Augustine

November 14, 2013

It is clear from a 21st century psychiatric perspective that Augustine was suffering from PTSD, but Augustine was victimized in ways far more horrific than filmmaker Alice Wincour revealed. More in this film review by Alan Stone, MD.

[[{"type":"media","view_mode":"media_crop","fid":"20930","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4054671023089","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1374","media_crop_rotate":"0","media_crop_scale_h":"200","media_crop_scale_w":"133","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]Augustine, the first feature film of the French auteur Alice Winocour, premiered at Cannes during La Semaine de la Critique, the week of screenings meant to encourage new filmmakers. It was warmly received and subsequently earned a coveted César nomination for best first film. American film critics also applauded it as a polished cinematic jewel with a welcome feminist perspective that exposed the greatest French physician of the 19th century variously as a charlatan, a misogynist, a sadist, and someone who violated his Hippocratic Oath to have sex with a teenage patient. Although there were one or two skeptical voices, most of the film critics believed what they saw. It is indeed a beautiful movie, but for those who know something about the history on which it is supposedly based, its flaws are painfully obvious.

The film, a costume drama set in the 19th century’s Belle Époque, claims to tell the story of the relationship between the preeminent clinician of that era, Jean-Martin Charcot (Vincent Lindon) who presided over the Salpetriere Asylum, and his hysterical patient, the kitchen maid Augustine (Soko). In Winocour’s screenplay, and in the mantra of the film’s marketing campaign, “the object of study becomes the object of desire.”

In fact, Winocour knows virtually nothing about the actual relationship between Charcot and Augustine, if indeed there ever was one. She made the doctor-patient story up out of whole cloth.

Charcot was in fact famously remote from the Salpetriere patients. His assistant, Dr D. M. Bourneville, was responsible for Augustine’s care and compiled her history. Winocour not only invented the erotic relationship between Charcot and Augustine, but she also misrepresented the unfortunate young woman’s history. We know from Bourneville’s medical records that when she first entered the Salpetriere with her “hysterical symptoms,” Augustine was 14 or 15 years old and had recently been brutally sexual abused. Winocour’s Augustine is instead a surprisingly self-confident 19-year-old woman who suffers from hysterical fits but has no psychological past.

Winocour, while she was still in film school, had done some reading about Charcot and the Salpetriere, and she learned about his research on hysteria-a poorly understood illness that at the time most doctors thought afflicted only women-and the famous Tuesday clinics at which patients were presented to doctors from around the world and to interested Parisians as well. Charcot had reintroduced Mesmer’s hypnosis as a diagnostic and clinical tool, and hysterical patients would be hypnotized so that assembled audiences at his Tuesday clinics could witness the natural course of hysterical seizures.

Much had been written about Charcot and his hysterics whose seizures often had sexual overtones. But Winocour was looking for her own way into this material. She read in the Salpetriere records that Augustine had escaped from the hospital dressed in a man’s clothes, and she saw this as a woman liberating herself. But what really intrigued her was that in all the hospital records, there was nothing about the doctor-patient relationships-she decided to fill in that void from her imagination. In the course of her interviews at French Film Festivals all over North America, where audiences and critics believed what they saw, she became less and less candid about how she had actually dreamed up the doctor-patient relationship.

As Winocour had acknowledged, she tried to forget what she had read and to think cinematically, and what came to mind is Dario Argento’s exotic Italian thrillers and Cronenberg’s horror films and supernatural exorcism films. But she also had literary thoughts-gothic love stories, Jane Eyre, and the Bronte sisters. And she imagined the art of her cinema in the style of the Pre-Raphaelites.

Winocour had no interest in making a docudrama or a biopic. She wanted her film to be sensual, and she directed it with a sexual subtext. As she explained in interviews, Charcot’s Tuesday lessons were a “peep show,” a scene where Charcot feeds Augustine soup is “a blowjob,” when Charcot lets Augustine pat his pet gibbon it is “foreplay.” Only when doctor and patient give in to their aroused passion and have intercourse is it not sexual-it is their farewell scene. When Augustine has her hysterogenic seizures, each of the four becomes more obviously sexual-simulations of intense female orgasms. Winocour imagines Charcot as a fascinated little boy aroused and frightened by the spectacle of the woman’s overflowing sexuality.

Winocour wanted to tell a feminist story about Augustine. In her version, feminism is a story about personal autonomy and sexual empowerment. Hysteria is the language of the woman’s rebelling body expressing its repressed pain and sexuality. She thought of hysteria as a form of feminine protest that continues today with different symptoms: anorexia, self-cutting, etc.

Taking a page out of Charcot’s Tuesday clinics, she enlisted real female psychiatric patients of today, dressed them in 19th century costumes, and filmed them describing their symptoms. In her discussions about hysteria and protest, she likes to quote Lacan: “A hysteric is a slave in search of a master to rule.” And Augustine goes from lowly servant to a woman who understands herself and her sexual power and conquers the great doctor. This gothic love story is less about love than about lust; more a battle of the sexes in which the young woman wins and the famous doctor is shamed. I warrant it tells us more about sexual mores in Paris today than about what happened during the Belle Époque in the Salpetriere.

In one of her many interviews, Winocour described how she thought about what happened at the Salpetriere. It was men in 3-piece suits looking at women in nightgowns-the male gaze-the subtext of all male-directed films.

Inverting that gaze, everything in her film is seen from the perspective of Augustine, and from the very first scene we identify with this distraught young woman. She is a kitchen maid serving dinner to a large bourgeois gathering. Her hands begin to shake as she pours the white wine then suddenly she reflexively grabs the tablecloth falling back in a fit and pulling everything off the table with her. This fit is meant to look like the cinematic depictions of exorcism in which the body is an independent presence separate from the conscious self and does things no human being could intentionally do. It was achieved by ropes that were attached to Augustine’s body, pulled in different directions, and then removed in editing. In a brilliant stroke, the dinner party guests stand and look on in silence, one woman crosses herself-exorcism-and the hostess pours a pitcher of water in her servant’s face, treating Augustine like an animal. It was originally Winocour’s intention that the fit be precipitated by a male gaze, a look from a dinner guest who had raped Augustine. That idea was discarded at some point, but an unidentified man still mysteriously gazes into the camera before the fit.

Augustine recovers from her seizure with one eye permanently closed, and the next day she is off to the Salpetriere. She soon realizes that Charcot is the god of the Salpetriere, and if she has prayers about being cured, they should be directed at him. As it turns out, Charcot is too busy even to examine her, but when he tours the living quarters, she conveniently has another seizure that commands his attention. This second fit has more erotic overtones and Augustine becomes Charcot’s favorite patient. She gets his full attention as stripped naked he examines her body and draws lines on it. His attitude denies any erotic interest and yet that is undeniably what we see. Adding to her empowerment over him, Augustine is the archetypal case Charcot desperately needs to present to the influential Academy that might fund his work. She is moved to a private room, takes walks alone with Charcot in a garden, and a human-erotic connection begins.

French neurologists decrying the factual inaccuracies of the film assure us that none of this special treatment ever happened. There were no private rooms and no such garden. In fact, the Salpetriere was originally more hospice than hospital. Incurable women were sent there to die along with homeless women. Most of them were geriatric patients. Charcot began to develop case histories and hospital records for all these abandoned women.

In this neglected warehoused population, Charcot, almost single handedly, invented modern clinical neurology, showing the relation between lesions of the brain and symptoms of the patients. That is what brought doctors from all over the world-including Sigmund Freud and Harvard’s William James-to Charcot’s Tuesday lessons, not just prurient curiosity.

All kinds of medical conditions were demonstrated, and new cases were presented to Charcot for diagnosis. Of course, this was an era of medicine in which there were few efficacious treatments. But Charcot was the greatest clinician and teacher of his time. Students flocked to his clinics and lectures; among them were the future leaders of clinical neurology: Babinski and Tourette. Rich and famous private patients came from all over the world seeking his advice.

In the final scene, the fictional Augustine falls down a stairway and her hysterical symptoms all disappear without medical assistance. When Charcot tries to present her to the assembled Academy at the crucial Tuesday clinic, she whispers to him that she is cured. When he tries to hypnotize her, he is unable. He turns to the assembled amphitheatre and is about to admit defeat when Augustine takes pity on him and feigns a seizure. This time the sexual overtones are all too obvious and she knowingly looks up at Charcot so that he realizes this show of hysteria is performed for him.

Charcot had argued throughout his career that the symptoms of hysteria were not feigned, that the women burned at the stake during the inquisition were suffering from hysterical symptoms. Now in what was to be his moment of triumph, he knows that his patient is faking it. When Augustine’s performance is complete and Charcot’s sense of integrity is demolished, the dignitaries of the Academy, totally taken in, erupt in applause. Charcot and Augustine repair to his office, where she greets him with an open-mouthed kiss and lifts her skirt, and the doctor succumbs to the passion she has inspired.

At the reception for the Academy that follows, a bewildered Charcot is showered with compliments and then we see Augustine with a hood pulled over her head. She is walking through the reception and out the door: cured, sexually triumphant, and now liberated.

Soko, the single-named singer-actress, is superb in the role. She seems to become Augustine rather than acting a part. Vincent Lindon, a great French actor, is quite convincing as Winocour’s Charcot. The haunting score by Jocelyn Pook will remind you of Philip Glass; it echoes the emotions of the narrative. The cinematography is done with a painterly sensibility in the style of tenebrism or chiaroscuro. All this is what gives the film its jewel-like quality.

But what Winocour has done with Augustine’s own story is the greatest flaw of the jewel. At age 13, Augustine, who had been raised with cruel discipline in a nunnery, was handed over by her mother to her employer and lover who brutally raped the young girl. Then her older brother offered her to his friends. These ghastly experiences brought her to the Salpetriere at age 14.

It is clear from a 21st century psychiatric perspective that Augustine was suffering from PTSD. D. M. Bourneville’s case history amply documents that diagnosis. Charcot did not invent the human suffering that he called hysteria, he just gave it the wrong name. It is worth noting that in his time, Charcot was derided by British and German doctors for insisting that male hysteria was not an oxymoron but a reality. Charcot described it in men who had been traumatized in railroad accidents and in war.

In the history of PTSD, Jean-Martin Charcot deserves a place as he does in a host of other conditions, many of which bear his name. Charcot had his faults, but they were not those portrayed in Winocour’s film. And Augustine was victimized in ways far more horrific than Winocour revealed. Horror thrillers and gothic romance, the stuff of Winocour’s imagination, feed the emotional brain and provide the audience escapist fantasies that insulate them against the painful realities.