A case from “The Sorrows of Love and Psychoses” by Constance Pascal, a pioneer of French psychiatry

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Que d’internements on pourrait éviter si tous les médecins connaissaient les chagrins psychogènes et les métamorphoses de l’amour malheureux

Constance Pascal, 1932.

“During the descent into the underworld, Virgilio draws Dante’s attention to the desperate people who cry out and cry out for lost love. One cannot avoid thinking of these damned of Eros when we listen to the laments of the alienated, overwhelmed by the pain of wounded love”.

This is the incipit of Chagrins d’amour et psychoses (The Sorrows of Love and Psychosis), by Constance Pascal ¹, edited and translated into Italian by us ². Dedicated “to Morel, who first described the Folie par amour”, Pascal’s valuable essay, besides constituting an important chapter in the history of psychiatry, allows us to reflect in a new way on a condition that is still so frequent in clinical and criminology today: the ‘lovesickness’.

The topos moreover is very ancient and has its roots in the early days of Western medicine. As Pascal reminds us, telling us, not without a touch of irony, the story of Hippocrates and Perdiccas, “It was in the shadow of the plane tree of Kos, around the year 428 B.C. that psychoanalysis was born, this abysmal science that reveals the secrets of love”. The young king Perdiccas, according to Soranus’ account, was suffering from a mysterious φθίσις (a term then denoting not tubercular “consumption” but a general physical wasting away) that consumed him. Hippocrates, called to his bedside, adopts a method not unlike today’s psychotherapies, and discovers that Perdiccas’s φθίσις was nothing more than a πάϑος of ψυχή, a disease of the psyche due to his love for his stepmother Phila. He cured his love sickness by advising him to marry the beloved woman, since his father had died and, “fortunately”, his beloved had been a widow for three years! Hippocrates was considered in the Greek world to be the first theorizer of the physical consumption caused by falling in love, and his followers considered him a specialist in the treatment of such illness ³.

Superimposable, and slightly later (ca. 325 B.C.) is “the illness of Antiochus”, narrated by Plutarch: Antiochus, general of Alexander the Great, falls in love with Stratonice, his father’s new wife. The passion consumes him. The physician Erasistratus is called in and discovers the cause of the illness. The father, Seleucus, renounces his wife and gives her to his son.

In both cases, the thwarted love (as semi-incestuous), finds a solution and the πάϑος of the ψυχή results in a happy ending. But, in the same 428 BCE, Euripides brings to the stage the tragedy Hippolytus: in this case Phaedra’s torment of love cannot but have a nefarious outcome (slander, suicide, curse and death), being part of the ruthless and well-thought-out plan of a goddess, Aphrodite, determined to severely punish the repudiation of love by Hippolytus, who has consecrated himself to her rival, the virgin goddess Artemis. It is a veritable “murder by proxy” that spares no innocent victims and precisely exploits the immutable mechanisms of love and passions, so finely described in Chagrins d’amour et psychoses.

Constance Pascal was described by her contemporaries “aussi belle que savant”, as “feministe en agissant non en reclamant”, as “the modern face of psychiatry” ⁴. Of Romanian origin, she had moved to Paris to study medicine and was the first woman to obtain the title of doctor alienist in France. She burned through the career ladder to the most prestigious role: “médicine-en-chef” of the Asile d’aliénés de la Seine.

After her death at age 60, she fell into oblivion. Rediscovered as the “Grande Dame de la médecine mental” ⁵, her merits as a scholar and researcher are coming to light again. At a very young age she corresponded with Kraepelin and at 34 wrote a treatise on dementia praecox that was widely circulated in France.

Why did a scientist of this significance devote the last book of her career to the “torment of love”? First, she believed, and not wrongly, that it was a cause or trigger of mental illness (mental disorder) in most of her patients. In addition, one of her favorite fields of research was that of emotional shocks. Inserting herself in the line drawn by Pinel, Esquirol and Morel, who proposed “passions” as a cause of mental illness, she studies them in the light of the most recent biological, physiological and psychological research.

In Chagrins d’amour she reveals the rigorous scientific approach that distinguished her, but draws from a wide variety of cultural domains, making a brilliant synthesis. She cites 150 authors, psychiatrists, literati (Proust, Racine, Renan) and philosophers, among whom she undoubtedly favors Henri Bergson. But we also find there Kierkegaard and his “refusal of love”: the philosopher abandoned his beloved maiden, Regine Olsen, in order to make their love eternally sublime and experience it only as a memory, moreover in the pretence of being reciprocated by her forever and making their story immortal (who knows what punishment Aphrodite would have reserved for such tracotance!).

Freud is credited with creating a new conception of love: “at a time when scientific positivism has reduced love to a mot-perroquet (parrot-word), to rigid academic schemes, Freud has reproposed for attention the mystery of the soul, where the hunted instincts live and suffer in the state of panic” ⁶. But, with elegant irony, she dismisses his claims that she finds unsupported, fanciful.

Love, she argues, must be studied dynamically, in its chronogenesis “from zero to zero” (integration-disintegration-healing) and in its chronogenesis “from zero to madness” (when the wound of love does not heal).

A cultured, independent and courageous thinker, Pascal highlights a rumination on painful memories (“affective hypermnesia”) in numerous cases of psychosis of sexual origin, which she assimilates to the terror psychoses induced by war. Love, this very powerful emotion, makes inroads into the psychism and also into the organism, bringing about a series of psychological, organic, humoral reactions. It is an intruder, argues Pascal: “the pathogenic emotion is to the psychism what the antigen is to the organism”, and it acts by the same mechanisms as in allergies and anaphylactic shock. The psychism that is invaded by it fears that vertigo of identity, that state of instability in which the individual ceases to be indivisible and feels lost in the other ⁷; it defends itself and the instinct of preservation becomes alert. Love can be a true trauma triggering a loss of a sense of self, and those affected enact immediate panic, fearful, destructive counterreactions that begin to appear as early as the integration stage (“the first thrill of love is not that of desire, but that of restlessness, of fear of loving”) and that deflect the curve. Eventually, in the normal zero-to-zero chronogenesis, falling in love ends, heals and turns into hate or loathing (or, if it goes well, friendship and affection).

Freud is wrong, according to Pascal, when he subordinates life to a single force, libido, as Cartesians once subordinated it to reason, and when he considers libido an invincible, always triumphant force. “The most beautiful human drive is also the most fragile. The self-preservation instinct always wakes up when there is a sexual upheaval, and it sets in place defensive and offensive elements: selfishness, self-love, fear, hatred and anger”. In Euripides’ Hippolytus, Phaedra’s words in Act I describe her terrible struggle. She is so “taken” by the intruder that she has a kind of dream vision that expresses a confusion of identity with Hippolytus, a kind of possession. She longs, like him, to go hunting in the woods, to run in the meadows of Artemis: she has lost herself in him, she has become him.... Then she seems to come to her senses, the instinct of self-preservation prevails for a moment: “Where did my soul flee? I rambled mad and a demon blinded me”; “I am ashamed”; “Painful much is the return of the mind and sad thing to lose it”. The chagrin d’amour is a furious struggle between a bundle of instincts. “My soul is defiled”; “When Eros wounded me, I tried to be strong and stand firm against my madness, and overcome it by mastering myself”. “When I saw that I could not with my weapons overcome Cìpride, I decided to die”. Her last salvation against the intruder is death. Self-love intervenes by suggesting suicide, while resentment suggests slander and revenge.

A CLINICAL CASE

Among the many clinical cases reported by Pascal exemplifying the “zero to madness” course, we quote one that comes from a classic of French literature (Ernest Renan’s Memories of Childhood and Boyhood, 1883) ⁸. It is “the madness of the daughter of the flax-crusher of Trézardec”.

It is the story of a beautiful girl condemned to bachelorettehood and loneliness because of her social rank and poverty. Her father was an aristocrat, who, impoverished by historical events, had retained his castle, but to make a living he had to be a “flax crusher” and could not marry his daughter to either a nobleman or a peasant. But she was “beautiful and flourishing, lifeblood flowing through her veins”, Renan says. The sexual and maternal instincts, which dominated in her, sought their satisfaction in vain in religious sublimation; she fell in love with the vicar of the parish, a young priest who also had a remarkably attractive figure. “She felt that he had heart and senses, but a higher principle dominated them; they had transmuted, in him, into something higher”. Just as Hippolytus is consecrated to Artemis, so the vicar is consecrated to the Church and repudiates love, true to his religious role. But, like Hippolytus, he goes further and so denies the feeling of love that he is unable to offer any recognition, any pitying welcome, to the girl’s desperate one. She would have settled for some attention from him, but “her efforts met an iron bar, a wall of ice”. And it was this lack of “human” recognition of love’s existence that precipitated events. His detachment excited the girl’s imagination even more, love in her became worship, pure adoration, exaltation, and eventually a psychosis of desire and love culminating in the theft of her beloved’s linen to replace it with hers, encrypted with their initials intertwined. The symbolic embroidery meant, “This is my wedding trousseau; I am your wife”. The theft of the linen had created a great stir in the village, and the sacristan’s wife was accused and arrested. The substitution with the ciphered linen led to suspicion of the real culprit, but the vicar, so caught up in her purity and religious sentiment, pretended to ignore the facts and was unable to understand the girl’s feelings. She, in a state of stupor, was arrested and during the trial was unable to come out of her complete annihilation. The jury cried, the prosecuting attorney showed tact, dropped the charge, and she was acquitted. Only the vicar proved nothing. The obvious facts everyone was talking about, he pretended to ignore, and the first time he saw her together with her father in church, he simply said, “You have sinned grievously”. Just like Hippolytus, he feels no empathy or pity for her at the moment of revelation, and his cold and cruel attitude leads her to ultimate madness: the poor girl was now no longer a being capable of feeling. The sexton’s wife, freed, died of grief. The old father endured only a few years of this agony. Left alone, the flax-crusher’s daughter ended up at the Poorhouse Hospital, where Renan saw her as a child: a “vieille fille about 45 years old, with a big old-fashioned hat, who stood motionless, looking gloomy, lost, her eye misty and fixed, which could become now sweet and sad, now hard and fierce”, suggestive description of a catatonic evolution of an affective trauma.