Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  And waters clear, of Reason…

  If Mary’s illness was precipitated by the fact that the attentions of the brother she had effectively raised now lay elsewhere, her delirium, alongside his searing disappointment in love, played into the serious bout of ‘melancholy’ or ‘temporary frenzy’ Charles himself suffered at the end of 1795. Describing the illness in a letter to Coleridge (11 June 1796), he writes that a ‘tide of melancholy rushed in again, and did its worst mischief by overwhelming my reason’. Charles voluntarily confined himself to the Hoxton madhouse for six weeks, only coming out for his twenty-first birthday.

  At play in Charles’s bout of illness were not only a hopeless love and the family’s straitened circumstances, but the prospect, hardly attractive to a budding poet, of an interminable office life in the accounts section of the East India Company. Like some perspicacious contemporary adolescent, Charles in talking about his illness was also aware that weeks of high excitement, drinking and talking with the unstoppable Coleridge resulted, after his friend’s departure, in an uncontrollable descent. Indeed, Coleridge’s heady influence combined with heavy drinking remained a salient fact of Charles’s life. The later nineteenth century or our own time might well have medicalized the drinking and linked Charles’s recurring cyclical depression to alcoholism: he often needed drink to write; drink also lubricated his alarming stammer into what many considered charming wit.

  But Charles’s ‘hidden maladies’ were never again to take him to a madhouse–except when he was accompanying his sister. It could almost be said that Mary bore the madness for the entire family. Arguably, she had learned a little of its attractions and, one might speculate, its ‘behaviours’ from her favourite brother. Madness had, as many mind doctors were to note, its secondary gains. It had an enviable quality of escape about it, as Charles underlined to Coleridge, who was himself hardly immune to its charms as well as its horror:

  At some future time I will amuse you with an account as full as my memory will permit of the strange turn my frenzy took. I look back upon it at times with a gloomy kind of envy; for, while it lasted, I had many, many, hours of pure happiness. Dream not, Coleridge, of having tasted all the grandeur and wildness of fancy till you have gone mad! All now seems to me vapid; comparatively so. [11 June 1796]

  Mary’s murderous madness came some three months later. On 21 September 1796, the evening before the event, her state already so worried Charles that he rushed out first thing in the morning to find the doctor. But Dr Pitcairn, whose uncle had been the Christ’s Hospital school medic, was not at home and when Charles returned he found the bloody scene which was to colour the rest of their lives. On 27 September, he communicated the ordeal to Coleridge: ‘I will only give you the outlines:–My poor dear, dearest sister, in a fit of insanity, has been the death of our own mother. I was at hand only time enough to snatch the knife out of her grasp. She is at present in a madhouse, from whence I fear she must be moved to an hospital.’ Charles’s directness in naming Mary’s condition, his fear that she might be moved from a private madhouse to a public hospital, indeed the entire way in which her condition is described, interpreted and managed, pinpoints this period as a key transitional moment in the understanding of madness and the institutions and legislation which surround it.

  Little, of course, is as unstable as the ways in which madness is viewed in any given cut through its history. Competing definitions, causations, symptoms, treatments and cures seem ever to be at hand. There are, however, dominant trends to which loose dates can be put. This turn of the century in England, where madness was writ large in the fate of George III, could be said to mark the move from one era into another.

  MADNESS AND THE LAW

  Until the end of the eighteenth century, Common Law–the system of traditional law in Britain built up case by case out of individual judges’ rulings–dealt with criminal insanity in two interrelated ways. Either the subject was deemed ‘unfit to plead’–which could, nonetheless, result in a judge asking for her to be confined. Or the subject could be tried, deemed insane at the time of the crime and then acquitted on grounds of that insanity. The great jurist Sir William Blackstone in his Commentaries on the Laws of England (1765–9) supplied the broad guidelines: those who suffered from a ‘defect of understanding’ such as children, or a deficiency of will such as lunatics, could not be held accountable for their own acts, not even treason.

  In the summer of 1786, Margaret Nicholson had tried to stab George III with a blunt dessert knife. Like Mary Lamb, she was never brought to trial. Indeed the King had shouted out to his guards, ‘Take care of the woman–do not hurt her, for she is mad.’ The Privy Council committed her to Bethlem after examination by Drs John and Thomas Monro, two of the family of four physicians associated with the hospital who ran it over a period of 128 years.

  Bethlem Hospital, the Bedlam Charles Lamb feared his beloved sister might end up in, was one of the oldest asylums in Europe. Founded in the thirteenth century, the City of London took on the running of it in 1547 and continued to do so until 1948. Although there were several other charity-run asylums by the late eighteenth century, Bedlam remained the sole public institution–one with both paupers’ and private quarters. It loomed large in the popular imagination and was a regular haunt for Sunday pleasure-seekers avid for the spectacle Hogarth so sensationally portrayed in the final tableau of his Rake’s Progress, where the ranting and raving, chained and maniacal Bedlamites stand in for all Britons.

  In 1758, thirty-eight years before Mary Lamb’s crime, Bethlem was attacked by the founder of the competing St Luke’s, William Battie. His influential Treatise on Madness, the first tract to call for a proper study of a field which had been left too long to stagnate amongst untrained ‘empiricks’, or quacks, attacked the ‘shocking’ and therapeutically stagnant techniques of the Monros–the repeated bloodletting, vomiting and blistering they administered. The Monros defended themselves but had no real therapeutic programme with which to counter Battie. Bedlam was a chamber of horrors where the Georgian mad were no better treated than chained, raving beasts. The great painter J.M.W. Turner’s mother, admitted in 1800, died here four years later. As an anonymous poet wrote:

  Within the Chambers which this Dome contains

  In all her ‘frantic’ forms, Distraction reigns…

  Rattling his chains, the wretch all raving lies

  And roars and foams, and Earth and Heaven defies.

  This was not the place Charles Lamb wanted his dear sister Mary confined to. Indeed, she had expressed a fear, even before the murder, that she might end her days here. The gallows at Newgate, which had shadowed both their childhoods, now also loomed uncomfortably close.

  Directly after he found his mother dead, his father wounded and his Mary blood-spattered and with the tell-tale knife in her hand, Charles acted with admirable quickness. Mary was taken to an Islington madhouse. Coroner and jury–who did not constitute a court, but came to establish the facts–followed his lead and deemed her insane. According to the existing legislation, a lunatic charged on a criminal offence could ‘be liberated on security being given that he should properly be taken care of as a lunatic’. In other words, Mary’s freedom depended on the responsible presence of someone who could guarantee care either in a private madhouse or by a custodian.

  The discretionary nature of the coroner’s ruling must have provided Charles with an additional challenge: would he, at his young age of twenty-one, be able to reassure the coroner that he was sufficient ‘security’, particularly in circumstances as financially restricted as his own? His speedy removal of Mary to the madhouse was a way of pre-empting an unfavourable ruling: his prior experience of the madhouse system was of undoubted use here. It was certainly Charles who also informed the coroner of Mary’s earlier madness: the mention of this in the Times report underlines its importance in the verdict of lunacy. This was a society and a family which shared a certain sophistication about what madness meant, and the patter
ns it took. Recurrence was already one of these.

  The law which allowed Mary’s release into a ‘care system’ would change and harden in 1800 when the king whom Shelley termed ‘old, mad, blind, despised’ was once more subject to an assassination attempt. This time George III was shot at during the opening night of Figaro, ironically an opera in which traditional hierarchies are in question. James Hadfield, a former soldier, had taken good aim with two pistols and missed his target by inches. Hadfield’s attorney, Thomas Erskine, who had also defended the revolutionary Thomas Paine, put forward an early distinction between madness which was ever and always a form of manic raving and a more nuanced version. He argued that although Hadfield wasn’t mad by what became known as the ‘wild beast test’–far too simple a definition of insanity in that it called for total deprivation of memory and understanding–he was nevertheless insane: ‘insane persons frequently appear in the utmost state of ability and composure, even in the highest paroxysms of insanity’. Hadfield had shot at the King because he suffered from delusion–which was the true character of insanity, when there was no frenzy or raving madness. Erskine’s language was borrowed from John Locke’s psychology. When his insanity plea held, despite the greatness of the crime, it enshrined a new, subtler definition of madness, both in law and in the public imagination.

  In one sense it is remarkable that Hadfield was acquitted and saved from being hung, drawn and quartered, the ultimate penalty for treason. After all, these were times of Terror: revolutionary wars were being fought, a neighbouring monarchy had recently been overthrown, and a king sent to the guillotine. On the other hand, given the very excess of a historical moment in which extreme acts were part of the political landscape, perhaps it was better and expedient logic to label an attempt on a king’s life as insane rather than revolutionary. Madness, it must be said, was a condition George III was not unfamiliar with.

  The ruling Erskine attained for the assassin pointed out a serious gap in the law–the very one which had allowed Mary Lamb her relative freedom. The man, deemed insane, who had shot at George III could soon be at liberty. An ‘Act for the Safe Keeping of Insane Persons Charged with Offences’ was rushed through Parliament. This guaranteed that any person charged with ‘Treason, Murder, Felony’ and acquitted on grounds of insanity would be kept in strict custody until His Majesty saw fit to release him. Hadfield was promptly incarcerated for life in Bedlam. Here the man who, during his trial, had a residual head wound so severe that the jury were invited to inspect the membrane of the brain itself, murdered another patient. Hadfield was indeed dangerous.

  Under the new legislation of 1800, Mary Lamb, who never attempted a violent act again, would not have been permitted the freedom she had, whether or not there was a brother to hand to act as her carer and an assortment of private madhouses ready to take her in when need became evident.

  THE GEORGIAN MADHOUSE

  The private madhouse, small or sizeable, was a particularly English institution, one which thrived in the largely unregulated eighteenth century economy. In its smaller configuration, the madhouse often grew out of an informal boarding arrangement. A local doctor, pastor or widow might take in a lunatic or two who couldn’t be housed at home because of danger, shame, disruption or the fear of publicity. Slightly larger premises, serving between a dozen and twenty boarders, could mean a profitable business. These dotted the countryside. Even the most substantial houses–Hoxton House, where Mary would eventually go, was one such–rarely numbered over two hundred patients. Indeed in 1826, when national statistics began to be available, under five thousand people were confined throughout England out of a population of some eleven million. This is a mere handful if one considers that by 1900 the beds in just two London asylums, Colney Hatch and Hanwell, numbered 4800, and the figure for public asylums nationwide was 74,000.

  Partly because of relatives’ wish for secrecy, records were rarely kept until an act of 1774 turned madhouses into ‘licensed’ establishments with some form of minimal regulation. The business of the houses was confinement rather than cure: some had no medical presence at all. This largely continued even after 1796 and the establishment of the influential ‘moral treatment’ at the Quaker tea merchant and philanthropist, William Tuke’s, famous York Retreat. Madness became pre-eminently a medical concern in Britain only gradually.

  Promise of therapy or not, the conditions in madhouses did worry people and, eventually, the government. Throughout the eighteenth century advertisements seeking custom for private madhouses hold out the promise of something better than the usual chains and brutality. Champions of the new-wave public asylums such as William Battie, founder of St Luke’s in London, stress the importance of care and the need for gentleness. They abhor the use of violence. In a competitive market, selling a madhouse to the better rank of patient and her family meant living up to an ideal. From these ads and writings, the contours of the period’s utopian asylum are clear: clean, temperate air, pleasant gardens, good fires, meat and drink, privacy as well as entertainment, and above all kindness, accompanied by visits from a private physician.

  Existing conditions rarely lived up to this ideal. Chains and various forms of restraint, brutality, theft by vicious carers, were all too common. So were dirt, filthy accommodation and worse sanitation, not to mention rape and beatings by carers. Paupers, needless to say, whose weekly payment was made by the parish, were treated far worse than private patients. These could expect regular visitors for whom appearances needed to be maintained.

  Profiteering by keepers was also rife. A little bribe could have patients confined well beyond any period of madness, if indeed any madness had ever existed. There were cases where keepers collaborated with siblings or partners in abducting and confining troublesome, though sane, members of families whose fortunes were worth stealing. Rebellious women like Maria, the heroine of Mary Wollstonecraft’s unfinished novel The Wrongs of Woman, who escapes the sexual captivity of marriage to a lewd, drunken husband, might also find themselves imprisoned in a madhouse so frightening it made them doubt their own sanity.

  Forced to take over his sister’s role as the person principally responsible for his family and its welfare, Charles Lamb managed to assuage an elder brother who would have preferred a pauper’s ward for Mary, and find the sizeable £50–£60 annual fee necessary for a private room and nurse at an Islington madhouse. It is most likely that the one Mary was taken to was Fisher House on what is now the Essex Road.

  Charles writes to Coleridge that the women looking after his sister were ‘vastly indulgent’ to her, that they treated her as ‘one of the family, rather than one of the patients’. ‘The good lady of the mad house and her daughter, an elegant sweet behaved young lady, love her and are taken with her amazingly, and I know from her own mouth she loves them, and longs to be with them as much.’ The lady of the madhouse also told him he could drop doctor and apothecary and save some money in the process.

  It is uncertain what kind of treatment, if any, Mary actually received. At the time there was a variety of available options, most of them aimed at calming frenzy or mania, ‘cooling’ the patient, as the left-over humoral understanding of the mind–body relationship dictated. Cold baths followed by hot, cropped hair to cool the head, digitalis or opium, purging and bleeding–any or all might have been used on Mary. Whatever the actual treatment regime, her ‘reason’ returned quickly.

  ‘My poor dear dearest sister, the unhappy and unconscious instrument of the Almighty’s judgments to our house, is restored to her senses,’ Charles writes to Coleridge on 3 October 1796, less than two weeks after the murder. As if suddenly aware that this was almost too speedy a return to reason for someone who has committed murder, he adds that it is also a return

  to a dreadful sense and recollection of what has past, awful to her mind and impressive (as it must be to the end of life) but tempered with religious resignation, and the reasonings of a sound judgment, which in this early stage knows how to distinguish
between a deed committed in a transient fit of frenzy, and the terrible guilt of a mother’s murder. I have seen her. I found her this morning calm and serene, far very very far from an indecent forgetful serenity; she has a most affectionate and tender concern for what has happened. Indeed from the beginning, frightful and hopeless as her disorder seemed, I had confidence enough in her strength of mind, and religious principle, to look forward to a time when even she might recover tranquillity.

  CHILDHOOD AND ITS DEFORMATIONS

  Two weeks after this letter, Charles writes to Coleridge again about his sister. This time in describing Mary’s condition, one particular feature of his letter evokes an eerily contemporary conception. Like some proto Freud or Winnicott, Charles distinctly places the genesis of Mary’s illness in childhood. Mary does, too. He quotes her as hoping that her mother and grandmother will understand her better in heaven. It was the latter woman who plagued Mary with a repeated and self-fulfilling condemnation of her ‘poor, crazy, moyther’d [muddled]’ brains. Charles underlines their own mother’s lack of affection as a precipitating factor in her daughter’s madness, coupled with the burden of Mary’s own sense of overarching filial duty.

  Poor Mary, my mother indeed never understood her right. She loved her, as she loved us all with a mother’s love, but in opinion, in feeling, and sentiment, and disposition, bore so distant a resemblance to her daughter, that she never understood her right. Never could believe how much she loved her–but met her caresses, her protestations of filial affection, too frequently with coldness and repulse…she would always love my brother above Mary, who was not worthy of one tenth of that affection, which Mary had a right to claim. But it is my sister’s gratifying recollection, that every act of duty and of love she could pay, every kindness (and I speak true, when I saw to the hurting of her health, and most probably in great part to the derangement of her senses) through a long course of infirmities and sickness, she could show her, she ever did. [17 October 1796]