Madness was long considered to be reflected in the face and the disturbed mind, it was thought, could be captured in an image. The idea that the structure of the face reflects the mental attributes of the person eventually became known as physiognomy and was first discussed by the Ancient Greeks who started the practice of studying pictures of the mad as way of understanding insanity. Before the advent of photography, this form of artisan psychology probably reached its peak with a series of paintings by the French artist Théodore Géricault who created ten portraits of the insane, each with a different form of ‘monomania’, in an attempt to capture of the essence of each psychological disturbance.

Géricault’s paintings appeared just at the dawn of photography and the mania for capturing images of the mad was fuelled by the new technology which finally took the practice out of the hands of artists. It is no accident that some of the most influential, and, it must be said, notorious, people in the history of the mind were born at the same time as photography itself. The English psychologist Francis Galton and the Italian criminologist Cesare Lombroso, both now tainted by the stain of eugenics, created composite photographic images of criminals to determine the most common features of the ‘degenerate’. The pictures served not only as simple lab tools but also as unintentional but effective promotional material – the photos served to spread their ideas in a most striking visual manner.

The more medical version of this practice, the photographing of the insane, reached almost industrial levels in the mental hospitals of 19th century. London’s Bethlem Hospital began systematically taking photograph of patients as they were admitted, many of which are documented in Colin Gale and Robert Howard’s remarkable book, Presumed Curable. However, the images that left the most lasting impression on history were taken at the Salpêtrière Hospital in Paris at the behest of the French neurologist Jean-Martin Charcot. He was a thorough and tireless investigator of neurological problems, reliably linking nervous system damage to medical symptoms in a way that only a large hospital like Salpêtrière could allow. Photography proved invaluable for the project, both as a research and teaching tool, and the hospital photographic studio became a medical fixture. But it is not the depictions of patients with clear neurological damage which remain the most vivid in the photographic memory, it is the patients with a condition that involves no obvious lesions detectable to the naked eye, the photographic lens or to the medical scanner.

Hysteria, as it was known then, is the manifestation of neurological symptoms without any neurological damage, but Charcot was convinced that there was clear visual progression of the course of the condition and applied his photographic method to his patients. Hysteria has rightly been called protean and Charcot’s own test for the condition was that the symptoms could be altered by suggestion, something which could not happen with cases of clear nervous system damage. The photos show spectacular body contortions and contractions, trance-like states and dissociation from the external world. The photos have a strong theatrical quality, but Charcot did not have the insight to recognise that the photography itself, the very process of creating an image for show, could be influencing the very thing he was trying to capture with the seemingly objective lens. In The Invention of Hysteria, a history of photography at the Salpêtrière, Didi-Huberman notes:

What the hysterics of the Salpêtrière could exhibit with their bodies betokens an extraordinary complicity between patients and doctors, a relationship of desires, gazes, and knowledge. This relationship is interrogated here. What still remains with us is the series of images of the Iconographie photographique de la Salpêtrière. It contains everything: poses, attacks, cries, “attitudes passionnelles,” “crucifixions,” “ecstasy,” and all the postures of delirium. If everything seems to be in these images, it is because photography was in the ideal position to crystallize the link between the fantasy of hysteria and the fantasy of knowledge.

A reciprocity of charm was instituted between physicians, with their insatiable desire for images of Hysteria, and hysterics, who willingly participated and actually raised the stakes through their increasingly theatricalized bodies. In this way, hysteria in the clinic became the spectacle, the invention of hysteria. Indeed, hysteria was covertly identified with something like an art, close to theater or painting.

The images are like none that medicine has ever produced before or since. They have a picture postcard quality and the photos of a young woman named Augustine, clearly a star patient, even have a hint of soft focus that sits uncomfortably between the angelic and the erotic. Charcot’s photography glamorised hysteria not only for his medical colleagues, among whom the images had wide circulation in medical texts, but also among the public, as the images crossed-over to the theatre and cabaret. Elaine Showalter’s Hystories documents the singers and performers at the Folies Bergère “who called themselves the “Harengs Saurs Épileptiques” (The Epileptic Sour Herrings) or “Hydropathes” mimicked the jerky, zigzag movements of the hysterical seizure” and notes how performers of the time would lionise Charcot’s work to include it in their own performances.

Harnessed due to its presumed ability to objectively record the symptoms of patients, the camera became a vector for the condition, causing doctors to diagnose it in far greater numbers and for patients to express their distress through ‘hysterical’ symptoms in increasing numbers. We tend to think of media fashions as transient and frivolous but we forget that popular culture is as much an influence on illness and its treatment as science itself. For many, Charcot’s iconic pictures became the public expression of their private anguish and their documentary potential extended beyond the hospital walls to capture the broken spirit of the times.

Vaughan Bell is a clinical and research psychologist based at the Universidad de Antioquia, Colombia and the Institute of Psychiatry, King’s College London