Micale M
Department of History Yale University New Haven, Connecticut 06520, USA.
Rev Neurol (Paris). 1994 Aug-Sep;150(8-9):498-505.
Between 1878 and 1893, Jean-Martin Charcot published over twenty detailed case histories dealing with what he termed "traumatic hysteria" and what today would be labelled the psychoneurology of trauma. Charcot's cases record a highly diverse clinique tableau of symptoms. Etiologically, Charcot posited a dual model of a hereditary diathèse, or constitutional predilection to nervous degeneration, and an environment agent provocateur. Increasingly during the 1880s, he emphasized the role of "psychical shock". These writings of Charcot also exhibit many of the same, superb clinical qualities that distinguish his work on other medical topics. Charcot isolated several hystero-traumatic formations and provided outstanding clinical depictions of subgenres of the disorder, most notably brachial monoplegias. His clinical demonstrations of the differential diagnosis of organic and functional post-traumatic pathologies represent Charcot the virtuoso neurologist at his finest. Taken together, these writings offer a penetrating exploration of the complex and elaborate functional sequelae of minor bodily injury and the phenomenon of traumatic psychogenic somatic symptom-formation. The revival today of medical interest in psycho-traumatic pathology, particularly in the traumatic origins of dissociative states and post-traumatic stress disorders, provide an important context for the renewed appreciation of Charcot's work in this area.
在1878年至1893年间，让-马丁·夏科发表了二十多篇详细的病例史，涉及他所称的“创伤性癔症”，即如今所说的创伤性精神神经病学。夏科的病例记录了症状高度多样的临床图景。在病因方面，夏科提出了一种双重模型，即遗传性素质，也就是对神经退化的体质性倾向，以及环境激发因素。在19世纪80年代，他越来越强调“精神休克”的作用。夏科的这些著作还展现出许多同样卓越的临床特质，这些特质使他在其他医学主题上的工作也独具特色。夏科分离出了几种创伤性癔症的表现形式，并对该病症的子类型进行了出色的临床描述，最显著的是臂丛单瘫。他对器质性和功能性创伤后病理的鉴别诊断所做的临床演示，展现出了夏科这位技艺精湛的神经学家的卓越之处。总体而言，这些著作对轻微身体损伤的复杂精细的功能后遗症以及创伤性心因性躯体症状形成现象进行了深刻的探索。如今医学对精神创伤病理学，尤其是分离状态和创伤后应激障碍的创伤起源的兴趣再度兴起，为重新认识夏科在这一领域的工作提供了重要背景。
