Blanche Wittman and PNES (Psychogenic Non-Epileptic Seizures)
Blanche Wittman, famed La SalpĂȘtriĂšre hysteric is the pinnacle of what the modern-day public thinks of when they imagine "female hysteria" that being young women institutionalized and used as entertainment. In fact, most of our modern understanding of what hysteria was comes from Jean-Martin Charcot's work on La SalpĂȘtriĂšre's hysterics, one of the most notable examples being Blanche Whittman, forever immortalized in photographs and of course the famous AndrĂ© Brouillet painting "Une leçon clinique Ă la SalpĂȘtriĂšre"
Her dramatized and public portrayal of hysteria has led to an increase in awareness of neurological and psychiatric conditions primarily effecting women, PNES (Psychogenic Non-Epileptic Seizures) which falls somewhere between psychiatric and neurological being one of these conditions, which seems a likely diagnosis for her if Blanche were to visit a modern neurology clinic.
What is PNES? PNES (Psychogenic Non-Epileptic Seizures) are seizure episodes that highly resemble that of an epileptic seizure, though no brain activity resembling epilepsy is present. These seizures have a psychological basis, instead of a neurological one, though neurological imaging may be used in diagnosis before treatment is turned over to a psychologist or psychiatrist.
Blanche Wittman's symptoms present in her public case information across volumes of "Iconographie photographique de la SalpĂȘtriĂšre" line up very well with the current diagnostic criteria of PNES.
When Blanche was first admitted into La SalpĂȘtriĂšre in 1877, she was 18 years old, 1.62 meters tall (considered above average in this period) and weighing in at 70kg. Being raised in a troublesome and poor family, she was never taught to read and her intelligence was labeled as being below average by the hospital.
As stated before, Blanche was raised in a troublesome family, having nine siblings, including five who died in childhood from epilepsy and convulsions. Her father was prone to "fits of rage" and physically abused the young Blanche in many instances, and her mother died when Blanche was young, though the exact age varies from source to source.
She began a sexual relationship with her employer, a furrier, by force at the age of 15. She then admitted herself to a hospital (unclear exactly where) to escape the abuse eight months after it began. A while later she reported another sexual relationship with a boy called Alphonse. It seems to be unclear whether this relationship was consented to by Blanche, or another example of sexual abuse against her.
Abuse, especially sexual is an extremely common background in those with PNES. A diagnosis of PTSD or C-PTSD with PNES is quite common. It seems extremely likely that her abuse she went through played a role in these "hysterical attacks"
After some time taking refuge at a convent (Blanche seems to have been a devout Catholic, wearing a scapular and collecting various pieces of Christian iconography) she began working as a servant at La SalpĂȘtriĂšre, thinking this would make it easier for her to be eventually admitted into the hospital after they see her attacks.
Blanche eventually succeeded in her goal of being admitted to La SalpĂȘtriĂšre in 1877, at the age of 18. Her time there coincided with the peak of Jean-Martin Charcot's studies on hysteria, and she quickly became one of his star patients. Charcotâs research focused on hysteria as a neurological disorder, and his methods of public "demonstrations" of hysterical patients, including Blanche, led to increased attention to the condition. These public displays, often featuring dramatic reenactments of symptoms, cast a long shadow over how hysteria and by extension, womenâs health was perceived for decades.
Blancheâs displays of hysteria to the public were not only attended by a medical crowd, but was also popular among a non-medical crowd, including that of actors, who would come to study Blancheâs intense displays of emotion under hypnosis.
Hypnosis was frequently used on Blanche during these displays, often to achieve the state of somnambulism, or extreme suggestibility, where the hypnotist could make her to believe just about anything they so desired, the effects sometimes even lasting long after the trance.
While the primary purpose of these displays was supposedly to educate on hysteria, they often came off as more entertaining stage hypnosis than anything. Some of this was mindless entertainment, though some was clearly intended to use Blancheâs fear and distress for laughs, whether to the audience or the hospital staff themselves, often young male medical students, finding it hilarious to sexualize and upset her.
During her intense states of somnambulism, she was often made to hallucinate snakes and rats at her feet. She would hike up her skirt and squeal, prompting voyeuristic laughs from the audience.
Unlike the many âwandering wombâ theories we often associate with hysteria today, Charcot was among the first who believed hysteria had a neurological origin, attributing symptoms like convulsions, paralysis, and loss of consciousness to issues within the brain. This makes sense as Charcot was most certainly extremely knowledgeable about neuroscience. In fact, he was the first to identify and name multiple sclerosis as itâs own distinct condition, pioneered much amyotrophic lateral sclerosis research (the disease even being known as Charcotâs disease in parts of the world) and is associated with at least 15 different diseases named after him. For this reason, it only makes sense that a condition with invisible physical pathology must be caused by nervous system abnormalities, this being even more apparent when remembering this was a time before complex brain imaging and EEG technology was in use, it was nearly impossible to know whether something was psychological or neurological, and Charcot believed the latter.
However, many of these symptoms would align more closely with what we now understand as psychogenic non-epileptic seizures (PNES), a condition rooted in psychological trauma rather than physical abnormalities in the brain. Today, PNES is understood as a dissociative disorder, often linked to past trauma, which manifests in seizure episodes without the electrical disruptions seen in epilepsy.
Before her time institutionalized, Blanche's life was full of trauma and abuse, often seen in PNES patients. Not only that but Blanche also demonstrated a good example of "the teddy bear sign" a frequent pattern in PNES patients and an aid in diagnosis. A majority of PNES patients show up to EEG monitoring appointments with a comfort item, most often a stuffed animal. While we don't know exactly what Blanche would have done in the modern day, we do know she was an avid collector of stuffed animals and various little trinkets. This was common behavior among hysterics, suggesting what in the modern day we would call PNES was common among hysterics.
The "hysterical attacks" that made her a spectacle were, in all likelihood, trauma responsesâdemonstrations of a mind and body deeply affected by abuse. While these days are long gone, it's important to see just how much this outdated understanding of the brain both holds back and progresses our knowledge of the connection between body and brain.
