L’arc de cercle des hystériques. Historique, interprétations

Abstract

Charcot's “Grand hysteria” – with its systematisation in four phases – disappeared along with its author and is now considered to be a socioeconomical and cultural construction of a bygone era. ObjectivesThe objective of this study is firstly to find out whether the “arc de cercle” (arching-back attitude), which is the master symptom of hysteria “à la Charcot” and its current emblem, was itself socially constructed, or whether it is natural. Following on from this, we review the various interpretations, which have been proposed for it over the years. Materials and methodsAfter recalling the description of the “arc de cercle” by Charcot and his pupils, along with the various differential diagnoses that it raises, a dual inquiry has been undertaken: 1. Clinical, into the contemporary manifestations of hysterical conversion; 2. Historical, destined to discover when the first descriptions and iconographic representations were made. Results1. Some current manifestations of conversion are still seen, though essentially in neurology. Amongst these, the “arc de cercle”, also called opisthotonos, is a symptom of Psychogenic Non-Epileptic Seizures. However, the “arc de cercle” has also been observed – naturally – in an epidemic of collective hysteria, where its strong contagiousness was highlighted. 2. Even if the description of hysteria does not hark from the earliest times, that of the “arc de cercle” has been found in a text dating from the 2nd century A.D. and its first known iconographic representation also dates from antiquity. However, it is most notably in the 16th and 17th centuries that it became appropriated by the imagery of the day, amidst its witches and convulsionaries. Contrary to Charcot's opinion, it has been suggested that certain of these images represented tetanos or pathological rage, rather than cases of hysteria. The interpretation of the “arc de cercle” initially evoked uterine conceptions of hysteria before it was to be “desexualised” by Charcot and his pupils, (notably through the importance they accorded to masculine hysteria). Freud, with his term and concept of conversion, conferring a symbolic signification on the symptoms, opened the way to a resexualisation, which blossomed along with his disciples. Subsequently the vulgarisation of the “arc de cercle” in literature, imagery and film rendered it a “theme of modernity” and the cliché of a compelling feminine desire. A concurrent interpretation by Shorter – according to which the potential patients of the day draw from a pool of symptoms – places the accent on the cultural factors determining the symptomatology of hysteria. Conversely, a natural conception underpins the interpretations of Claparède, for whom the symptoms of hysteria were “the revival of adapted defence mechanisms” and of Szasz, for whom they composed a “protolanguage”. The “arc de cercle” thus appears as the archaic manifestation of major suffering or fright. Nonetheless, a physiological interpretation is provided by the analogy with the brief enjoyment – resembling orgasm – occurring after abrupt cessation of the powerful contraction of all the anti-gravity muscles during yawning. ConclusionsThe “arc de cercle” cannot be considered to be a social construction. It appears to be a natural phenomenon in the way Charcot understood it. We consider it as a final common pathway located at the convergence of the functional and the organic, pleasure and pain.