Keywords: history of the body, immigration and health, Israel, lobotomy, psychiatry, Zionism

In this paper we examine lobotomy operations in mandatory Palestine and Israel between 1946 and 1960. The aim is to reconstruct the circumstances in which these operations were done, and to examine: which patients were lobotomized and why; how lobotomy was perceived by the local psychiatric profession; and the reasons for its decline. Apart from shedding new light on the history of lobotomy, which is usually analysed from the viewpoint of the USA and Europe, this study provides an opportunity to investigate the relation between various concepts of the healthy and ill body in the unique context of Israel, as an immigrant country influenced by its Zionist ideology.

Introduction

As the historians Mark [START_REF] Jenner | The historiographical body[END_REF] have emphasized, the history of medicine has almost always been concerned with the interpretation of sick bodies. It has been predicated upon the shifting definitions of normativity and normality, the normal and the pathological body [START_REF] Canguilhem | The Normal and the Pathological[END_REF]. Somatic concerns were already apparent in the pioneering work of historians of medicine such as Karl Sudhof, Henry Sigerist and Oswei Temkin. Yet none of this work cared to style itself 'the history of the body'. Only in the last two decades has 'the history of the body' become a recurrent theoretical basis for a long series of interdisciplinary researches in the history of medicine. 1 In these works, the body, so often hidden as a 'natural', ahistorical and transparent given in our society, is itself deconstructed as a historical construct, as the primary locus upon which power has been inscribed. The construction of the various bodies -normal vs. pathological, hegemonic vs. marginalized -has vast political and social consequences. In the history of medicine, too, practices ranging from medical therapies to preventive medicine and hygiene, took their logic and power from the specific construction of the desired body.

A radical example of somatic practices in twentieth-century medicine was the introduction into the field of psychiatry of lobotomy operations, the surgical interruption of nerve tracts to and from the frontal lobe of the brain. The historiography of lobotomy is rich in attempts to explain why it became so popular in certain countries. [START_REF] Pressman | Last Resort: Psychosurgery and the Limits of Medicine[END_REF] agreed that lobotomy was 'a crude and reckless procedure devoid of any scientific justification', but he was unwilling to call it 'a medical mishap of epic proportions'. He reminded us that the usefulness of a therapy is contingent on the era in which it is applied, and that what is judged to work is specific to place, patients and doctors.

In this paper we examine lobotomy operations in mandatory Palestine and Israel between 1946 and 1960. The aim is to reconstruct circumstances that enabled the undertaking of lobotomy operations in the country and to answer the questions: who was lobotomized and why, how lobotomy was conceived by the psychiatric profession and what were the reasons for its decline. As will be discussed further, this case study also represents an opportunity to investigate the relation between various concepts of the healthy and ill body in the unique context of Israel, as an immigration country influenced by its Zionist ideology.

The Israeli and Zionist context

Pre-Israeli psychiatry in mandatory Palestine and Israeli psychiatry in its first years can be characterized as a hybrid form of colonial psychiatry and a national one. 2 The colonialist perspective was manifested in the way the small psychiatric community in Palestine, which consisted of central European Jewish psychiatrists, had viewed the native population. Based on the conception that mental illnesses are diseases of civilization (see Porter, 1993: 590, 592), these psychiatrists shared the belief that they are the outcome of modern urban life which has alienated men from nature. They saw mental illnesses among the native population as a result of their difficulties in adjusting to the increasing modernization that Palestine experienced during the first decades of the twentieth century due to British Mandate [START_REF] Halpern | Psychic morbidity among the Jews in Erez Israel[END_REF].

Contemporary statistics showed that Jewish immigrants suffered from mental diseases more than Arabs in general, and that Christian Arabs suffered from them more than Muslims did [START_REF] Mills | Census of Palestine 1931[END_REF]. The psychiatrists claimed that these data reflected the cultural state of each group in Palestine. According to their logic, Jews who came from Europe had a higher incidence of mental illness in the new country because they belonged to a modern civilization. Similarly, the constant involvement of Christian Arabs in Palestine in modern life -namely, their activity in trade, the increase of their education level and their growing participation in bureaucratic state mechanisms -resulted in the development of mental health problems. In contrast, the low percentage of mental diseases among Muslim Arabs was correlated to their relatively quiet agrarian life according to traditional patterns (see, for example, [START_REF] Halpern | Some data of the psychic morbidity of Jews and Arabs in Palestine[END_REF].

The national aspect of pre-Israeli psychiatry was expressed in the distinction made not only between Jews and Arabs, but also between native Jews and Jewish immigrants from Europe, and between Jewish Ashkenazi and 'Oriental'-Sephardic. The main assumption was that both native Jews and native Arabs suffer from the same kind of mental diseases and share a 'common oriental motorial line' [START_REF] Herman | Ten years of experience in psychiatric work in Jerusalem[END_REF]. This was how psychiatrists contrasted mentally ill immigrants with the mentally ill from the 'old Jewish settlement' and the local Arabic population. This differentiation process was essential for the creation of the national 'new Jew' and its justification. 3 We should remember that the Jewish psychiatrists in Palestine were not operating in a professional and social void. The rise of scientific anti-Semitism, mainly in Europe, which perceived the Jewish race as degenerative and diseased, reshaped the discussion of identity among Jewish thinkers. The Zionist Movement also approached these questions of Jewish identity through the prism of the uniqueness of the Jewish race. 4 Many Zionists, themselves influenced by the dominant voice of their time, came to see the Jewish body as degenerative and ill: physically and mentally, individually and collectively. 5 The remedy for the 'psychopathology of the Jew', intended to improve the body and soul, was believed by many Zionists to be a return to a Jewish identity through immigration to Palestine, where a national Jewish home was to be established -a healthy society of equals. In this state the degenerative Jewish body -both individual and collective -could be cured of its various illnesses: physical, mental and social. 6 The 'Oriental' Jew had a very small role in this worldview [START_REF] Khazzoom | The great chain of Orientalism: Jewish identity, stigma management, and ethnic exclusion in Israel[END_REF][START_REF] Shohat | The narrative of the nation and the discourse of modernization: the case of Mizrahim[END_REF]. The main human resources for future immigration were sought in Europe, and the 'Oriental' Jews were not part of the mainstream Zionist plan until World War II. This situation changed markedly after the extermination of most European Jews during the Holocaust and with the foundation of the state of Israel. Between May 1948 (the founding of the new state) and 1951, Israel experienced an influx that more than doubled its population. During this period a very diverse and very large group arrived: some 700,000 people, half from Europe and half from Africa and Asia (primarily Yemen, Iraq, Iran, Turkey, Libya, Tunis and Morocco). Immigration on this scale was unprecedented in modern times; even countries such as the USA and Canada had never absorbed such a large proportion of immigrants in such a short a time. This mass immigration to Israel presented the state with urgent practical problems. Within a few years the Jewish population of the state had to absorb hundreds of thousands of immigrants, many of them ill with diseases that required immediate hospitalization [START_REF] Hacohen | Immigrants in Turmoil: The Great Aliyah and its Absorption in Israel. 1948-1953[END_REF]. As some recent works have shown, the health dimension played an important role in the social and cultural tensions among the various groups and in the melting-pot policy of the establishment [START_REF] Davidovitch | Health and hegemony: preventive medicine, immigration and the Israeli melting pot[END_REF][START_REF] Weiss | The Chosen Body: The Politics of the Body in Israeli Society[END_REF]. Another crucial aspect was the dramatic change in the demographic composition of the immigrant population due to the large numbers arriving from North Africa and other Arab countries. The 'Oriental'-Sephardic Jews now became the main demographic group of immigrants, thus imposing a challenge to the identity of the existing population, which was mainly of European origin, secular and often socialist.

The beginning of lobotomy operations

Lobotomy, the destruction of the frontal lobes, was invented by Egas Moniz, a Portuguese neurologist and Nobel prize winner, and was promoted extensively by Walter Freeman, an American neurologist. The success of lobotomy is attributed to several contemporary medical, historical and social conditions, such as the lack of other effective treatments, and the large number of mentally ill patients in state hospitals. The acceptance by the medical profession of such an irreversible procedure is traditionally viewed in the light of the somatic treatments developed in the first half of the twentieth century, for instance, hydrotherapy, malaria therapy, insulin coma, Metrazol convulsions and electroconvulsive therapy. 7 Lobotomy was only one of the innovative somatic therapies imported to Palestine and adopted by the local psychiatric community: electroconvulsive therapy was first used in 1937/38, and a year later psychiatrists also began treating mentally ill patients with insulin shock [START_REF] Halpern | Electroshock as a diagnostic aid in schizophrenia[END_REF]. These therapies were imported from Europe, and several of the Jewish psychiatrists had already gained some experience with the treatments before moving to Palestine in the late 1930s.

Lobotomy, on the other hand, was the first therapy imported to Palestine from the USA after World War II. This geographic change of influence was not just a technical one, but should be seen as part of the general shift that took place in the professional identity of psychiatrists in Palestine. Until the mid 1940s, these psychiatrists considered themselves as part of the European medical tradition, and especially as a continuation of the German one. This was a natural development, since most of the psychiatrists were educated in German medical faculties, and Germany was the most important psychiatric centre at the time. 8 After the end of World War II, psychiatry in Palestine -and later in Israel -became American-oriented. This was a result of financial and organizational co-operation between Israelis and Americans, and the shift of the main arena of 'scientific' medicine, including psychiatry, to the USA and the simultaneous decline of German psychiatry. It was also a consequence of a significant break with European medicine in general, and with German psychiatry in particular, because of their role in euthanasia killings and other holocaust horrors.

The topic of lobotomy operations begins to appear in the pre-Israeli psychiatric literature only in 1944. Simon Fleischman, a local psychiatrist encouraged by the positive results presented the year before at a neurological society meeting in Chicago, evaluated lobotomy operation as an effective therapy for curing all sorts of obsessive disturbances. After presenting the new therapy to his colleagues in Palestine, he concluded:

. . . also in the negative results of lobotomy, we can hope that these are only teething troubles and they might be reduced as experience and research progress. The importance of the described treatment is enormously significant, especially if we keep in mind the unsuccessful means that we have now against mental diseases. (Fleischman, 1945: 143) When lobotomy reached its 'golden age' in the USA in 1946/1947, four lobotomy operations had already been done in Palestine by Aharon Beller, a neurosurgeon who had emigrated from Vienna in 1938 and later became chief neurosurgeon of Hadassah Hospital. It can be assumed that he learnt about lobotomy procedure from the literature and used the Freeman-Watts technique. 9 From 1948 onwards, lobotomy operations became an established therapy in Israel. This was possible through the foundation of two neurosurgical departments in the country: one in Hadassah Hospital in Jerusalem, which was reopened, and the other in Belinson Hospital near Tel-Aviv. The setting up of these new departments was a direct outcome of the 1948 war: many soldiers suffered from severe head injuries, and the existing medical departments could not provide proper treatment, so specialized neurosurgical units were needed. After the end of war, the departments began to perform lobotomy operations on mentally ill patients sent from state and private psychiatric institutions.

The significance of lobotomy as an innovative treatment -which had been introduced into the scientific Israeli domain and had become established as part of local psychiatric activity -was clear, and it was the main subject of the fourth conference of the Israeli Neuro-psychiatric Society in November 1949. At this meeting, 43 cases of lobotomy were presented by the staffs of the neurosurgical departments. Beller and Lipman Halpern, a psychiatrist and a prominent neurologist from Hadassah Hospital in Jerusalem, reported 22 cases of lobotomy operations conducted on schizophrenic patients from four private institutions. The neurosurgeon Heinrich Ashkenazi and the psychiatrist and neurologist Zvi Winnik, who belonged to Geha psychiatric hospital and the general hospital Belinson, both part of the General Sick Fund, presented 21 cases of schizophrenics and psychotics who underwent lobotomy. Both teams expressed satisfaction with the results, despite the death of one patient in each group.

These two presentations and the discussion which followed show how psychiatrists and neurosurgeons conceived lobotomy and the patients whom they perceived as favourable candidates for the operation. None of the conference participants doubted or criticized the new therapy. The only questions were when was the best timing to operate and on whom. One psychiatrist said that since lobotomy is a bodily mutilation, it should be conducted only in cases where there is nothing to lose. Another psychiatrist replied that 'it is inappropriate to call an operation, which is performed with the serious intention of helping someone medically, "mutilation"'. The speaker said that, in spite of the anatomical changes that the four speakers had discovered in some of the cases during the operation, no therapeutic opportunities should be missed, and 'there is no doubt that lobotomy might cause damage, but which operation does not? It is not clear that convulsive therapies are causing less damage' (Israeli Neuro-Psychiatric Society, 1951).

Most of the psychiatrists agreed that the operation should be performed on a patient only if his or her personality had not broken down completely. These psychiatrists used this fluid criterion in order to explain the negative results of lobotomy operations: when they failed it was due to the patients' personalities and not to the lobotomy operation or the psychiatrist or neurosurgeon.

Interestingly, some psychiatrists reported treating post-lobotomized patients, which proved to them that lobotomy operations are successful only if followed by intensive psychotherapy. The discussion ended with the conclusion that 'our experience with lobotomies is small but encouraging, especially since we were, and will be, successful in discharging those patients who, without an operation, would have stayed there forever' (Israeli Neuro-Psychiatric Society, 1951).

Who was lobotomized and why?

Lobotomy is considered to have been the most extreme therapy conducted on mental patients in the twentieth century. It was promoted with relative success at the time, although it lacked a strong scientific theoretical basis and it caused irreversible damage to the brain. Several historians have tried, therefore, to understand its appeal in the contemporary context. An important part of this understanding is to investigate who was subjected to the procedure, and what were the indications required to carry it out. In our case, the specific context of colonial and Zionist frameworks in an immigrant country provides the particular circumstances of lobotomy operations.

The first patient who underwent lobotomy in Palestine was a Jew from Egypt, who had already fallen ill in 1943 in Cairo where he was hospitalized and received 18 ECT treatments and Cardiazol for two months. In July 1944 he was admitted again, and due to a lack of improvement in his condition, was sent by his family to Kurt Blumental's asylum in Haifa. There he was diagnosed as 'schizophrenic combined with emotional attacks and stupidity'.

After 35 sessions of insulin shock and 11 ECT treatments during one year, Blumental and Beller decided to perform a lobotomy as a last resort [START_REF] Halpern | Oedema in lower limbs after lobotomy[END_REF]. This operation and the next one on a 28-year-old male patient -also schizophrenic -were considered to be successful. The second patient, it was proudly reported, was recruited to the army, 'participated in the 1948 war and was injured. Now serving without a fault in the IDF to the full satisfaction of his commanders' [START_REF] Halpern | Oedema in lower limbs after lobotomy[END_REF]. It is evident that the criteria of what should be counted as a successful operation were deeply influenced by the local perception of what is a normal and productive behaviour.

The 53 available documented cases of patients who underwent lobotomy operations between 1946 and 1953 do not allow generalizations to be made or firm conclusions to be drawn. However, they do illustrate a few characteristics and may function as a sample that indicates who was lobotomized, what the operative indications were, and whether the procedure was considered as successful and according to what criteria. 10 Most of the operations took place in 1949, namely, when the first two neurosurgical departments in Israel were opened. All patients except one underwent lobotomy on both sides. Thirty patients (57%) were women. Forty-three (79%) were diagnosed as suffering from various types of schizophrenia. Other diagnoses were melancholia agitatis, paranoia and manic depression. One person was not a typical psychiatric patient: he suffered from phantom pain and underwent one-lobe lobotomy on the opposite side to the amputated limb.

Information about previous therapies attempted before the lobotomy was available for 27 of the 53 patients. Of these, three could not be treated with shock therapies due to physical limitations, 10 did not show any improvement after shock treatment and the rest showed a short-term improvement. In many cases, the indication for conducting a lobotomy operation was 'as a last resort'; in others the patient's family pressed for the operation to be done, an important factor in many psychiatric treatments, especially lobotomy.

It seems that the main indication for performing lobotomy in Israel was the failure, or the inconsistent effect of, other therapies such as ECT and insulin, mainly (though not entirely) in chronic mentally ill patients. In other words, lobotomy was used in Israel as a last resort. However, the concept of 'last resort' was very flexible and subjective, as illustrated by the next case, which was presented by [START_REF] Winnik | Sur certaines indications vitales de la lobotomie[END_REF]. A 56-year-old woman -a married housewife with two children -was sent to be lobotomized after only 6 months of hospitalization in the psychiatric institute. She had been admitted to the institute after a suicide attempt and diagnosed as suffering from melancholia agita. She could not be treated with insulin shock as she had a gall-bladder disease, and she had not reacted to 12 sessions of ECT. Winnik and Ashkenazi (1950: 507) explained:

After taking into account all the factors of her condition, which seemed hopeless, we decided to perform lobotomy. In the post-lobotomy phase, the patient was very confused, incoherent and disorientated. A few days later, the anxiety was reduced and she gained weight. Mentally there was a certain state of apathy and inertia with a weak form of hallucinations.

In a follow-up examination a year later, Winnik and Ashkenazi have reported that 'the subjective state of the patient was normal, her appearance and behaviour were totally normal, she was fulfilling her tasks in the household, read newspapers and books' (p. 507). The gender aspect of what constituted normality was prominent -the first sign of 'normality' for this patient was that she could undertake housekeeping routines.

In 1957 Bental 11 published in Schweizer Archiv für Neurologie und Psychiatrie the results of lobotomy operations conducted on psychotic patients in comparison with their psychotic relatives who had not been lobotomized. The cases presented in this paper allow us to examine the categories of immigration and gender in the context of lobotomy operations in Israel. In one of the cases Bental describes three schizophrenic sisters who emigrated from Baghdad to Israel. It is important to remember that in this case the psychiatrist and his patients were from different cultures: the psychiatrist was an established immigrant who had arrived from central Europe in 1933 and was established in class and profession, in contrast to the immigrants from Iraq who had just arrived. This is how Bental described the cultural and family background of the three sisters, Louise, Margaret and Evelyn:

The milieu is typically oriental in which the father stands at the head of the patriarchal dynasty, beloved, frightening and hated. However, modern conceptions have also penetrated; although they have been 'only daughters' they were sent to a boarding school and learnt languages: French, Arabic, Hebrew, which they mastered more or less. The father spoke only Arabic and some Hebrew, the mother spoke only Arabic. In spite of this progress in their view, the daughters could marry only in the order of their age. That is why, in 1955, the adult daughter despite her mental defects was getting married in order to pave the way for the marriage of the younger ones. -To describe the parent as suffering from a schizoid personality would be inappropriate, since this point of view is very traditional. (Bental, 1957: 8) The first daughter, Louise K., first became ill when she was 19 and was hospitalized for two months in a nerve clinic in Baghdad. In April 1945 the illness recurred and she became upset again, beat her father, threatened to commit suicide and was hospitalized again. In July that year she arrived in Palestine and was institutionalized in Blumental's hospital in Haifa. He described her behaviour as agitated, aggressive and sexual. After several treatments with insulin and ECT, her clinical condition was stabilized. The possibility of a lobotomy was rejected due to her family background, the evolution of the disease and the symptoms. In a follow-up examination, it seemed that Louise became a quiet schizophrenic.

The middle sister, Margaret K., was diagnosed by Bental as suffering from inferiority complex and 'not intelligent'. At the age of 17 she became psychotic and was hospitalized in an Iraqi psychiatric institution for three months. After insulin and ECT treatments, her condition improved. At the beginning of 1950 she went into Bental's hospital, and after five months of insulin and ECT sessions she had partly improved and was released. In March 1951 after two further hospitalizations when she was suffering from a catatonic state and aggressive attacks, it was decided to conduct a lobotomy:

It seemed to us that the second sister, Margaret, could perhaps be saved from the fate of the elder sister. The operation was an attempt to avoid such a tragic situation. On the other hand: negative developments and the family situation left no illusions concerning the chances of success. The indication for the operation was then only 'the lesser of two evils'. (Bental, 1957: 10) The youngest sister, was hospitalized in Bental's institution during Margaret's treatment, and was also diagnosed as schizophrenic. She was not lobotomized since she reacted to a combined treatment of insulin and ECT. According to Bental's description 'the patient is very much interested in her treatment', even 'almost addicted to her treatment with insulin and E.C.T.'.

About two years after their treatment in his clinic, Bental made a followup visit to the sisters' house, where they were living with their parents. He concluded that the deterioration of Margaret, the lobotomized sister, could not have been prevented since 'the endogenous-genetic component was not influenced by the surgery' (Bental, 1957: 13).

Apart from the fact that that the case described is a tragic story of three sisters who suffered from mental illness, Blumental's description of his diagnosis and treatment illustrates the interrelations among the medical establishment (including psychiatrists, neurologists and neurosurgeons), the patients themselves and their families. It is probable that chronic cases of patients who did not fit the Israeli 'melting pot' plan during the first years of statehood in Israel were conceived as medical psychiatric cases which required harsh solutions if necessary. The determination of Bental to save his patient Margaret from the 'fate of her older sister' led him to perform the operation, even when admitting the low chance of successful surgery. His claim that the operation was 'the lesser of two evils' reflects the values behind his decision -what constituted worthwhile surgery, and what was the right choice between what he conceived as meaningless life and a calculated risk, knowing the physical damage that the operation caused.

We cannot reconstruct the family discussions of the various therapeutic choices, since the family was almost entirely missing from Bental's narrative (except as part of the case history). But the fact that the parents brought their daughters to the clinic indicates that they agreed to the suggested treatments, including the lobotomy procedure. We should bear in mind that the family's part in lobotomy operations was a crucial one; various studies of the history of lobotomy and other somatic treatment show that the family frequently pleaded for the 'desperate' treatments, following years of despair in caring for a chronically ill relative. This was especially true in the first years when lobotomy operations were conducted and were seen as a promising and a progressive procedure.

In the case described above, the cultural tensions between Bental and his patients and their family is clear, in his explanations of both the aetiology of the illnesses and the consequences of treatment. The reason given by Bental for the lobotomy failure was related to the 'endogenous-genetic component', a component that could not have been influenced by the surgery, no matter how radical. Bental did not elaborate on how much this 'endogenous' component was related to the patient's ethnic and cultural background, but it is clear from his analysis that it played an important part in his understanding of the aetiology.

The performance of a wider destruction of the frontal lobe by a second operation was extremely rare in Israel (in contrast to the USA), and we know of only two cases. One of them was a woman, a holocaust survivor, who survived her first lobotomy in Budapest and three years later, after a relapse, was lobotomized again in Israel. The claims of Joel [START_REF] Braslow | Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century[END_REF] and Elaine [START_REF] Showalter | The Female Malady: Women, Madness and English Culture[END_REF], that a higher proportion of women than men underwent lobotomy and had more than one lobotomy, cannot be supported in the case of Israeli lobotomy operations (Zalashik and Davidovitch, 2005). Although it seems that women were slightly more lobotomized than men, the difference is negligible since the proportion of women in psychiatric hospitals in Israel was higher than that of men. Furthermore, the argument that lobotomy was widely adopted in state psychiatric hospitals for economic reasons cannot be substantiated for Israel. Due to the historical roots of the development of psychiatric hospitalization in mandatory Palestine, 75% of mental patients were resident in a private institution in 1948, and only 55% of patients were hospitalized in state psychiatric hospitals in 1955; the economic argument was mentioned only rarely in Israeli psychiatric literature. This is not to say that it did not exist, but it was not one of the fundamental reasons for the performance of lobotomy operations in Israel.

Local criticism of lobotomy operations

In general, scientific optimism concerning lobotomy was very common among Israeli psychiatrists and neurologists, and only a minority expressed various criticisms. The psychiatrist and psychoanalyst Daniel [START_REF] Dreifuss | Brain surgery or psychotherapy?[END_REF] rejected lobotomy operations in general, and in particular for mentally ill people who suffered from non-organic diseases. He said that someone suffering from a real neurosis had the right to enjoy more humane treatment; a real cure for neurosis required a substantial liberation of personality and not its destruction. Moreover, he expressed the fear that a lobotomy operation would be taken as an immediate and easy solution for psychiatrists: they would turn to the surgical solution instead of investing time and resources in psychotherapy. Therefore he warned against this procedure without making a serious attempt at a real psychotherapeutic treatment.

Only a few psychiatrists, such as Blumental, were concerned about the substantial change in patient's personality. He was head of a small private psychiatric institution who therefore knew his patients well, and he seems to have felt the great loss suffered by a mental patient, who despite the disease, had a rich personality before being lobotomized. Such was the case of Susannah K. who suffered from manic depression and underwent lobotomy at the end of 1951. Bental (as Blumental was now called) described her after the operation as apathetic, someone for whom everything was lost, and acting more like a marionette. It was clear to him that in this case 'lobotomy caused a destruction of her highest layer of personality' (Bental, 1957: 19). Also, the psychiatrist Haim [START_REF] Strak-Eitan | Report of Fourth National Conference[END_REF] reported on post-lobotomized patients who had been improved by the operation and sometimes even recovered, but said that the price they paid was the destruction of their personality.

A unique aspect of criticism was sounded by the Israeli physician Mark Dvorzarsky, who rejected lobotomy for human and moral reasons. He wrote an article -based on publications of the French Jewish psychiatrist Henri Baruch, who dealt with ethical questions of the psychiatric profession -with the title 'What is a medical consciousness? What is a Hebrew Medicine? Psycho-surgery, a Danger to Man's personality?'. In it [START_REF] Dvorzarsky | What is a medical consciousness? What is a Hebrew medicine?[END_REF] defined psychosurgery as a danger for the personality and warned against its misuse by psychiatrists. He was a general practitioner and not a psychiatrist. Moreover, he was a holocaust survivor who dedicated himself, as part of the rebuilding of an ethical and moral medicine, to warning the profession not to repeat crimes committed by physicians from all branches of medicine during the Nazi era. His criticism of lobotomy and its potential to be used as a punishment or as a human experiment came from this background. Furthermore, he perceived the operation as a means to reduce the free will of the patient and to degenerate his personality in a procedure which lacked a solid scientific basis, and was more a medical experiment than a therapy. Yet his voice was unique and his views were not shared by the medical profession.

In general, there was no regulation of the procedure of lobotomy in Israel. However, at the beginning of the 1950s, the Israeli Ministry of Health recommended that two psychiatrists should see every lobotomy candidate, and document the consultation in written reports. 12 As time passed, even the main lobotomists started to express a more complex opinion of the procedure. A psychiatrist who had been one of the first to perform a lobotomy in Israel, and had been much in favour of it, said by the mid-1950s:

Prefrontal lobotomy, which was thought to open up new horizons for the psychological understanding of the essence of psychosis and also for a neurological clarification of the frontal lobes' functions, has fascinated [. . .] our members. [. . .] At the society's conference, the experiences of our members were presented for wide discussion which concluded with a restrained optimism -in contrast to the exaggerated enthusiasm that prevailed at the time concerning the results of the same operation in the United States, for example, where it was almost considered to be a routine treatment. And indeed, the developments of the last years have very much proven the correctness of our meticulous approach in restricting the operation to special patients only. (Israeli Neuro-Psychiatric Society, 1956: 74)

Summary

Lobotomy did not become a popular treatment in Israel in comparison with the USA and other countries. On the one hand, although it had the potential to become popular -since Israel was an immigrant society with acute lack of psychiatric beds and a very low budget for psychiatry -only a few hundred people underwent lobotomy between 1946 and 1960. On the other hand, these figures are not very low if we consider the total numbers of institutionalized mentally ill in the country : 2000 in 1948; 3000 in 1955; 5100 in 1959; and 5254 in 1961. We claim that the number of lobotomy operations in Israel was relatively small because this imported innovative technique reached its golden age in Europe and the USA, when the local disciplines of psychiatry and mainly neurosurgery in Palestine and later in Israel were still in their infancy. Therefore Israeli psychiatry and neurosurgery missed the narrow time-window when lobotomy was a common and well accepted therapy. Furthermore, as in the USA, lobotomy quickly became a last-resort procedure, although we have shown in this paper that 'last resort' could be interpreted in a rather flexible way.

Another important factor in Israel was related to the role of the public and especially of the patients' families -which, in the USA at least, was a significant factor in the popularity of lobotomy -who were not always aware of the new technique of lobotomy. A rare criticism from the medical profession was related to the ethical aspects of lobotomy in the post-Holocaust era.

The other point which concerns historians of lobotomy is trying to understand why lobotomy almost vanished in the 1960s. Some claim that the poor long-term results of lobotomy operations and the introduction of antipsychotic drugs such as Chlorpromazine caused the decline of lobotomy. These reasons do not explain the situation with lobotomy in Israel. First, lobotomies were performed in Israeli psychiatric hospitals until the 1970s. Second, Chlorpromazine was introduced in December 1953, and in 1955 was already widely used in local psychiatric institutions. This was also the period when lobotomy operations were performed relatively frequently in Israel. So this question remains unanswered until scholars have access to a wider archival primary literature about lobotomy in Israel. This material will also enlighten us on issues such as the interaction between the medical establishment, physicians who were treating mentally ill patients, and the lobotomized patients and their families.

Notes

1. See, for example: [START_REF] Armstrong | The Political Anatomy of the Body[END_REF][START_REF] Butchart | The Anatomy of Power: European Constructions of the African Body[END_REF][START_REF] Gilman | The Jew's Body[END_REF] These are just a few examples from a vast amount of literature published on the historical construction of the body. For a helpful overview from a sociological perspective, see also [START_REF] Turner | Recent developments in the theory of the body[END_REF]. 2. On the history of psychiatry in Palestine and Israel, see: Vinic and [START_REF] Winnik | The development of psychiatry in Israel[END_REF][START_REF] Witztum | Chapters in the history of psychiatry in Palestine and its neighbourhood[END_REF][START_REF] Zalashik | Pioneering psychiatry: Zionist newcomer and Jewish psychiatry in Palestine in the 1920s[END_REF]Zalashik, , 2005. 3. 3. See also [START_REF] Peled | The New Man' of the Zionist Revolution: Hashomer Hatzair and its European Roots[END_REF] For an incisive critique of Zionist discourses of masculinity, see [START_REF] Boyarin | Unheroic Conduct: The Rise of Heterosexuality and the Invention of the Jewish Man[END_REF]. 4. Though as Anita Shapira (1992) has pointed out, with respect to Nordau and his contemporaneous German Zionist colleagues, Nordau's 'acceptance of the anti-Semitic diagnosis did not entail concomitant acceptance of the racist deterministic prognosis preached by anti-Semitic ideologues.' 5. For the discourse of Jewish 'self-hatred', see the classic work by Sander Gilman, 1986. 6. On the various medical reactions to the 'Jewish problem', Zionist and non-Zionist, see: [START_REF] Efron | Defenders of the Race: Jewish Doctors and Race Science in Fin-de-Siècle Europe[END_REF]Hart, 2000. 7. On the development of somatic therapies, see: [START_REF] Braslow | Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century[END_REF][START_REF] Grob | The Mad Among Us: A History of the Care of America's Mentally Ill[END_REF][START_REF] Shorter | A History of Psychiatry: From the Era of the Asylum to the Age of Prozac[END_REF]Valenstein, 1986. 8. On the German influences on the Jewish medical and psychiatric professions in Palestine, see [START_REF] Baader | The impact of German Jewish physicians and German medicine on the origins and development of the Medical Faculty of the Hebrew University[END_REF][START_REF] Gelber | New Homeland: Immigration and Absorption of Central European Jews, 1933-1948[END_REF]Niderland, 1982. 9. This assumption is based (a) on the fact that Beller did not travel abroad for a fellowship in that period, and (b) on an interview with Bental's son, Haifa, December 2000. Learning medical practices through professional medical literature was not unusual at the time, especially when economic and political circumstances prevented frequent travels from the 'periphery'. The Department of Neurosurgery in Hadassah was established by Henri Wigderson at the end of 1941 and included only seven beds. It was reopened at the end of the 1948 war [START_REF] Segal | Neurosurgery at the Hadassah-Hebrew University Medical Center in Jerusalem[END_REF]; Zionsit Archive, J113/2051). 10. There are no official data on the total number of lobotomy operations conducted in Israel.

Our estimate is that about 200-300 such operations were done. 11. Blumental had changed his name to David Bental after the foundation of the state of Israel. 12. Israeli State Archive, G/ 4265/ 181/7.

  , 17(1): 091-106 Copyright © 2006 SAGE Publications (London, Thousand Oaks, CA and New Delhi) www.sagepublications.com [200603] DOI: 10.1177/0957154X06058593


Keywords: aphasia, detour, illness, language, present thinking, psychic link

HAL is

Introduction

that entirely reconstructs the achievement of a single scientist, or analyses his role in the process of the creation and evolution of a discipline. Numerous studies investigate a specific problem, issue or scientific field; some recreate the scientific discourse of a certain epoch, while others propose typologies of the historic stages of a discipline. A fair number of publications focus on the social and political constellations that contribute to the emergence of a theory, to the popularity or to the decline of an author or scientific movement.

Despite these diverse approaches, many publications and textbooks suggest a notion of progress, which presupposes the belief that not only researchers have understood one another, but also that there is an accumulation of knowledge throughout the history of a science. However, my argument develops a slightly different angle. I hypothesize that in the history of science there have been very selective readings by some researchers of the work of others or even misunderstandings between them, which specifically deserve greater attention. This hypothesis does not question the grounding for a conception of cumulative knowledge, which appears to be needed for the sake of teaching, but it puts forward more complexity as shown below in an example taken from the history of aphasia.

A shared interest in language

A special issue of the Journal de Psychologie was published in 1933, comprising almost 500 pages entirely devoted to the problem of language. Contributors included psychologists and linguists, and also philosophers and physicians (see Friedrich, 1998). Together with the linguistic conceptions of Antoine Meillet, Albert Sechehaye and Charles Bally, for instance, we find Nikolaj Trubetzkoy's phonological propositions, Ernst Cassirer's outline of a philosophical approach to language, Karl Bühler's work on onomatopoeia, and both Kurt Goldstein's and Adhémar Gelb's research on aphasia. The choice of contributions shows that the special issue was published in the context of international debate, with an important precedent in 1931: at the twelfth congress of the German Psychology Society in Hamburg, an entire day was organized on language. 2 As Karl Bühler (1879Bühler ( -1963)), the Society's president, said at the opening ceremony: 'Human language seemed to us to be the most suitable topic for a common discussion between psychologists and representatives of other disciplines' (Bühler, 1932: 5).

But this interest in language did not seem to be solely motivated by a simple desire to collaborate with colleagues in medicine, philosophy and linguistics. In fact, psychologists undertook the elaboration of language conceptions themselves, a task nowadays reserved for linguists. Thus, in 1934 Bühler, famous for his publications on the psychology of thinking and child psychology, wrote a 400-page book entitled Sprachtheorie (Bühler, 1934[START_REF] Bühler | Theory of Language: The Representational Function of Language[END_REF]. A year later Walter Benjamin (1892Benjamin ( -1940) ) published a long review article on the sociology of language, in which he demonstrated that contemporary studies of language phenomena were key contributors to sociological thinking [START_REF] Benjamin | Probleme der Sprachsoziologie[END_REF][START_REF] Benjamin | Werkausgabe[END_REF]. Likewise, Kurt Goldstein (1878Goldstein ( -1965)), in his contribution to the Journal de Psychologie [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971)), does not merely state that research on language disturbance might be useful for elaborating a theory of language; instead he promotes such a conception himself, which he considers relevant for the interpretation and explanation of many aspects of aphasia. This may be regarded as added proof that 'language is a central area of concern in the twentieth century', to quote the philosopher Charles Taylor (1985: 215).

Yet the interest in language expressed in psychology, sociology and medicine in the early 1930s was not brought into these disciplines by linguists. The hegemony of linguistics over other social sciences was a later phenomenon, particularly linked to the development of French structuralism. I would like to demonstrate that there is a significant and original difference between the interest in language apparent in the early 1930s and the 'explosive growth of the science of linguistics' (Taylor, 1985: 215) that marked the social sciences in the 1950s and 1960s. Where did such an interest in language -as explicitly expressed by numerous French and German psychologists, philosophers and clinicians in the 1930s -originate, and what was it really focusing on? I shall attempt to answer these questions through Kurt Goldstein's work and will specifically focus on his text 'L'analyse de l'aphasie et l'étude de l'essence du langage' published in the special issue of Journal de Psychologie [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971)).

A reading that is neither disciplinary, nor interdisciplinary Goldstein's text and several other articles in the 1933 special issue were reedited by Jean-Claude Pariente in his publication Essais sur le langage (1969). Pariente's approach in the introduction is somewhat ambivalent. On the one hand, he suggests using the original texts to reconstruct the field of linguistic thought at that particular time by 'highlighting the notions with respect to which the problems set by language in 1933 are defined' (Pariente, 1969: 12). On the other hand, he identifies a link between the texts reflecting, in his view, the autonomy of the science of language and at the same time the extent to which its object is irreducible to all other principles. [. . .] Knowledge of linguistic data should not be sought outside the data themselves: thus both race and natural sounds are divested of any explanatory value, and so, on an individual level, are physiological and psychological data. (Pariente, 1969: 13) Consequently, he proposes an interpretive framework that is directly borrowed from 1960s linguistics. As he introduces Goldstein's text, Pariente immediately refers the reader to the work of Roman Jakobson (1896Jakobson ( -1982)), for example, who, Pariente believes, showed how linguists may use the thoughts of researchers from other fields to elaborate a theory of language. In fact, by the late 1930s Jakobson was already interested in language disturbances from a strictly linguistic point of view (see Jakobson, 1940Jakobson, -42/1972), but it was not until the period 1953 to 1963 that he published a series of articles in which he proposes a linguistic interpretation of aphasia which is largely based on Goldstein's clinical descriptions (see [START_REF] Jakobson | Aphasia as a linguistic topic[END_REF]Jakobson, /1971[START_REF] Jakobson | Toward a linguistic classification of aphasic impairments[END_REF]Jakobson, /1971[START_REF] Jakobson | Linguistic types of aphasia[END_REF]Jakobson, / 1971)). Jakobson has two objectives: (1) to test, using clinical cases, a conception of language based on de Saussure's heritage; (2) to offer clinicians linguistic models that allow them to describe and classify aphasic phenomena better.

Reactions to Jakobson's work have been varied. In their textbook on aphasia, Roch Lecours and Lhermitte (1979: 46) consider that Jakobson is the one who granted 'neurolinguistic research the growth seen today'. In their view, Jakobson also proposes one of the first linguistic theories of aphasia. Yet, as illustrated by their chapter on aphasia classification, they follow quite a classic approach: they present Jakobson's contribution as they do Goldstein's, chronologically, as a suggestion (among others), to be integrated in the neurolinguistic classification they developed themselves. Other readings, like Forest's (1993: 292), more strongly in favour of Jakobson, argue that his classification completes the history of aphasia, because it develops the whole programme put forward by the earliest investigators.

Several voices play down the productiveness of linguistic research for the study of aphasic anomalies and note that they have contributed much to their description but not to their explanation. 3 Other authors mention the limits of current knowledge on the nature of aphasia and the need for new research in the area of language. For instance, Sabouraud (1995: 64) claims 'we must accept that forms of aphasia cannot be defined without first recognizing what language is made of'. By reading current interpretations we can highlight a common trait: they almost always emerge within well-established disciplines or 'interdisciplines', with two significant consequences. First, because arguments are based on a well-circumscribed definition of their object and on a stabilized vocabulary, either in neuropsychology, psycholinguistics or clinical psychology, the way in which precursors are taken into account is more or less predetermined: ideas that cannot be grasped within the current disciplinary conceptual framework are simply not considered. Second, the issue of collaboration between fields of research in aphasia is once more very timely, and debate is reopened. But the issue of collaboration is often expressed from the perspective of a single discipline and with only itself in mind, as shown by Guibert's (2004: 115) formulation of the problem: [. . .] what are the conditions, for clinicians, of a contribution of language sciences to the understanding of language impairments? What are the conditions, for linguists, of a clinical contribution to the elaboration of a scientific explanation of language?

In this study I hope to return to the history of aphasia at a moment when disciplines were not yet completely established, when the development of a conception of language was the object of a shared interest and was thus a common reference point, a kind of 'epistemological condition for the founding of the human sciences'. To develop this hypothesis, I will provide a comparison: Jakobson's reading of Goldstein's clinical materials based on a linguistic theory of language will be compared with the conception of language on which Goldstein bases his interpretation of the same clinical cases. Jakobson acts as if it were possible and necessary to complete Goldstein's clinical study with a theory of language, which implicitly suggests the absence of such a theory in Goldstein's writing. The current text aims to show that there exists a conception of language in Goldstein's research and that it is different from the one Jakobson proposes.

Aphasia as linguistic problem: Jakobson's reading

The twofold character of language and the two types of aphasia [START_REF] Jakobson | Two aspects of language and two types of aphasic disturbances[END_REF]Jakobson ( /1971: 239) : 239) justifies his interest in language pathologies as follows:

If aphasia is a language disturbance, as the term itself suggests, then any description and classification of aphasic syndromes must begin with the question of what aspects of language are impaired in the various species of such a disorder.

He even once explains: 'no exact diagnosis can be made without a competent linguistic examination of what in the patient's language is impaired' [START_REF] Jakobson | Aphasia as a linguistic topic[END_REF](Jakobson, /1971: 234): 234). [START_REF] Jakobson | Toward a linguistic classification of aphasic impairments[END_REF]Jakobson ( /1971[START_REF] Jakobson | Linguistic types of aphasia[END_REF]Jakobson ( /1971) ) regrets that the indispensable participation of linguists in the study of language impairments has not yet occurred and quickly suggests the reason for such a delay. He argues that it is due to the fact that a structural analysis of language has only just been developed and that it is the only kind which can provide efficient and relevant concepts, instruments and methods for studying aphasia. Jakobson repeatedly describes as progress the possibility of treating language impairments using purely linguistic criteria. Whereas other recognized authors in the area of aphasia, such as Goldstein, could only refer to 'basic linguistic literature' [START_REF] Jakobson | Aphasia as a linguistic topic[END_REF](Jakobson, /1971: 231): 231), more recent research had led, in his view, to the foundation of a modern science of language, enabling new knowledge in the field of aphasia.

The linguistic analysis that Jakobson applies to language pathologies is based on the idea of the twofold character of language, according to which each verbal behaviour implies two distinct operations: the selection and combination of linguistic units. The two operations are, in Jakobson's view, fundamental and underlie all verbal behaviour. However numerous terms are used in linguistic literature to characterize these two operations. De Saussure (1916) -the reference for all authors who defend this idea -talks of the 'paradigmatic axis' and 'syntagmatic axis' of language to situate both operations in relation to space and time. The term 'paradigm' easily brings to mind the simultaneity of different competing words from a 'lexical storehouse' existing in a vertical mode outside time, words among which the speaker makes a choice. According to Jakobson the constituents of the paradigmatic axis are in a substitution relationship with one another due to the similarity of some of their aspects. Whereas syntagms are on a horizontal or temporal axis, along which words are subjected one after the other to combination, following certain rules in terms of their position in the sentence and in terms of their necessary transformation (conjugation, declension). Jakobson emphasizes the notions of 'contiguity' and 'context' to describe the latter axis. Basing himself on this model of language, Jakobson deduces that there are two types of aphasia: 'similarity disorders', which involve altered selection, and 'contiguity disorders', in which combination is altered. To determine which symptoms go with which type, Jakobson consults Goldstein's clinical materials, which appear to validate the expected deficiencies.

With regard to substitution impairments, Jakobson first refers to descriptions of motor aphasia and also of affection of internal speech. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 301) : 301) describes the difficulties some patients encounter when confronted with words they usually know only within verb groups. In such situations they become incapable of finding the first word to start a sentence, of reading words one-by-one or of choosing a word in a more or less voluntary way. Grammatically it is the same disorder that explains why 'words with an inherent reference to the context, like pronouns and pronominal adverbs, and words serving merely to construct the context, such as connectives and auxiliaries, are particularly prone to survive' [START_REF] Jakobson | Two aspects of language and two types of aphasic disturbances[END_REF](Jakobson, /1971: 246): 246). These difficulties appear to be compensated by the least affected language operation: It could be predicted that under these conditions any semantic grouping would be guided by spatial or temporal contiguity rather than by similarity. Actually Goldstein's tests justify such an expectation: a female patient of this type, when asked to list a few names of animals, arranged them in the same order in which she had seen them in the zoo; similarly, despite instructions to arrange certain objects according to colour, size, and shape, she classified them on the basis of their spatial contiguity as home things, office materials, etc. (p. 249) Jakobson promptly concludes that 'when the selective capacity is strongly impaired and the gift for combination at least partly preserved, then contiguity determines the patient's whole verbal behaviour, and we may designate this type of aphasia similarity disorder. ' (p. 250; original italics) The second type of aphasia is consequently the result of the alteration of the other major language ability: the combination of linguistic units, the construction of sentences and texts. In the history of aphasia the phenomena that illustrate this type of disorder, such as agrammatism, have always particularly interested clinicians. This type of aphasia is characterized by symptoms that include the loss of the ability to organize words into sentences ('word heap' without any grammatical link), the disappearance of pronouns and articles, the abolition of flexion, or a so-called 'telegraphic style'. Jakobson discusses at length Goldstein's descriptions of cases revealing these types of symptoms.

Jakobson completes his discussion of the two major types of aphasia with an unexpected reference to two rhetorical figures: metaphor and metonymy (see [START_REF] Jakobson | Two aspects of language and two types of aphasic disturbances[END_REF]Jakobson, /1971Jakobson, : 254-9, 1963Jakobson, /1971: 296-7): 296-7). This reference to tropes is found in all his aphasia publications, and not only aims to show that they are affected in different ways in both types of language disorders but also wants to compare these disorders with characteristics of normal human speech. The ability to produce metaphors, i.e., linguistic images that are based on the similarity of two objects or concepts, presupposes an analogical substitution and is thus missing in substitution disorders. In contrast, metonymy represents a semantic relationship of a causal, spatial or temporal nature that is well preserved in this type of aphasia. Jakobson even claims that the metaphor-metonymy opposition is in fact the meta-relation, in other words the most condensed expression of the two axes of language, 4 characterizing the axes as products derived from this opposition.

Two reasons can be suggested to clarify Jakobson's approach. Introducing the twofold character of language (substitution operations on the paradigmatic axis / combination operations on the syntagmatic axis) in another equally bipolar structure (metonymy/metaphor) is used by Jakobson to broaden the scope of linguistics of language towards semiotics on the one hand and discourse linguistics on the other. These happened to be two very modern tendencies at that time, particularly in French linguistics. Nevertheless, this theoretical extension is of interest in the present context in view of the consequences it will have for the interpretation of aphasia.

A positive conception of pathology

Let us remember that contrasts such as language/speech or synchrony/ diachrony are at the basis of de Saussure's project. They are the premises of his thought and remain the foundation of all structural thinking. They indicate the discovery of the universal structures that underlie speech as the central object of modern linguistics. This view was used by neo-structuralists in social science research. The fact that universal structures are almost all bipolar in nature is reflected in semiotic systems: pictorial art, cinema and literary theory, where a clear opposition between prose (which works using metonymy) and poetry (based on metaphor) is apparent. By situating his interpretations of aphasia within neo-structuralist semiotics, Jakobson proposes a theoretical model that has a very powerful predictive ability. The bipolarity of all linguistic and semiotic behaviour has the advantage that, on the basis of the existence of one component, we can predict the existence of the other, or, in the case of aphasia, the reinforcement and prevalence of one component can be interpreted as the result of the deterioration of the other. As this development is virtually contained in the bipolar scheme, the need for any activity other than the one already predicted is excluded. Further, each kind of aphasia fits within a table elaborated using a combination of symptoms (see [START_REF] Jakobson | Toward a linguistic classification of aphasic impairments[END_REF]Jakobson, /1971[START_REF] Jakobson | Linguistic types of aphasia[END_REF]Jakobson, /1971)). We see that this bipolar model is well articulated within a purely symptomatological framework, based on a nosological classification thus approved not by physiology but by the science of language.

In this model there is no reason to be interested in the function that language has for the patient because function is identified with a balanced functioning along both language axes, a balance that in the case of aphasia may be more or less impaired or compensated. It is obvious that once we deduct one type of aphasia from such a theoretical model, the issue is no longer the way in which the patient uses language but the search for symptoms, which correspond to a certain classification of the disorder.

This way of discounting the person affected by aphasia is compensated by Jakobson's further extension of the conception of language. The need to complete the analysis of language as a formal structure by an analysis of verbal speech was not dealt with by de Saussure, but it was one of the main preoccupations of linguistics, especially in France in the 1950s and 1960s. Jakobson integrates this interest for discourse -the implementation of language components in genuine individual speech -in his thinking, via the metaphor-metonymy opposition. He states that 'the development of a discourse may take place along two different semantic lines' [START_REF] Jakobson | Two aspects of language and two types of aphasic disturbances[END_REF](Jakobson, /1971: 254): 254), either via metaphorical processes or via metonymic processes. He cites a psychological test in which children are given a word and asked to describe the first verbal reaction that comes to mind when they hear it. The test proves that children react either with synonyms and metaphors, or with metonymies. The two processes available to the speaker can thus be carried out in different ways. Some individuals favour metaphorical operations in their verbal behaviour, others metonymical operations, so that 'an individual exhibits his personal style, his verbal predilections and preferences ' (p. 255).

This reference to discourse allows Jakobson to introduce the 'speaking subject' into his discussion of aphasia. Yet we must point out that the subject of discourse is the 'normal speaking subject'. This is highlighted several times: While each of these two types of aphasia tends toward unipolarity, normal verbal behaviour is bipolar. But any individual use of language, any verbal style, any trend in verbal art displays a clear predilection either for the metonymical or for the metaphorical device. [START_REF] Jakobson | Aphasia as a linguistic topic[END_REF](Jakobson, /1971: 238) : 238) In daily speech, as well as in dreams or even in writing, a competition between both models may take place, yet a certain preference for one over the other may be observed in all language actions, in some cases even a very marked predominance for one over the other. Therefore language disorders may be played down; they appear to be a case among others, albeit clearly a specific case since patients affected by aphasia suffer from the unipolarity of their verbal behaviour in contrast with the poet who, reassured by a chosen literary canon, consciously decides to work with metaphors. Certainly, in this case, we observe a kind of 'normalization of pathology' in Jakobson's interest for the speaking subject. It appears that the subject of aphasia is a 'concrete' abstraction, a particular case that can be derived from normal speakers who also 'deviate' somewhat from the linguist's model.

Goldstein's data, after being integrated into Jakobson's language model, begin to make sense. This interpretation of facts described in clinical protocols -often long and indigestible -is one of Jakobson's remarkable contributions to the debate on aphasia. His project for establishing a specific order in language disorders is embedded in the theoretical research model still used in order to conceptualize complex realities. 5 However, an important problem remains to be solved: as soon as the facts studied by Goldstein are fed into a structural model of language, they address nothing but language and its functioning. Yet [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein's ( /1971: 282-3: 282-3) core analysis is neither language, nor its functioning, but the 'total personality of an individual' living with a language disorder. Jakobson acts as if Goldstein were only describing the characteristic symptoms of different aphasia types, whereas Goldstein first and foremost is trying to understand how a patient affected by a language disorder can use language to respond to situations in the world, in spite of his impairment which prevents him from reacting in a normal way. Goldstein focuses his interest on subjects acting or reacting with language as a way of being in the world, characterized by the deterioration of language.

Aphasia as a way of being in the world: Goldstein's reading

An individual conception of illness and the detour concept

In the historical literature on aphasia, as well as in neurolinguistic textbooks, Goldstein has been described as favouring an organismic and holistic point of view 6 or, as others have said, of a globalized conception of aphasia (see Roch Lecours and Lhermitte, 1979: 43). Goldstein, who trained with Carl Wernicke (1848[START_REF] Goldstein | Zur Frage der amnestischen Aphasie und ihrer Abgrenzung gegenüber der transcorticalen und glossopsychischen Aphasie[END_REF], started to develop this perspective very early, criticizing the localization approach of his master, which had grown from the idea that each clinical form of aphasic disorder must correspond to a localized lesion, precisely circumscribed in the cortex. Together with Adhémar Gelb (1887-1936), a close collaborator at the Institut für die Erforschung der Folgeerscheinungen von Hirnverletzungen in Frankfurt, Goldstein completed and published many studies on aphasia. The two scientists developed basic principles to guide their analyses of various pathological phenomena. Confronted with aphasic patients, they not only paid attention to changes in language behaviour, but also addressed the personality change experienced by the patient: 'That requires a detailed analysis of each specific phenomenon in relation to the entire personality of the patient and the particular momentary situation' [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 285): 285). By considering each individual in his entirety, Goldstein started looking into reactions developed by aphasic individuals when confronted with this new pathological situation, reactions aimed at preserving or recreating possibilities of action. [START_REF] Gelb | Remarques générales sur l'utilisation des données pathologiques pour la psychologie et la philosophie du langage[END_REF]Gelb ( /1969) argues that it is the analysis of the environment in which a patient can still act without conflict that provides most information on behaviour changes. Goldstein mentions two different ways of reacting when confronted with pathology: (1) the creation of a changed environment, narrowed in order to avoid failure situations and anxiety 7 that could paralyse a patient's actions; (2) the use of detours that allow access to a desired situation by a very different way than that used by normal subjects. Whereas in Jakobson we observe a kind of normalization of pathology, detour analysis is a favourite Goldstein topic for the investigation of human pathologies. Such studies show us: to which extent these reactions are impaired; in fact, only such studies can reveal the change which occurred in the patient, since we can show, using carefully chosen experiments, that these reactions no longer fit certain normal requirements. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 285) : 285) However, Goldstein is not interested in the detours used by patients to achieve a remainder of normal behaviour, since this would imply he was neither taking the patient nor the pathology seriously. 8 Instead he analyses in depth the means mobilized by patients to act despite their illness, because these inform us about normal function that is lacking. From this perspective, Goldstein addresses language disorders, and in particular amnesic aphasia, to reveal the normal functioning of language.

The main clinical trait of amnesic aphasia is missing words, expressed by short sentences spoken in replacement of these words, so that speech often loses coherence because of the frequent use of circumlocutions. Patients are unable to recall the words they want to pronounce intentionally and/or after seeing objects. The repetition of heard words, text reading and oral and written comprehension are normal in most cases. What does an aphasic person do to find words despite the disorder? Below I briefly report three examples discussed by [START_REF] Goldstein | Über Aphasie[END_REF]Goldstein ( /1971). 9

(1) Literal paraphrasing is discussed by Goldstein for its detour function, as it helps complete a task that has become impossible because of amnesic aphasia. It is characterized by the preservation of general word structure -length and rhythm -but certain letters are left out and others introduced wrongly or in the wrong place. In such cases we often observe the use of imperfect replacement products, deviated and erroneous replacements, which take the place of the desired word. But Goldstein considers that the characteristic trait is that the detour is based on a sensory memory of the word. Thus, [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 312) : 312) observes:

The patient functions rather as we do when we learn a foreign language and we do not immediately find a word. We try to reconstruct it from our memories, in an optical, acoustic or motor manner. The patient proceeds in exactly the same way.

(2) Another way of finding a word is verbal paraphrasing. The patient produces another word from the same sphere of meaning without it being a synonym. Thus a patient asked to say 'God' might say 'church' or another might say 'turtle' for 'crocodile', etc. According to Goldstein, patients refer to verbal knowledge (here: lexical knowledge) acquired during their life. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 340) : 340) cites other examples for this extremely important strategy in amnesic aphasia: A patient, for example, cannot find the word 'forget-me-not' or 'blue', but the object awakens in him the memory of a nursery rhyme 'Blau blüht ein Blümelein, es heisst Vergissmeinnicht' ['Blue blossoms a small flower, it is called forget-me-not'], and immediately he says 'forget-me-not' and 'blue'. He did not use these words with their usual meaning, they have presented themselves to him as external verbal knowledge [. . .].

(3) A third strategy used by patients presents slightly different characteristics and refers to the reality experienced by patients. Goldstein describes the case of a woman who could not name the objects in her kitchen. Yet by appropriate conversation, one could make her to walk around her kitchen in her memory and suddenly she would be able to list the various objects in her kitchen. Thus the words have been directly evoked by the imagined presence of the objects. It is as if she could read the words on the objects when walking through her kitchen.

Externality between words and the world

In these three examples of strategies, words are recalled by detours, through sensory and motor memories, references to learned verbal knowledge, or the imagined presence of the objects to which the word corresponds. These three ways of finding words have a common characteristic that Goldstein immediately highlights: the patient solves the problem in a completely external way. What does he mean by 'external'? At least two other ways can be found in Goldstein's thinking.

When a patient tries to call to mind -by trial and error -the sensory or motor memories of a word, he somehow detaches himself from the world to let the word 'come' into his head. The same thing is observed when referring to verbal knowledge: a patient cannot find the word 'doormat' but then remembers an expression often heard and stored in his verbal memory, 'don't stumble on the doormat', and the word 'comes back'. The procedure used by the patient is very similar to the one described later in psychological research on evocative memory. But what do 'evoke', 'evocative memory' and 'recollection' mean? Vermersch (1990: 230) describes it as follows: 'it is, for a subject, to be more present in a past situation than in the present one. Subjectively, it is what happens when a subject rediscovers the images, sounds, and sensations of a past experience [. . .].' 10 In Goldstein's texts (1933Goldstein's texts ( /1971: 314-15: 314-15) the same characteristics are described. The subject who seeks words somehow leaves the world of objects and subjects around him, his stare is directed differently, the rhythm of his speech slows down, normal mechanisms are replaced by detours, the rapid and complete course of language is altered and suddenly words appear. This articulation between a slowed-down verbal process and the emerging of words emphasizes the subject's external relation to the world in that situation.

In fact the relationship is external in character, not only between the world and the subject, but also between words and the world. This is well expressed in the use that the patient makes of verbal knowledge to find missing words. This ability informs us, says Goldstein, about the extraordinary richness, the extraordinary independence of language with regard to the world, which even allows us to reach conclusions on the world that are purely verbal. He cites an example:

On the table there is a red book. The patient distinguishes a square via a motor pathway. If we place the book in such a way that he can now see white pages, he says 'white' and distinguishes a certain shape. He then says, 'Red square, white, thick, on the table, that could be a book.' [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 343) : 343) For Goldstein this example proves that, for this patient, language is the only way of knowing things and finding his way in the world. He seems only to know the world through his verbal knowledge. This externality between words and the world is therefore based on an extremely important mechanism, which is produced by the aphasic person to escape a distressing situation. The patient is confronted with an object from the external world and, lacking a word to name it, makes a detour and inserts his verbal knowledge between himself and the world. Instead of producing knowledge of the world by using words, he refers to his verbal knowledge to rediscover knowledge of the world. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 335) : 335) characterizes this way of using language as instrumental because the value of words only consists in 'the effective and external possibilities they offer us'.

From his analysis of the instrumental use observed in patients, Goldstein comes to two conclusions with regard to the normal expectations of language that the patient can no longer achieve. First, the language of a normal subject is characterized by a rapid and complete flow of words. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 311-12, 318-19: 311-12, 318-19) also considers the development integrity of the various language processes. The 'natural discourse flow' is disturbed in aphasic patients, who are obliged to carry out deliberate word retrieval. 'Deliberate' means, in this context, that patients try to recall lost words through an internal or external situation specifically conceived with this in mind. As the examples show well, the implementation of word recall procedures by patients slows down the process of speech, the patient leaves the present situation and moves into the past of memories and verbal knowledge. Language loses spontaneity or, in Goldstein's words, the speaker no longer has 'natural intuition' towards language, as characterizes normal speakers. Second, while word evocation process has become 'deliberate' in the patient, the thought process that normally accompanies each language activity is no longer certifiable:

The patient certainly speaks without thinking first. He does not speak via thought, as Hochheimer says, it is an action brought on by involuntary words. The speech is not meaningless, it holds a lot of knowledge and usually leads to some kind of solution to the problem, but such language does not imply simultaneous mental work, it contains intelligent arguments that do not come from present thinking. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, / 1971: 342-3;: 342-3;original italics) The way in which aphasic individuals carry out the verbal conclusions described above bears witness to a use of language which bypasses mental work. But what is this mental work, involved in language and carried out at the moment of speaking, this 'present thinking' that the patient no longer is able to do?

Mental work is apparent according to Goldstein in the normal use of language, a use that he also calls 'representative' or 'symbolic'. Words used by aphasic patients 'are only linked to personality by a wholly external relation-ship. They do not enlighten us, they are only an instrument of action'. Instead, words used in a representative manner are 'linked to objects by a sense link.' [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 335): 335). This sense must not be mixed up with the meaning that each word carries and which is found in dictionaries. Another of Goldstein's comments provides us with a clue to grasp this sense more fully:

As soon as man uses language to establish a living relation with himself and his peers, language is no longer an instrument, no longer a means, it is a manifestation, a revelation of our intimate being and the psychic link that unites us with the world and fellow beings. (Goldstein, 1933/1971: 344) 11 For Goldstein, the ability to stare down at the world and its link with oneself seems to be simultaneously the result and the condition of a normal use of language. If language always represents the world as the link uniting one with the world, as Goldstein says, each linguistic activity must be accompanied by present thinking (mental work) to produce this specific representation of the world. Thus, the semantic link between the word and the world is rather an abstraction made by the linguist analysing the products of language or an abstraction that takes place under pathological conditions when speech slows down or stops. In the real flow of speech there is always an interference between this semantic link and the intimate link of the subject with the world, the latter being produced in the present thinking that accompanies each linguistic production.

In terms of language this present thinking is theorized by [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 309-10) : 309-10) through the notion of 'word-concept' (Wortbegriff) which is 'a determined viewpoint of whatever is being experienced, a certain language attitude we choose in the presence of a word, a sentence, etc.'. There exists, according to Goldstein (1932: 155) a 'specifically linguistic experience' (Erlebnis des spezifisch Sprachlichen), a perception of the way in which a word is expressed in its language form and this perception allows us to consider words as 'attached to the subject'. 12 At the end of 'The analysis of aphasia and study of the essence of language', Goldstein makes a comparison which seems strange to contemporary readers, more used to sober rationalism. While speaking subjects repeatedly reveal the link that unites them to the world, the world is never deprived of soul for the speaking subject. We always create a meaningful link towards the objects of the world when we speak of them, and thus we perceive them as animated, endowed with a soul. Such being in the world, represented by the subject through language, a being in a world 'which is never bereft of soul' [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 344) : 344) is thus affirmed by Goldstein as the state of normal psychism and the condition of normal language functioning.

Conclusion: a knowledge principle for social sciences

From the point of view of a psychopathology research, the comparison of Jakobson's and Goldstein's approaches allows us to appreciate the key importance of the latter's works, which in my opinion is linked to the following, apparently non-modern concept: the essence of language. Goldstein uses it in the title of his 1933 text and clarifies it in the first paragraph. He sees the concept as a:

knowledge principle from which we can grasp the activities of organisms that we represent as depending on this principle. The 'essence' is only revealed to us in operations and it is after such operations that we construct an image of it. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 291;: 291;original italics) Goldstein thus undertakes the analysis of a subject's language behaviour from a very specific point of view, i.e., aiming to produce a representation of the intimate link holding the subject together with the world. This does not mean that the study of language ought to recreate this representation, which is always individual, intimate and idiosyncratic, but such research aims to describe and grasp the language operations that might allow us to do so. Consequently, 'specifically linguistic aspects' are the object of the research on language because they bear witness to language as the essence of operations. We can never construct such knowledge of language in a generic model since it must be produced on the basis of completed linguistic operations and is never independent of the knowledge of the latter. This is precisely the basis of the following difficulty mentioned by [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 291): 291): 'We do not hide the great methodological difficulty that descriptions of operations and of the essence of language both condition and support one another'. Goldstein actually talks about descriptions, but does not attempt to give an explanation. 13 The difference between Goldstein's approach and that of Jakobson, as well as much of modern linguistics, is surprising. Jakobson's project was to deduce from a theoretical model of language the symptoms that would prove the existence of language impairments of a predicted type. Yet Jakobson does not try to describe linguistic operations but to highlight them in certain wellstabilized ways. According to his model, the change that future research might bring is, at most, further aphasia classification proposals, which become increasingly complex in order to represent the largest number of clinical cases. This would ultimately allow the identification within each patient of a specific mode of normal language functioning.

Goldstein's approach is very different. Instead of developing, or basing himself on, a language model, he argues in favour of studying the essence of language; this does not enable -as he says himself -definitive knowledge, as this 'is only possible when basing one's ideas on certain metaphysical hypotheses'. Yet such research is sufficient to 'achieve such results as to make intelligible the behaviour of organisms in various possible situations' [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF](Goldstein, /1971: 291): 291). Goldstein does not give up the possibility of making both normal language and impaired language behaviour intelligible, but he claims that it is not possible to do so based on a model of language, be it structural, linguistic, neurolinguistic, psychological or clinical. Does Goldstein's method suffice when research is situated within an established scientific field? By taking this question into account, I can attempt to answer the opening question: why was there so much interest in language in the 1920s and 1930s? Goldstein claims that it is the use of language by individuals, which most clearly reveals that spontaneity and productivity are the 'deepest essence of man', a productivity that then means that all knowledge of human beings is provisional. Goldstein shared with many other researchers the project of grounding a social science in full conformity with this postulate. If such a project has not lost its attractiveness, in particular in the area of neuropsychiatric pathologies, it would confirm my opinion that scientific development is not purely linear.

Notes

1. This article was first published in French as: Psychopathologie et essence du langage: l'aphasie interprétée par Kurt Goldstein et Roman Jakobson. Psychiatrie, Sciences humaines, Neurosciences, 5, 22-36 (2004). 2. Parts of Goldstein's article in the Journal de Psychologie are similar to his Hamburg congress presentation (Goldstein, 1932). 3. Villard andNespoulous (1989: 27) write: 'We recognize that formal linguistic theory provides essential tools for the structural description of pathological language. But things do not look quite so good if we try to characterize or even explain the genesis of aphasic behaviour in linguistic terms of structural deficits […].'; see also Dubois (1977: 36). 4. [START_REF] Jakobson | Aphasia as a linguistic topic[END_REF]Jakobson ( /1971: 232) : 232) writes: 'The two opposite tropes, metaphor and metonymy, present the most condensed expression of two basic modes of relation: the internal relation of similarity (and contrast) underlies the metaphor; the external relation of contiguity (and remoteness) determines the metonymy.' 5. Jakobson's model was tested and made more complex in later studies; see [START_REF] Dubois | De la linguistique à la neurolinguistique: 1939-1976[END_REF]. 6. Howard and Hatfield (1987: 45) refer to Goldstein as 'the epitome of holistic and organismic aphasiology'. Goldstein, in his publication La structure de l'organisme. Introduction à la biologie à partir de la pathologie humaine (1933/1995), develops his idea, summarized by Gurwitsch (1940: 245) as follows: 'Any vital expression must be brought back to the entire organism, it must be considered an expression of that organism, its concrete current state, the general tendencies which dominate it'. For Goldstein's life and works, see Simmel, 1968. 7. The concept of anxiety plays a central role in Goldstein's conception (1959Goldstein's conception ( /1971: 5-9): 5-9). 8. [START_REF] Goldstein | L'analyse de l'aphasie et l'étude de l'essence du langage[END_REF]Goldstein ( /1971: 289) : 289) is very firm: 'Attitudes which remain in the patient never appear that way in the normal subject, even at earlier ontogenetic stages' (original italics). 9. Goldstein was already interested in this type of aphasia in 1905; see also [START_REF] Goldstein | Über Aphasie[END_REF]. 10. Vermersch situates evocative memory towards episodic memory (itself linked to personal experience, events which have been experienced in a precise time and place by a person) rather than in the area of semantic or generic memory; see, for example, [START_REF] Tulving | Elements of Episodic Memory[END_REF]. 11. For Walter Benjamin (1935/1980: 480), it is this non-instrumental understanding of language, developed by Goldstein, which is at the basis of a modern sociology of language. 12. See more details on 'specifically linguistic aspects' in [START_REF] Friedrich | Die Apperzeptionsgebundenheit des Sprechens. Ein historischer Exkurs in die Diskussion um die innere Sprache[END_REF][START_REF] Jakobson | Linguistic glosses to Goldstein's 'Wortbegriff[END_REF]/ 1971) develops some thoughts on Goldstein's word-concept by highlighting the fact that there exists in our verbal behaviour 'various degrees of switching off the signans' (p. 269). There are situations in which the word-concept is radically freed from the sensory and motor phenomena of signans (particularly noticeable in language disturbances), and it then appears as a 'disembodied 'word-concept' (Wortbegriff)' (p. 269). Nonetheless, and in this Jakobson agrees with Goldstein, 'a zero signans and the rules of its relation to the verbal environment remain' (p. 270). 13. The desire to explain is not absent from Goldstein's work (1941Goldstein's work ( , 1948) -see, for example, his proposition for explaining aphasic phenomena by distinguishing between an abstract (categorical) attitude and a concrete attitude of subjects, with a preference for concrete attitudes in pathological cases. This explanation model gave rise to Goldstein's reputation in psychopathology, but has also been considered inaccurate. I do not dwell on this because the conception of language proposed by Goldstein can be reconstructed precisely without referring to the model.

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