This division was accentuated by the organization of the studies and the treatment of the patients.  The houses that received the neurotic patients and the insane were absolutely distinct.  The physicians who attended the ones and the others were different, and even supplied by different competitions.  In France, even now, the recruiting of asylum house pupils and hospital house pupils, the recruiting of asylum doctors and that of hospital doctors, give an opportunity for different competitions.  One might almost say that these two categories of house pupils and doctors have quite a different education.  The result was that the examination of the patients, the study thereof, and even their treatment, were for the most part often conceived in quite a different manner.  For example, neuroses were studied publicly; the examination was on elementary sensibilities, the movements of the limbs, and especially reflexes; the insane were more closely examined in the mental point of view, in conversations held with them by the physician alone.  Their arguments, their ideas were noted more than their elementary movements.  Strange to say, just when the psycho-therapeutic treatments by reasoning and moralizing with the patients were being developed, they stood out the contrary of what one might have supposed—­that this treatment should be applied to neurotic patients alone.  It was admitted that lunatics were probably not able to feel this moral and rational influence; they were treated by isolation, shower-baths, and purgatives.

This complete division did not fail to bring about singular and unfortunate consequences.  In a hospital such as La Salpetriere the tic sufferers, the impulsive, those beset with obsessions, the hysterical with fits and delirium were placed near the organic hemiplegics and the tabetics who did not resemble them in the least, and completely separated from the melancholic, the confused, the systematical raving, notwithstanding evident analogies.  If Charcot who, moreover, has brought about so much progress in these studies, committed some serious errors in the interpretation of certain phenomena of hysteria, is it not greatly due to his having studied these neurotic patients with the neurology methods without ever applying psychiatry methods?  Is it not strange to refuse psychological treatment precisely to those who present psychological disorders to the highest degree, and to place the insane who thinks and suffers altogether outside of psychology?

In fine, this distinction between the neurotic sufferer and the mental sufferer was mostly arbitrary and depended more than was believed on the patient’s social position and fortune.  Important and rich families could not be resigned to see one of their members blemished by the name of lunatic, and the physician very often qualified him as neurasthenic to please the family.  A few years ago this distinction of the patients and of the physicians gave rise to a very amusing controversy in the newspapers.  The professor of the clinic for diseases of the nervous system asserted that neurotic sufferers should be patients set apart for neurologist physicians alone, whereas the alienist should content himself with real lunatics.  The professor of the clinic for mental diseases protested with much wit and claimed the right of attending equally the neurotic patients.  All this proved a great confusion in the ideas.