The Placebo Disavowed:
Or Unveiling the Bio-Medical Imagination
Introducing the discriminatory logic that subtends all subsequent “blind-testing,” and hence all contemporary uses of the placebo, the classic denunciation of the imagination appears at, and perhaps even as, this threshold of modern medical science. In 1784 Louis XVI appointed two royal commissions comprised of members drawn from the Faculty of Medicine and the Royal Academy of Science to decide the credibility of the Austrian physician Franz Anton Mesmer's claims that he was able to harness the forces of "animal magnetism" to healing ends. At the time, the vogue for Mesmerism among the Parisian elite, as well as among their social subordinates (to whom Mesmer offered his services pro bono) raised both political and ethical concerns about the practice that Mesmer introduced to the French capital city. Prior to his entry into French society, Mesmer had trained as a doctor in Vienna, receiving his degree in 1766 after completing a thesis on the generalized influence of celestial bodies on the human organism which he named “animal gravity.”[xxv] He practiced medicine in Vienna through the middle of the 1770s during which time he began to experiment with the use of magnets in healing. From these attempts he claimed to have discovered a more diffuse, energetic “magnetism” which he could channel through various instruments or through his own body towards the suffering bodies of others. He came to understand animal magnetism as a material influence which bodies (animate or inanimate) exert upon each other through the mediation of universal super-fine fluid which sustains and embraces all animal life. Illness in this model results from the blockage of the magnetic fluid and health is restored when the fluid runs free. Since there is a natural tendency towards this end anyway, the role of the physician is simply to assist and augment natural healing.
Mesmer arrived in Paris in 1778 and with good connections was quickly able to set up a thriving practice. His unorthodox techniques—centered on his famous ”baquet” (a wooden tub filed with metal and glasses of water designed to concentrate and channel animal magnetism)—proved simultaneously incredibly popular and incredibly provocative. At first glance, Mesmer’s practice might seem perfectly aligned with the non-interventionist protocols of the “anti-medical movement” of the 1770s which condemned the use of radical and often violent cures (bleeding, blistering, cupping, the use of emetics, dieturetics, starvation diets, etc.) and affirmed the traditional Galenic reliance on the “healing powers of nature.” However, Mesmer himself was not interested in playing the oppositional outsider and instead assiduously, and indeed somewhat testily, sought the approval of the official bastions of medical practice: the Academy of Science, the Society of Medicine, and the Faculty of Medicine of the Université de Paris, none of which proved very amenable to his approaches. Moreover by the early 1780s he began to evoke hostility among numerous well-placed members of the medical establishment (including Noel de Rochefort Retz, physician ordinaire to the King) who fired off severely critical attacks launching what over the next decade amounted to a virtual pamphlet war. The matter was only put to the test, however, after the repeated intercession of Charles D’Eslon, one of Mesmer’s protégés, who before apprenticing with Mesmer had been the physician ordinaire to the King’s brother, the Comte d’Artois, and who after this apprenticeship was struck off the roles of docteurs régants by the Faculty of medicine for his trying to promote his new affliliation. Using his aristocratic connections, D’Eslon successfully lobbied for the establishment of a royal commission of inquiry and positioned himself as the official subject of the inquiry—a usurpation of position that caused Mesmer to break with him definitively.
The results of D’Eslon’s efforts were contained in two reports commissioned by Louis XVI: one written by a committee of comprised of members from the Faculty of Medicine and the Academy of Sciences--chaired by Benjamin Franklin and including Guillotin, Lavoisier, Bailley, Majault, Sallin, Darcet, Laroi, and Bory-- and the other of members of the Royal Society of Medicine (Poissionner, Caille, Mauduyt, Andry and Jussieu), plus a dissenting report produced by the famed eighteenth century botanist Jussieu as well as a reply by Mesmer himself. The documents are wonderfully complex taking up not only the epistemological questions raised by the practice of Mesmerism per se, but also the gendering of the female body, its susceptibility to male influence, the autonomy of human bodies generally, the permeability of individuals to social and natural forces, etc. These documents were widely disseminated at the time and gave rise to a very lively—and often hostile—set of replies and counter-replies that continued throughout Europe well into the Nineteenth Century. While an analysis of this dense textual nexus would do much to disclose the complex negotiations that underlie the emergence of scientific medicine during this period, such a reading is beyond the scope of my concerns here. Instead, let me focus exclusively here on the primary report produced by the committee chaired by Benjamin Franklin , which introduced the discriminatory calculus that continues to underwrite the contemporary uses of both the placebo and the placebo effect.
In the process of debunking animal magnetism as a non-verifiable, and hence socially invalid, and therefore dangerous form of healing, the commission established a hallmark which two centuries later continues to serve as the standard for bio-medical truth: “blind testing.”[xxvi] In their proto-type for this procedure (which included lengthy deliberations about just how to construct a really effective blindfold) the commissioners sought to eliminate any possibility that the subjects of their examination could be influenced by factors other than the single agent whose efficacy they were charged to evaluate. Having literally blinded their experimental subjects to the actions of the mesmerist, the commissioners decided, or as they would say “proved,” that there was no causal connection between the action of the force that the mesmerist purported to invoke and the reactions manifest by the human bodies under their scrutiny. Instead, according to the interpretation developed by the commission, animal magnetism produced its results not by establishing determinant material effects, but through the confluence of "contact, imagination, and imitation" with the imagination doing preponderance of the work: "There are no real cures and the treatment is tedious and unprofitable. . . . [T]hey are to the unobservant the result of magnetism, a proof of the existence of that agent, although they are really due to the power of the imagination."[xxvii] Stengers argues that this "mode of denunciation" inaugurates medical rationality by constituting an exclusionary logic that purports to distinguish between "real” and “imaginary” cures. Real cures are those that unilaterally determine their effects, while the results due to the imagination are defined only negatively by their non- or multi-determinations. There was no dispute then that Mesmerism gave rise to effects, just that these effects were produced by imaginary causes and therefore could have no real therapeutic value. Thus, as Stengers succinctly puts it, in bio-medicine: "the imagination . . . is nothing other than a manner of disqualifying phenomenon, not of comprehending them."[xxviii]
But what exactly is disqualified under the name of the imagination? And how is this disqualification accomplished? The first time the commissioners invoke the imagination as way of undermining the claims about animal magnetism they do so in order to explain why one of the working-class female subjects upon whom they have been performing their experiments continually testifies to animal magnetism’s positive effects. Their account begins by conjuring a thought experiment:
Let us picture a woman of the people, ignorant, attacked by an illness and desiring a cure, ceremoniously conducted before an august assembly composed in part by doctors, where an unfamiliar treatment is administered which she has persuaded herself in advance will prove prodigious. Add to this that her compliance is paid for and that she believes us more satisfied if she says that she experiences these effect and we have the natural causes that explain these effects; or we have at least legitimate reasons for doubting that their real cause is magnetism.[xxix]
Invoking the reader’s imagination on their own behalf, the commissioners dismiss their subject’s responses as a form of anticipated persuasion which they characterize as “an effect of the imagination.” Suggesting that the woman on whom they are practicing is interested—physiologically, psychologically, and financially—in affirming the very effects that they seek to put into question, the Commissioners identify imagination (and interest) exclusively with their experimental subject but only insofar as they disavow their own imagination (and interest) which they conceal beneath their interpretive labor. Hence, they purport to determine “the natural causes that explain these effects,” thereby establishing imagination and interest as “natural” actants on which they themselves rely in order to cast doubt upon animal magnetism as a “real cause.”
[xxv] On the history of mesmerism, see Robert Darton. Mesmerism and the End of the Enlightenment in France. Cambridge: Harvard UP, 1968; Franklin Rausky. Mesmer ou La Révolution Thérapeutic. Paris: Payot, 1977; René Roussillon. Du Baquet de mesmer au <<Baquet>> de freud: Une archéologie du cadre et de les pratique psychoanaltiques. Paris: Presses Universitaires de France, 1992 ; Isabelle Stengers and Leon Chertok. A Critique of Psychoanalytic Reason: Hypnosis as a Scientific Problem From Lavoisier to Freud. Trans. Martha Noel Evans. Stanford: Stanford University Press, 1992 ; Alan Gauld, A History of Hypnotism. London: Cambridge UP, 1992. 1-38; Adam Crabtree. From Mesmer to Freud: Magnetic Sleep and the Roots of Psychological Healing. New Haven: Yale UP, 1993. Some of the documents addressed below appear in Albert Binet and Charles Féré, Animal Magnetism. New York: D. Appleton and Co, 1888 .
[xxvi] Shapiro and Shapiro, 151-154, identifies the first use of the term “blind or test experiments” in William Stanley Jevons. The Principles of Science: A Treatise on Logic and the Scientific Method. New York: Macmillian, 1874. They note the discontinuous employment of the term over the next 50 years, until the 1930s when Harry Gold began to use the term more systematically. In an oral history, one of Gold’s students and subsequent collaborators, Nathaniel Kwit, reports on the inspiration for Gold’s usage: ”’Where did the idea come from?’ After a minute or so he exclaimed, ‘I know where we got it! It came from the “Take the Blindfold Test” advertising for Old Gold cigarettes. In this campaign, smokers were asked to compare Old Gold cigarettes with another brand while blindfolded—in other words, blind about which they were smoking. Our design was similar, except that the patients were not blindfolded, so we called it the blind test” (154). This anecdotal account brilliantly situates the contemporary metaphorical adoption of “blind testing” as a recapitulation of this late eighteenth-century innovation in the technology of “blindfolding” for the sake of “objective” comparison as mediated by the marketing practices of consumer capitalism. What goes around, comes around.
[xxviii] Stengers, "Le medicin et le charletan," 136.