Charcot's Error: Understanding Historical and Modern Manifestations of Trance and Conversion Disorder

Introduction to Dancing Plagues

• Dancing plagues, such as the 1518 Strasbourg event, were extreme responses to widespread misery, heightened suggestibility, and deeply held cultural beliefs. These events highlight how the human brain, when subjected to intense strain, can manifest sensations and behaviors that mirror societal ideas, often moving beyond conscious control. The phenomenon is not isolated; it includes a range of psychogenic responses such as spontaneous trance, compulsive movements, mutism, anesthesias, paralysis, overwhelming fatigue, and psychogenic pain. A key aspect is that even when individuals lose volitional control, their actions frequently align with culturally prescribed norms, suggesting a profound influence of societal expectations on psychological manifestations.

Understanding Spontaneous Trance

• Spontaneous trance states are crucial for understanding not only dancing plagues but also a variety of other unusual behaviors observed throughout history and across cultures. These states are neither rare nor idiosyncratic; anthropological studies suggest that over 90% of modern cultures incorporate rituals that induce trance. Psychologists have cataloged at least eighteen distinct altered states of consciousness, which extend beyond typical states such as sleeping and dreaming. These trance states can arise from various conditions:

  • Learned Behaviors: Such as possession trance or deep meditation.

  • Pathological Conditions: Including fugue states, somnambulism, and dissociative identity disorder.

  • Transient Experiences: Like feeling detached from one's body.

• These states often involve a fragmentation or sidelining of normal consciousness, known as dissociation, which can significantly alter perception and behavior.

Cognitive Changes During Trance

• During trance states, several key cognitive changes occur:

  • Impairment of Critical Analysis: A reduction in the ability to critically evaluate information, assess reality, and engage in rational thought.

  • Distorted Perception of Space and Time: A breakdown in the normal perception of spatial dimensions and temporal flow.

  • Increased Suggestibility: Heightened susceptibility to both internal thoughts and external stimuli, making individuals more receptive to suggestions.

  • Confusion of Reality and Fantasy: A tendency to blur the lines between fantastical ideas, visions, and reality.

  • Elevated Pain Threshold: An increased tolerance for pain, allowing individuals to endure discomfort more readily.

  • The characteristics of the dancing mania of 1518 closely mirror these criteria, suggesting that those affected were likely in a trance-like state.

Inducing Psychic Disintegration

• Various factors can induce psychic disintegration and facilitate trance states:

  • Extreme Sensory Bombardment: Overwhelming the senses with repetitive stimuli such as singing, clapping, drumming, dancing, intense changes in light and dark, and strong olfactory stimulation.

  • Focused Attention: Intense focus on one or two stimuli, which disrupts the normal flow of consciousness, as seen in yogic meditation or hypnosis.

  • Malnutrition: Particularly diets deficient in essential minerals, which can disrupt serotonin production and lead to abnormal psychological states. This is relevant as low-status women, who often experience poorer diets, are overrepresented among those prone to spontaneous trances.

  • Extreme Psychological Distress: Severe distress can trigger trance states, as observed in environments such as austere convents, strict boarding schools, and harshly managed factories.

Stress and the Dancing Plague

• The role of stress is evident in the Strasbourg dancing plague. Historical outbreaks, like the one in 1374, followed severe natural disasters, such as the extensive floods in the Rhine and Moselle valleys. These events, chronicled in historical records, caused widespread devastation and likely contributed to the psychological conditions conducive to mass hysteria. The dancing plagues in regions like Holland, western Germany, and northeastern France in 1374 were concentrated in areas most affected by the flood. Furthermore, acute dread, similar to that experienced by skydivers during freefall or soldiers in combat, can also trigger a trance state, highlighting the connection between extreme stress and altered states of consciousness.

Neurological Aspects of Trance

• At a neurological level, trance involves significant shifts in the dynamics between the left and right hemispheres of the brain. MRI and PET scan studies suggest that intense focus driven by the left hemisphere, which is responsible for analytical and logical thought, allows the right hemisphere, associated with imagination, fantasy, and creativity, to become dominant. This hemispheric imbalance can cause individuals to lose their sense of reality. Repetitive motions and activities may further intensify the trance state by continuously preventing the left hemisphere from regaining control, thus perpetuating the dominance of the right hemisphere.

The Power of Suggestion

• The likelihood of experiencing altered states is notably higher in individuals who anticipate or expect them to occur. For instance, in Strasbourg in 1518, Frau Troffea’s initial dance escalated into an epidemic when onlookers became convinced it was a manifestation of St. Vitus’ wrath. Similarly, in 1643, Ursuline nuns in Loudun, France, entered trance states after their Mother Superior claimed they were bewitched by a priest named Urbain Grandier. This accusation led to Father Grandier being burnt at the stake, underscoring the grave consequences of suggestibility and mass hysteria.

Suggestibility in Modern Contexts

• Modern examples of suggestibility leading to trance states can be seen in Malaysia and Singapore, where factory workers, often rural migrants holding traditional beliefs about spirits and possession, experience trances induced by harsh factory conditions. These workers may interpret their experiences as the work of evil spirits, manifesting symptoms that are then replicated by others. These episodes are frequently resolved through religious ceremonies involving sacrifices, demonstrating the cultural context's role in the manifestation and resolution of trance states. Studies of possession cults further illustrate how minds can be primed to shift into different states of consciousness, indicating that the anticipation and expectation of such states can significantly influence their occurrence. The American anthropologist Erika Bourguignon describes this as an "environment of belief," wherein communities absorb and internalize ideas about the spirit world, thereby "preparing" themselves for possession states.

Cultural Influence on Trance

• Cultural context significantly shapes trance experiences, with possession rituals, learning about them, and the anticipation surrounding participation placing the mind in a state of readiness for alternative consciousness. Some cultures, such as the Brazilian Candomblé cult, systematically prepare their members for ritual trance through specific practices and indoctrination. The behaviors of both the dancers of Strasbourg and the nuns of Loudun were profoundly influenced by a shared set of supernaturalist beliefs prevalent in their respective societies. Modern possession rituals continue to demonstrate how culturally determined beliefs and expectations guide thoughts and actions during these states.

Examples of Cultural Influence

• The influence of culture on trance states is illustrated by various examples:

  • Tarantelleees of Southern Italy and Sicily: Danced to rid themselves of spider venom, assuming postures resembling spiders, reflecting a belief in the curative power of such mimicry.

  • Participants in Haitian Vodou Rituals: Adopt the roles of specific deities, embodying the characteristics and behaviors associated with those gods.

  • Female Mediums in Madagascar: Take on distinct personas of spirits, each with unique traits and mannerisms.

  • The Kung of the Kalahari: Practice two trance rituals with different rules: the 'Giraffe Dance' for healing and the women-only 'Drum Dance' for shivering and shaking, each adhering to specific cultural norms.

  • The 'Possessed' Ursulines of Loudun: Acted in ways that were expected of the bewitched, including writhing, foaming, convulsing, dancing, speaking in strange tongues, and making obscene gestures, all of which aligned with contemporary beliefs about demonic possession.

  • Female Choreomaniacs of 1374: Bared their breasts and offered their virginity, reflecting specific beliefs about divine curses and the need for atonement.

  • Hallucinatory Visions of Mystics like Joan of Arc: Conformed to expectations of divine experiences, reinforcing the cultural shaping of subjective experiences.

Ecstatic Religion and Choreomania

• Ecstatic religious experiences are often fueled by a combination of psychological distress, suggestion, and cultural conditioning. Entering an altered state, whether through intense peace or speaking in tongues, can be interpreted as evidence of a divine presence, reinforcing faith and communal bonds. Historical examples include:

  • Early Quakers: Who held meetings during which they were "strangely wrought upon in their bodies…roar, and swell in their bellies," indicating extreme physical and emotional manifestations of religious fervor.

  • Early Shakers of New York: Who engaged in singing and dancing until they entered trance states, demonstrating the use of physical activity to induce altered states of consciousness.

The Great Awakening

• The "Great Awakening" in the American South featured massive prayer meetings where worshippers succumbed to the "falling sickness," displaying behaviors such as shrieking, falling, losing consciousness, writhing, hallucinating, jerking violently, barking like dogs, or dancing for extended periods. Participants often lived in challenging environments marked by high rates of sickness and frequent attacks by native tribes, highlighting the role of stress in these phenomena. Modern Pentecostal churches continue these ecstatic traditions, with worshippers reporting feelings of being infused by the Holy Spirit, speaking in tongues, or collapsing to the floor. These practices often attract the poor, the lonely, and the oppressed, suggesting that these experiences provide a form of relief and community.

Secularism and Trance

• Deliberately induced trances are rare in the secular West, largely because the "environment of belief" that supports them has been undermined by secularism. However, epidemics of unusual behavior still occur, often involving distortions to conscious thought processes. Examples include:

  • Koro in Southeast Asia and China: Where men believe their penises are shrinking into their bodies, leading to desperate and often harmful attempts to prevent retraction.

  • The Tanzanian Laughing Epidemic of 1963: Which primarily affected children and lacked any identified biological cause, leading it to be considered analogous to the dancing plagues. Notably, the epidemic did not affect adults who were "literate" or "relatively sophisticated," suggesting a link between education and resistance to mass hysteria.

• These examples illustrate that suggestibility to terrifying beliefs tends to increase during times of distress, highlighting the ongoing relevance of these phenomena.

Hysterical Fears in the West

• Even in Western cultures, paranoid delusions can manifest, such as widespread beliefs in alien abduction and flying saucers. Psychiatry itself has inadvertently contributed to some epidemics of suggestion, as seen in cases where therapists implanted false memories of incest, demonstrating the potential for harm when psychological interventions are not carefully managed.

Conversion Disorder

• Conversion disorder presents patients with symptoms like odd movements, paralyses, tics, mutisms, blindness, anesthesias, and unexplained pains without any identifiable organic cause. These histories often reveal underlying issues such as depression, trauma, or abuse. In these cases, psychological pain manifests as disturbances to voluntary motor or sensory function, with one study indicating that about 35% of patients referred to neurology clinics exhibit disorders lacking a clear medical basis.

Neurological Basis of Conversion Disorder

• Recent advances in neuroscience have provided insights into the physical reality of conversion disorder. Studies using PET scans on paralyzed patients have shown that while the brain activates motor function areas when preparing to move the paralyzed limb, other areas simultaneously inhibit the movement. This indicates a neurological conflict that underlies the physical symptoms of the disorder. The specific expression of conversion disorder is also significantly shaped by prevailing cultural ideas and expectations, further highlighting the intricate interplay between mind and body.

Jean-Martin Charcot and Hysteria

• Jean-Martin Charcot, who studied "hysteria" at the Salpêtrière asylum in Paris, used hypnosis to induce fits in female patients. He identified four distinct phases of these attacks, characterized by an epileptic-like fit, bodily contortions, impassioned poses, and delusions. However, Charcot's neurotic patients convulsed and spasmed not according to immutable natural laws, but because they were highly suggestible individuals housed alongside patients with severe epilepsy. As a result, their neurotic fits began to mimic the pattern of epileptic seizures, vividly demonstrating the power of suggestion. The four-stage hysterical attacks Charcot described were rarely observed outside the Salpêtrière asylum, suggesting they were, in part, a product of that specific environment. While Charcot was not easily challenged, his colleague Dejerine correctly pointed out that there are no absolute laws of hysteria. Instead, Charcot’s work provided a compelling demonstration of the suggestibility of the human unconscious and the potential for anxiety, when combined with specific beliefs, to produce outlandish symptoms.

Post-Charcot Psychiatry

• Following the 1880s, psychiatrists became more open to recognizing hysterical symptoms as manifestations of underlying psychological distress. However, Sigmund Freud sometimes misdiagnosed patients, attributing physical pain to hysteria. Freudians maintained that physical symptoms could result from ideas stored in the unconscious mind, furthering the understanding of the complex relationship between mental and physical health.

Trauma and Conversion Disorder

• Lewis Yealland, an English shell-shock doctor, famously documented a case where a mute soldier’s symptoms were treated with electrotherapy, chasing the symptoms around his body. Yealland believed that these patients recovered only when convinced they suffered from treatable organic conditions, highlighting his understanding of the power of suggestion. Edward Shorter argues that hysterical symptoms have evolved over time, reflecting changing modes of thought and expectation. Emotional breakdowns during the Middle Ages and early modern period often conformed to stereotypes of witchcraft, mysticism, or demonic possession. With the rise of secularism, these breakdowns began to emulate medical trends rather than religious tropes. For instance, hysterical paralysis was uncommon before the 1800s but became widespread as discussions about nerve damage and spinal inflammation increased. The relationship between conversion symptoms and cultural context is further illustrated by the experiences of traumatized soldiers in World War I. Frontline British officers, in contrast, were more prone to night terrors, persistent anxiety, and mood swings—symptoms now categorized as post-traumatic stress disorder. This suggests that developing histrionic symptoms may not have been an option for an officer class trained in self-composure and emotional restraint.

Modern Hysteria

• The 20th century saw a decline in dramatic motor symptoms associated with hysteria. Mutisms, convulsions, paralyses, altered states, and sensory deficits linked to anxiety appear less prevalent today than at any other time in recorded history. Instead, severe stress is more often expressed as "somatoform disorder," characterized by psychogenic pain, fatigue, dizziness, or a general sense of malaise. Research in rural India indicates a shift from conversion disorder to complaints of pain and fatigue, attributed to improved access to education and reduced "public credulity," suggesting that increased awareness and understanding of mental health issues influence how distress is manifested.

Secondary Gain

• Psychiatrists sometimes suggest that conversion provides an unconscious means of gaining sympathy, referred to as "secondary gain." Medical anthropologist Arthur Kleinman notes that depressed patients in China more frequently report aches, pains, and fatigue than low mood or anxiety, likely due to the stigma associated with mental illness. However, the concept of secondary gain does not imply deception; the pain experienced is real and deserving of appropriate care and attention.

Cultural Mandates

• The pool of symptoms associated with conversive disorders has changed in response to the decline in magical beliefs and shifts in disease theory. Some cases of conversion disorder are linked to specific traumas or fears, while others reflect broader cultural norms and expectations. For example, Victorian ladies with anesthesias from their gloves to their blouse sleeves reflected societal modesty, while soldiers with paralyzed hands or stomach pains stemming from combat experiences demonstrated how ideas and experiences can manifest as physical symptoms, distinct from organic disorders.

Parallels with Choreomania

• Both choreomania and conversion disorder highlight the limitations of dismissive statements like "it’s only stress." While secular Western individuals typically express distress in a more restrained manner, historical accounts of trance and conversion disorder reveal the capacity for far more dramatic responses. Psychological trauma has the power to alter mental function, disrupt voluntary control, and induce dissociative states. The effects of trauma and distress are far from trivial; the prognosis for conversion disorders remains challenging, underscoring the need for comprehensive and compassionate care. Few disorders of the mind can be classified as precisely as typical organic conditions, as symptoms are highly dependent on beliefs and cultural worldviews, necessitating a nuanced understanding of the individual’s cultural context.

Choreomania as a Cultural Phenomenon

• Epidemics of wild dancing are perplexing from a modern, secular perspective. Historians strive to understand the experiences, imaginations, and beliefs of those gripped by what they perceived as saintly wrath. Choreomania serves as a powerful lesson in how cultural conventions shape the expression of pathological anxiety and demonstrates the profound impact of suggestibility under conditions of extreme stress.

Relevance to Modern Society

• Parallels can be drawn between the wild dancing seen in the dancing plagues and modern-day clubbing. Clubbing is often fueled by recreational drugs, such as MDMA, which enhance the individual’s sense of kinship and communal experience. However, it is important to note that recreational drug use is perhaps more closely related to phenomena like Pentecostal worship than to the psychological agonies experienced during the dancing mania. Nevertheless, clubbers demonstrate the capacity to dance for extraordinary lengths of time, often mitigating fatigue through drug use, which somewhat replicates the bizarreness of the dancing plague. Viewing clubbing as a chemical equivalent of St. Vitus’ Dance might make it easier to comprehend how altered states of consciousness could have driven thousands of people in 1518 to dance for days on end.