Leaving Van Gogh

Eleven





ONCE AGAIN VINCENT avoided our house during the weekend, increasing my anxiety about him. That made me all the more glad that I might be able to enlist the aid of Dr. Charcot. I had written a note to him and received a very civil reply. He would be happy to discuss a patient with a former colleague, as he put it. This terminology went some small way to console me for Vincent’s low estimation of my skills.

It was strange to see the changes surrounding the Salpêtrière when I arrived that Tuesday. In the thirty years since I had been there, the city had swallowed the hospital. As a student, I had often fancied that countryside lay just beyond its walls. There was a quiet, a limpid quality to the light in those days that made it easy to envision cattle grazing and rustic yokels in smocks carrying water in wooden buckets. The Gare d’Austerlitz now dominated the area. Its tracks sliced between the hospital grounds and the river, bringing whistles and coal smoke and even a kind of urgent vibration to the very earth that had once been a sodden riverbank—an inescapable reminder that times had changed.

I had to ask at the gate for directions to the new outpatient clinic where Charcot’s Tuesday lessons were held. The doctor wanted to train others to see as he saw. Thus the sessions were small and informal, located in a ground-floor room holding little more than a group of chairs and a battered table. I knew I had arrived in the right place because I recognized Dr. Charcot from the famous 1887 Salon painting called Une leçon clinique à la Salpêtrière. The painting had been widely distributed in a lithographed version, and of course I possessed a copy. It was disconcerting at first to see the celebrated physician in person, since his image was so familiar to me; the barrel-shaped body, the hair worn brushing his collar, the solidly fleshed face. Everyone looked at me as I entered the room, so I introduced myself, adding, for the benefit of the young men, that I had been an extern myself more than thirty years earlier.

The first case was a porter at Les Halles who, several months earlier, had astounded everyone around him by falling into a fit and causing considerable damage to the stalls nearby. Worse, the fits had continued. Charcot swiftly read through a file while the man sat brooding on a plain chair before us, eyes cast to the ground. The doctor raised his eyes and addressed us. “The question, here, gentlemen, is this: epilepsy or hysteria? They are very easy to confuse. I hope we can establish a diagnosis in this man’s case. I see there is some history of nervous illness in the family. Your father suffered mentally?” he asked the patient. The man looked up readily.

“Poor man went mad,” he confirmed. “Thought he was St. Peter. And then sometimes it was Napoleon. When he was Napoleon, he always thought he was being poisoned. Anyway, he couldn’t work. Ended up at Bicêtre.”

“So you see, we have an inheritance of weakened mental processes,” Charcot told us all. “We also have a situation of partial anesthesias,” he read from papers in his hands. “Dr. Lagarde, perhaps you would like to demonstrate?” At this point one of the younger doctors showed us, by pricking the flesh with a long pin, how there were several areas of the patient’s body that appeared to have no feeling at all. Charcot went on noting information from the chart: the attacks were sometimes preceded by warning periods with various sensory disorders. The patient heard voices; he had once seen a cabbage turn into a bleeding skull. When in the throes of a fit, he shouted and thrashed and had to be restrained, which, owing to his size and strength, was often difficult to do. Once a fit wore off, he was perfectly lucid.

Fortunately I had brought a little notebook, and I scribbled down all of these details as they were described, for this case sounded very similar to Vincent’s. Charcot pointed out that the attacks differed from epilepsy in an important way: an epileptic falls in one place and does not create further disturbance. Vincent’s attacks, then, sounded more like hysteria than like epilepsy. But it was the conclusion of the presentation that I found especially intriguing.

“In many cases of masculine hysteria,” Charcot said, “we see changes in the patient’s behavior. This is certainly true in this instance. According to the patient’s wife, who accompanied him here, he has been a different man since the first episode. He is nervous, suspicious, mournful. He is withdrawn where he used to be sociable, irritable where he used to be merry. He has terrible dreams, and resists sleeping for fear of them. For all of these reasons, I believe that the patient suffers from hysteria. The standard medication for epilepsy, potassium bromide, does not appear to be efficacious in this situation, so we will keep our patient for a while.” Here he put his hand on the man’s shoulder. “And see what other treatments may do for him. Perhaps we shall see him again, in an improved state.” He nodded, and the man was led out.

In came a tall wraith of a woman, so thin and withdrawn that her very clothes seemed to be weeping, or rather oozing around her. I followed Charcot’s description of her symptoms—she had stopped eating, spoke only in monosyllables, slept around the clock—while part of my mind wandered to hysteria. I was particularly intrigued by the list of the hysterical patient’s mood changes: his insomnia, his suspicions, his withdrawal. This certainly matched Vincent’s behavior. If he were suffering from hysteria, would that not explain why he had avoided coming to our house? Might it even be responsible for his dark thoughts about me?



I was first introduced to hysteria during the bal des folles, the annual costume ball at the Salpêtrière that took place several weeks before Easter. I had been at the hospital for only a few months, and I found the idea of the ball disturbing. Some of our patients, it seemed to me, were quite fragile. I could not see how the excitement of a ball would improve their mental states. Yet it was obviously a long-standing tradition that the staff and patients anticipated keenly. In the weeks before the ball, little else was discussed. The most coherent patients spent hours thinking about their costumes, hoarding scraps of fabric, bartering and collaborating. One woman with nimble fingers might twist ends of ribbon into flowers while another folded gold paper into a halo. Even the patients who were apparently lost in their madness sometimes responded to the atmosphere of anticipation. The melancholy might speak; the furieuse—confined to a straitjacket to prevent violence—might cease her raving and smile.

I was not on duty on the night of the ball, but the junior medical staff was expected to attend, costumed, to mingle with the patients and keep order if necessary. Like my charges, I gave considerable thought to my costume. I did not want to appear undignified, so I borrowed a wine-colored velvet robe from my friend Gautier. He said the garment came from a costume chest at the École des Beaux-Arts, which was evident—it smelled quite strongly of turpentine and had streaks of oil paint on the bottoms of the full sleeves. With a long gilt chain over my shoulders, I felt that I looked like a courtier in one of the larger Rubens canvases. In the interest of verisimilitude, I should not have worn my trousers and boots, but I did not believe anyone would notice my footwear. As it happened, I was grateful for this later.

The ball was a jolly affair. The largest sewing workroom had been adapted ingeniously for the festivities. It seemed that every oil lamp and every candle in the building had been brought to the atelier and set aflame. Mirrors had appeared from somewhere and had been hung high on the walls, reflecting the light and the heads of the dancers. The window frames and the enormous portrait of Dr. Pinel had all been decorated with garlands, which I had seen prepared in the previous days: they were stitched from rags and dyed a deep pink with the peelings of beetroots, then hung to dry in the sunniest corner of a courtyard for several days.

The music was no less improvised and no less gleeful than the garlands: the chapel organist, wearing a plum velvet jacket in the style of the Restoration, with puffed shoulders and long tails, was seated at an upright piano, pounding away at a polka. He was keeping time with his head so emphatically that he almost flew off the piano bench, coattails flapping, at each downbeat. One of the groundskeepers squeezed an accordion with his eyes shut tight, while a clerk from the registrar’s office sawed away on a violin. I heard, but did not see, a trumpeter and someone with a pair of cymbals.

And our patients danced. They whirled around merrily, in pairs or threesomes or alone, some keeping time and some merely moving with the crowd. The stamp and shuffle of their feet added to the din, and the heat in the room was pronounced. There were benches lined up on three sides, most of them empty, except for one that was occupied by the furieuses, restrained in their canvas jackets but nodding to the music. A few melancholiacs sat in the darkest corner, apparently oblivious to all the stimulation. I supposed that their wardress had wanted to see the ball and had roused them from their normal stunned state to bring them along. Perhaps she thought the music would cheer them.

I had not intended to dance, but shortly after my arrival my hands were seized by a tall dark-haired woman in the conical headdress of the Middle Ages. “Come, Doctor!” she shouted over the noise. “We’ll have no hanging back. All who come to the bal des folles must dance!” And indeed as we whirled around the room I saw doctors, patients, gardeners, warders, even a fat laundress dressed as Marie Antoinette, complete with a white wig apparently made from a mop.

I was relieved when the music stopped with an abrupt crashing chord and the whirling circle of dancers jostled to a halt. Gathering up the hem of my robe, I hastened to what I hoped would be a quiet corner but was halted by a strong hand on my shoulder. This time it was my friend Gautier, resplendent in the costume of a Roman centurion. I was surprised to see him there; though he had obtained my costume for me, he never hinted that he, too, planned to be present. But, he explained, attendance at the bal des folles was a tradition for the students of the École des Beaux-Arts.

“Where did you get that costume?” I asked.

“Borrowed it, just like yours. I wanted something showy for the parade.”

“What parade?”

“There’s always a parade at a costume party, Gachet, surely you’ve been to one?” Then a wavering note sounded from the accordion and the dancing resumed. Without another word, Gautier plunged into the crowd. I managed to avoid dancing again by standing behind the furieuses. More men in costume had appeared; I saw a monk, a Pierrot, and several musketeers in thigh-high boots and capes. Gautier had apparently been correct. The women gaily flocked around the men, smiling and laughing.

I did not know what to think of it. It was the animal side of their nature that caused trouble for many of our patients, since their mental state often stripped away the controls of civilization. Some women, despite every precaution, managed to get pregnant every year, and bore their babies, who were subsequently sent to an orphanage. I wondered at the wisdom of bringing these young male students into the asylum to mingle with madwomen.

But then a hubbub near the door caught my attention. All I could see over the crowd was a giraffe’s head, apparently constructed of canvas and yarn. It was crude but very charming, with shiny black eyes fringed with layers of stiff bristles; numerous paintbrushes must have been sacrificed for the effect. The movement at the far side of the room suggested that the giraffe had brought quite a few friends. The door was blocked for a moment by the head of an elephant whose back end was somewhat too wide. The trunk must have been guided from the inside by wire, for it slithered through the crowd or lashed up in the air in a lifelike way. One of the musicians, watching from the dais, picked up his trumpet and made a rude blurting noise with his hand in the bell. The elephant’s trunk stretched out straight in response, and all who saw it laughed.

This group of art students had all managed to dress as zoo animals; in addition to the elephant and the giraffe, there were exotic birds, a jaguar with a real animal’s skin and a lion with a brown-paper mane, an enormous fish, a bear, and three mischievous monkeys. The menagerie heightened the gaiety of the evening. I was hauled back onto the dance floor by the Marie Antoinette laundress, and as she steered me capably through the crowd, I got more than one strong whiff of wine or brandy, brought no doubt by the students. Our patients were never permitted to drink spirits.

“What do you think of our ball?” the laundress shouted as we took up our position at the end of a line of couples. The chapel organist was trying to organize a quadrille, apparently.

“It seems very festive,” I said, despite my growing unease. I looked up the line of women’s faces across from me. There was a range of expressions on them, a much greater range than you would normally see at a dance. Yes, I saw the laughter, happiness, vague annoyance, concentration on the music that bourgeois women would display. But there were also frowns, inattention, and that expression I have only ever seen among the mad—you might call it exaltation, an exaggerated excitement in which every emotion, every perception reaches an intensity unknown to the sane.

But then I could see no more, because our two lines became a single column of pairs, and we began our grand parade around the room. We paced by the portrait of Dr. Pinel, and past the bench of the furieuses, who stamped their feet in approval.

Normally, the dance would have ended once we had made a circuit of the room, filed back into our original positions, and bowed to each other. But before we reached the end, the room grew much less noisy, and as the laundress and I turned the corner, we saw that there was no double line of dancers in the center of the room. Instead, one of the monkeys snatched a pair of candles from a sconce on the wall and handed one to the monkey behind him. They linked arms with their partners and disappeared through the door.

The laundress and I looked at each other in horror. This possibility had never occurred to me. I had been worried about women getting too stimulated by the dancing and the costumes and the lights, but I had never imagined that they would be taken out of the room, let alone into the darkness of the quadrangle below.

A knight and a musketeer had seized the accordion and violin from the band: they played a medley of marches at the head of the group. They were skipping up the long walkway, lit only by the flickering from candle flames or oil lamps that had been snatched from the walls. The misty evening softened the outlines of the dancers in the dark.

“Was that gate open when you came in?” the laundress asked me, pointing to the end of the enclosure.

“I didn’t enter that way. I’ll go check it now,” I said and lifted my robe to my knees. Harm could still be averted. The Salpêtrière was like a maze. Most courtyards had two or three gates, and most buildings had two or three entrances. Of course these were all supposed to be locked—one of our primary responsibilities was quite simply to maintain custody of our charges. But what if the gates were open? I could imagine it all too clearly. Carried away by the music and the costumes and the lights, our patients could so easily get lost, become frightened and anxious. This was where madness told: these women would not be able to help themselves. They would not be able to stay calm, to scan the sky for light coming from a nearby courtyard, to listen for voices, to call for help, even to remember which way they had come—or why.

And then there were the young men, as spirited and stimulated as the women. Who knew what kinds of violations they were capable of?

I was almost at the head of the line now, a few meters from the men with the instruments, who marched triumphantly backward, facing the stream of dancing followers. A confusion of voices arose. “The wall! Mind the wall!” “Pay attention to the gate!” people called, as the leaders backed into the obstruction they could not see. As they hit the gate, they did not fall: they merely mimed the impact and pretended to stagger. Then, to my relief, they turned, following the wall, steering the crowd around the edge of the yard. Everyone changed course happily, as a procession would turn a corner in a church, following their leader, absorbed in the movement rather than the destination.

I finally reached the end of the courtyard and stood panting next to the gate. The leaders of the parade were marching gaily toward the glow of light from the tall windows of the atelier. As the stragglers paced toward me, ready to turn the corner, I leaned back against the heavy wooden panel of the gate to draw a deep breath.

But it did not support me. It shifted. I staggered as the knight with the accordion had, then fell when the gate swung open. I tumbled onto my back and rolled quickly to my knees, but not before a small group separated from the procession and followed me through the gate.

I couldn’t count them in the dark. One of the art students carried something like a torch, but there was no other light. I scrambled to my feet and pushed the gate closed but met resistance. Someone was pushing against me. I set my feet in the gravel and put my shoulder to the heavy timber to push with all my strength, while behind me I heard someone shout, “Let’s play hide-and-seek!”

Amid the clamor, I heard a voice calling my name. “Gachet! Gachet, it’s Lemaire!” I stood up straight and pulled back the gate. One of the other young externs slipped through, then closed it behind him.

“How many are there?” he asked me.

“Perhaps a dozen.”

“How many are patients?”

“Most,” I answered. “And three young men, I believe. But they’ve split up, they’re playing hide-and-seek.” As I said this, one of the male voices cried out in the dark, “Cache-cache!”

“Are there other entrances to this yard?”

“I think so,” I said. “We must be sure they are closed off. But I may know one of the men from the École. Let me see if they won’t help us gather the women.”

“Yes, you do that. Try to start them moving back inside, will you? I’ll be with you in a moment. Thank God this is one of the smaller gardens,” he called as he ran off.

The rest of the sounds in the courtyard had diminished. I was glad the ground was covered with stones rather than grass, so that I could at least hear my quarry. A giggle came from my far right, and ahead someone was trying to step silently but merely prolonging the quiet crunch his or her feet made on the gravel.

“My friends and patients,” I called out. “This is Dr. Gachet speaking. I am an extern in training here. Some of you may know me, and the artists among you might know my friend Amand Gautier. He came tonight dressed as a Roman soldier. I would like you please to rejoin the party. I am concerned about our patients being out in the cold night air.”

“F*ck the night air!” said a female voice.

“Amen to that!” said a man, and laughter echoed back and forth. I was walking toward the light of the torch, hoping that an art student still held it.

“You’ll have to find us!” trilled a woman.

“It’s cache-cache, so come seek the hidden!” answered another. “La-la-la-la-la, here I am,” she sang, and her feet made rhythmic noises in the gravel.

I was trying to sound authoritative, but my breath was coming faster. The voices around me gave the scene the air of a nightmare. I kept walking steadily toward the torch.

“Are you hearing voices, Doctor?” sang out a woman. “Just like the rest of the crazies! Oh, ha, ha, ha!”

“He’s one of us now!”

“Take him to Bicêtre!”

“No, keep him with the women at the Salpêtrière! We’ll entertain him!”

“Who’s mad anyway?” asked a female voice nearby, sounding utterly reasonable. “Not I.”

“Nor I!”

“Nor I!”

They came from all around me now, a series of echoing voices. Some, I knew, were the men speaking in falsetto. The rest were the women, drawn together in uncanny unison the likes of which I had never witnessed. One of the marks of the mad was that they inhabited their own worlds and not those of others. That night, in the damp and the dark with the torch flaring straight in the sky, they were acting and thinking together. Saner than ever, one might have thought.

I reached the torch only to find that it had been tied to an old wellhead with a strip of fur-trimmed leather from someone’s costume. Without thinking, I untied it, then clambered up onto the wide stone lip of the well. I had hoped that the height would allow me to see better, but the circle of light around me made the darkness more profound. Across the yard, I could see the orange glow of my torch reflected from a window. I heard Lemaire’s footsteps pounding toward me.

“The gates are closed. There is one doorway into a building, but it leads only to another locked door. They must all be here,” he panted.

“Oh, it’s the yellow-haired doctor,” one of the patients said, quite near to us. “Dr. Saffron.” The torch I held over my head must have made my features visible.

“Oh, I like him,” someone else replied from behind me. “He’s a nice one.”

“Then I hope you will do as I suggest,” I broke in quickly. “Why don’t you all come here, toward the torch, and we will go join our friends at the ball? Dr. Lemaire, will you open the gate?”

From where I stood on the lip of the well, the workroom beckoned a hundred meters away. The rounded panels at the tops of the windows had been opened, and music escaped, this time a waltz. The light streamed through the mist in palpable-looking golden blocks. The sight was as good as a signpost: “This way to warmth and comfort and music.”

“Let us go, then,” I called out and jumped down from the well. “Can someone tell me if there are prizes at this ball? For the best costume, perhaps?” I started forward, walking with purpose and what I hoped looked like confidence.

I listened for a moment. There was silence. Only my footsteps crunched on the gravel, one, two, three, four … Then I heard a deep sigh very close to me. “Well, the doctor has a point,” a woman said, stepping into the light. She was an older patient who was one of the gifted needlewomen of the curtain workroom. Once, I had walked through her atelier and seen her in charge, calmly beating a tambourine to establish the rhythm for the other women’s stitches. “It’s a little bit chilly for outdoor games, no?”

“Marthe, you old woman!”

“That’s it, Solange,” she called back. “Too old for this kind of fun, anyway.” Marthe was trudging alongside me now, her arm linked in mine. I was hopeful. My authority as a doctor alone might not have been sufficient to lure the women inside, but with Marthe’s help, I thought I could safely lead all of our charges back to the party.

I heard footsteps coming forward, and a few faces emerged into the torchlight. I counted six, seven women joining us. None of the men. I kept on walking.

Then someone screamed. I knew right away who it was. Odette was easy to overlook in any group. She was neither young nor old, neither tall nor short, and her behavior was such that she could pass for normal—except when she was screaming. And she did not simply scream: she threw herself to the ground and flailed and thrashed around, kicking and hitting anything nearby.

She was not vicious and had never hurt another woman, but she was often restrained. What else could one do? The power of those fists and feet posed a threat. And now, so did the power of her voice.

Once again, I had no time to plan. The evening had become a nightmare. I could only act and hope for the best. “Marthe,” I said, to the woman next to me. “Will you take the torch and lead everyone inside? I need to help Odette, and I don’t want the other women upset.”

She nodded decisively but said, “Keep the torch. They will follow me, and you should never put fire in the hand of a madwoman, Doctor. Surely that was the first thing they taught you?” With a little smile she ran past me down the path, calling out, “Come to me, ladies, let us see who won the prize!”

I followed the sound of the screaming, which was coming from somewhere to my left. A figure brushed past me, away from Odette, with a papery rustle as I hurried to her. I remembered the lion costume with its clever brown-paper mane.

I slowed down, because I could hear that I was getting close to Odette now, and that she was on the ground. Her body was grinding against the gravel, and her boots were thudding steadily as she drummed her feet. I didn’t want to be in the way of her blows, but it seemed imperative to touch her.

I had seen Odette in this kind of fit only once. It was at dinner, and the noisy order of the refectory was suddenly broken by a clatter as she threw down her mug and fell to the floor. To my surprise, the other patients just glanced at her and went on with their meals. Only the wardress came to her side and spoke to her gently, with a hand on her shoulder. It had seemed to me that Odette almost knew what she was doing. Almost. The screaming and thrashing were a way to shut out her surroundings. It did not appear that she was in control of herself, exactly, or that she had deliberately launched herself into this state, but it did seem that something had alarmed her and the fit was a form of self-protection.

As I knelt beside Odette on the damp, cold pebbles, I began to speak, though I doubted she could hear me through her screams. “Odette,” I said, “Odette.” Nothing more. I reached toward her thrashing body but was defeated. Her stiff arms batted away my outstretched hand. When I reached again, I touched only her chest or her breast. She was rolling on her back, becoming rigid. “Odette,” I tried again. “Odette!” In a moment the flailing and screaming stopped. I wondered why, and what was happening to her. I reached out again, and made contact with her arm. It felt stiff, as if she were gripping something.

Footsteps approached, from behind me, then the gloom brightened as a soft ring of light surrounded us. Lemaire had returned with a lantern. “Dr. Theroux is the senior physician on duty tonight,” he said, panting, kneeling beside me. “He will be here in a moment.” He held the lantern high so that we could see Odette more clearly.

She looked dreadful. She was lying on her side, with her stiff body arched backward into a near semicircle. I couldn’t imagine how she even drew breath with her body so contorted. Just a few minutes earlier, I had thought I could reach her with touch or a gentle voice, but now it seemed as if Odette was not even present. Lemaire gently pulled up one of her eyelids. Her eye was white, the pupil rolled back. Lemaire touched the back of his hand to her neck.

“So strange,” he said. “It’s like death, only not.”

I put my hand to her wrist. I had no watch to time her pulse, but it was steady. I felt both ignorant and helpless.

More footsteps came our way, several sets this time. I turned my head. It occurred to me that Lemaire and I, kneeling side by side in front of Odette’s body, looked like mourners at a corpse’s bier. Dr. Theroux had brought another lantern, two porters carrying a stretcher, and a black bag. I noticed that he was in evening dress, as if he had been called from a dinner.

“Gentlemen,” he acknowledged Lemaire and me as he leaned down to look at Odette. “What happened here?” he asked, straightening up. His lantern along with Lemaire’s made the scene almost brilliant. I rose to my feet.

“Odette was at the ball, sir,” I began, then explained about the improvised grand march, my attempt to gather our scattered patients, and Odette’s screaming fit. Theroux nodded. I tried to read his expression, but the lantern light reflected off his eyeglasses and cast strange shadows down his face. “Did you do anything to help her?”

I opened my mouth to speak but closed it again. No. I hadn’t done anything to help her.

Lemaire broke in. “Sir, there was no time. By the time Dr. Gachet and I found Odette, she was … beyond help.” And, I added to myself, we did not know what to do.

Dr. Theroux looked over to the porters, who picked up the stretcher and laid it next to Odette. He bent down again, and, in a gesture that looked comforting, put his palm on her forehead. Then he straightened and nodded. “Perhaps you young men would help,” he said to us. “This is a classic case of hysteria. If you have not encountered it yet in your studies, you can count this as an excellent clinical opportunity. The patient is in what we call the rainbow position. It is not possible to assume this position voluntarily. After a while the rigor wears off. The duration varies. Nothing I know of acts consistently to halt it. But we can at least get her indoors, out of the damp.”

It was awkward, lifting her. She was rigid as a piece of wood, but the drastic arch of her body meant that she did not fit easily onto the stretcher. The best we could do was balance her on the poles, rather than nestle her body onto the canvas in between. It was surprising to look up at the windows of the workroom and hear cheering as we shuffled down the walkway. “I suppose they must have crowned the king and queen of the ball,” Dr. Theroux commented. “They will be returning to their dormitories quite soon. We will take this patient to the infirmary.”

Once we had Odette lying in the brightness of the ward, I could see how alarming she looked. Her gray uniform gown was wet and muddy. One of her cheeks was bruised, and her wrists were scratched. It was hard to know if she had done it to herself. What had set her off? What event, tiny or significant, had launched her into her flight from reality?

Remembering this episode as I sat in Charcot’s classroom at the Salpêtrière, I thought of Odette with pity. Her attacks continued after the ball, and in the ever-shorter periods between them, she seemed oppressed. Before I finished my term as an extern, she had been transferred to another division, where the women were even more closely supervised, and generally restrained. It was tacitly acknowledged that there was no hope they would improve.

In the years since my encounter with Odette, I had seen many more female hysterics, and they always made me uneasy. So often the triggers for their attacks are mysterious and the attacks themselves terrifying. I tended to refer hysterical women to one of the specialist doctors who offered rest cures. I had not given much thought to hysteria in men, however. Hysteria, with noisy, thrashing attacks, hallucinations, nightmares. Hysteria that answered to no treatment.

As my mind wandered in this fashion, the melancholiac woman was led away. I had not heard the treatment plan. Charcot took out his watch and spoke in a low voice to the orderly next to him, then addressed us. “We do not have much longer, gentlemen, but I do have a case here that I would like you to see. As most of you know, many hysterics exhibit hysterogenic zones. When we stimulate these portions of their bodies, we bring on an attack. Now, I must reiterate that I do not believe hysteria to be the result of a misplaced uterus, as was the opinion of our medical ancestors. Yet … well, we shall see.”

The next patient was a little man with pale skin and very fair hair. If he had been an animal, he would have been a white mouse. He was a clerk for the railroad. His problems dated from the moment he witnessed a fearsome accident in which an engine had severed the left leg of a track attendant. He had not himself been touched—although he was near enough to be spattered by blood—but he found, shortly after the event, that he had terrible shooting pains in his left leg.

“I cannot say how these events may be related to what I am about to demonstrate,” Charcot said. “They may have no bearing at all, but merely be a coincidence. We are very far from knowing how our mental experiences affect the functioning of our bodies. I have just mentioned hysterogenic zones. This patient, we have discovered, exhibits them, and they are located precisely where a woman’s ovaries would be. Would you mind standing, to show my colleagues?” The patient stood, wordlessly. The attendant lifted the white gown he was wearing and turned him around so that his back was to us. There were two ovals inked onto his lower back, on either side of the spinal cord. Charcot was now facing the patient. “May we?” he asked. The response was a slight nod. Charcot in turn nodded to one of his young colleagues, who stepped over and put the heels of his hands against the inked circles.

He leaned against the man’s back. The attendant moved around to serve as a brace against the pressure. We all waited. Nothing happened. Charcot had taken out his watch again and was looking at it, keeping track of the time. Then suddenly, the patient’s back went rigid, and he fell to the ground.

As an extern in this very hospital, I had grown accustomed to seeing a fellow human apparently released from all civilized controls. I’d seen patients bite warders and tear their own hair, I’d heard cries to wake the dead. But I was never as shocked as I was watching this man.

There was something cold-blooded about the situation, I thought. We all sat upright in our coats and shoes, watching a fellow human writhe on the floor. His gown was rucked up beneath his shoulders, and he was naked beneath it, no better than an animal. Two attendants knelt next to him, each holding one wrist so that he couldn’t tear at his face with his nails. He bellowed: a bold, deep, blaring cry. One would never have thought such a sound could emerge from his slight frame. He beat his heels so hard so that I was afraid he would draw blood, then tried to crack his head against the floor. I could not believe that the poor man had consented to undergo this torture.

The convulsions began to subside, but as the patient’s physical distress diminished, his mental distress increased. He was sitting now, cross-legged, and his garment had been restored to order. He rocked back and forth, as if in tremendous grief, and his eyes streamed tears. His mouth was open to voice an endless wail, but no sound emerged. Then a change came over him, and he leapt to his feet, crouching, fists clenched at his sides. Where before he had resembled a mouse, he was now a mouse prepared to fight to the death.

“Now we see the attitudes passionnelles,” Charcot said quietly, as the patient glared around him fiercely. “The classic phases of the hysterical attack do not always present themselves in the cases of men. The patient has never, for example, fallen into the rainbow pose. He does not spend a long time in any of the stages, and his recovery is correspondingly brief. This makes him an excellent patient for demonstrations. Also remarkable is the clear relationship between pressure on the hysterogenic zone and the onset of the attack.” Charcot glanced at the patient, who was now smiling quietly but raptly, like a mystic hearing voices. “We will leave Monsieur Bernet; he will come to himself shortly. Gentlemen, that is all for today, thank you.” He nodded at us, and we stood to file out the door. Our route took us to within a foot of poor Monsieur Bernet. I looked down at the top of his head as I passed him. His scalp showed pink through the strands of his hair, dampened with sweat. He was murmuring quietly to his folded hands while the attendants crouched patiently by his side.

Dr. Charcot was answering a question from a student, so I waited by the door, watching the patient. He appeared to be discussing something with himself, taking two sides of an argument. One of the attendants leaned forward and spoke quietly in his ear, but he did not seem to hear. When Charcot introduced himself to me, he also looked at Bernet.

“What is the next phase of the attack?” I asked as we left the room.

“For Bernet, after a short fit like this, probably a deep sleep. He may feel weakened. Possibly he will have a headache for a few hours.”

“And when will he come back to himself?”

“Quite soon. Probably within an hour. I must return to my office; I find that my colleagues get agitated when I am not where they expect me to be. Will you walk with me? Your note mentioned your concern for a painter, if I remember correctly. Is he someone I know of? Did he exhibit at the last Salon?”

I hastened to explain first Vincent’s marginal position in the world of conventional painting and then my own concern with him. I finished with a synopsis of his medical history as I understood it. By this time we were seated in his surprisingly modest office, tucked into a corner of a new building called the Policlinique.

“My knowledge of Monsieur van Gogh’s attacks is very limited,” I said in summary. “But there are hysterical features, it seems. He was diagnosed as epileptic, yet during his fits he is apparently destructive and noisy. In his letters he wrote of hallucinations, both auditory and visual, though when I asked him, he had little memory of them. He is a menace to himself and others.”

“Does Monsieur van Gogh’s reasoning seem disturbed?”

“Without doubt,” I said, describing the Foreign Legion scheme. Charcot nodded, tapping the end of a pen against his blotter. There was a moment’s pause. I waited, for it seemed he was formulating a statement.

“Of course you know, Doctor, that I cannot make a diagnosis without seeing the patient.” I nodded without interrupting him. “I would be very interested to meet this gentleman. There seems to be a high incidence of hysteria among men of genius; painters, musicians, authors. However, they are resistant patients. Sometimes they fear that improvement of their mental illness will adversely affect their creative abilities. I treat some of these gentlemen privately. I cannot intervene with them as strenuously as I do with my patients at the clinic. Some of the treatments, or indeed the diagnostic methods, are painful or unpleasant, like what you just witnessed. The patients who come to me reluctantly would not tolerate them.”

“And, if I may ask—why does a patient like that poor Bernet willingly submit to having an attack brought on?” I asked.

“Because he is so unhappy, and he hopes we will be able to help him,” Charcot answered. “With some patients who exhibit hysterogenic zones, like Bernet, an attack can be halted—as well as initiated—with pressure. We have not found this to be true yet for Bernet, but we hope that in time it will be.”

I was not aware that my expression revealed my pity, but the doctor was famous for his powers of observation. “You must remember, colleague, that as doctors we are sometimes required to inflict pain in order to find out how to end it.” I could only nod my acceptance. “Now, to return to your Monsieur van Gogh,” he went on. “I would eagerly see him as a private patient. I have a sizable practice based at my house on Boulevard St.-Germain. Do you think Van Gogh would consent to an examination?”

“I don’t know, Doctor. I believe he is very distressed. He is a great stoic, but at the moment he is in despair. If he thought his suffering could be relieved, he might see you.”

Charcot now picked up his pen and held it gently between his two extended forefingers. He sighed and replaced it on the blotter, then raised his dark eyes to mine. “I cannot pretend to you that we have any way to end hysteria,” he said. “I have known the attacks to become less frequent, less violent. More generally, though, they continue.”

“Until?” I asked. “For the rest of life?”

He leaned back in his chair. “Our specialty is a difficult one, isn’t it? I sometimes envy the men who can set a bone or stitch up a wound and be confident they have accomplished something. Despite all the progress we have made, these mental maladies are still baffling. Before you leave, Doctor, I suggest you visit the old sections of the hospital, where the restantes stay. The dormitories and workshops are still full. We sometimes cure patients. Usually that is when they have not been ill for long. But the truth is that we do not know exactly how we do it. When a patient leaves here and has no more hysterical attacks, we do not know whether the baths helped her, or the separation from her family, or the nourishing food. I sometimes send my private patients to Dr. Fourgon in Passy, and the hysterics are sometimes cured, in about the same proportion as the hysterics who stay here. But, again, I don’t know why.”

He got to his feet. I rose, too. I am not a tall man, but he was even shorter than I. Still, there was a strong air about him, an impression of competence and assurance. Next to him I felt somehow insubstantial, as if I were not quite everything I had thought.

“Thank you for your generosity and your frankness, dear Doctor,” I said, holding out my hand. “I will talk to Monsieur van Gogh. I hope I can persuade him to come and see you. His last visit to Paris was unhappy, but if I accompany him …” I trailed off. “I will send word if we decide to make the trip. Thank you again.” He shook my hand warmly and inclined his head to acknowledge my thanks.

I visited the older wards of the hospital as Dr. Charcot had suggested. I had intended to all along: what man, returning to the site of his professional formation, would not take the time to roam around and attempt to come to terms with the intervening years? What man would not walk the paths he used to walk, hoping to see his younger self, hurrying forward toward some goal? We want to know what is the same and what is different, in us and in that old world. As I came around the corner to the cour des agités, I smiled slightly, and resolved to walk part of the way home, past the École des Beaux-Arts. Perhaps I would see a saffron-haired ghost peering out of a garret window on the rue de Seine.

Little seemed to have changed in this part of the great old hospital. The alterations that had brought the surrounding area into the nineteenth century—almost into the twentieth—did not penetrate the walls of the asylum, apparently. I crossed several courtyards, hearing the familiar sounds: the beating of a small drum to help seamstresses keep time in a workroom, the rhythmic scrape of a rake, a high voice wailing. In one courtyard a gardener wheeling a barrow thanked me for stepping off the path. He called me “Doctor.” What else could I be, in that place?

I crossed to the archway between buildings and turned left into the long hallway without thinking. I found the door I knew was there and opened it. Three steps led down into the courtyard, and a stout wardress stood at the bottom. She looked up at me.

“Good morning,” I said. “My name is Dr. Gachet. I was an extern here many years ago and I just met with Dr. Charcot. He suggested I might visit the section of the hospital where I worked. May I stay here for a moment?”

“As you like, Doctor,” she said. “I doubt you’ll see much difference.”

I gazed around. “No,” I agreed. “Nothing has changed.” It was remarkable. The trees were perhaps taller. The gravel must have been renewed at some point. The patients, however, could have come from Gautier’s painting The Madwomen of the Salpêtrière. Poor Gautier, now deep in debt—I wished he were with me now. We would have sat on the steps with our drawing pads, and I would have believed I could help these poor creatures. “Do you have any hysterics in this group?” I asked the wardress.

“No, these women are all quiet. The hysterics upset them. One minute your hysteric’s strolling around calmly, next minute she’s upside down and screaming. Having them in with the calm ones just upsets everybody.”

“You’ve worked with them?” I pursued the subject.

“Of course. Some of us like it, adds some interest. I don’t. I feel for these poor things.” She gestured to an obvious melancholiac sitting on a bench in the shade. “Poor Gabrielle, how can you not pity her? Gentle, kind, hates to give trouble. Some of the hysterics put it on for Dr. Charcot, you know. He says they have fits, so they have fits. He says the fits look like this or that, sure enough they do. They like to get off work, go over to the studio and be photographed. Sometimes they perform in his lectures, and I do mean perform!”

This did not surprise me terribly. If the women intuited what Charcot and his students wanted to see in a “hysterical” patient, they would provide that. I had seen a few volumes of the famous Iconographie photographique de la Salpêtrière, published by one of Charcot’s protégés, and some of the patients had appeared very knowing indeed.

“Do they ever get better?” I asked.

The wardress looked carefully at me for the first time. “You should know that if you’re a doctor. Or don’t you treat the mad anymore?”

I looked up at the sky, holding my hat on my head. “Sometimes I wonder if anyone gets better,” I said.

She frowned, and her eyes shifted away. “Well,” she said. “If you say so.” She caught sight of a woman on the ground, scrabbling at the earth with her hands. “Cécile,” she called out, and bustled away. “Cécile, we do not dig!” The woman, spotting her, only began to dig faster, though her busy fingers made no visible hole in the hard ground. It was a futile exercise. She was acting on compulsion, a mysterious command that told her to dig, here, now. Dig. I didn’t think my compulsion to visit the madwomen had been much more productive.