Spring 2004

The Figurative Incarnation of the Sentence (Notes on the “Autographic” Skin)

Dermographia and the inscribed body

Georges Didi-Huberman

In 1862, when Jean-Martin Charcot assumed the position as head of the Salpêtrière clinic in Paris, he described its 5,000 inmates as offering “a kind of living museum of pathology,” one especially rich in neurological and mental disorders, areas already within his field of specialization. At this time, Charcot was becoming acquainted with photography to document symptomatology and, thereby, to classify certain disorders by means of their visual appearance. This predilection toward the visual example is already apparent in his reference to the clinic as a museum. Therefore, when he noted a pattern of mock epileptic seizures among a group of convulsives assigned to the hospital, he named the symptom grande hystérie, began to document it photographically and, by the late 1880s, had appointed Albert Londe as resident photographer. The creation of this post was the first of its kind, and indicates Charcot’s fascination with noting and fixing the image of a human disorder.

In formulating the concept of grande hystérie, Charcot noted its three stages—lethargy, catalepsy, and finally somnambulism—and associated them with specific physical attitudes and gestures. His linking of illness and image became so firmly entrenched that many patients caught the suggestion and began to perform according to his expectations. As a reward, they were frequently photographed, elevated to a kind of star status, and thereby participated in an extraordinary way within the relationships of power in the closed world of the clinic.

For several months during 1885 and 1886, Sigmund Freud attended these demonstrations. The sojourn was to be important in his eventual clarification of the nature of hysteria, the uses of hypnosis, and in the development of his own clinical method. While noting Charcot’s many attributes, Freud ultimately characterized him as a visuel, not a “thinker” but an “artist.” Indeed, the artistic is prominent within Charcot’s work. He and an associate, Paul Richer, published Les démoniaques dans l’art (1887) and other work illustrating the correspondence between Charcot’s “iconography” and representations of similar disorders throughout the history of the fine arts. In addition, Richer had also begun to make drawings, then etchings, which further distilled the photographic images into composite exempla of symptomatology. The two men also founded what was to become a monumental serial publication combining photographs and textual diagnoses, the Iconographie photographique de la Salpêtrière (1876–1880) and the Nouvelle Iconographie (1888–1918), which continued after Charcot’s death in 1893. Together, these publications are an important document in the history of 19th-century photography and medicine.

Charcot’s work at the Salpêtrière is replete with significance concerning the pitfalls of classification, the power exerted by clinical method, and the allure of a certain kind of imagery as an index to truth. It is worth noting that Freud, in one of his many departures from Charcot, abstained from using photographs of patients to illustrate his work, thereby acknowledging the unreliability of physical appearance to describe emotional and psychic reality.

The following text is an abbreviation of a longer essay by Georges Didi-Huberman which treats a particularly meaningful event in the history of Charcot and the Salpêtrière—the fascination with the phenomenon of dermographism, writings upon the human skin. It is an instance that illustrates much about the complex iconography of Charcot and the relationship between images and the exertion of power. What is more, since most of the patients subjected to these experiments were women, all under the control of male clinicians, the question of sexual gender is placed squarely in the center of the drama.

The notion of skin exists as a lacuna in speculation relating to the nature of surfaces.[1] Is it “tegument,” that which merely covers, or is it “dermis,” that which is uncovered and sensitive? Descartes, although he conceived of the body as res extensa (a unitary concept of expanse that accounts for both external and internal space), was himself obliged to equivocate regarding what he calls “the surface areas.” On one hand, there is the skin as glove, a skin which separates. This is a surface without sensation, which covers the sensible nerves below. Here, the skin is an intervening surface between internal and external. In the same way, the membrane which covers the eye allows for the passage of light to the optical apparatus, leaving it completely undisturbed.[2] However, there is also in Descartes the notion of “dermis,” the skin of non-separation. The human placenta is, for instance, such a generative and integral covering, a kind of origin of the skin itself.[3] In a similar fashion, Descartes speculates about the veins lying under the human skin, imparting color to the surface, but separated from it by the infinitely subtle “First Element.”[4]

The skin is then a complex structure, reticular, defying geometric thinking, separating and non-separated, intervening yet indistinct. It is not without reason that Descartes opposes the eye and the skin, in spite of Aristotle’s classification of touch as the primary human sense.[5] The skin complicates clear and distinct visualization because of its curious dynamics, phenomena described by the psychiatrist Paul Schilder in the following passage: 

Another astonishing fact is that when subjects compare what they feel and perceive tactually on their body with the optic imagination or the optic perceptions of the body, they find that there is a discrepancy. The skin that is felt is distinctly below the surface of the optic perception of the body. It is of great interest to study the changes which occur in the feeling of our skin and of the tactile surface of our body, when an object is touching the skin or when we touch an object with our hands or with another surface of the body. At this very moment, the surface becomes smooth, clear, and distinct. The tactile and the optic outlines are now identical with each other. It is a remarkable psychological fact that though we distinctly feel the object and distinctly feel our own body and its surface, yet they do not touch each other completely. They are not fused together. There is a distinct space between. In other words, object and body are psychologically separated by a space in between. 
It is an interesting experiment to diminish the pressure of the fingers against the object. We feel the object less and less and the fingers more and more. When the fingers are finally only just touching the object, the object is scarcely perceived any longer, but we have a distinct feeling in the tips of our fingers. We can now observe a paradoxical sensation. It is as if the skin were protruding over the surface and forming a slight cone, which almost reaches for the object.[6]

We might consider more seriously this discrete magic of skin which swells up and “reaches for the object” at the moment of contact. The phenomenon is one of “touching-without-touching,” an instance in which contact exists simultaneously with estrangement. Consider this chiasmus of the surface, how it swells between vision and touch, like something blind which gropes for sight and expression.

I will base my remarks on an “observation,” as it is called, in Nouvelle Iconographie de la Salpêtrière (1904) in which the curious life of the skin is revealed with unusual coherence and richness. We have the story of a 27-year-old woman, Eugénie, diagnosed by her doctors as “catatonic dementia praecox.“ In fact, it is perhaps just as accurate to say that she suffers from a fate like that of Narcissus, the fall into the abyss of “seeing-dying,” a term no more fictive than the clinical description.[7] The doctor notes her visual hallucinations, especially one in which she imagines a worm which surfaces and mounts her body whenever she eats. The trope of depth and surface reappears in her convulsive fear of drowning, elicited even when she hears the sound of liquid being poured into a glass. At other times, she surrenders to the trope by attempting to drown herself in a nearby river.

Between the worm of the depths and the reflective surface of the water lies the corporeal presence of the patient. Bound up with these images is the substance of glass: Eugénie compulsively throws her hands through the panes of the windows at the clinic, breaking their clear, reflective surface and tearing her skin. The ver (worm) surfaces into the visible by means of the verre (glass) which cuts the surface of the flesh. Apart from these outbursts—dramas enacted upon the skin—Eugénie lives in a state which is nearly catatonic.

This frantic flight away from the ver to the verre becomes a pun on word and image written upon the skin, the laceration of which is both the patient’s fear and desire. The trope of the pierced surface is elaborated by the scratching of her flesh with her fingernails and, in calmer moods, by her favorite pastime, sewing. These acts of textual inscription are in fact more complex and eloquent than her intermittent vocal tirades. Her text is meant to be seen rather than to be heard. What is more, it is always in the process of being violently rewritten. The “text” lies below, like the worm beneath the surface, ready to spring up—an action which both delineates and does violence. When Eugénie is asked why she mutilates herself, she replies, “Because my blood is not circulating. The blood has accumulated in my hands, like an abscess, which must be lanced.” Blood becomes a secret ink, secreted from underneath toward the surface. The doctors, taking their cue, note that “during the four or five days preceding her menstrual period, the patient is more agitated, negative, and more insolent than usual.” Blood and insolence become the signs that a text is about to be produced.

There is a final effect which Eugénie employs to raise herself to iconographic status, definition, and celebrity. This is her complicity with the doctors, her ability to provide dermographic pictures which the clinicians lightly sketch upon her skin, then photograph, display, and study. The skin-image and the photographic image are deeply related.

The dermographic symptom was first noted in 1879 and was described as the “autographic” capacity of the skin, a phenomenon both figurative and scriptural.[8] That is to say, the markings can appear unassisted, or can be lightly imprinted by another.[9] These markings then swell into clear delineation. What is more, in these descriptions, a complex notion of desire is associated with the phenomenon, one which links the redness of the skin, the rising of blood, and the connotations of a sexual rising of color and tissue.[10] Throughout the last quarter of the 19th century, clinicians frequently studied dermographism and emphasized the conjunction of the tactile and the optical in the production of a visible sign, or text. At the same time, the clinical attention never seriously departed from repeatedly invoking the symptom in order to ratify a judgment about the patient and, thereby, to inscribe upon the body its own “sentence.” For example, the phrase “démence précoce” was written on Eugénie’s neck by one of her doctors.[11] The dermographic skin becomes an intervening surface between the desire of the patient and the desire of the doctors who control and render her “readable.”

As early as 1846, dermographism was associated with patients suffering from delusions, problems of vision, and from a sensitivity to hypnosis, a predilection toward which was linked with hysteria as it was formulated before Freud’s redefinition.[12] In 1893, Barthélémy noted the conjunction of the menstrual period, dizziness, and a propensity for inexplicable irritations of the skin, all prerequisite to the dermographic manifestation.[13] He noted a pattern in which the patient suffers a crisis of vision, “falls” into vertigo, and produces a text which “surfaces” into the visible.

This involuntary sequence of events has a corollary in the extreme suggestibility of dermographic patients. Barthélémy describes an instance in which a mother sees her child nearly beheaded by a falling chimney damper. Taken with fright, a welt rises around her own neck.[14] The body is paralyzed, unable to react. Instead, it writes and records a stigma received from the Other. In this instance, the subject is dominated over, just as Eugénie is “inscribed” by the doctors. Barthélémy’s descriptions always note some element of violence within the clinical method:

“If the patient is told that the marking instrument is a hot iron rod, a red stripe appears on the skin, then a blister. The scab can take up to three weeks to heal.”[15]

The word Urticaria (an alternative for dermographia) written on patient’s arm, 1887. Photo George Fox.

In the dermographic experiments carried out at the end of the 19th century, the clinicians’ intention is to transform the patient’s body into an icon, a surface to be rendered iconographic and, at the same time, to represent a complex amalgam of connotations. Frequently, doctors inscribed their own names on the subject’s skin, thereby appropriating the body as a “work.”[16] The dermographic symptom becomes a vehicle for medical authority to exert its power, a fact noted by Baudelaire when he labeled the experimental method “the ethic of the plaything.”[17] The early formulation of hysteria also bears resemblance to an act of prostitution, wherein the female patient acquiesces to the domination of the male clinician, each participant receiving a kind of “favor” from an act upon the feminine flesh. The dermographic text given and received creates a heterograph wherein possession and stigma operate with a wide range of meaning.

The concept of the stigmata figured in the understanding of dermographism during this period. It was, however, always associated with diabolical possession and religious ecstasy, issues also bound up with the associations adhering to hysteria. From this point of view, dermographism belongs historically to that which Barthélémy calls “sacred derma tology,” or “diabolical dermatology,” wherein “the demon left the image of his hand upon the body of the possessed girl.”[18] In fact, clinical descriptions of dermographic experimentation describe the infliction of the doctor’s hand upon the skin of the patient, eliciting the image of the palm upon the flesh and inscribing the subject within the context of illness, abnormality, and, even, demonic possession.[19]

Throughout Barthélémy’s work, the word “Satan” served as an experimental signifier; it was inscribed on the side of a woman “from the upper classes” as well as upon the back of a woman from a lower economic sphere.[20] Each patient exhibited entirely different traits of personality and temperament, but both were included within the category of hysteria and possession because of their dermographic capacity. The inscription written by the demon is, in fact, the text written by the hand of clinical experimentation, one disposed to its own mode of violence: “If one lightly touches the patient, the dermographism does not always manifest itself. If, however, one gives a quick slap or flick to the skin, one soon sees the entire finger or hand take shape as a swelling.“[21]

The early experimentation with hypnosis is intimately related to the dermographic phenomenon and to the creation of a clinical fact shaped by a fiction and by a drama of power and control. Barthélémy relates a pertinent case history: a patient is hypnotized; the doctor writes his own name on the patient’s forearms with a rubber stylet and issues the following suggestion: “This evening, at 4 p.m., after falling asleep, you will bleed from the lines that I have drawn on your arms.” At the appointed time, the patient obliges. The characters appear in bright relief upon his skin, and droplets of blood rise in several spots. The words persist for more than three months.[22]

Thou shalt bleed where I write, thou shalt bleed on the very letters of your name. The word “sentence” is pregnant with meaning. It is not surprising that, even before the first publication of the data in 1879, doctors at the Salpêtrière clinic had practiced dermographic experiments on their favored hysterics, notably on Augustine, in 1877, and on a patient identified only as “W,” on whose abdomen the doctors wrote the name of the clinic.[23]

The most radical instance of the “autographic sentence” is probably that inflicted upon Célina, Charcot’s “accursed” hysteric. It is she who breaks what might be called the iconographic contract. Physically unattractive, she is forever agitated and uncontrollably lewd. She thwarts any attempt to heroize her illness and presents herself as a “hater of images.” The doctors retaliate: “With a pin, letters are written on the upper part of her chest.” Her body is compared to a wax manikin and treated like a kind of magic writing tablet, despite her furious attempts not to cooperate, not to “represent.” Her agitation and resistance are unabated. She is cauterized on the cervix four times with a hot iron. During the operation, her face becomes covered with “red erythemic blotches,” a variant of the dermographic phenomenon. Her body is assaulted by subcutaneous injections, inhalations, showers, metalloscopies, leeches, ovarian compressions. She dies in 1879, without the cause of death noted in her dossier. In that year, Dujardin-Beaumetz establishes a clinical proof of dermographism with his concept of the femme-cliché, the “photographic woman.” Regardless of her resistance, “W” is transformed into an example, a medical icon. Dermagraphism produces here a kind of thanato graphy,[24] a sentence which controls the destiny of the patient and which incarnates the corporeal to corpse.

”Our sentence does not sound severe. Whatever commandment the prisoner has disobeyed is written upon his body by the Harrow.” ... “Does he know his sentence?” “No. ... There would be no point in telling him. He’ll learn it on his body.” ... ”But surely he knows that he has been sentenced?” “Nor that either.” ...”No,” said the explorer, wiping his forehead, “then he can’t know either whether his defense was effective?” “He has had no chance of putting up a defense,” said the officer.[25]

The essay by Georges Didi-Huberman, “L’incarnation figurale de la sentence (note sur la peau ‘autographique’),” appeared in Scalène no. 2 (October 1984), pp. 143–169. An abbreviated version of the text based on a translation by Caryn Davidson and accompanied by an introduction was printed in the Journal of the Los Angeles Institute of Contemporary Art in its Spring 1987 issue. Cabinet thanks Geoffrey Batchen and Meg Cranston for their help in preparing this article for reprinting.

  1. For discussion of the genesis of the concept of the “autographic” skin, see Georges Didi-Huberman, “Une notion du corps-cliché aux XIXème siècle,” Parachute no. 35 (June–August 1984), pp. 8–14.

  2. René Descartes, Treatise of Man (1664), tr. Thomas Steele Hall (Cambridge: Harvard University Press, 1972), p. 153.

  3. René Descartes, La description du corps humain(1648), Oeuvres, vol. XI, ed. Adam and Tannery (Paris: Cerf, 1909), pp. 283–284.
  4. Ibid., pp. 254–255.

  5. Aristotle, De Anima, III, 13, 435b, 2–20.
  6. Paul Schilder, The Image and Appearance of the Human Body (New York: International Universities Press, 1950), pp. 85–86.

  7. L. Trepsat, “Un cas de démence précoce catatonique avec pseudo-oedème compliqué de purpura,” Nouvelle Iconographie de la Salpêtrière, vol. XVII (1904), pp. 193–199.

  8. Cf. G. Dujardin-Beaumetz, “Note sur des troubles vaso-moteurs de la peau observés sur une hystérique (femme autographique),” L’Union médicale, no. 144
(9 December 1879), pp. 917–922. This text is reprinted in Parachute, no. 35 (June–August 1984), pp. 8–14.

  9. Dujardin-Beaumetz, op. cit., p. 919.

  10. Cf. F. Allard and H. Meige, “Effets produits par les différents modes d’excitation de la peau dans un cas de grand dermagraphisme,” Archives générales de médecine, 8th series, vol. X (1898), vol. II, pp. 40–42. See also T. Barthélémy, Etude sur le dermagraphisme ou dermoneurose toxivasomotrice (Paris: Société d’Editions Scientifiques, 1893), pp. 24–26.

  11. L. Trepsat, op. cit., p. 197.

  12. E. Mesnet, “Autographisme et stigmates” in Bulletin de l’Académie de médecine, vol. XXIII (1890), meeting of 25 March, pp. 367–368. Cf. C. Binet-Sanglé and L. Vannier, “Noevus veineux et hystérie” in Nouvelle Iconographie de la Salpêtrière, vol. XIV (1901), pp. 214–237.

  13. T. Barthélémy, , op. cit., pp. 163, 22, 126.
  14. Ibid., p. 82.

  15. Ibid., p. 97.

  16. Cf. Georges Didi-Huberman, op. cit.

  17. Charles Baudelaire, “Morale du joujou” (1853), Oeuvres Completes, vol. I (Paris: Gallimard, 1979), p. 587.

  18. E. Mesnet, pp. 362, 370, 380, op. cit. Cf. J.M. Charcot and P. Richer, Les démoniaques dans l’art (Paris: Delahaye et Lecrosnier, 1887), reprinted by Macula, Paris, 1984.

  19. Cf. C. Richer, L’homme et l’intelligence. Fragments de physiologie et de psychologie (Paris: Alcan, 1884), p. 553. See also T. Barthélémy, op. cit., pp. 86–120.

  20. T. Barthélémy, op. cit., p. 130.

  21. Allard and Meige, op. cit., p. 43.

  22. T. Barthélémy, op. cit., pp. 83–84.

  23. Cf. D. M. Bourneville and P. Régnard, Iconographie photographique de la Salpêtrière (Paris: Aux Bureaux du Progres médical, Delahaye et Lecrosnier, 1876/1880), vol. II (1878), pp. 128–141; vol. III (1880), pp. 19, 111–113.
  24. Ibid., vol. 1 (1876/1877), pp. 119–120, 129–130, 150–151; vol. III (1880), pp. 93–96. Cf. Georges. Didi-Huberman, “Le cynisme iconographique,” Études françaises, special issue, “Écrire l’image,” 1984.

  25. Franz Kafka, “In the Penal Colony,” in Kafka: The Complete Stories (New York: Shocken Books, 1971), pp. 144–145.

Georges Didi-Huberman teaches at the École des hauts études en sciences sociales in Paris.

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