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

by Lisa Appignanesi

  Both the dangers of madness and the danger of asylums preoccupied Wilkie Collins. He and Dickens both visited asylums. Indeed, their jointly written mock travelogue of 1857, The Lazy Tour of Two Idle Apprentices, contains an asylum described as:

  An immense place…admirable offices, very good arrangements, very good attendants; altogether a remarkable place [in which there are]…long groves of blighted men-and-women-trees; interminable avenues of hopeless faces; numbers, without the slightest power of really combining for any earthly purpose; a society of human creatures who have nothing in common but that they have all lost the power of being humanly social with one another.

  In his hugely popular novel of 1860, The Woman in White, Wilkie Collins put the many concerns Victorians had about insanity into dramatic perspective. Set in the decade after the law of 1845 was put in place–a law which should have eliminated the dangers of wrongful confinement by instituting stricter inspection of asylums and certification on admission–the book illustrates rampant social fears about mistaken incarceration and the ways madness can be induced. Collins graphically evokes the difficulty of an individual establishing a ‘sane’ identity once medical and social forces have combined to put the suspicion of insanity into play. He is alive to the way in which extreme circumstances–abusive relationships, the fatal power of suggestion by the strong over the weak, incarceration itself–can derail sanity. Through the fate of his two look-alike heroines, the ghostly Anne Catherick and the pure Laura Fairlie, Collins evokes the ways in which women are prey to corrupt men. Out to ensnare a wife’s fortune or a girl’s body, men in power can literally drive women mad, whether through marital sadism, drugs or sexual violation. Yet for all this, for Collins the sense persists that madness itself, however arrived at, can be dangerous–for the mad person as well as for those around her.

  The novel opens with a declaratory preamble in which Collins’s first narrator, the artist Walter Hartright, claims that the story will be told by witnesses to the events: the action is deliberately played out before the readers, who are in a sense invoked to become judge and jury. Who is to be judged mad, who bad, in the tumultuous stream of events that follows? The first of these is an encounter on a dark night on a lonely stretch of road just outside London with a woman in white. Lonely, helpless, gentle, beautiful, this intriguing creature asks nothing more of Hartright than that he let her leave him when and how she pleases–an apt request, given her history. When the smitten hero learns that the woman, Anne Catherick, is an escapee from an asylum, his musings sum up his time’s perplexity about the constitutive features of madness, its mystery, and about the rights and wrongs of confinement.

  …the idea of absolute insanity which we all associate with the very name of an Asylum, had, I can honestly declare, never occurred to me, in connexion with her. I had seen nothing, in her language or her actions, to justify it at the time; and, even with the new light thrown on her…I could see nothing to justify it now.

  What had I done? Assisted the victim of the most horrible of all false imprisonments to escape; or cast loose on the wide world of London an unfortunate creature, whose actions it was my duty, and every man’s duty mercifully to control.

  Collins’s novel highlights the ways in which asylum confinement can be exploited by treacherous men against innocent women. Both men and asylums drive women mad. Laura Fairlie is prompted into a disastrous marriage with Sir Percival Glyde, a man whose bullying hold over her makes her grasp on reason slip. She finds her sanity slipping further when he has her incarcerated–as he had Anne Catherick before her–and the asylum doctors refuse to believe her protests that she is not Anne. Her mad state is described as an extreme vulnerability, a childlikeness which is an excess of the girlish femininity she inhabited before. Anne Catherick’s madness, in contrast, has a monomaniac feel: she is reasonable until the villainous Sir Percival is mentioned, at which point a rage beyond reason overcomes her.

  The instant I risked that chance reference to the person who had put her in the Asylum she sprang up on her knees. A most extraordinary and startling change passed over her. Her face, at all ordinary times so touching to look at, in its nervous sensitiveness, weakness, and uncertainty, became suddenly darkened by an expression of maniacally intense hatred and fear, which communicated a wild, unnatural force to every feature…

  ‘Talk of something else,’ she said, whispering.

  Is this the kind of madness that needs vengeance to calm it, or incarceration? Surely not the latter, Collins seems to be saying, since the asylum proves therapeutic for neither of his victimized heroines. Even though doctors and premises seem pleasant enough, the asylum’s merciful control is simply a form of imprisonment: it mistakes sanity for madness as easily as it takes one person for another. If the individual cannot be recognized by medical authority, then what beneficial impact can that authority have on the individual mind?

  Collins’s attitude to women is at once conventional and decidedly radical. His hero’s preferred women–the beautiful, submissive, decorous, pious, elusive and good Laura Fairlie and her look-alike Anne Catherick–share that weakness of mind which is so susceptible to toppling into madness. The very childlike vulnerability which characterizes the period’s ideal feminine and cries out for male protection thus shades into the distraught madwoman who needs the moral management the asylum offers. On the other hand, Collins gives us Laura’s half-sister Marian Halcombe, a woman of great and outspoken intelligence, perfect grace and physical desirability, all marred by an ugliness of feature which is equated with the ‘masculine’. The disjunction between masculine ugliness paired with such evident desirability tips the male narrator into another kind of madness state–the discomfort of dream:

  To see such a face as this set on shoulders that a sculptor would have longed to model–to be charmed by the modest graces of action through which the symmetrical limbs betrayed their beauty when they moved, and then to be almost repelled by the masculine form and masculine look of the features in which the perfectly-shaped figure ended–was to feel a sensation oddly akin to the helpless discomfort familiar to us all in sleep, when we recognise yet cannot reconcile the anomalies and contradictions of a dream.

  These unreconcilable anomalies, Marian’s intelligence and evident sexuality, masculine in its directness, need to be conveyed as ugliness so as not to upset convention or seduce the narrator, thereby rendering Marian bad in the Victorian moral register. But to Collins’s credit, he labels Marian neither a neurasthenic nor a hysteric as the alienists of the time might well have. Instead, while she remains utterly laudable, though never the object of his hero’s desire, neurasthenia is attributed to the ‘feminized’ male, Uncle Fairlie, whose sensitivity is such that he can never leave his ‘aesthetic’ chamber to take part in life. As for ‘absolute insanity’, for Collins it exists not on that shadowy borderline where the sexes slip into each other and partake of each other’s attributes, but at the extremes of the period’s feminine where weakness is prey to the malevolence of men and the marital, hereditary and mental institutions they have put in place.

  The case of Hersilie Rouy

  The memoirs of Hersilie Rouy share more than a melodramatic plot line with The Woman in White. Both books call on us to judge questions of sanity and the reigning system of confinement. Despite the inevitable one-sidedness of personal recollection and the heightening of experience that the writing of memoir often entails, Hersilie Rouy’s Mémoires d’une aliénée remains a vivid document detailing the abuses inherent in the asylum system. It also shows how quickly the profession of alienism had grown, students attaching themselves to famous doctors, and medical loyalty displacing the needs of patients.

  Born in Milan in 1814, Hersilie was the illegitimate daughter of the astronomer Henri Rouy with whom she lived until his death in Paris in 1848. Known as a proficient pianist by Paris society, she was mysteriously removed from her apartment, probably at the conniving of her half-brother, in 1854. Her belongings were seized
and she was taken first to Charenton (where she may have been attended by Louis-Florentin Calmeil, who had served as inspector there), then to the Asile de Maréville and finally to the Salpêtrière. Here the well known alienist Charles Lasègue, a latter-day member of the Esquirol circle, though one who had fallen under the new wave of conservative clerical influence in the 1840s, examined her. In a way that foreshadows a modern entrapment within diagnosis, Rouy invokes the system of medical referrals which ensnare her: ‘He saw me for only a minute or two…and he sentences me on the strength of Doctor Calmeil, who sentenced me on the strength of a doctor who had never seen me at all, who took me away as a favour to somebody else, on the strength of what they had told him.’

  From the 1850s to the 1870s Lasègue worked painstakingly on a clinical study of hysteria, not a fashionable diagnosis in those years. He proceeded by examining single symptoms–such as the cough, anaesthesia or lack of sensation, loss of appetite–in order to try and recompose the whole malady, which according to anecdote he called ‘the wastepaper basket of medicine where one throws otherwise unemployed symptoms’. But despite her independence, her lucidity, her combativeness, her sense that writing kept her sane–all features that could have earned Rouy a diagnosis of hysteria–Lasègue, it seems from a letter she discovered, described her as suffering from something called folie lucide, or lucid madness. The diagnosis was based on the state she was in on her arrival in Paris. In her possession she had a ‘delusional letter containing threats to the police station of the Seine [department]’.

  Lasègue names Rouy ‘Chevalier’, the name given her by a doctor called Chevalier and one which, like a slave, she found herself bearing whatever her protests, as if the very fact of illegitimacy deprived her of an identity. Refused her birth name, Rouy signs her many letters to doctors and civil authorities with a variety of appellations not calculated to prove her sanity: the Antichrist, the devil, sylphide, Polchinelle–the last the name the other inmates gave her because she understood them better than the doctors and, when called, took up their cause with the cudgel of her witty pen. Asked at one point if she still uses all these varying signatures, she tells the doctor, ‘Of course! There is no law forbidding the use of pseudonyms, especially when one is officially anonymous.’

  When Rouy refuses to play the piano the doctor knows she can play, she is told she suffers from ‘incurable pride’. When she protests against her incarceration and demands compensation for the wasted years, she is told, ‘Your delusion is total, and all the more dangerous and incurable in that you speak just like a person who is fully in possession of her reason.’

  Sent to provincial Auxerre after she has proved too difficult at the Salpêtrière, and incarcerated there for five years, Rouy continually battles for her release with a passionate and justified sense of the wrongs she has suffered. There seems to be no way out of the trap: once one doctor has called her mad, all others follow suit. At last, Rouy meets the Inspector General of Asylums who is impressed enough with her to send two officials to see her: ‘They came to test my thinking, my beliefs, to see if there were grounds for keeping me in perpetuity…How can you destroy the future of a woman and allow her liberty to be assaulted simply because she carries her head high and has the audacity to want to live from her own talent and her own writing? I have been buried alive.’

  Despite the fact that her half-brother, now the director of a newspaper, didn’t want her released and conspired against her, the arrival of identification papers from Milan, fourteen years after her incarceration, linking her to a member of Napoleon III’s household cavalry, changed everything. Suddenly release looked imminent. But because Rouy wanted to make her wrongs public, the medical profession closed ranks against her once more, all of them testifying to a madness that was belied by the reasonableness of her letters, which reached as high as the Minister of the Interior. He demanded an inquiry.

  Calmeil, her early doctor at Charenton, defended his incarceration of her. The minister might well have seen ‘Chevalier’ when she appeared sane, but that was because she was in a ‘latent state of alienation’. The source of her insanity, he wrote to the minister in a letter of 22 May 1869 was that ‘she tired her nervous system by an excess of late nights and by her diligence in study and in her devotion to music…her life was filled with emotions’. This fatigue of the nervous system, the curse of books and music for impressionable women, are tropes that will appear again and again in a round of diagnoses from neurasthenia on. What seems unusual in Rouy’s case is the length of time she is trapped in the claws of an intractable asylum system. She is early proof of the experiment set up by David Rosenhan in America in the 1970s, which showed how easy it was for a sane person to be admitted as insane into a psychiatric institution and, once admitted, how nigh-impossible it was to demonstrate sanity. Rouy’s difficulties are compounded by her demands for rights, for judicial hearings, for compensation and vindication. The doctors, the entire establishment that adjudicates on asylums, dig their heels in.

  The Inspector General of Asylums puts the matter to the Minister of the Interior in what has become the classic way of professions:

  I cannot grant that ten, fifteen people with official titles, esteemed, honoured, of whom several are justly cited in the scholarly world as being masters, could have each of them become complicit in a bad action, in a crime…you are accusing not only these men, but also all the functionaries, judges, and others who had, during the long seclusion of your protégée, been forced to hear, listen to and judge her numerous and incessant protests.

  Rouy, an early anti-psychiatrist, didn’t give in: she had no intention of either hiding what she had undergone or excusing those responsible for her incarceration. In 1878, twenty-four years after her initial confinement, the Ministry of Justice at last saw the rights of her case and offered her 12,000 francs compensation, together with an annual pension. She was to benefit from it for only three years before she died, in 1881 at the age of sixty-seven, two years before her memoirs appeared.

  THE DECLINE OF THE THERAPEUTIC ASYLUM

  What Rouy’s memoirs make clear is that the ideal of the therapeutic asylum of the early nineteenth century had foundered. As the pressure of numbers in the asylums built up over the coming decades, moral management with its advocacy of cure often gave way to simple, often brutal, containment. Despite their medical training, and faced by the intractability of many mental conditions, the alienists or psychiatrists in charge were no longer much better than the old Bedlam caretakers. A therapeutic pessimism set in, bringing with it matching theories of degeneration: biological inheritance, it was now thought, paved the way to madness as well as to criminality. Both were abetted by alcohol in an ever downward generational spiral which gathered physicality, morality and poverty in its swoop.

  Dementia of the kind that was later discovered to be part of the progress of syphilis and led to what was called ‘general paralysis of the insane’ had never, even with Pinel’s optimism, been a condition susceptible to cure. Nor had alcohol-related insanity, or the dementia linked to old age and ‘imbecility’, which might now be categorized under the large umbrellas of Alzheimer’s and either ‘learning difficulties’ or ‘autism’. As nineteenth-century family patterns changed in the crowded conditions of city and slum life, removing sufferers from the care of relatives, the asylums provided by the new state regulations were themselves gradually filled to bursting. Their very success became their failure. They grew into ‘bins’–the ‘snake pits’ of horror movies, worse than any Bedlam. In 1827, the average asylum in Britain had housed 116 patients; by 1910, the number was 1072. The vast Colney Hatch, which had opened in 1851 to house 1220 of the lunatic poor, was filled almost immediately. A census of the insane in 1854, including public and private asylums, noted a doubling of figures over ten years to a total of 30,538. The English malady was on the rise. John Hawkes, the medical officer of the Wiltshire County Asylum, worried: ‘I doubt if ever the history of the world, or the experience of
past ages, could show a larger amount of insanity than that of the present day.’ Even the increasing presence of alienists–hardly in line with rising numbers–could make little therapeutic difference.

  Contesting explanations for this rise in asylum numbers were rife. Few pointed to the existence of the asylums themselves and the changing family patterns urbanization brought as reasons, which is what historians today argue–unless, like Foucault, they postulate a disciplinary movement in a society which chose to incarcerate deviants of any kind, alongside the ‘mad’. Was the apparent increase in madness ‘a manifest fallacy’, really due to new and more sophisticated diagnoses and statistics, as was claimed by the Journal of Mental Science, born in 1853 and first edited by the powerful quartet of medics and asylum heads, John Bucknill, C. Lockhart Robertson, Henry Maudsley and Hack Tuke? (The journal was later to become the British Journal of Psychiatry, but was already then the official voice of the budding profession.) Or was the rise in numbers due to the escalation of neurosyphilis, to chronic conditions and alcohol-related madness, all of which could be linked to the growth of vice, which frightened Victorians and French moralists alike?

  Emil Kraepelin (1856–1926), the leading fin-de-siècle asylum psychiatrist, gave the syphilis and alcoholism argument solid legitimacy. An exemplary Munich-based asylum diagnostician who eventually rejected Freud’s dynamic psychoanalysis and put the periodicity of manic depression into the medical textbooks, he bemoaned, in his 1895 lectures, the fact that the asylum population in Germany had risen to two hundred thousand and become a much increased proportion of the population. Sufferers from syphilis and alcoholism accounted, he claimed, for one-quarter to one-third of the cohort. He feared for the increasing degeneration of his race. Kraepelin also underlined that the insane were dangerous to their neighbours and even more so to themselves: around a third committed suicide. The only therapeutic hope lay in attacking alcoholism and syphilis, together with the ‘drug abuse’ of morphia and cocaine. The ‘prophylactic education of children’ was called for. None of these, needless to say, were therapies that could take place within the walls of the asylum. Rather, they required moral and social transformations.