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

by Lisa Appignanesi

  In December 1799, de Méricourt was amongst the women transferred to the Salpêtrière where Pinel had taken over and begun to establish his therapeutic regime. De Méricourt, however, protested at whatever treatment it was that she received, and was soon sent to the Petites-Maisons hospital. In 1807 she was returned to La Salpêtrière, where Esquirol was now in charge of the patients. In Des Maladies Mentales, the drawing of her that Esquirol commissioned from the former guillotine artist Georges-François Gabriel shows a fierce, ravaged beauty, with short spiky hair and an expression of great intensity. Esquirol himself–fully aware that he has a ‘curiosity’, a relic from the Reign of Terror, amongst his patients–describes her as a woman of middle height, with chestnut hair, large blue eyes, mobile physiognomy and a quick, casual, even elegant demeanour. By the time he writes his case history, he has taken on the conservative tone of a man of the Restoration. He is quick to blame the Revolution for de Méricourt’s madness. He deplores her ‘loose’ actions at the time. ‘She gave herself to various heads of the popular party whom she served during various disturbances’, and ‘especially contributed, during 5–6 October 1789, to corrupting the Flanders regiment by bringing prostitutes into the ranks and distributing money to the soldiers’. He disapproves not only of Théroigne’s revolutionary activism but also of her sexual activity, let alone her current monomania about people’s degrees of radicalism and political affiliation.

  She was very agitated, swearing, threatening everyone, talking of liberty and committees of public safety, revolutionaries, etc., accusing everyone who approached her of being a moderate, a royalist, etc.

  In 1808, when an important man, who had been head of a political party, came to see her at the Salpêtrière, Teroenne [sic] recognized him, rose from her straw bed, swore at him roundly and accused him of having abandoned the party of the people, of being a moderate, whom an arrest warrant from the Committee of Public Safety would soon bring justice to.

  Esquirol’s disapproval, however, fades into sympathy as de Méricourt’s condition is aggravated and she falls into a state of dementia, in which ‘traces of her dominant ideas’ are still visible. Interestingly, no Pinel-like appareil, or ploys or bits of stage management, are used to rupture the cycle of her delusional thinking and fixed ideas. Perhaps she was already considered to be too far gone. For the rest of her life, she remained trapped in the tumultuous years of the Revolution.

  Whatever improvements ‘moral management’ may have brought to the care of patients, de Méricourt’s living conditions are barely adequate. Esquirol continues:

  She can hardly bear to wear any clothes, not even a chemise. Every day, morning and night and at regular intervals through the day, she pours several buckets full of water over her straw bed, lies down in it and covers herself with a sheet in summer and a sheet and blanket in winter. She likes to walk around barefoot on the wet stone floor…

  Despite the small dark humid room without furniture, she seems happy enough. She pretends to be busy with important things, she smiles at people who come up to her…in a low voice, she repeats phrases in which the words fortune, freedom, committee, revolution, decree, idiot, arrest warrant repeat themselves. She hates the moderates…

  She hardly leaves her cell and is normally lying down. If she comes out, it is naked or wearing only a chemise. She only takes a few steps, more often, she walks on all fours or stretches out on the ground. Her eyes fixed, she picks up whatever morsels she can find and eats them. I’ve seen her devour straw or feathers or dry leaves, pieces of meat that have been dragged through mud. She drinks the water from the gutters while the courtyard is being cleaned; though the water is foul and full of excrement, she prefers it to all other drink…All sense of modesty has left her and she doesn’t blush to find herself naked in the full view of men…

  De Méricourt died at the age of fifty-seven on 9 June 1817, having spent the last ten years of her tumultuous life in Esquirol’s Salpêtrière. Describing the post-mortem–post-mortems were carried out on most patients–Esquirol comes full circle to where he began his case history to note that de Méricourt’s colon had moved out of its proper place and was close to her pubic bone. It is something he has observed in other monomaniacs who also suffer from depression. The observation apart, he proposes no causal links from the physical to the mental.

  Despite the case of Théroigne de Méricourt and others like her, Esquirol is generally optimistic about the possibility of cure. He offers little new, however, apart from douceur and the ploys that never seem to have been used on de Méricourt. Lukewarm baths, antispasmodics, together with the moral treatment in which understanding is combined with ingenious subterfuges devised by a doctor of experience and talent, are the chosen therapies. There is no attempt to mask the fact that patients often suffer a relapse.

  Under his classification of mania, Esquirol includes cases which within a contemporary diagnostic regime would be reclassified under obsessive-compulsive disorder or manic depression. It is interesting to note that these cases–from both the upper and the working class and monitored over years–meet with no more or less success than those treated by contemporary psychiatry. Esquirol’s patients go home, sometimes permanently. Others return six months or two years later. The asylum renders them ‘better’, but life often seems to shunt them straight back into care. Monomania in its emphasis on partial madness may be a diagnosis that offers hope, yet the hope is never much more than modest.

  It is possible–as historian Jan Goldstein argues–that were it not for the controversy stirred by Esquirol’s pupil Etienne-Jean Georget in 1825–6, monomania would have kept to the confines of the asylum. Instead, in the way of imperializing diagnoses–hysteria, multiple personality disorder and latterly OCD–it became something of a cultural phenomenon. To use the philosopher Ian Hacking’s term, monomania made people up–shaped and stirred and suggested them into a configuration which for a while was contained by, then amplified, the diagnosis.

  What Georget did was to give the profession of alienism a wider brief by taking this diagnosis of monomania into the courts. Like some talented contemporary reality-TV courtroom presenter, he graphically conveyed the case of what he called the homicidally monomaniac mad in order to distinguish them from the murderous bad. This is the moment at which alienists take on a key role as expert witnesses, usually for the defence: simultaneously the terrain, the popularity and the familiarity of the new diagnosis grow. Several criminal cases in which heinous, incomprehensible crimes are committed mark out the territory for the new alienism. Chief among these, for Georget, is the case of Henriette Cornier.

  HENRIETTE CORNIER AND HOMICIDAL MONOMANIA

  On 27 October 1825, Henriette Cornier, abandoned wife of a certain Berton, birth mother of two, took on a new post as servant to the Fourniers in Paris. She was twenty-seven years old. Over the last six months her normal ebullience had given way to a sad dreaminess, a sombre, taciturn manner which had resulted in her losing her previous job. The melancholy had gone so far as to lead her at the beginning of September to the parapet of the Pont au Change, where she was prevented from jumping only when passers-by threatened her with arrest. She reported this suicide attempt to her cousins, who eventually helped her find the new job.

  In the house next door to her new posting, there was a grocery run by a Monsieur and Madame Belon. The couple had two small children, a nineteen-month-old called Fanny and a baby who was boarded out with a wet-nurse. Henriette seemed enamoured of the little girl: she liked to exclaim over her and caress her. On 4 November, a bare ten days after her arrival, Henriette was asked to buy some cheese for dinner while her mistress went for a stroll.

  Henriette arrived at the grocers’ at about 1.15. Madame Belon had little Fanny in her arms and Henriette took her, murmuring regret that she didn’t have a child as sweet as this little girl. She already had a plan, she later said. The weather was fine and when Madame Belon said it would be lovely to go for a walk, Henriette urged her to run off a
nd get ready while she looked after the child at her own place. Madame Belon protested, but her husband intervened. Covering little Fanny in kisses, Henriette quickly carried her off.

  Back next door, Henriette went straight to the kitchen, found the big knife, and took the child to her room on the first floor just above the mezzanine. At the foot of the stairs she met Madame Drouot, the gatekeeper. Henriette cuddled the child fondly to her. When she reached her own room with its window overlooking the rue de la Pépinière, she stretched little Fanny out on the bed. With one hand she held up the small head and with the other, sliced it off. The child didn’t have time to scream. Blood spurted everywhere–on Henriette, on the bed, and into a chamber pot placed at exactly the angle needed to catch the flow. Henriette put first head, then body, on the window ledge.

  During all this, she later said, she felt no emotion, neither horror, nor pleasure, nor pain. Nor was she agitated. She performed the deed in a contained manner, not mechanically but with a certain careful precision. The sheer quantity of blood did, however, startle her into a momentary trembling. They will kill me, she thought. The person who kills, deserves death. She had considered this before, but only now, after the act, did the idea hit home and frighten her. She ran to take refuge in her master’s room. It was almost two o’clock.

  From the bottom of the stairs, Madame Belon called for her child.

  ‘She’s dead,’ Henriette shouted back from the landing. The woman rushed up, but Henriette blocked her entry. She pushed past into Henriette’s room and let out a curdling scream.

  ‘Get out, run. You’ll be a witness,’ Henriette shouted. It wasn’t clear whether she wanted the witnessing or was ordering the woman out of the way. But simultaneously, she threw the little girl’s head out of the window.

  Roused by Madame Belon’s screams, her husband rushed to Henriette’s house. Any disbelief his wife’s words had provoked was banished when he found his daughter’s head rolling towards the gutter. He just managed to take hold of it before a carriage clattered by.

  Henriette Cornier didn’t try to flee. She sat on a chair close to the body. The first person on the scene heard her moan, ‘I’m a lost woman.’

  By the time the police arrived, she was in the stupor that lasted the length of the interrogation period. Listlessly, she admitted to the crime, even confessed to premeditation. She gave no excuses, no extenuating circumstances, no motive. The idea simply took hold of her, she said. The action had to be carried out. It was her destiny. And why had she thrown the child’s head out of the window? So that there would be no question of her guilt, she replied. She seemed to her first questioners, as well as to the judge who led the inquiry, completely in control of her reason–but for the fact that there was no reason, no motive of any kind, for this monstrous crime.

  Henriette Cornier’s trial roused heated controversy. Was the woman insane? Or was she a murderer of the worst kind, cold and implacable in her malevolent determination? Commentators pondered her state of mind, her motives and the utter lack of them. They argued about the appropriate verdict, both before and after it was declared.

  For the first time, there were commentaries feeding into the verdict from those new kinds of doctors, the alienists. The recently launched Gazette des tribunaux, a popular outlet which, not unlike a dedicated cable channel, brought court reports into the public arena, gave her case in full. According to French law and Article 64 of the Napoleonic Penal Code, those who committed crimes in a state of insanity were exempt from responsibility. But at the very core of Henriette Cornier’s trial was the question of what exactly constituted a state of insanity, now that monomania had introduced a category of ‘partial’ madness.

  Where Mary Lamb had been quietly spirited away into a madhouse with no more than a coroner’s hasty verdict, Henriette Cornier’s trial turned into a public debate and heralded a new moment in the relationship between the nascent psychiatry and the courts. Mary Lamb had needed no more than her actions and her brother’s word to be deemed mad and therefore not responsible for her crime. Child-murdering Henriette Cornier needed a battery of experts, amongst them Esquirol, to attribute the category of ‘insanity’ to her brutal and seemingly motiveless act. The writing talents of Esquirol’s pupil Georget made the case a defining one for the diagnosis of ‘homicidal monomania’. It also set the new alienists up as border guards patrolling the line between reason and madness.

  Georget’s earlier pamphlet about a series of sensational murders had claimed that specialist doctors needed to examine the perpetrators of inexplicably hideous crimes to determine whether they were mad or not. It wasn’t just for the courts to be sending ‘unhappy imbeciles’, who should be in asylums, or at least under lengthy observation, to the gallows. These forceful arguments advocating doctors in the courtroom, and the ensuing public clamour, brought Esquirol and the specialists to the trial of Henriette Cornier. They examined her and asked for more time for observation. This was granted. When they claimed that yet more observation was needed, this, too, was granted. Arguably, medical evidence went some way to destabilizing a jury which finally skirted a verdict of madness, but determined that the abominable crime had been committed without premeditation. Instead of execution, Cornier was condemned to hard labour in perpetuity.

  Georget’s argument in Cornier’s defence takes as its starting point that insanity isn’t necessarily a set of visible actions and deluded associations–such as Hamlet had adopted in order to ‘play’ madness. The sufferer from monomania could well appear quite reasonable. Madness could be hidden, partial, and for long stretches make its way in the world as sanity. Only expert interpreters could read signs that might lie to the uninitiated. Monomanie homicide, a subcategory of Esquirol’s inclusive monomania, was a lesion of the will rather than the intellect, a perversion of the ‘affections, passions and sentiments’, and it could propel the person to sudden and brutal action.

  Henriette’s coldness, her lack of emotion, her stupor which was almost stupidity, all this together with her lack of motivation, her constant repetition to her interrogators that she simply wanted to do what she had done, that she was working out a desire, were all symptoms. They were signals to the experienced doctor of her monomaniacal state–or, to be more precise, of the ‘homicidal mania’ that Georget wants to see legitimated. So, too, was Henriette’s physiognomie–her lowered and fixated gaze, her sadness of feature–and her preoccupation with a dominant idea. On the day of the crime a local doctor had already described these self-same symptoms, as well as a slow and depressed pulse, a difficulty in hearing her heartbeat, a great sluggishness of response.

  In building his case, Georget pays little heed to the kinds of evidence a contemporary psychiatrist might have focused on to arrive at a diagnosis, probably of personality disorder. He mentions, but in no way stresses, Henriette’s earlier depression and her suicide attempts. Her difficult childhood, where there seemed to have been violence, plays a negligible part in the picture. Her own prior children are simply not part of the case, nor is there any speculation–as there might be today–that the distress attendant on their loss might have been a contributory factor in her ‘motiveless’ killing. What Georget does note is that her failed suicide is linked to the brutal murder of the child which would in a roundabout way achieve the desired self-annihilation.

  Cornier, herself, refused the designation of madness. During her observation at the Salpêtrière, she insisted that she shared nothing with the other inmates and refused to mix with them. The doctors argue that her very insistence on her sanity is the ultimate sign of her madness. This disagreement between doctors and patient indicates the new kind of medicine that is being constituted through the figure of Henriette Cornier. Georget is arguing that expert doctors can see beyond the patient’s individual, subjective perception. They listen, they are alive to her words and her personal history, they take note of the physiognomy of her state, they observe carefully: their assessment is ultimately more neutral than hers, mo
re ‘clinical’.

  Cornier’s case is perhaps the first instance we have in the annals of psychological medicine in which the female patient resists the doctors’ diagnosis: Henriette in that sense is akin to Freud’s Dora, who refuses the interpretation he gives her and flees. Henriette cannot flee: she is a servant and a murderer. She can only resist. It is worth noting that Georget’s argument in defence of her insanity is one that was later used in the 1950s by psychoanalysts giving evidence against the death penality to Parliament and by psychiatrists against capital punishment in America: to execute the murderer is to give her exactly what she wants–to collude with her desire for death, to collaborate in that very murderousness through which she madly sought her own annihilation. People may murder in order to commit suicide.

  In pleading, together with Cornier’s defence attorney, for the establishment of a diagnosis of homicidal monomania, Georget is allying himself with the progressive forces of his time and making a passionate case for a ‘just’ society. Better to keep the homicidal monomaniac in hospital than to execute her, he is saying. Even better, to hospitalize her before the murderous act occurs.

  The arguments of Cornier’s prosecutor and defence and their supporters in the press persist into our day. Is preventive detention for the dangerously insane–what we categorize as ‘dangerous personality disorder’–a breach of civil liberties? Should individual rights prevail over society’s call for security?

  A battle is being waged between social interests which demand justice and new systems [of thought] which claim to be defenders of humanity. It is you [the jury] who will decide these important questions…Man is composed of two parts: unregulated appetites which ceaselessly agitate him; and that rich portion of divinity which is reason and which man must obey like the son the father and the soldier his captain.