Madness and Enterprise by Nima Bassiri;

Author:Nima Bassiri; [Bassiri, Nima]
Language: eng
Format: epub
Tags: SCI000000 SCIENCE / General, SCI034000 SCIENCE / History, MED039000 MEDICAL / History
Publisher: University of Chicago Press
Published: 2024-01-19T00:00:00+00:00

Traumatic Simulations

The increasing interest in mimetic behaviors was accompanied by the gradual neuropsychiatric legitimacy of the diagnosis of hysteria. It was mainly through the medical affirmation of hysteria after 1870, particularly in terms of its wide-ranging symptomatology and its link to a precipitating trauma, that simulation was able to crystallize into a viable pathological symptom.91 While clinicians like Paget sought to maintain a difference between hysteria and mimicry, it was instead as a symptom of hysteria that simulation obtained its status as a legitimate pathological expression. Midcentury railway physicians had already proposed that hysteria was one likely consequence of the traumatic effects of railway collisions, which could often yield symptoms that mimicked organic nervous disorders.92 Among traumatized patients there was often an observable “unconscious exaggeration of symptoms,” a “simulation or nervous mimicry” that was “common to all hysterical people.”93 Many railway physicians, however, never fully abandoned their commitment to an organic approach to traumatic pathologies and remained polemically committed to upholding a strict divide between somatic and psychical etiologies.94

Scholars have instead looked to the English railway surgeon Herbert Page as the first trauma clinician to explicitly emphasize the purely psychogenic nature of traumatic shock, that is, the first to fully “psychologize” the effects of railway collisions.95 It might, however, be more accurate to claim that Page did not so much psychologize traumatic injury as envision traumatic injuries as part of a complex psychosomatic economy.96 It was a topic Page was not the first medical expert to broach; clinicians had observed for some time the mutual influence that the mind and body had on one another, or how excessive strains on the mind could translate into somatic disease states.97 In 1883, Page published his influential forensic manual on traumatic railway accidents gathered from his observations as surgeon to the London and North Western Railway Company, where he had been employed for a decade.98 While written for railway physicians and, ostensibly, in the interest of the railway industry, the book went a long way to shedding light on and medically legitimating simulative behaviors as pathological effects of traumatic injuries.

Simulations were not necessarily unintentional contrivances of the mind’s influence on the body; nor were they simply cases of intentional medical fraud. One of the major effects of the “purely psychical causes” of shocks associated with railway collisions were cases of the “nervous mimicry” of “functional disorders” throughout different parts of the nervous system. Although he invoked Paget’s descriptions of neuromimesis, Page offered a very different explanation for the mechanisms underlying these psychically induced simulated pathologies.99 They were nothing more than the automatic emergences of disinhibited lower nervous centers, which arose because higher and otherwise inhibiting neurological processes had been “put hors de combat” as a consequence of traumatic shock.100 The expression hors de combat was part of a passage that Page excerpted from the work of the English psychologist James Sully, who was himself drawing on the work of John Hughlings Jackson.101 To whatever degree Page advocated for a psychogenic view of traumatic injury, he appeared to do so through a Jacksonian theory of neuropathology.

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