Alexandre Brierre de Boismont and the limits of the psychopathological gaze

Introduction

In a well-known fragment from the second edition of his Traité médico-philosophique sur l’aliénation mentale (1809), Philippe Pinel justified adopting a new term of reference for mental pathology and defended the need to banish from medical vocabulary the coarse word ‘insanity’ as it ‘could have an undetermined latitude and be applied to all mistakes and defects affecting the human race’. ‘Would it not be necessary, therefore – he wondered – to include in this category all the false, inexact ideas formed about objects, all the notorious mistakes of the imagination and judgement or all that irritates or provokes fanciful desires?’ (Pinel, 1809: 129). Without doubt, the choice of ‘mental alienation’ reflected a new ‘psychological’ (morale) comprehension of insanity (Swain, 1977: 22–3) and it made sense to mark off the specific object of the new specialty in relation to other behavioural and experiential anomalies (Lantéri-Laura, 2000: 73–6). Yet it is still of great significance that, with prescient lucidity, Pinel expressly alerted us to the fact that, if terms and concepts were not accurately delimited, the alienist would soon ‘emerge as supreme censor in man’s private and public life, and his points of view would preside over history, morality, politics and even the physical sciences, whose domain has often been seen to be infested with dreams and brilliant flourishes’ (Pinel, 1809: 129).

In spite of these rhetorical preventions, there is no doubt that the advent of clinical psychiatry in the transition from the 18th to the 19th century led to the emergence of a new way of looking at the human being and the introduction of new tools to analyse not only individual behaviour and experience, but also historical facts, collective patterns of behaviour or cultural achievements with supposed myriad side effects. Thus, for example, some pioneers of psychological medicine did not hesitate to qualify as delusions or hallucinations – or later hysteria – the mystic and creative experiences of eminent figures from the past, outlining an alternative, rational and secular interpretation of these phenomena against the traditional narratives from religion or art (Gumpper, 2008: 120–55; James, 1995: 84–97). In the same way, ‘technical’ disputes about the existence of clinical conditions such as monomania did not stop their (corporative) use as a category that extended the reach of the psychopathological gaze to almost any type of behaviour or experience. Therefore, in the opinion of Jean-Étienne-Dominique Esquirol, it became particularly useful for detecting spiritual trends predominant in society (Goldstein, 1987: 152–96). And, in the same way, many of the first alienists postulated a hypothetical increase in the incidence of insanity, crime or suicide that echoed the widely held Rousseaunian perception of civilisation’s problematic consequences; a perception that was quickly reinforced with concepts such as ‘moral insanity’ and later with more ambitious theories about an alleged biological and cultural decline of the human race (Roelcke, 1999).

To a large extent, and as US historian Jan Goldstein has pointed out, the history of psychiatry is the history of a ‘set of categories’ and of ‘a way of looking at and making sense of human behaviour that can be applied outside the asylum as well as within’. Thus, one of its crucial questions should be the process by which this ‘interpretive framework gained authority in our culture’ (Goldstein, 1987: 6). In fact, and in spite of having to face significant ideological resistance and bitter professional disputes, by the end of the 19th century the view of the psychiatrist – which Marcel Proust compared to that of a judge or an inquisitor – had managed to penetrate ‘courts of law, where it could transform criminality into monomania; into the doctors’ private consulting room, where it might turn spiritual distress into mild hysteria; and even the cemetery, where it tried to eradicate the sin of suicide and replace it with a morally neutral mental disease’ (Goldstein, 1987: 383).

One of the few 19th-century alienists who stood out precisely for explicitly questioning this expansion of the psychopathological gaze was the Frenchman Alexandre-Jacques-François Brierre de Boismont (1797–1881). An old member of the Esquirol circle, doctor–director and owner of several maisons de santé specialising in the treatment of mental illness, prolific author of notable medical and psychiatric works, editor and collaborator of the Annales Médico-Psychologiques (AMP), prominent member of the Société Médico-Psychologique (SMP) and recognised authority of French psychological medicine in other countries (Novella and Huertas, 2011), Brierre can be considered an exponent of French post-sensualist spiritualism à la Maine de Biran, Pierre-Paul Royer-Collard and Victor Cousin (Goldstein, 1987: 257–63), and an author close to the ideological and political positions of Catholicism and post-revolutionary conservatism (Trémine and Moltó, 2001). He was a ‘declared supporter of the principle of human duality’ and ‘full of respect for the beliefs that have illuminated the world and to which humanity owes its most beautiful conquests’; further to this, he never stopped ‘fighting the doctrine that tries to explain intellectual and moral acts through the pathological state of the organs’ and, above all, challenging the notion according to which ‘the most sublime opinions, the greatest undertakings, the most beautiful acts have been advocated or performed by madmen’ (Brierre de Boismont, 1852: V–XIII).

In particular, Brierre’s crusade focused on two emblematic topics of the emergent psychopathological discourse, which were hallucinations and suicidal behaviour. Since they were canonically described by Esquirol (Huertas, 2008), hallucinations had become one of the distinctive, yet also most controversial, symptoms of psychological medicine. Therefore, their definition, their psychopathological comprehension and their semiological value were the object of numerous discussions in the central decades of the 19th-century that reflected not only more or less subtle clinical or theoretical questions – such as their relationship with sensorial images or optical illusions, their preferentially visual or auditory nature, or their possible analogies with sleep or mystic states – but also significant epistemological or ideological concerns (Álvarez and Estévez, 2001; Ey, 1973; Lantéri-Laura, 1994). In this respect, as will be seen, Brierre stood out as an ardent defender of the existence of ‘physiological’ hallucinations and for frontally attacking the views of some alienists according to whom great religious, literary or philosophical figures of the past who had supposedly experienced hallucinatory phenomena should be classified as mentally ill.

Encouraged by a slightly different intention, although with a similar approach, Brierre also proposed distinguishing suicides secondary to mental pathology from those committed in the absence of cognitive or affective disturbances, whose very possibility had been doubted by Esquirol (Esquirol, 1838a: 665). In his enthusiasm to set up a convincing medical model for suicidal behaviour through concepts and categories such as melancholy (‘lipemania’ in his terminology) or ‘suicidal monomania’ (Berrios, 1996: 443–54; Cahn, 1998: 175–85), Esquirol had specified that suicide should not be seen as a disease in itself, but as ‘a consecutive symptom almost always dependent on a delirium of the passions or on some type of mental alienation’ (Esquirol, 1821: 275). But, in Brierre’s opinion, ‘seeking to establish that [suicide] always implies a psychic disorder’ (Brierre de Boismont, 1850a: 563), his mentor had overlooked the important role of culture in the genesis of ‘mental and bodily conditions’ such as ennui, which, ‘even with suicidal tendencies, cannot be considered a variety of insanity, unless it is accompanied by a disorder of sentiments and intellectual faculties’ (ibid.: 561). In this case, and unlike hallucinations, the excesses of the (psycho)pathological gaze – that, in Brierre’s own words, ‘justify the reproach that is so often directed at alienists of seeing their subject matter everywhere’ (ibid.) – did not irreverently transform normality into pathology, but prevented awareness of the consequences of certain phenomena that threatened modern society and led it down a hazardous slope of idleness, dreaminess and scepticism.

In synthesis, then, and as I will try to demonstrate throughout this article, Brierre de Boismont’s contributions and the tensions related to his understanding of hallucinations and suicide have logically to be seen as a consequence of the epistemological problems faced by alienists when establishing the boundaries of insanity and normality at a psychological level, but, above all, in the context of the background conflicts accompanying the deployment of the new gaze embodied by the concepts and categories of psychological medicine. As the case may be, however, the important place the new bourgeois society must grant to alienism – which, not in vain, Brierre defined as the discipline ‘most apt to clarify great philosophical questions’ (cited by Motet, 1882: 348) – was not exempt from paradox: psychopathological discourse should not under any circumstances replace the pre-eminence of Christian beliefs or dogma on divinity, the spirituality of the soul or free will, but, in turn, the cause of tradition needed the trained eye and the privileged testimony of the alienist to adequately diagnose and redirect the deep moral crisis faced by European culture with the advent of modernity.

Physiological hallucinations

‘The problem of hallucinations – wrote the French psychiatrist Paul Guiraud in 1950 – is the central problem of psychiatry. It is the battlefield on which all theories confront each other’ (cited by Lantéri-Laura, 1994: 110). In this sense, and in spite of being one of the first symptoms of insanity to be described as such, that is, as an ‘essentially psychic’ fact (Esquirol dixit) whose presence in mental life can only be referred to by the subject or inferred by others (Novella, 2016), more than two centuries of psychiatric practice have turned them into one of the phenomena carrying most shared semiological baggage and, in turn, most discrepancies between different theoretical models (be they neurobiological, psychological, phenomenological, etc.). In the authoritative opinion of Henri Ey, the problems still caused by the understanding of hallucinations are an inevitable consequence of the same ‘elemental reduction’ that guided their conceptual evolution throughout the 19th-century, that led to understanding them as a kind of spontaneous production of ‘inadequate sensations’, to split them off from delusion – and, by extension, from psychic life as a whole – and to postulate a long series of discrete generating mechanisms (Ey, 1973: 77–8).

Be that as it may, it has already been stated that it was Esquirol who formulated the first proper psychiatric doctrine concerning hallucinations. In his entry written in 1817 for the famous Dictionnaire des Sciences Médicales by C.L.F. Panckoucke, the great patron of French alienism defined hallucination – as opposed to ‘illusion’ – as a ‘perception without object’ that can affect all the senses, but usually has a clear preference for the visual dimension: ‘a man who is intimately convinced of an actually perceived sensation, when no exterior object that could cause this sensation has reached his senses, is in a state of hallucination: he is a visionary’ (Esquirol, 1817: 64). At this point, it is important to note that Esquirol recognised the possibility that people who are not deluded experience hallucinations, yet also pointed out that they are usually a ‘symptom of delusion’ and can be detected in ‘almost all of those who are deluded’ (ibid.: 70–1). Over the following decades, hallucinations were one of the main points of debate among his disciples, divided between those who – like Jean Pierre Falret and Jacques-Joseph Moreau (de Tours) – sustained their essentially imaginative and delusional nature and those (more numerous) that leaned towards underlining their primitively sensorial character (Bercherie, 1984: 38). Among the latter, Jules Baillarger made a decisive observation about the peculiarity of the voices experienced by some patients in an award-winning memoir presented in 1844 to the Académie Royale de Médecine: ‘there are those who, as they themselves say, experience nothing like an audible sensation: they hear thought. The phenomenon contains nothing sensorial for them. The voice speaking to them is a secret, inner voice and is completely different from that perceived by the ears’ (Baillarger, 1846: 368). As a consequence, Baillarger proposed distinguishing between (‘complete’) psycho-sensorial hallucinations and (incomplete) psychic ones, that is, between those ‘that are the result of a joint action of the imagination and the sensory organs’ and those ‘due only to the involuntary activity of memory and imagination’ (ibid.: 369). Henceforth, the analysis of this type of phenomena – that began to be known as ‘pseudo-hallucinations’ to underline their non-aesthesic character – would lead to a progressive displacement in the interests of alienists from the visual to the audio-linguistic dimension, and from the most crass manifestations to more subtle and ‘elemental’ ones (Álvarez and Estévez, 2001).

Within these coordinates, Brierre de Boismont published in 1845 the first edition of his treatise (Des hallucinations), that created intense dispute due to his fiery defence on the compatibility of hallucinatory phenomena with the integrity of reason and his indignation over the attempts by some of his colleagues to reinterpret the biographies of some outstanding figures of thought, literature and – above all – religion resorting to the new categories of psychological medicine. Some years before, in effect, François Leuret had suggested in his Fragmens psychologiques sur la folie (1834) not only the invariably pathological character of hallucinations, but their presence in some eminent individuals from Judeo Christian tradition such as Moses himself. Therefore, after pointing out that ‘hallucination is a phenomenon having nothing analogous in the normal order of the operations of human understanding’ (Leuret, 1834: 136), Leuret did not doubt to affirm that, as long as both were carriers of ‘an invincible cause of error, […] [there was] no essential difference between visionaries from other times and those around today’ (ibid.: 255). Nevertheless, the authors who made these first essays into the ultimate expression of what Émile Littré would call ‘retrospective medicine’ (Littré, 1869) were Louis-Florentin Calmeil – for whom a large number of religious experiences and heretical behaviour in previous centuries corresponded to misdiagnosed lunacy (Calmeil, 1845) – and, above all, Louis-Francisque Lélut, a physician from the Salpêtrière and La Roquette prison who in 1836 published Du démon de Socrate, significantly subtitled Spécimen d’une application de la science psychologique à celle de l’histoire (Lélut, 1836), and in December 1844 presented a controversial memoir to the Académie des Sciences Morales et Politiques titled De l’amulette de Pascal, subtitled in this case Étude sur les rapports de la santé de ce grand homme avec son génie (Lélut, 1844). In his opinion, hallucinations corresponded to the highest degree of the ‘sensorial’ transformation of ideas, so that the (imprudent) exercise of imagination, the movements of the passions or the paroxysms of faith could provoke them and even be mistaken for them. His works tried thus ‘to demonstrate the fragility of human intelligence and the transformations that can affect it, even in the most powerful minds, when an ardent, enthusiastic brain lends itself to a passion or exclusive idea’ (Lélut, 1836: 16); so it became necessary to study the ‘most illustrious members of humanity’ and ‘the mysteries of their weaknesses after having admired them in the external contours of their greatness’ (Lélut, 1844: 456). Absorbed in body and soul by their ideas, great geniuses like Socrates and Pascal had experienced a ‘sensorial insanity’ that, admittedly, had not led them to an openly delusional state, yet was not essentially different from phenomena characteristic of mental alienation and revealed what some years later Moreau would label as a ‘neuropathic’ constitution (Moreau de Tours, 1859).

Dismayed by such audacity, Brierre presented his work with a resounding and explicit declaration of intentions: ‘This subject affects all that is most elevated in the world […]. If all hallucinations must be considered products of a deluded imagination, holy books, Christianism and the beliefs of our fathers would be nothing more than a mistake […]. What could be more irritating and painful?’ (Brierre de Boismont, 1845a: IV–V). Curiously, Brierre thought, on the basis of a very similar understanding to that Baillarger and Lelut, that hallucinations were the result of the capacity of mental life of ‘producing images’ or, rather, ‘of perceiving the tangible signs of ideas’: ‘all that determines a strong impression on the mind is capable, under certain circumstances, of producing an image, a sound, an odour, etc.’ (ibid.: 5, 395). Accordingly, and providing a large number of clinical observations – including the visions of Berlin book-seller Nicolaï and the strange sounds assailing Leuret himself while suffering from flu (Leuret, 1834: 135) – and quoting analogous experiences from such celebrated personalities as Descartes, Malebranche, Samuel Johnson, Pope, Byron, Goethe or Cromwell, he energetically postulated the existence of hallucinatory experiences ‘consistent with reason’ and secondary, for instance, to ‘optical errors, intense concerns or morbid dispositions of the body’ (Brierre de Boismont, 1845a: 28). In his opinion, if Socrates, Joan of Arc, St Ignatius of Loyola or Martin Luther had had hallucinations at some moment of their lives, their content had been totally consistent with the beliefs of their time and – what is more important – had not prevented them from fulfilling their high mission nor the demands of social life. And this decisively distinguished them from modern hallucinators who did suffer from ‘true mental aberrations’ (ibid.: 414) ultimately due to modern individualism, scepticism, materialism, utopian reformism and the decline of religion and traditional values: ‘These hallucinators are not the expression of a deeper need, the representatives of any idea nor the promoters of any project useful to their peers […]. How can a parallelism be drawn between organisations that are powerful, creative and full of life and weak, plagiarising and lifeless natures?’ (ibid.: 433–4).

Motivated just as much by his friendship with Lélut as by the conviction – very close to the influential theses by Jules Michelet – that catholic ideas were a serious threat to free thought, reason and progress, the first attacks against Brierre’s position came from Alfred Maury (Dowbiggin, 1990), well-known in the history of psychopathology for his pioneering description of ‘hypnagogic’ hallucinations in the transition from wakefulness to sleep (Maury, 1848). In a review in the AMP, where he declared as ‘perfectly reasonable to look in physiology for the solution to certain problems in the philosophy of history’ (Maury, 1845: 318), Maury pointed out the artificiality of the distinction between physiological and pathological hallucinations and, above all, among the ‘extraordinary experiences’ of saints or geniuses of the past and the ‘mistakes and reveries’ of the ‘vast pandemonium of deviant minds and sick brains’ filling the asylums (ibid.: 321): in the Middle Ages, he said, ‘the hallucinator saw God, the devil or angels; today he sees police officers and conspirators. Why? Because nowadays we are more concerned about political and social interests than religious ones. But, how does this alter the very nature of hallucinations?’ (ibid.: 330). In his opinion, Brierre had not stopped ‘accumulating contradictions’ in his crusade to ‘save psychological medicine from the [alleged] abyss to which it had been driven’ (ibid.: 321), waving around an inconsistent ‘pseudo-Catholicism’ for which religious ecstasy or moments of genius, so common and revered in other times, had become literally impossible with the advent of modernity.

Supported by the editor of the AMP, Laurent Cerise, who soon came out in his defence with a review of his work that deplored the lack of sensitivity of alienists to religious matters (Cerise, 1845), Brierre replied in an open letter that he ‘had never had the intention of setting himself up as the sole defender of Catholicism, […] a social organisation that all efforts by encyclopaedists, directed by Voltaire and seconded by a powerful aristocracy, have not been able to destroy’ (Brierre de Boismont, 1845b: 339–40). Nonetheless, and in agreement with the opinion of ‘nearly all the wise men of our age’, he did believe he had legitimately and scientifically questioned the project of ‘explaining through categories of disease the intellectual and moral actions of many celebrated people’, a determinist interpretation ‘opposed to facts and history’: ‘the big mistake of doctors is to try to subordinate doctrines, beliefs and convictions to the morbid state of the organism, as what may be true for character and humour is totally false in relation to the soul’ (ibid.: 341).

Some months later, Brierre again set forth the same arguments to defend himself from the criticism of Republican politician and writer Alphonse Esquiros, who in 1840 had been condemned to several months in prison after publishing a work (L’Évangile du peuple) presenting Jesus of Nazareth as a mere reformer and forerunner to socialism. From the prestigious Revue des Deux Mondes, Esquiros showed his support for the views held by Leuret and Lélut and accused Brierre – as did Maury – of succumbing to the inconsistency of ‘claiming that a natural phenomenon in some cases must be taken as supernatural in others’, something that betrayed an excessive ‘influence of religious beliefs over medical doctrines’; ‘theology – he concluded – has nothing to do with medicine’ (Esquiros, 1845: 314, 325). Outraged, Brierre brought an angry protest before Victor Cousin, former minister of public instruction and all-powerful professor at the Sorbonne (Goldstein, 2005: 139–81), whose eclectic philosophy inspired another notable monograph on hallucinations that was pompously dedicated to him (Michéa, 1846). Referring to his observations about Lélut’s memoir on Pascal, Brierre asked Cousin in a letter to get involved in the discussion and to assert his authority as the ‘main philosopher of our time’ (Brierre de Boismont, 1845c). Furthermore, he reminded him that ‘he had never tried to dress himself up as a theologian’; his arguments had been limited to pointing out ‘the integrity of reason in Socrates, Pascal, Luther, Muhammad and many other historical personalities’, something that he ‘believed to have demonstrated by establishing that hallucinations can be compatible with reason’ (ibid.). After (quite unfairly) noting that Esquiros had even suggested that ‘Greek philosophy, Protestantism or Islam were products of mental alienation’, he repeated his request that he (Cousin) should make blatant ‘the false, ridiculous role medicine is condemned to by explaining in this way history through pathology’ (ibid.).

Unfortunately, we do not have Cousin’s reply to this missive, although we may assume that his position was quite close to Brierre’s thesis. When in 1846 Lélut published an extensive monograph based on his memoir on Pascal (Lélut, 1846), Brierre resorted to the pages of the Annales d’Hygiène Publique et de Médecine Légale (AHPML) – a journal widely followed by alienists on whose editorial board he sat – to again address the issue and highlight that his views were shared by ‘almost all philosophers of our time’, a statement he said he could support by presenting ‘numerous letters that leave no shadow of a doubt’ (Brierre de Boismont, 1847: 232). Reaffirming his ideas, Brierre then pointed out that ‘he had never crouched under the cover of faith’ to declare ‘Socrates’ hallucinations and those of other pagan enthusiasts as supernatural illuminations beyond all discussion’ (ibid.: 238); his insights, on the contrary, were based both on science and on common sense, which Lélut’s and his supporters pretension particularly offended in their attempt to convert pathology into the ‘criterion of history’ and to extend too much the ‘boundaries of insanity’ (ibid.: 231, 233). ‘To reject physiological hallucination – he would say in 1850 while reviewing in the AMP, a work strongly influenced by his approach – is to negate in man the existence of a higher faculty that, whatever you call it, enthusiasm, enlightenment or ecstasy, escapes all analysis and touches upon the deepest mystery of being, but is however no less real’ (Brierre de Boismont, 1850b: 519).

Some years later, and after his treatise had been edited a second time (1852) and even translated into English (1853), Brierre had the opportunity to return to the fray during the prickly debate the SMP held over the issue of hallucinations between February 1855 and May 1856. In the first years after its foundation in 1852, the Société was very divided from the ideological point of view (Biéder, 2002), although, as Canadian historian Ian Dowbiggin has noted, shared corporative interests prevented to a large extent discussions leading to open confrontation (Dowbiggin, 1989). As was to be expected, and apart from the analogies with sleep and mystic states or the blurred relationships between sensation, imagination and hallucination, the compatibility (or lack thereof) of hallucinatory phenomena with reason was again one of the main points of conflict (Berrios, 1996: 52–4; Ey, 1935: 585–90; Lantéri-Laura, 1994: 66–8). In the session on 26 February 1855, Brierre’s views were openly questioned by Baillarger, for whom the presence of hallucinations fell always in the realm of abnormality: ‘I confess – he said – that I don’t support the scientific use of the term physiological to refer to states which I find impossible to not consider as pathological’ (SMP, 1855: 531). But, counting on the support of the president of the SMP at the time, catholic socialist Philippe Buchez, and other colleagues such as Louis Delasiauve or journalist Louis Peisse, Brierre underlined in the session of 31 December of the same year ‘the existence in the human being of a faculty of internal vision and audition that could only be distinguished from hallucinations by a matter of degree’; this faculty was especially operative in ‘men of genius’, in whom ‘the ideal, which is no more than the highest degree of representation, is embodied in a sensitive form and constitutes physiological hallucination’ (Brierre de Boismont, 1856a: 292, 304).

If, as Henri Ey believed, the 1855–56 debate set the bases for the subsequent evolution of ideas about hallucinations on the path of ‘elemental reduction’ (Ey, 1935: 590; 1973: 83), at least until Jules Séglas linked them with the problems of language (Álvarez and Estévez, 2001: 78–83) and psychoanalysis restored their semantic dimension (Berrios, 1996: 60), it is true that, more than 150 years later, none of the essential points of the discussion is definitely clear (Lantéri-Laura, 1994: 200–4). Initially, Brierre’s position – still defended in an extensive essay on the hallucinations of Joan of Arc (Brierre de Boismont, 1861) annexed later to the third and final edition of his treatise (1862) – became a minority. In fact, and in a context marked by the doctrinal predominance of positivism, the secularising impulse of the Third Republic and the shift of a large number of French alienists towards more militant anticlerical views (Goldstein, 1987: 351–77), the last third of the 19th-century witnessed the emergence of several psychopathological studies on artistic genius (Peset, 1999: 107–27), mystic states and spectacular phenomena like stigmata, possessions, etc. now analysed following the model of la grande hystérie from the Salpêtrière school or degenerationism (Gumpper, 2008: 168–248). But, once the scientistic ardours of this period were over, culminating in the 4 volumes of such an explicit work as La folie de Jesus (1908–1915) by French military physician and psychologist Charles Binet-Sanglé, it must be said that psychopathological discourse slowly abandoned the anachronism of ‘retrospective medicine’ and, with the counterpoint of the psychoanalytical understanding of religion, started to take on a more nuanced, neutral and prudent view on ‘spirituality’ (Hopkins and Battin, 2004). In the specific case of hallucinations, there is no doubt that current epidemiological studies suggesting their broad distribution among the general population (Johns and Van Os, 2001) and the social movement vindicating them and claiming their demedicalisation (Romme and Escher, 1993) would have delighted Brierre and irritated his adversaries.

Tedium vitai

As is widely known, suicide and self-destructive behaviour underwent a double process of secularisation and medicalisation with the advent of modernity (Andrés, 2015; Healy, 2006; Rosen, 1971). With such notable precursors as Biathanatos (1608) by English poet and essayist John Donne, the 18th-century produced more or less heterodox defences of voluntary death, so that almost all illustrated scholars – with the notable exception of Kant – called for its decriminalisation and even defended it as a legitimate act of individual sovereignty (McManners, 1981: 409–37). Probably, the best known testimonials in this sense are those of David Hume, Voltaire and the Baron de Montesquieu, whose Persian letters (1721). Montesquieu's text contains one of the most explicit criticisms of the opprobrium to which religion and European laws condemned suicide: ‘when I am loaded with grief, misery and contumely, – wrote Usbek, one of his main characters, in Letter LXXVI – why should I be hindered from putting an end to my sufferings, and cruelly deprived of a remedy which is in my hands?’ (Montesquieu, 1891/1721: 186).

Usually distant from this autonomist fervour, physicians – more and more concerned with the deleterious effects of the passions and the (alleged) contagiousness of moral dispositions – wondered about the reasons behind a phenomenon that by the end of the 18th-century had become a very popular romantic stereotype and seemed to reach epidemic proportions. Even though some recent studies have showed that, at least in some European cities, there was a noticeable rise in the incidence of suicidal behaviour (Watt, 2004), the true range of the so-called ‘Werther effect’ has never been evaluated conclusively due to the lack of reliable epidemiological data (Steinberg, 1999). Whatever the case, it is true that suicide started then to be seen as a pressing public health problem and became one of the preferred indicators of the disruptive consequences of cultural change, social unrest and political instability (Martínez-Pérez, 2001; Minois, 1999: 319), to the extent that some physicians – including Brierre himself – did not hesitate to brandish it in his particular crusade against modernity. Not in vain, an article published in 1836 in the AHPML explained that ‘the damage suicide does to society is not at all in the number of men who are taken, but in the contagious despondency it propagates […]. Suicide, […] like a contagious typhus, weakens the strengths and courage of those who breathe it in the air. For them, setbacks become misfortunes and temporary upsets become desperate calamities, and these corpses […] do no more than infect the ground they lie in. Thus suicide takes on a far greater importance than is believed on the surface: it is a real evil and its progress must be immediately halted’ (Brouc, 1836: 259–60).

Initially, French pioneers of psychological medicine enhanced the notion of old theorists of the ‘English disease’ – from Robert Burton to George Cheyne (MacDonald and Murphy, 1990) – according to whom most (if not all) suicides were due to insanity in its different degrees and varieties. Thus, Pinel described a form of melancholy – which he defined as an ‘exclusive delusion about an object’ (Pinel, 1809: 137) – in which there was ‘an irresistible inclination to suicide’ (ibid.: XXVIII) and which, some years later, Falret denominated ‘suicidal melancholy’ (Falret, 1822). For his part, it has already been seen that, in Esquirol’s judgement, suicide was not a ‘disease sui generis’, but ‘a phenomenon arising from a large number of different causes’ (Esquirol, 1821: 214). His ambiguity establishing these causes –amongst them he included lipemania, mania, monomania, ‘febrile delirium’ or hypochondria, but also ‘acute impassioned states’ or rather chronic dispositions such as nostalgia, haine de la vie (hate of life) or tedium vitai – has led some authors to claim that, in spite of his decisive contribution to medicalising suicidal behaviour, Esquirol firmly believed in the existence of non-pathological suicide (Berrios, 1996: 445–7). Nonetheless, detailed reading of his first writings, the testimony of disciples such as Georget or Brierre and some of his later formulations force us to at least qualify this interpretation. In 1821, for example, he was already pointing out that it seemed inconceivable that happy people kill themselves, and that ‘voluntary suicide’ commonly associated with tedium vitai seemed ‘to have the strongest analogies with lipemaniac suicides’ (Esquirol, 1821: 219). And, later, the extension of the concept of monomania – as Pinelian melancholy, a delusional but circumscribed affection of psychism (Goldstein, 1987: 155–8) – and the emergence of the notion of ‘moral insanity’ for cases ‘without any remarkable disorder or defect of the intellect’ (Prichard, 1835: 6) facilitated the appearance of ‘suicidal monomania’, defined by Esquirol himself as a ‘partial delusion characterised by a more or less voluntary impulse to self-destruction’ (Esquirol, 1838b: 792). Not exempt from controversy, this notion was adopted for a time by some doctors such as Jean-Baptiste Cazauvieilh or Claude-Étienne Bourdin, who, in an essay significantly dedicated to Lélut, even categorically claimed that suicide is always a ‘pathological deed’ and is often ‘the first delusional act of an incipient monomania’ (Bourdin, 1845: 7–8).

Even though these approaches were later associated with all alienists, above all by Émile Durkheim, who was very interested in underlining the originality of his socio-genetic theses (Mucchielli and Renneville, 1998), it is true that many of them did not want to accept this exclusively psychopathological interpretation of suicidal behaviour. Thus, while some were repelled by their determinism and negation of free will and others thought it was a rather extreme thesis from the clinical point of view (Berrios, 1996: 447–8), Brierre's protest was motivated above all by the conviction that this theory was an obstacle to appreciating the actual origins of an increasing number of suicides. In 1850 he published an article in the AMP on ennui, ‘tedium vitai’, that not only anticipated the master strokes of his thought, but also constituted one of the most relevant essays on cultural criticism of 19th-century French alienism. Indeed, Esquirol himself had already stated en passant that ‘the more developed the civilisation, the more the brain is excited and susceptibility augmented, the more needs are increased and desires are more imperative, the more the causes of sorrow multiply, and the more mental alienation abounds, the more suicides must be committed’ (Esquirol, 1821: 275). But, unsatisfied with the vagueness of these statements, Brierre took his analysis much further, trying to demonstrate how modernity and, especially, materialist philosophy, the excesses of reflection, the abandonment of faith or romantic literature had consecrated this tedium vitai – and, in essence, sadness – as a sign of cultural distinction and suicide as the sublime, heroic gesture of legitimately tormented individuals. As a consequence, far from representing ‘the first degree of a sad monomania [as intended] by a system that excessively generalises insanity’ (Brierre de Boismont, 1850a: 573), ennui was nothing more than a ‘sickly disposition of souls’ generated by an ‘enervated civilisation in which man, self-absorbed and suffering his own destiny, is isolated from his peers and focuses all his existence on sterile and pitiful pride’ (ibid.: 561).

‘In the current age,’ he stated, it was not ‘necessary to be insane to be bitten in the heart by ennui and nuisance of life’ (Brierre de Boismont, 1850a: 566), and this became specially evident upon examining the notes, letters or poems left after death by a large number of suicides. In fact, many of them declared themselves victims of ‘weariness, desperation, scepticism, indifference or materialistic beliefs’ (ibid.: 570), and not a few openly recognised that they had always had these kind of ideas and feelings. This ‘primitive, original or depressive’ ennui was usually accompanied by a chronic feeling of despondency, impotence and desperation that could become clinically significant; but, in Brierre’s opinion, its growing prevalence was the result of the intensification that modernity – the ‘age of general indifference, doubts and individualism’ (ibid.: 583) – had provoked in the human tendency to dissatisfaction and disgust with the limitations and hardships of life. Indeed, it was a disease, but a moral disease for which – following the old receipts of stoics and Christian moralists – only the recovery of faith, the virtues of the aurea mediocritas (family, work, active life, etc.) and the most energetic rejection of sadness could be prescribed.

Deciding to ‘demonstrate’ his arguments through a sort of ‘moral statistic’, Brierre presented on 5 April 1851 at the Académie des Sciences Morales et Politiques his research on the ‘last feelings expressed by suicides in their writings’ (Brierre de Boismont, 1851) and spent some years developing the results of a detailed study on 4595 trial records of suicides committed in Paris between 1834 and 1843, writing his important monograph Du suicide et de la folie suicide (1856). Closely analysing the mental states and the motives given by suicides themselves, especially in the 1328 cases where some type of testimony had been preserved, it seemed ‘undisputed’ that many of them had remained ‘aware of the act and the freedom of their will’ (Brierre de Boismont, 1856b: 515) in such a way as to be able to confidently reject the theory (‘as false as it is common nowadays’) according to which ‘suicide is always an act of insanity’ (ibid.: 139). Thus, it was necessary to distinguish – in their causes, physiology, symptomatology, treatment and final nature – two fundamental classes of suicide depending on the existence or not of mental illness, and to clarify the constellation of circumstances that was making those committed in the absence of cognitive or affective disturbances more and more frequent.

Now alluding to inheritance as a ‘predisposing cause’, but still keeping the passions as the etiological reference factor (Pigeaud, 1980), Brierre pointed out that insanity or ‘acute delusion’ had been the ‘determining cause’ in only 700 of his 4595 suicides. With the exception of a few cases whose background was unknown, the rest could be attributed to a long list of factors including drunkenness, physical diseases, family upsets, setbacks, love (or lack of it), misery, financial problems and, of course, weariness and ennui (Brierre de Boismont, 1856b: 100). Therefore, ‘reasoned examination’ of the causes permitted flatly discarding insanity as ‘the sole possible explanation for suicide’, so stoutly defended by the followers of the ‘physiological school’ against ‘all evidence, the teachings of history and common sense’ (ibid.: 136). Thus, the study of the physiology and symptomatology of suicide in ‘reasonable people’ confirmed a certain tendency to ‘sadness, a disposition to anger or entrenched opinions on the legitimacy of voluntary death in certain circumstances’ (ibid.: 435). But ‘their discourse, their acts and their writings’ were always ‘coherent with their temperament, their character or their education’, and had no ‘relation whatsoever with the delusional conceptions of the insane’ (ibid.: 447). Their ‘treatment’, therefore, could not be limited to selective medical intervention, but required a vast pedagogical and social programme in order to ‘educate the passions in time’ and promote ‘religion, morals and the fulfilment of obligations’ (ibid.: 620).

Thus, in short, convinced that ‘the great mistake of some alienists is to see insanity everywhere’ (Brierre de Boismont, 1856b: 486), Brierre compiled an enormous amount of observations along with arguments and data that seemed to him to drastically limit the scope of the psychopathological interpretation of suicide. Yet he did not do this motivated by epistemological cautions, autonomist prejudices or a more or less tragic or romantic conception of existence, but because the determinist excesses of the ‘physiological school’ infringed upon very sensitive doctrinal principles (especially, the spirituality of the soul and free will) and, at the same time, impeded the formulation of a critical diagnosis of modernity taking into account the apparent increase in the number of voluntary deaths. After studying ‘suicide in Antiquity, the Middle Ages and modern times from the historical and philosophical point of view’ and statistically analysing ‘the influence of civilisation’ on its development, Brierre had no doubt that, by ‘propagating doubt, exalting pride and making self esteem, scepticism and indifference a code of behaviour for the majority’, modernity had given ‘suicide a renewed impulse’ (Brierre de Boismont, 1856b: 46). Resorting to Rousseaunian phraseology, it seemed perfectly logical that, in times of ‘weak, misdirected spirits’, ‘overexcitement of the passions’ and a manifest deficit in ‘religious and moral education’, tolerance and resistance to pain had diminished to such an extent that the smallest reversal of fortune led individuals to attempt against their lives and challenged God’s sacred designs (ibid.: 388–9).

The sick society

Widely known among French and foreign specialists, Du suicide et de la folie suicide had an excellent reputation until well into the 20th-century and, alongside the important monograph on the ‘moral statistics’ of suicide published by Italian alienist Enrico Morselli in 1879 (Brancaccio, 2013), it became one of the reference works of pre-Durkheimian suicidology. However, its publication did not generate such intense debate as Des hallucinations, probably because – as the reviewer for the AMP pointed out – the author’s points of view were ‘already quite well known’ among his colleagues (Legrand du Saulle, 1857: 148). Not in vain, Brierre had for many years made his arguments known in articles, public interventions and professional meetings. In 1831, for example, he had already pointed out that revolutions and political crises such as that of a year before in France ‘determine the loss of reason in a large number of people’ (Brierre de Boismont, 1831: 22), and – relying on observations made in his own professional practice – in 1848 he insisted again on the same point and urged political leaders to withdraw from insurrectional temptations: ‘if those that forge revolutions knew the catastrophes they cause and the thousands of victims sacrificed, instead of resorting to brute force and spilling rivers of human blood, they would call for the reforms demanded by the advance of human understanding by all the legal means within their scope’ (Brierre de Boismont, 1848: 336).

Similarly, in 1837 he presented a memoir at the Académie Royale des Sciences where he set forth in some detail the arguments which would permeate all his works from the beginning until the end. Taking into account the great historical and cultural variety of the forms of insanity that always ‘bear the seal of each age and each country’ (Brierre de Boismont, 1839: 244), Brierre postulated a clear predominance of moral causes over physical ones in ‘civilised peoples’. Therefore, for instance, while there were hardly any insane in Latin America (as European travellers such as Alexander von Humboldt had been able to verify), in France they were more and more numerous, their illness was usually a consequence of passions such as ‘vanity, pride, ambition, hedonism, scepticism or love’ (ibid.) and their delusions were of a preferentially persecutory or megalomaniacal character. There was no doubt, therefore, that ‘alienation is more frequent and its forms more diverse when peoples are more civilised’ (ibid.: 293), a conclusion that, on the one hand, was quite disheartening in view of the sad fate of intelligence – what a ‘wretched, painful spectacle for the philosopher watching alienation threatening the mind with an intensity that increases the more it shines and the closer it gets to its peak’ (ibid.: 242) – yet, on the other hand, was very instructive regarding the vulnerability of the human being, the sacrilegious arrogance of modernity and the religious and moral rearming urgently needed by the new bourgeois society.

Taking into account the ideological divisions nestling in its breast, it is not by chance that, when the SMP started out its activities in 1852, Brierre – who was its first secretary – raised again the question and incited one of the foundational debates of the society (Coffin, 1993). On the occasion of the presentation of a monograph by English physician Thomas Wise on insanity in Bengal, the discussion took hold in August of the same year after a controversial intervention on his part where he presumed proven that in no part of the world were there (proportionally) as many insane as in Europe, and from that it was necessary to deduce that ‘the current civilisation has a marked influence on the production of insanity’ (SMP, 1853: 300). Thereupon, Maury, Baillarger and other colleagues such as Jean-Baptiste-Maximien Parchappe – at the time general inspector of French asylums for the insane – pointed out that Brierre’s affirmations did not do justice to the complexity of the matter, since they lacked a solid statistical basis and revealed an excessively gloomy image of the present. Yet Brierre asserted again and again his conviction that ‘multiplying the causes of cerebral excitement’ and ‘devastated’ by moral diseases such as ennui, ‘universal confusion in ideas, generalised laxity and the most absolute disenchantment’ (SMP, 1853: 309, 333), modern civilisation had generated a climate particularly conducive to the development of all types of psychic imbalances.

Against this background, it is easy to understand why, despite his firm corporate commitment, Brierre’s contributions focused mainly on denouncing the indiscriminate spread of the new gaze embodied by the concepts and categories of psychological medicine: to label as pathological all hallucinatory phenomena and voluntary deaths was, on the one hand, a sign of the disrespectful neglect of traditional values in modern ‘scientified’ societies, but, on the other hand, it was also a way of ignoring the fateful social and cultural consequences of this neglect. In fact, and although some authors have suggested that the singularity of his work consists in having opened the doors of alienism to a sort of reflection on normality (Trémine and Moltó, 2001: 142–3), it seems evident that his purpose was rather to preserve the co-existence of the scientific view of psychological medicine with Christian beliefs and dogmas regarding divinity, the spirituality of the soul or moral freedom (Gumpper, 2008: 165). For this reason, there is an essential tension in his arguments that, with his usual lucidity, Maury was the first to notice: ‘Mr. Brierre loves his profession and his opinions as a doctor, but he is no less attached to his Catholic faith. On the one hand, he does not wish to be retrograde and reject the discoveries made by psychological medicine over the last half century […], yet, on the other hand, he wishes to continue being orthodox; that is to say, although alienism has gone down less-than-Catholic roads, he believed he could follow the impetuous current of science without losing touch with the church or having to go back to ancient lands bathed by the waters of religion. But these are two difficult things to do: go down-stream and, at the same time, wish to go up-stream’ (Maury, 1845: 323–4). However, and considering Pinel’s ardent Rousseauism (Goldstein, 1987: 96–7, 100–1) and the persistent fondness of psychological medicine for conservative cultural criticism (Roelcke, 1999), this (apparent) contradiction is surely not exclusive to Brierre: blaming modernity for creating the conditions for an increasing proportion of insanity and mental suffering is, now as then, an extremely common (and perhaps constitutive) feature of psychiatric discourses and practices.