The Yale Journal for Humanities in Medicine

The Placebo Disavowed: Or Unveiling the Bio-Medical Imagination
(continued)

Ed Cohen
edcohen@rci.rutgers.edu

It is at this point that the Commissioners conceive the brilliant idea of blindfolding the woman in order to “screen out her imagination, or at least to baffle it” [il ne s’agisait que de la mettre a l’abri de son imagination, ou du moins de mettre son imagination en defaut].[xxx]  Repeating their experiments under wraps, they find that there is no regular or predictable correlation between the actions of the mesmerist and the responses of the magnetized subjects.  Instead the blindfolded subjects respond randomly leading the commissioners to affirm: “it is consequently an effect which has absolutely no physical or exterior cause and which can have no other cause than the imagination.”[xxxi]  Or as they conclude: “the imagination is the true cause of the effects attributed to magnetism.”[xxxii]  Yet in so characterizing  imagination as “the true cause” the Report establishes the imagination as a “true” form of causality.  Indeed, we might say that the imagination serves here as the figure for an effective cause, but it does so precisely by providing a rhetorical form within the scientific discourse for effects for which there is no “real” determination—including the effective cause which is the discourse itself. 

Undoubtedly, the Report’s use of the imagination here draws upon contemporary understandings of the concept.  In his magisterial  meditation on the “creative imagination,” James Engell succinctly summarizes the mediating function that the imagination performs throughout the eighteenth century:

By the mid 1700s a rapid movement was under way to show that the idea of imagination, with one foot in the empirical and one foot in the ideal or transcendental, could bestride those two peninsulas of thought, and like a colossus, protect and unify the harbor between.  The imagination could, in its dialectic, synthesize soul and body; it could unite man’s spirit and affections with the concrete reality of nature.  The imagination would solve the dilemma of dualism.[xxxiii]

Extrapolating from Engell’s characterization, Forest Pyle acutely observes:

[T]he imagination does not denote a process of mind and is more accurately regarded as the figural juncture of forces in conflict than as consistent activity, . . . imagination refers both to the necessity of linking mind with nature, spirit with matter, subject with society and to the formidable resistances to all such linkages. . . .[xxxiv] 

Thus, Pyle concludes : “[T]he imagination is assigned the responsibility of making a linkage, an articulation. . . .”[xxxv]  Certainly, the Report must be situated within this general historical horizon and partakes of the philosophical and aesthetic considerations of the imagination that are the hallmark of much eighteenth-century reflection.  However, the Report’s characterization of the imagination also seems particularly indebted, as Franklin Rausky has suggested, to the great French naturalist Georges Louis-Leclerc Buffon’s more embodied sense of “imagination.”[xxxvi]  This indebtedness reflects both Buffon’s role as the  giant of eighteenth-century natural history as well as  his enduring prominence within the Academy of Sciences, several of whose members were among the authors of the Report.  It also marks the Report’s larger project to circumscribe the practices of legitimate—and legitimated--medicine within the domain of natural science.  Unlike the philosophical psychology of thinkers like Shaftesbury and Liebnietz, who theorized the imagination as a mental faculty that considered human engagement in the world primarily as a perceptual problem (eg., Liebnietz’s famous distinction in his Nouveau Essais (1704/1765) between “perceptions insensibles” and “la puissance active” which founds a duality of mind), Buffon situates the imagination at and as the threshold between sensory and conceptual intelligence, thereby both recapitulating and revising the famous Cartesian duality of body and mind.[xxxvii]

Buffon introduces his discussion of the imagination  in the fourth volume of his magnum opus Histoire Naturelle published in 1753.  Here he applies his naturalist gaze to a comparison of humans and animals in order to “lead us to the important science of which man himself is the object.”[xxxviii]  As a prelude to the section that considers human exceptionalism, under the rubric “Homo Duplex,” Buffon defines the imagination as simultaneously a faculty of the soul unique to humans and as “a principle which depends only on the corporeal organs and which we have in common with animals.”[xxxix]  This dualistic imagination is critical  for Buffon’s project since it allows him to simultaneously link humans to and distinguish them from other animals.  Indeed, for Buffon, the duality of the imagination figures the duality of the human: “Inner man is double, he is composed of two principles different by their nature and contrary in their action.  The soul, the spiritual principle, the principle of all knowledge (connaissance), is always opposed to this other animal and purely material principle.”[xl]  Yet the two opposed “principles” are always already joined in and by the imagination, and this is precisely the point.  The ability of images to act directly on the human organism constitutes the residue of our animal appetites, appetites that  link us physically to the material world through which as organisms we express and satisfy our desires. 

[T]his tumultuous and forced action is excited inside of us by objects which correspond to or contravene our desires. These lively and profound impressions, produced by the images of these objects (which in spite of ourselves are constantly renewed) constrain us to act like animals, without reflection or deliberation.  This representation of objects, more active still than their presence, exaggerates everything, falsifies everything. This imagination is the enemy of our spirit, it is the source of illusion, the mother of passions which master us, prevailing over us despite the efforts of reason, and rendering us the unhappy theater of a continual combat, where we are almost always vanquished.[xli]

Here Buffon–perhaps prefiguring Lacan’s insight concerning the “dehiscence at the heart of the [human] organism”[xlii]--characterizes the physiological  impact of images on and within the human subject.  In spite of ourselves, and particularly in spite of our rational selves, we are “constrain[ed] to act like animals without reflection or deliberation” in so far as the imagination  articulates us in an embodied universe whose materiality overpowers the limited resources of our knowledge [connaissance].  The imagination functions then both as the condition for and the limit on human knowing, incorporating the very contradiction that Foucault so eloquently characterized in The Order of Things as that “strange empirico-transcendental doublet” called Man.[xliii]

It is precisely in order to assert the ascendancy of reason over bio-matter, then, that the Commissioners must rigorously exclude the imagination from their understanding of medicine.  When the mesmerist whom they were examining attempts to concede the point that the effects produced by animal magnetism could be produced through the imagination and then even more provocatively suggests that perhaps the imagination could provide a resource for medical practice (anticipating the way that contemporary physicians seek to reinscribe the placebo effect within medicine proper) the Commissioners not only reject this possibility out of hand, but use it to proclaim their victory.

[The mesmerist] believed that it is possible to suppose in fact that the imagination played the largest part in the effects of animal magnetism.  He said that this new agent was perhaps only the imagination itself, whose power is as effective as it is little known.  He reported having constantly recognized this power in his treatment of patients, and he reported as well that many had been cured or infinitely assuaged.  He remarked to the Commissioners that the imagination, thus directed to the amelioration of human suffering would be a great resource for the practice of medicine and, persuaded of the truth of this power of the imagination, he invited them to examine in his office the process and its effects.  If [he] is still attached to the first idea that these effects are due to the action of a fluid [animal magnetism] which is communicated from individual to individual by touching or by the direction of a conductor, he will not delay in recognizing with the Commissioners that an effect requires only one cause, and that if the imagination suffices the fluid is unnecessary.[xliv]

Here the Report triumphantly affirms the logic which underwrites their interpretation and justifies both the denial of the existence of animal magnetism and the exclusion of the imagination from medical practice.  The axiom that only one cause is needed for an effect [“il ne faut qu’une cause pour un effet”] defines determinism as the epistemological ground for bio-medical truth.  The imagination, which admits of over- or non-determinations, contravenes this principle and hence much be debunked as the source of misguided or even dangerous healing practices.   By refusing to even consider the imagination as a possible medical technology, the Report establishes the exclusionary calculus that legitimates bio-determinism as the sole criteria for verifying “true cures” and thereby marks the threshold of modern medical practice.

Continued
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