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

by Lisa Appignanesi

  The proportion of men to women in confinement has been much debated: while some have commented on the preponderance of women in asylums, particularly as the century progressed, others have noted that the difference between the sexes was not statistically significant. What became known as general paralysis of the insane, for example, a condition later linked to tertiary syphilis, began to rise sharply during the Napoleonic Wars, and was far more common amongst men than women. Women, on the other hand, lived longer, and therefore made up larger numbers amongst the demented old. There were also more women in the poorhouses in Britain, and movement from these to asylums was common. Where there is a definite preponderance of women is in the diagnosis of ‘neurotic’ disorders, the milder hysterias and neurasthenias which are the property not so much of the large asylum doctors, particularly when the patients are middle-to upper-class, but of the growing number of ‘nerve doctors’ in private practice.

  What is unarguable is that the rise and rise in numbers by the latter part of the nineteenth century led to a change in medical practice in the larger asylums. The clinical-pathological method, which moved back from post-mortem examination to attempt an understanding of the patient’s symptoms in life, had been a strand of investigation into madness from the early 1800s when Antoine-Laurent Bayle had studied the inflamed meninges of Esquirol’s patients and linked this to their mania and paralyses. Now this search for biological or physiological explanations moved to the forefront. In Germany Wilhelm Griesinger, known as the founder of biological psychiatry, definitively declared in 1867 that patients with mental illnesses were individuals with brain and nerve diseases. In Vienna Theodor Meynert, who taught Freud, was far more interested in his research into the frontal lobes of cadavers than in his living patients. In those overcrowded asylums where it existed, the march of science was increasingly separating itself off from therapy.

  Henry Maudsley (1835–1913)

  In Britain, one of the leading alienists of the high Victorian period and the fin-de-siècle was a sonorous proponent of the physical basis of all mental illness and a believer in degenerationist theories, which imagined the spread of insanity in the march of heredity. Through his many books and his editorship of journals, Henry Maudsley’s influence travelled across Europe and to America as well as Australia. Endowed with prodigious energy and a sense of life as a ‘stern duty’, a believer in a Darwinian or, more accurately, a Spencerian struggle for which the mentally weak were not fit, Maudsley became head of the Cheadle Royal Hospital for the Insane in Manchester at the startling age of twenty-four. But he had none of the early nineteenth century’s faith in the curative power of asylum life, and after a mere three years at Cheadle, in 1862 he moved to London where private practice and the Journal of Mental Science beckoned. Soon there was a professorship in medical jurisprudence at London University and a series of books, none more influential than his first, the widely translated Physiology and Pathology of Mind, published in 1867.

  Maudsley’s therapeutic pessimism, embedded in what seems to have been a native misanthropy, left no scope for any reformist hopes. Like the theoretician of criminal degeneracy, Cesare Lombroso, in Italy, heredity for Maudsley was destiny, physiology its sign. He had early taken up ideas of ‘moral insanity’. The ‘moral’ in the term is a far-ranging concept–as it is in moral reason–embracing not only the ethical, but the psychological and social, and relates, according to the Oxford English Dictionary, to matter ‘having influence on a person’s character or conduct, as distinguished from his or her intellectual or physical nature’. The concept of moral insanity had been elaborated by the medical criminologist, James Bruce Thompson. It infects Maudsley’s writing with a disciplinarian undertow devoid of compassion. Vice, for Maudsley, was everywhere, and everywhere visible in the ‘stigmata of degeneration’. Here, physiology itself takes on an ethical dimension: individuals are born with madness and badness already in them. Crime and mental illness stalk the teeming pauperlands of the Victorian city like a disease, which is the result of its inhabitants’ parlous state. To talk of survival of the fittest, Maudsley underlines, hardly means to talk of survival of the best: ‘it means only the survival of that which is best suited to the circumstances, good or bad, in which it is placed–the survival of a savage in a savage social medium, of a rogue among rogues, of a parasite where a parasite alone can live’.

  Natural selection is not the only idea Maudsley borrowed from Darwin. He takes his cue from him where women are concerned, as well, though leaves out Darwin’s more challenging propositions about the female choosing her sexual partner.

  In his Descent of Man and Selection in Relation to Sex of 1871, Darwin emphasized the difference between the sexes emphatically to women’s detriment, and with little sense that the source of what he described might have something to do with his own time’s cultural conditions. Basing himself on the physical anthropologists and the cranial measurements they had taken, Darwin noted woman’s smaller brain size and that she emerged with a skull ‘intermediate between child and man’. Accordingly, her mental disposition showed ‘greater tenderness’ and ‘less selfishness than man’. That male selfishness combined with ambition may be an ‘unfortunate birthright’, but these are qualities which nonetheless make man superior in the struggle for survival. In women, ‘the powers of intuition, of rapid perception, and perhaps of imitation, are more strongly marked than in man’. But these are no advantage: indeed, they mark out women’s inferiority since they are faculties ‘characteristic of the lower races’, and therefore of a past and lower state of civilization. Meanwhile, Darwinian men are endowed with greater ‘intellectual powers’ and attain to a higher ‘pre-eminence’ in any sphere ‘requiring deep thought, reason, or imagination, or merely the use of the senses and hands’. But above all else, what marks man as superior in the ongoing struggle for existence are his ‘higher energy, ongoing perseverance, and courage’. This stubborn perseverance is indeed what allows the male to win over the female.

  As if struck by a sudden worry about his own progeny, Darwin remarks towards the end of this chapter: ‘It is, indeed, fortunate that the law of the equal transmission of characters to both sexes prevails with mammals; otherwise it is probable that man would have become as superior in mental endowment to woman, as the peacock is in ornamental plumage to the peahen.’

  Darwin’s own genius, in perseverance as well as science, marks him out as his own superior male, while his woman is the frail, tender, maternal vessel of Victorian womanhood. The view was commonplace in Britain. Amidst alienists of the hereditarian school, like Maudsley, that frailty made women more prone to madness than men. Darwin and Maudsley were, of course, acquainted, each quoting the other. Maudsley, however, was beset by a visceral misogyny, which is absent from Darwin. If, for both, women are so formed as to look after children, for Maudsley this is a lowly task, equal to what he thinks of as the excremental nature of parturition. Men’s constitution makes them incapable of the necessary sympathy and attachment, let alone the ‘base services’ that the child requires. Maudsley urges men to examine potential wives carefully for any physical signs that might betray degeneracy: ‘Outward defects and deformities are the visible signs of inward and invisible faults which will have their influence in breeding.’ As for those ‘hysterics’ who begin increasingly to populate the fin-de-siècle, Maudsley sees them as morally degenerate: ‘believing or pretending that they cannot stand or walk’, only to lie in bed all day asking for the sympathy of their anxious relatives. They are ‘perfect examples of the subtlest deceit, the most ingenious lying, the most diabolic cunning, in the service of vicious impulses’.

  It was the very women Maudsley railed against, their nerves considered constitutionally frail, who would have a definitive impact on the course of his profession. As a therapeutic pessimism took over asylum doctors, private neurological practice rose and with it came a shift in diagnoses. Nerves and their attendant disorders gained in prominence as sites of illness and explanati
on. With the invention of neurasthenia and the reinvention of hysteria, a new kind of mind doctor came into being–one who had to listen to the patient as much as observe; one who would come to believe, as did Janet and Freud, Jung and Bleuler, that mental disorders had their roots in psychic problems whatever their expression in the body.

  4

  NERVES

  By the 1870s, commentators everywhere in Europe and America were adamant that life had taken on a clang, clamour and speed that acted as an irritant on the nerves. Sensations forced themselves on any and everyone, whether in real or fictional streets. The times themselves, it seemed, were a shock to the nervous system, with their crowds and dirt, and the inevitable ‘decadence’ that followed. Trains chugged, hooted, smoked, crashed and produced the trauma of ‘railway spine’ as well as a spate of railway murders. In Europe, driven by poverty or pogroms, people moved in ever greater numbers across borders and from countryside to town, or emigrated to the New World. Squalid housing, drink, that very crowding which gave birth to concepts of the mass and of degeneration, ensued.

  In Britain, the ‘undeserving poor’ drank and reproduced in slums, as the vice and temperance squads would have it, or prostituted themselves on streets where no middle-class woman, protected though she was by metres of skirt, bustle and corset, could tread. Mayhew numbered unlisted prostitutes at some eighty thousand in London alone, a startling figure which underlines just how important it was somehow to keep ‘the angel’ who was the Victorian wife in the house, so that double standards along both sexual and class lines could be maintained.

  In France, the Franco-Prussian War and the uprising of the Paris Communards left a legacy of death, displacement and class distrust: in la semaine sanglante, that single blood-soaked week of 21–28 May 1871, French troops, marching the length of Baron Haussmann’s new grand and commodious boulevards, and fired on their own compatriots. The death toll had mounted some say as high as 30,000. The Third Republic, born out of civil war, saw an infernal increase in traffic on these very same streets–some 60,000 clattering vehicles a day powered by 70,000 horses. Between these and the trams, by the end of the century 12,000 people a year were being injured, and over a hundred killed; and new, speedier means of transport were coming into being as men burrowed underground to produce the métro in time for the Universal Exhibition of 1900.

  America, recovering from the horrors of the Civil War with its five hundred thousand dead and countless wounded, moved into an expansionist phase in which the rapid accumulation of material wealth covered over any need for mourning–except by women, who became the guardians of that sensibility and culture the businessman might own, but have insufficient time for. Meanwhile, telegraphs ate up distance. Electricity invisibly produced instant light out of darkness. Vast new steamboats crossed the Atlantic in days, bringing the huddled poor one way and the travelling newly rich the other.

  By the time the century had turned, it had definitely become, as the Viennese novelist Robert Musil noted in his Man without Qualities, ‘a nerve-racked age’–one of ‘restlessness and constant change, of speed and shifting perspectives, in which something was definitely amiss’.

  Countless novels and stories dissected, described or emphasized what was amiss. As early as 1839, the American poet and great author of gothic tales, Edgar Allan Poe, had created characters whose nerves ‘by long suffering had grown unstrung’, particularly when their owners were scions of noble houses. The word ‘nervous’ had started off in the language as a synonym for strong, sinewy and energetic, and had grown, with the eighteenth century and Dr George Cheyne, to take on all the notions of an excitable, agitated, apprehensive and hypersensitive temperament. But by the mid-nineteenth century the word had become increasingly associated with mental features. In 1848, John Stuart Mill in his Principles of Political Economy notes, ‘Labour is either bodily or mental; or, to express the distinction more comprehensively…either muscular or nervous.’ This linkage of the mental and the nervous paralleled the neurologists’ and alienists’ focus on the brain as the centre of nerve and bodily activity. Evolutionary thinking collaborated in emphasizing the brain’s primary place: it had become the location of the distinguishing features of the human.

  As nerves and brain took on scientific and medical importance, they also became symptomatic sites of worry. Everything coalesced to produce a new kind of malady. Diagnoses focusing in on nerves coincided with symptoms which expressed a malaise with the stresses of the times as well as with gender restrictions. Any transgressing of the policed boundaries of what was appropriate to each gender took a toll on the nerves. In 1869, the condition was given its own name–neurasthenia–though the symptom picture had been more or less in place well before. The Woman in White (1860) had its Mr Fairlie, an ‘effeminate’, ‘womanish’ invalid who suffered from a disorder of the nerves. This entailed not only a hypersensitivity to light, sound, touch and motion and an attendant aesthetic over-refinement, but a weakened judgement.

  Some twenty-five years later Mr Fairlie’s French counterpart, Des Esseintes, the highly strung aesthete and hero of J.-K. Huysmans’s A Rebours of 1884, last in a degenerating line of inbred aristocrats, has similar gender codings–ones we would now openly read as homosexual. But Des Esseintes, unlike Mr Fairlie, has his maker’s sympathy. Indeed, Des Esseintes becomes the very icon of fin-de-siècle decadent sensibility, a man who is ‘against nature’ and, like a woman, is valued for his refinement. Depending on the critic’s relations to those opposed poles of artistic modernity and moral Victorianism, Des Esseintes was hailed or reviled. His mother, meanwhile, was the very type of the neurasthenic: ‘a tall, pale, silent woman, [who] died of nervous exhaustion’. The hero’s chief memory of her is almost a stock memory–repeated in fiction from Poe, through Silas Weir Mitchell and in modernist, bluestocking garb in D.H. Lawrence–of a ‘still, supine figure in a darkened room…for the Duchess had a nervous attack whenever she was subjected to light or noise’.

  The Duchess palpably suffers from neurasthenia, the diagnostic term generally attributed to the American physician George M. Beard, who coined it in 1869 in a leading medical weekly for ‘the morbid condition of the exhaustion of the nervous system’. According to Beard, who went on to publish several widely translated books on the subject, the condition was one which grew out of the American way of life, with its race for money and power, its excessive pursuit of capital and technological progress. Beard blamed nervous exhaustion on the popular press, the telegraph and steam power, all of which had exacerbated the pressure of modern life. These had made striving, successful men prone to nervous prostration. As for women, who constituted a large proportion of the ranks of the neurasthenic, an incursion into the masculine sphere of intellectual labour together with the ‘exhausting sentiment of love’ were responsible for their nervous depletion.

  It was soon to become clear that often enough a nervous woman was also a ‘new woman’. The contradictions of a time which demanded compliance and quiescence of the idealized feminine while championing dynamism in the culture as a whole might drive a woman to action or to the couch. The escape into illness was the mirror image of rebellion. Emancipation, feminism and neurasthenia, or its sometime twin sister, hysteria, took shape in the same nervous soil.

  Nerves, their relationship to the brain, temperament and mental life, were still mysterious areas for the scientists and doctors of the second half of the nineteenth century. As time moved on, however, they became increasingly confident about their ability to map the brain, understand the nervous system and diagnose its ill effects. Treatment, though bullishly applied, was often less certain. Particularly in America and Britain, it could look much the same as ‘moral management’, even if it came within the context of private practice for relatively affluent patients.

  Silas Weir Mitchell, the Philadelphia-based nerve doctor whose Lectures on Diseases of the Nervous System, Especially in Women of 1881 made him famous, invented a much imitated ‘rest cure’, which
allowed for no coddling of the ‘couch-loving invalid’ who was the patient, and no theatrical expatiating on her pains for an audience. Self-control, taking oneself in hand, was essential: ‘I tell the patient her pains will be well when she gets well, and then cease to allow them to be further discussed.’ What the rest cure entailed was ‘the breaking up of old habits…the cutting off of many hurtful influences; but above all, it means the power of separating the invalid from some willing slave, a mother or a sister, whose serfdom, as usual, degrades and destroys the despot, while it ruins the slave’.

  Conceptualizing uncharted parts of the body, particularly in its relationship to mind, has always led to metaphors: these are particularly apt at revealing the preoccupations of their historical moment. Where the eighteenth century posited nervous energy as fluid, a kind of hydraulic or water power, the nineteenth understood it as an electric force. At first, this was in keeping with the galvanic physics of vital, animal electricity. Gradually, the conception shifted to take on Volta’s chemistry, so that the brain emerged as a rechargeable voltaic battery generating electricity through the nerve fibres. It then played with thermodynamics and ideas about energy conservation, and finally moved on to Faraday’s more complex model of electricity as a force that passes from particle to particle. Sometimes all these hypotheses functioned alongside each other.