theology by revelation and metaphysics by intuition” attribute personality “to a soul which uses the brain like an instrument.”9 He thought that double consciousness should provide an elegant rebuttal of the one, original, transcendental consciousness. But the cases available to Littré were old anecdotes, or marginal recent cases of personality disorders. What was wanted was a good live multiple. Enter Félida. Within six years Théodule Ribot—Janet’s predecessor as professor of psychology at the Collège de France—had published a book about diseases of the memory, subtitled An Essay in the Positive Psychology. There he had written about “the detailed and instructive observations of Dr. Azam.”10
How did nonpositivists see things? Pierre Janet was not a positivist. He did not have the doctrinaire panache of Taine or Ribot, yet for a time he became caught up in dédoublement. His uncle Paul Janet was an influential philosopher, altogether opposed to positivism. Paul was nevertheless active in the creation of Ribot’s chair, first at the Sorbonne and then at the Collège de France. The Collège, an ancient and autonomous institution, the highest in the land, has just so many chairs but can determine, at each appointment, the subject for a given chair. The chair of natural and international law was turned into the chair of experimental and comparative psychology. Paul Janet rationalized this radical move, devoting a substantial part of an essay in the leading intellectual review of the day to Azam’s Félida and other cases of doubling. “Those,” he concluded, “are the principal facts with which psychological science is occupied.”11
Thus dédoublement played a powerful role in the philosophy of the era. But it involved more than a battle between the old school and the new school, the eclectic spiritualists and the positivists. The positivists were ranged on the anticlerical, republican side of the new Third Republic. They were part of a larger politics, a battle for the character of France itself, for a France that had just been disgraced in war, for a France that was obsessed by the problem of degeneration, for a France that saw its science in visible decline before the vigor of the German- and English-speaking worlds. That humble woman, Félida, was part of the republican armory.
Azam despised the magnetizers and hence the murky French tradition of spontaneous somnambulism. He did not at first know the British material, although he soon found it out. In need of a symptom language for Félida, he had an immediate model. Among the bizarreries de la mémoire being discussed during that fateful spring of 1875 were those of Louise Lateau. She was called the stigmatic of Bois-d’Haine (a small Belgian village near the French border). She was famous all across Roman Catholic Europe for the miraculous stigmata that appeared on her side, hands, and feet every Friday. She was also famous for her devotional trance, and for the fact that she had eaten no food for years. Secular medicine tried to ignore her, but finally the Belgian medical academy established a commission to study her. The report, written by Evariste Warlomont, appeared early in 1875. For some time this was the only work to which Azam referred.12
In the first months of 1875 the Belgian academy of medicine, gripped by the question of Louise Lateau, charged Mr. Warlomont to make a report on this subject. This work, excellently done, insisted on the reality of doublement de la vie, double consciousness, condition seconde, states that can be produced spontaneously or artificially…. I recognized in these facts analogues to my observation in 1858. Although I had appreciated their importance ever since that time, I had not published them, thinking them to be too isolated in science, and too distant from the surgery that I practiced in Bordeaux. I thus sought out Félida X*** and found her again, presenting the same phenomena as before, but worse.13
He took some of Warlomont’s terminology. Even his first tryout for the name of Félida’s illness—doublement de la vie—was taken straight from Warlomont. Azam spoke of Félida’s alters as her first and second states, using for the latter the terms état second and condition seconde. I remarked that most readers would have encountered the expression “double consciousness” only as it was going out of use, in Breuer and Freud’s Studies in Hysteria. The same is true of condition seconde and état second, the names taken over by Azam. They became standard in French psychiatry for another two decades. Thus this other humble person, Louise Lateau, left her mark on psychiatry.
Félida was always a very sick woman. I find it remarkable that she got on with her life. She may have been the great teacher of Taine and Ribot, but psychology and psychiatry did not help her at all. Born in 1843, she became a seamstress at an early age. The family was poor; her father, a seaman, had drowned. When Azam saw her at the age of fifteen, she was, in her normal state, intelligent, sad, morose; she spoke little, worked hard, and seemed to have little emotional life. She was an extreme hysteric. In her normal state she had no sensations of taste. She had the globus, the lump experienced in the throat before a hysterical attack. Many parts of her body were anesthetic. Her visual field was restricted. After the least emotion she had convulsions in which she did not completely lose consciousness. She bled from the mouth when she was asleep. Azam declined to go on listing symptoms that “are so well known. Suffice to say that with Félida the [diagnosis of] hysteria is certain, and that the singular features that she presents depend on this overall illness.” Félida set the pace. Every French multiple was a florid hysteric.
When Azam first encountered Félida, she would experience fierce pain in the temples and fall into a state of extreme fatigue, almost like sleep. This lasted ten minutes. She would then appear to wake up and would enter her condition seconde. This lasted a few hours, when she would again have a brief trance and return to her ordinary state. This happened every five or six days. In her second state she greeted people around her, smiled, exuded gaiety; she would say a few words and continue, for example, with her sewing, humming as she did so. She would do household chores, go shopping, pay visits, and she had the good cheer of a healthy young woman of her age. After her second brief trance, she woke up in her normal state and had no memory of what had happened, or of anything she had learned in her second state. Her family had to bring her up to date. During this early period the attacks became more and more frequent, and the second state lasted longer and longer.
She had a sweetheart. She was made pregnant in her second state, and in that state she enjoyed being pregnant. But in her first state she denied her pregnancy until a neighbor rudely insisted on it; she then had terrible seizures that lasted several hours. But her confinement went well. She married the young man and seemed to get somewhat better. That was in 1859. The child, a boy, grew up fairly healthy but with considerable minor psychopathology.
Azam lost sight of Félida for sixteen years. During that period she had ten additional pregnancies or miscarriages, with one more child surviving. Azam relied on her husband for accounts of what happened during that time. By 1875 she would spend as much as three months in her second, cheerful, state, which gradually became her normal state. In middle age she generally settled into the second state. In fact Azam’s reporting became quite confusing. Initially the morose condition had been the first state, while the gadabout was in condition seconde. In due course the second state became the usual one, and the one previously called normal became increasingly unusual. As she grew older, that original state may almost have disappeared, but it also became unbearable. When she was in that state, she fell into despair. She would avoid people because she had no idea what had been going on for months and months. She believed that she was incurable. Her pains, bleedings, and paralyses became ever more intense.
Unfortunately the so-called second, but increasingly dominant, state was no longer one of irrepressible gaiety. She grew morose and began to acquire somatic symptoms. Parts of her body would become painful and inflamed. She had pulmonary hemorrhages and interminable nosebleeds. She would vomit blood. On one occasion blood oozed from her forehead “reproducing, without the least miracle, the bloody stigmata over which the ignorant make so much fuss.”14 At one time she became convinced that her husband had a mistress, a woman with whom, in her first state, she remained on good terms. In her condition seconde she hanged herself, but she botched it; she was rescued and woke up in the same condition.
Pursuing her livelihood as a seamstress, Félida took in sewing. In mature years, when she felt an attack coming she would scribble a quick note to her other self about the stage she had reached in her work, so that after a brief spell of discomfort she could continue without loss of time. But at that time the normal condition into which she switched was not so much that of a mature woman as that of a child of fourteen. She did not talk much; her memory was not looked into carefully, but she was sad and juvenile. Azam did not think of this as a third personality, but simply as a version of her normal state. Some clinicians today would wonder if this were not a child alter. There was yet another state, a terrible fourth condition of extreme terror. Azam described this as “accessory” to her condition seconde. She would begin to cry, “I am afraid, I am afraid….” She had terrifying hallucinations, especially in the dark or when she shut her eyes. Azam said that “she was close to madness.” Some would now call these attacks schizophreniform episodes. Other clinicians might suspect that a persecutor alter was at work. And there seems even to have been a fifth state. Victor Egger wrote that Azam had told him of one entirely different from anything in Azam’s many articles—and then declined to say what this state was.15 Something altogether improper? It is perfectly possible to imagine that Félida manifested at least three fragmentary alters in addition to her normal and second states. But Azam’s model was of doubling: there could be no third personality to see. Multiple personality did not yet exist.
How did Azam think of Félida? To use the vogue word that is now current, he thought that her disorder was “psychobiological.” He believed that all the phenomena—material, intellectual, or mixed—had the same cause and should be studied by the same science. He called this physiology, but a physiology enlarged by incorporating its relatives, metaphysics and psychology. “Today, although these are arbitrarily separated, they lean upon each other; tomorrow there will be an intimate fusion, and later the absorption will be complete.”16 Azam’s conjectured explanations ran along physiological lines. Like so many others he was much taken with the relationship between the two hemispheres of the brain and the two states. He conjectured that an attack involved an impediment to the flow of blood to one hemisphere, causing inaccessibility of memories stored there.
Far from breaking with the tradition of somnambulism, Azam became more and more convinced that it was the right idea. The condition seconde of every double was a state of “total somnambulism.” He stated this in one of his early papers, withdrew from it for a while, but returned to it in 1890 with renewed firmness.17 Today’s clinicians may find Azam’s stance attractive. For he apparently believed that adult “total somnambulism” would, if one looked into it closely enough, have a precursor in childhood.
As soon as Azam published in Paris, a veritable torrent of doubles followed. On 15 July 1876 we have this from Paul Janet: “When I read [Azam], I seemed to recognize the history of one of my own former clients.” And directly after Azam’s memoir had been read to the Academy of Moral and Political Science, Bouchut, who later contributed other multiples, said, “I have observed two similar cases….”18 The cases go on, and on. In August 1887, when he was taking the waters in the Pyrenees, Azam encountered a spectacular case of a teenage boy. The characteristic features of the prototype established by Azam are clear. A woman. Early onset. Bad times in childhood. One-way amnesia. Subsidiary quasi-states additional to the condition seconde. Highly suggestible. Hypnotism reproduces second states. Second state is like (or is) total somnambulism. Above all: the prototypical case of dédoublement suffers from florid hysteria, and she is overwhelmed by bodily crises.
The connection between hysteria and dédoublement became so strong that someone who merely split had to be made to have hysterical symptoms. Take, for example, a young Swiss woman described by P. L. Ladame, a pioneer of Charcotian hypnotism in Geneva. The woman was as close to good old-fashioned British double consciousness as could be. As a child she had been terrified by a fire, and she developed a second state when she thought she had started a fire by overturning a lamp. In one state she was gentle, in the other aggressive. All the adjectives applied to this Swiss girl had been applied in the English-speaking world for a century. Aside from a certain paleness and indifference to grooming, “she presented no morbid symptom, and none of the marks of hysteria.” But conceptually, from the point of view of her physician, she had to be a hysteric. Horrible bodily symptoms were produced by hypnosis, which also cured her.19
Félida was a confusing prototype. She had so much wrong with her, so much pain. Types of suffering needed to be sorted. So she, as prototype, led to new models—two, as it happened. Wouldn’t you know it? Both models were furnished by male patients. One was the first multiple personality in history, that is, the first person to have a substantial number of what were perceived as distinct personalities. I describe that remarkable man in the next chapter. The other model was provided by another citizen of Bordeaux, who was treated by a medical student there; that student later became an associate of Azam’s, not in medicine, but in archaeology. The patient, Albert, traveled compulsively, with little sense of who he was. He inaugurated psychogenic or dissociative fugue. Philippe Tissié described him in a thesis published in 1887, but Tissié was upstaged by Charcot a year later. Charcot’s diagnosis of ambulatory automatism was, for twenty years, an important part of French psychiatry.20 An extraordinary battle was waged. Charcot had made popular the diagnosis of male hysteria, but he denied that the fugueurs were hysterics; they were epileptics. His foes rallied to a diagnosis of hysteria. Several things are transparent in the debate. Some doctors described the fugueurs as having doubled personality, but these doctors could only do so when they came out against Charcot and held that the men had hysteria. That is evidence for the intimate bond between hysteria and multiple personality. Hysteria disappeared from the French scene by 1910. So did fugue. A second feature of fugue is that we have an easy answer to the gender problem. In the 1980s it was suggested that the male multiples were in jail. We know much more about the late 1880s and early 1890s. In those days the male multiples took trips.
The relations between multiple personality and hysteria, or fugue, were fleeting. Something else became permanent. In the century before 1875, double consciousness, and even spontaneous somnambulism, had only an incidental relation to memory and forgetting. Félida came to life during a conversation about memory in 1875, and for the rest of the century double or multiple personality was unthinkable except with oneway or two-way amnesia. This was not an empirical fact but a conceptual one. It was part of the nature of a doubled personality to be a hysteric. It was part of her nature to be hypnotizable. And it was part of her nature to have a maladie de la mémoire.