-
- In December 1905, eight years before he
published the first volume of "In Search of Lost
Time", Marcel Proust entered a sanatorium to
follow a six-week treatment for "neurasthenia"
under the care of Dr. Paul Sollier who, along
with Babinski, was considered the cleverest
pupil of Charcot. Following Charcot's wish,
Sollier had studied memory in depth, and he used
this knowledge to provoke emotional surges of
involuntary memories in his patients. Proust's
novel contains over 1,200 allusions to memory,
with a specific emphasis on involuntary memory,
which was largely inspired by Sollier's
theories.
- Beyond that, Sollier highlighted several
other concepts which make him a major precursor
of modern cognitive neurology: memory
stabilization requires specific conditions,
learning is based on cellular changes and
plasticity, memory is a universal phenomenon of
the nervous system, memory organization centers
differ from perception centers, memory
organization is controlled by the frontal lobe,
and neurophysiological mechanisms explain the
difference between perception and memory. The
rediscovery of Sollier's extraordinary work on
memory should rehabilitate a forgotten, atypical
neurologist whose critical interest in
psychology may, in retrospect, make him one of
the first modern neuro-psychologists.
-
- Marcel Proust (1871-1922), one of the
greatest novelists of all times, is also known
for his extraordinary skills in analyzing the
forms and psychological mechanisms of memory.
His main novel "In Search of Lost Time" (1)
(first published in 1913) emphasizes the
importance of what he called "involuntary
memory", which is deeply associated with
emotions. In 1905-1906, Proust, who suffered
from psychological exhaustion, spent six weeks
in a sanatorium under the care of Dr. Paul
Sollier. a pupil of Charcot, whom the master of
La Salpêtrière had asked, a few
years before his death, to synthesize the most
recent discoveries on memory (2). Sollier
subsequently published two major works on
memory, "Les Troubles de la Mémoire" in
1892 (3) and "Le Problème de la
Mémoire" in 1900 (4), followed by a book
on emotions ("Le Mécanisme des Emotions")
(5) a few months before Proust's admission to
the sanatorium. It is striking that, in Proust's
novel, many of the developments on memory,
including "involuntary memory", seem to take
their roots in Sollier's work. While Sollier's
influence on Proust's work has recently been
rehabilitated (6), his role as a major precursor
in the field of cognitive and behavioral
neurology of memory remains completely
forgotten.
-
- Marcel Proust and Neurology
-
- While Proust studied philosophy, he
developed and always maintained a specific
interest in medicine. He was the brother of
Robert, who became a urologist of some repute,
and the son of a famous physician, Adrien
Proust, who became professor of hygiene at the
medical faculty in Paris in 1885, and who
founded the International Office of Hygiene,
predecessor to the World Health Organization
(fig. 1). Adrien Proust had deep interests in
neurology; he had studied aphasia,
labio-glosso-pharyngeal palsy, stroke, and
ambulatory automatisms (7), before becoming
interested in "neurasthenia", a disease which
had just been identified by Beard (8) to
describe "nervous exhaustion", covering what
today largely belongs to psychosomatic
disorders. Along with Gilbert Ballet, he
publi
- shed "The Hygiene of the Neurasthenic" (9),
immediately after introducing&emdash; with a
preface&emdash; Edouard Brissaud's "The Hygiene
of the Asthmatics" (10). These choices were not
surprising, as Marcel had been suffering, from
the age of nine, from recurrent attacks of
severe asthma, a condition which, at that time,
was considered a subcategory of neurasthenia
(6,7).
-
 - Fig 1. Proust's
father Adrien and Brother Robert at home in
Paris. Both were medical
doctors,
- and the first
published several works on aphasia, stroke, and
neurology.
-
- Proust met many physicians through his
father and friends, including famous names such
as Dieulafoy, Pozzi, Vaquez, Cotard,
Jean-Baptiste Charcot, and Antoine Blanche, who
had cared for Guy de Maupassant when he
developed general paresis (11). But Proust's
main medical connections were to neurology,
which led him on a rewarding, lifelong tour of
the Parisian neurological intelligentsia (7).
Included in this grouping were Charcot's pupil,
Edouard Brissaud who, along with Pierre Marie,
founded "La Revue Neurologique" in 1893, Jules
Dejerine, the second successor to Charcot at La
Salpêtrière, and Joseph Babinski,
who cared for Proust's mother when she had a
stroke and became aphasic, and with whom Proust
would subsequently consult when his own fear of
aphasia developed. Later, Babinski would come to
Proust' home to examine him just a few hours
before his death, at age 51 (11). However, it is
with another of Charcot's pupils, Paul Sollier
(1861-1938), that Proust had his closest
contact, referring himself to his clinique in
Boulogne-Billancourt in order to follow a
six-week "isolation cure" to improve his asthma,
to re-set his totally desynchronized
sleep-wakefulness cycle, and also to accomplish
a deep self-exploration to retrieve a "will" for
literary creativity (6). Following Brissaud's
advice, Proust selected Sollier after hesitating
between Dejerine and two Swiss neurologists,
Paul Dubois in Berne, and Henry-Auguste Widmer
in Valmont (11). His choice was influenced by
the shorter duration of Sollier's treatment and
his interest in homosexuality. Proust entered
the sanatorium on December 6, 1905, and was
discharged six weeks later.
-
- Paul Sollier
-
- It is striking that, without his famous
patient, Sollier's name would be completely
forgotten today (12). His name appears only in
connection with idiocy in Berrios' "History of
Mental Symptoms" (13), while it is absent from
neuropsychological textbooks and monographs on
memory, as well as in textbooks on the history
of neurology (7). His face (fig 2) also seems to
have disappeared from most archiving
institutions, since we had great difficulty in
finding a portrait at the "Académie
Nationale de Médecine", and we have been
unable to locate any portrait or photograph in
any other official archives in Paris, including
the "Archives et Photothèque de
l'Assistance Publique des Hôpitaux de
Paris", the "Service de la Documentation de
l'Université de Paris", or the
"Bibliothèque et Fonds Charcot de La
Salpêtrière". Charcot's biographies
do not quote Sollier (14, 15), although at the
time he was reported to be the cleverest
collaborator during hospital rounds and the best
follower of Charcot&emdash; together with
Babinski (16).
- Before training with Bourneville at
Bicêtre in Paris, Sollier became
an"interne"in 1887 and a doctor in medicine in
1890 (17). In 1897, he was appointed at
Boulogne-Billancourt, located in a suburb of
Paris, one year before starting a regular series
of lectures at the "Université Nouvelle"
in Brussels, where, in 1909, he became a member
of the board. One of his career achievements was
his election to president of the
"Société de Psychologie". Sollier
wrote articles and books on many topics,
including alcoholism, morphine addiction,
hysteria and neurasthenia, aphasia from insular
lesion, chorea and athetosis, spinal cord
claudication, hiccups in syringomyelia, tabes
dorsalis, epilepsy, anorexia nervosa, autoscopy,
war neurology, and neuromuscular physiology
(18). He also contributed to the literature with
papers on psychological-philosophical topics,
such as doubt, consciousness, the mental state
of dying, gambling, miracles in science, and
morality (17). However, apart from memory, his
main expertise was in mental retardation, the
topic of his medical thesis in 1890 (18). He
developed a means of measuring mental state by
comparing normal individuals of the same age,
and supported a quantitative view which
ultimately led to the creation of the
intellectual quotient (IQ) (12). His
international fame was considerable in his time,
as shown by translations of his books into
Italian, Russian, Polish, German, and English. A
few years after he died, in 1938, his sanatorium
in Boulogne (fig 4), which had been transformed
into the Ambroise Paré hospital, was
destroyed by the allied bombing of the nearby
Renault factory during World War II (7), with
the disappearance of many archives.
 - Fig 3. The letter
written by Sollier to offer oneself as a
candidate for the Medicine Academy in
Paris.
-
- Sollier's work on memory
-
- In his first book on memory (3), Sollier
attempted to synthesize Charcot's teaching on
amnesia in order to provide the best update of
the time. It was published in 1892, shortly
before Charcot's death, with a level of success
that justified a second edition, in 1901.
Sollier's major opus on memory appeared in 1900
(4), based on a series of lectures at the
"Université Nouvelle de Bruxelles". This
book appears as a masterly synthesis of
neurological and psychological ideas on memory,
both forming the platform for further, novel
concepts that have proven themselves precursory
by several decades.
- Sollier asked a series of simple questions,
such as: What are the cellular modifications
that underlie the process of memory? Which brain
regions are active in memory? What are the
components of autobiographical memories? What
are the mechanisms of remembering? How do
invariant and variable features of memories
match with each other? Sollier's main references
include Ribot, Richet, Ebbinghaus and Pitres,
while he virulently criticized Bergson's
spiritualist theories and poor knowledge of
brain anatomy and function. Sollier complained
that, in general, memory was addressed too
little by the neurophysiologists and the
neurologists of his time, while as early as page
one he emphasized Richet's formula that memory
is "the critical key to the whole intellectual
building", an opinion which has recently been
revived (19). Overall, several of the concepts
developed by Sollier can be considered
incredibly advanced for his times, making him an
extraordinary precursor in terms of contemporary
thought on the mechanisms of memory (20):
-
- 1. Conditions for memory stabilization.
Sollier delineates six main factors required for
memory stabilization: stimulus intensity,
duration, repetition, attention, coexisting
emotion, and will. He also underlines the fact
that lack of successful voluntary recall does
not correspond to a failure of stabilized
fixation, since involuntary retrieval
demonstrates effective stabilization.
- 2. Cellular changes and plasticity during
learning. Sollier underscores the constant
changes which take place at the nerve cell level
following incoming stimuli (pp.59-84) :"An
excitation (…) determines (…) a
special molecular arrangement", where new
stimuli transform the cell from a "static" to a
"dynamic" state. Since a cell cannot provide a
simultaneous "perception of the present" and a
"representation of the past", it is likely that
"a cell, not only does not maintain a permanent
modification under activating excitations, but
cannot be differentiated and adapted to a
special stimulation", while "the molecular
arrangement is not definitive (…), it is
constantly transforming itself". On the other
hand, at the morphological level, stimuli and
learning are associated with nerve cell
extensions through "free endings which develop
contacts with those of adjoining nerve cells".
These extensions grow and subsequently develop
closer contact with the extensions of adjoining
cells", explaining why "exercising develops
memory, and how memory retrieval becomes quicker
with increased repetition". While the concept of
plasticity can already be found in the work of
Ebbinghaus, Taine, and Bergson (21), this is the
first time that a precise mechanism linking
neuronal plasticity to memory was put
forward.
- 3. Memory is a universal phenomenon of the
nervous system. Sollier emphasizes memory as a
basic property of nerve cells. This leads him to
develop a concept of brain functioning that
associates global functioning with specialized
activity in focal cerebral regions, in an
interesting effort to reconcile localizationism
with antilocalizationism (pp.18-19).
- 4. Memory organization centers are different
from perception centers. Basing his reasoning on
the fact that a localized lesion of the
perception centers does not abolish
corresponding memories of perception, Sollier
draws a simple pathway for stimuli, which travel
from reception centers to perception centers,
and then to memory centers, which are not
co-localized in the brain. "Everything suggests
that there is a brain center where memories are
stored, and from which memories can be
retrieved" (p.94).Sollier did not hypothesize
where these memory centers were located, and
another 60 years would have to pass before the
role of the hippocampus became clearly
delineated (22).
- 5. Memory organization is controlled by the
frontal lobes. Over 80 years before the
scientific demonstrations of Milner's and
Tulving's groups (23, 24), Sollier spoke of an
"intellectual center" localized in the frontal
lobes, which regulates learning and the
retrieval of memories (p.115).
- 6. Neurophysiological mechanisms explain why
a recalled memory is identified as memory rather
than as an actual perception. While Taine had
merely emphasized a psychological explanation
whereby the recognition of a past memory occurs
because it is contradicted by current
perceptions, Sollier put forward a
neurophysiological phenomenon: in perception,
the excitatory cell current is "centripetal" at
the level of the structures where memory will be
stored, while during retrieval the excitatory
cell current is "centrifugal" from these
structures (pp.131-3). This hypothesis also led
Sollier to suggest the modern concept that,
while actively remembering, the corresponding
perceptive cortical zones become activated
(25).
-
- In addition to formulating the
above-mentioned novator concepts, Sollier
envisioned the study of memory from a unique
multidisciplinary point of view, combining
biology, physiology, psychology and
pathology.
-
- Involuntary memory
-
- Although the phenomenon of an involuntary
surge of memories had already been mentioned by
Aristotle, Voltaire, Diderot (21) and, more
recently, by other neurologists such as Pitres
(26), Sollier was the first to analyze this
surge in such detail, in order to use it during
specific therapy for his patients. He
transformed Ribot's idea that "forgetting is the
condition of memory" (27) into "the passage from
the Conscious to the Unconscious" (p.58), with
the reverse phenomenon during
"re-experiencing"("reviviscence"): "A memory is
an image(…) which reproduces a past
impression. Re-experiencing is something more:
it is not only the appearance of an image into
the field of consciousness, but this appearance
is so clear and is accompanied by such a precise
and intense reproduction of the state of
personality of the subject at the time of the
initial impression, that this subject again
believes they are going through the same events
as before (p.29). For Sollier, autobiographical
memories thus may often correspond to
"re-experiencing anterior states of personality"
(p.68-9): "the memory which is building up in me
thus is not really formed by the impressions
which come from it, but by all concomitant
impressions. The main images of the object
belong to that picture. They have the main
place, but not the only one. Later, I will be
able to retrieve them, as they are the sole
perceptions which have been conscious; but in
reality, a whole state of personality may
surge". The items which coexist with the main
image precisely allow for a distinction to be
made from among memories of the same object:
"This is the cenesthetic state, i.e. the state
of personality which allows for the
differentiation of memories which seem
identical".
-
- Sollier linked involuntary memory with
affective and emotional factors: "I am feeling a
violent emotion during an accident which I have
witnessed, and this emotional state triggers in
me the revival of memories of facts which bear
no relationship to the actual accident, but have
determined in me a similar emotional state"
(p.113). Besides emotional triggers, Sollier
also underscores the role of less conspicuous
factors which may lead to involuntary retrieval
of memories, and he called this phenomenon
"association", a topic about which he would
subsequently write an entire book (28). In
parallel, he emphasizes the poor efficiency of
the voluntary retrieval for life events: "Our
will really plays a trivial role in the
evocation of memories, and it is an illusion to
believe that it is under the influence of free
and voluntary efforts that this evocation takes
place" (p.115).
 - Fig 4. Sollier's
clinique "sanatorium" in Boulogne-Billancourt
which had been transformed into
- the Ambroisé
Paré hospital after the retirement of
Sollier and destroyed by allied bombing 1942
march 5.
-
- Proust's treatment by Sollier
-
- For treating hysteria and neurasthenia,
Sollier made use of the fact that in involuntary
re-experiencing, "the personal element dominates
the sensory element at the time of the
impression" (p.122). He applied "isolation
therapy", which had been introduced by Esquirol,
had been applied by Jules Dejerine and other
neurologists, and was subsequently used by
Charcot, then summarized by Camus and Pagniez
(29): the patient was admitted to hospital and
isolated from his usual social environment,
being in contact only with his physician and one
or two of his collaborators. Psychological
regression was supposed to be triggered by
confinement to bed for at least one week, with
feeding being limited to milk products. The aim
was to produce a "dependence" of the patient
upon his physician, so that therapy would be
easier. Sollier's therapy was known to be
shorter than Dejerine's, which was an attractive
feature for
- Proust, who was also attracted by the fact
that, under Sollier's care, the isolation was
less strict than with other physicians (11).
With Proust as with his other patients, Sollier
used involuntary memories to trigger
re-experiencing, in order to obtain a new mental
and affective balance, which would lead to
improvement of the reported symptoms.
Unfortunately, one knows very little about the
specific development of Proust's therapy, since
Sollier's archives have not been recovered, and
Proust remained mute about it. It is even
striking that, while Proust is known to have
written thousands of letters, his therapy at the
hands of Sollier is scarcely mentioned in his
correspondence. Proust mentions that his therapy
was a "psychotherapy", a novel term which had
been introduced in 1894 (6). In his rare
accounts of his stay in Boulogne, he complained
about the inefficacy of the treatment, which was
painful or was doing him harm (7). It is clear
that this treatment could not be expected to
improve Proust's severe asthma. On the other
hand, it was useful&emdash; though only
temporarily&emdash; in reorganizing his
disturbed sleep-wakefulness cycle, and also to
stimulate him to continue writing. Moreover,
several of Proust's ideas on involuntary memory
appear to have developed from what he learned
from Sollier, both from his books and from his
personal experience as a patient (2, 6, 7).
- In his scarce comments on his stay with
Sollier, Proust did not convey a positive image
of his physician, especially since their
interaction apparently began with a quarrel over
the philosopher Henri Bergson, who was also
Proust's cousin (11). It is likely that Proust
tried to impress his physician by quoting
Bergson by memory, not knowing that Sollier had
a deep knowledge of&emdash; and aversion
to&emdash; Bergson's work. Later, while Proust
never acknowledged how Sollier's theories on
memory may have benefited him, it is interesting
to see that he always vigorously defended
himself from such attribution, claiming to have
been influenced by Bergson, while Bergson
completely omitted any mention of involuntary
remembering in his work on memory (11). However,
in his 1908 notebook, in which he elaborated the
framework for his novel, Proust wrote down
Sollier's name just beside the main involuntary
memory phenomenon which leads to the final, key
understanding in the novel (2). This probably
constitutes the best&emdash; though
involuntary&emdash; homage that Proust could
ever give to Sollier.
-
- In Search of Lost Time
-
- This is the exact translation of the title
of Proust's novel (1), which first appeared in
English as the inaccurate rendition "Remembrance
of Things Past". We counted 1,210 uses of terms
relating to memory (like remembering,
forgetting, recall, etc.) on 3,125 pages, which
corresponds to an allusion to memory every 2.6
pages. In the 270 pages of volume 6 ("The
Fugitive"), memory is quoted more than once per
page. Although certain experts (30) have claimed
that memory is not the central concept in the
novel, "In Search of Lost Time" probably remains
the great novel of autobiographic memory. This
is not the venue to discuss the place of memory
in Proust's work, but we believe that it
contains a thorough analysis of at least 10 main
topics on memory: involuntary memory, voluntary
memory, affective memory, the constructive and
deconstructive process of memory, reality-memory
discrepancy, the phenomenology of memory and
remembering, habitude, forgetting, memory
processing into patterns, the role of time in
memory, and memory dysfunction. Involuntary
memory is the best known of these topics. Proust
emphasized direct and indirect associations
which may lead to re-experiencing as defined by
Sollier. He also mentioned the "floating of
consciousness", sometimes provoked by
medications, which may lead to a surge of vivid
memories, and he drew a parallel with similar
phenomena which develop during sleep and dreams.
Although no proof of this is available, it is
highly likely that Proust was markedly
influenced by Sollier through his books and his
own therapy at Boulogne, where he may have
discovered the "function" of his own forgotten
memories (2, 6). However, Proust went beyond
Sollier on two matters. Firstly, he emphasized
the "shock" provoked by the surge of a
previously forgotten vivid memory, which may
lead to an intense feeling of happiness and
beatitude due to the affective overlap between
the past and present. This phenomenon leads to a
synthesis of the past and present persons in the
subject, with a feeling of untemporality.
Secondly, the resurgence of vivid, past memories
first produces an impression, which may
subsequently lead to desire and decision, to be
followed by action.
-
- Proust never emphasized his main sources,
and in that regard he behaved with Sollier as he
did with Schopenhauer and Bergson, who also
greatly influenced him. Until recently, Sollier
was considered by Proust experts as just the
doctor who conducted Proust's only inpatient
treatment, without success. In neurology and
psychology, Sollier's contribution was also
forgotten, probably because his atypical studies
led him to be regarded as not a neurologist by
the neurologists and as not a psychiatrist by
the psychiatrists, at a time where these two
fields were diverging from each other. Sollier
indeed criticized the two rising stars of
psychiatry, Janet and Freud, because they were
not adequately considering neurophysiology and
brain studies (6). At the same time, neither
memory nor emotions were considered a
neurological topic, despite Charcot's legacy.
Sollier's many applications to the
Académie Nationale de Médecine
were never accepted (fig 3). As it appears that
the early twenty-first century is providing the
scientific grounds for some form of
reunification of neurology and psychiatry, it is
also certainly the right time to rehabilitate
Paul Sollier and to bring from the shadows his
extraordinary precursor work on memory.
-
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