lexiones clinicas sobe las enfer mentales y nerv seglas

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DOI: 10.1177/0957154X0001104105

2000 11: 107History of PsychiatryFiliberto Fuentenebro and German E. Berrios

Introduction: Jules Sglas and 'hallucinatory obsessions'

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Classic Text No. 41

Introduction: Jules Sglas and

hallucinatory obsessions

FILIBERTO FUENTENEBRO and GERMAN E. BERRIOS*

Reprint requests to G. E. Berrios, Department of Psychiatry, University of Cambridge,Addenbrookes Hospital (Box 189), Hills Road, Cambridge, UK CB2 2QQ. E-mail: [email protected]

In the locus classicus that follows, Jules Sglas discusses the possibility of anon-coincidental association between hallucinations and obsessional disease.

Hallucinations are not included in the DSM IV definition of OCD. In

general, the grounds on which such clinical link has been dismissed byofficial psychiatry are not altogether clear .2 It is easy to argue it out of

existence, for example by stating that it is coincidental or simply the resultof misdiagnosis, i.e. that either the patient is reporting a pseudo-hallucination3 or has a psychosis. Because these claims are empiricallyunsupported, Seglass view that hallucinations may actually be part of the

picture of OCD remains a tantalizing possibility.Bom in tvreux, department of the Eure on 31 May 1856, Jules Seglas

entered the Paris Medical School in 1873. Between 1877-1880, he worked

as an intern to the Paris Hospitals under Charcot, Delasiauve andBourneville. He graduated on 20 January 1881 with a thesis on Theinfluence of intercurrent diseases on the course of epilepsy. In 1898, S6glasbecame a consultant at Bic~tre, and from 1909 until his retirement he was

chief of service at La Salpetriere. In 1884, Seglas occupied the placevacated by Moreau de Tours at the Societe Medico Psychologique of Paris,

becoming its President in 1908.~4His four major works are a faithful

reflection of the glorious clinical tradition reigning in those two French

hospitals at the turn of the century.

Seglas has been accurately portrayed as a retiring, non-assuming clinician,of great moral and academic integrity, and with marked disdain for punditry

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and academia. In keeping with this, he requested that no obituaries bewritten for him.A man of deep and lasting friendships, he was close to PhilipChaslin, that other giant of French psychopathology.A year younger, Chaslinreplaced Sglas at La Salptrire and also took over his house at 96 rue deRennes. They shared views on psychopathology and a taste for Condillac,for example, Seglas once stated: the study of the psychopathology ofperception and hallucinations suggests that psychiatry is not a well made

language.8 Sglas died on 6 December 1939 and is buried at the PierreLachaise cemetery.

Seglas et le groupe de la Salpetriere has been identified by Bercherie as an

important period in the evolution of French psychiatry. The Frenchhistorian is right for the work of Seglas has an extraordinarily wide compass.In addition to original contributions to the understanding of hallucinations,delusions, obsessions, dementia praecox and melancholia, Seglas single-handedly opened a new area of research, namely that of the languagedisorders in the insane.A tour de force in terms of originality, description and

taxonomy, his book has been sadly neglected. Therein, S6glas draws ourattention to the fact that, because in psychiatry diagnosis depends to a largeextent upon patients verbal reports, it follows that it may be negativelyinfluenced by disorders of language, for these may affect both the experiencingand the reporting of subjective experiences. S6glas identified and catalogueda variety of disorders of grammar, syntax, semantics, gesturing and

mimicking, and recognized before most the potential importance of formal

thought disorder.&dquo; Veritably, Seglas created a new approach to the analysisand classification of the language of the insane.

Delivered between 1887 and 1894, and taken down by Henry Meige, 12 thetwenty-eight Leons cliniques sur les maladies mentales et nerveuses carry anumber of princeps clinical observations (like the one translated below). On

occasions, Seglas went on to expand upon some. This is the case with Le

Ddlire des negations: srniologie et diagnostic where he disagreed with the viewsof Jules Cotard

3and suggested that such delusions constituted a non-

specific syndrome which could also be found in hypochondriacal states,mania, general paralysis of the insane, febrile delirium and circumscribedbrain lesions.

Seglass 200-page pr6cis of descriptive psychopathology appeared in 1903.With characteristic generosity he allowed Gilbert Ballet to include it as a

chapter of the monumental Trait de pathologie rnentale where it became thehub that kept all contributions together. Given the current scarcity of the

Treatise, it is to be regretted that Seglas never bothered to publish it as abook in its own right. Divided into three sections (morphological andsomatic signs and symptoms), the chapter develops a full system of

descriptive psychopathology. The section on symptoms deals in detail withdisorders of language, action, mood, cognition, hallucinations, and delusionsand shows great awareness of the debates of the day. Like Chaslin, Sglas



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constantly moves from concepts to patients and back so as to maximizeinformation and increase reliability and validity.

Seglas first dealt with the relationship between hallucinations andobsessions on 30 November 1890, in a paper read before the SocieteMedico Psychologique entitled On hallucinatory obsession and obsessionalhallucination. 14 He started by expressing regret at the fact that already in histime alienists were inclined to believe that absence of hallucinations was a

feature of obsessions experienced in clear consciousness and that this viewhad been voted as correct (in spite of objections by Charpentier) at the1889 National Congress of Mental Medicine. Seglas had a deep interest onboth hallucinations&dquo; and obsessions6 and his knowledge of the literature onthese symptoms was impressive. His distinction between hallucinatoryobsession (when an obsession gives rise to a secondary hallucination) andobsessional hallucination (when the hallucination has an independentexistence only to the extent that in its form and content it behaves like an

obsession) is interesting and needs to be tested empirically. Reading Seglasswork helps also to appreciate the high standards reached by descriptivepsychopathology in Europe before the phenomenological tradition came toclaim an exaggerated role in its development.

Classic Text No. 41

Leons cliniques sur les maladies mentaleset nerveuses by J. Sglas

(Paris:Asselin et

Houzeau, 1895.Fourth Lecture:

Obsessions (pp. 106-111))

Translated byG. E. BERRIOS

I wouldnow like to deal with a controversial issue, namely, that of the

presence of hallucinations in obsessional patients.According to the majorityof authors, hallucinations should not form part of the clinical picture of the

obsessional disorders. For example, following a proposal by Mr Falret at arecent Congress of Mental Medicine, 17 and in spite of opposition from Mr

Charpentier, this very view carried the day.


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