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

by Lisa Appignanesi

  The Handbook for the Instruction of Attendants on the Insane of 1884 used the contemporary analogy of the telegraph to explain nerve and brain function:

  The grey skin of the brain may be compared to a great city, the headquarters of the telegraph system, and the grey clusters scattered through the white substance of the brain are the suburbs of the city, the grey clusters of the spinal cord are the towns, and the points of skin, muscle organs…where nerve fibres end, are the villages. The nerve fibres connect villages, towns, suburbs and the great city with one another…The internal nerves and the nerve cells of the mind connect with each other so as to form a network, which, while we are awake or dreaming, is in a state of busy activity, telegraphing ideas from cell to cell…In proportion as this network becomes broken or weakened does the mind fail in its functions; the snapping of a few fibres; the sickening of a few cells, makes a serious difference; and because of the delicacy of it, the structure requires constant repair and careful preservation.

  George Beard, who had some success with electrotherapy, postulated a chemical explanation of ‘want of nervous force’: ‘My own view is that the central nervous system becomes dephosphorized, or perhaps loses somewhat of its solid constituents, probably also undergoes slight, undetectable, morbid changes in its chemical structure and as a consequence becomes more or less impoverished in the quantity and quality of its nervous force.’

  Whatever the metaphoric or speculative base borrowed from the sciences or the new technology, Victorians also turned the nervous system, as they did sexuality, into an economic model with an in/out ledger of income and expenditure. Each person had only a certain amount of nervous energy, an inherited capital fund that could more easily be depleted than replenished. ‘Heedless overexertion, whether mental or physical, could drain an individual’s supply, leaving an exhausted nervous system incapable of all endeavour. Failure of nervous power meant utter incapacitation.’ Just as bankruptcy was a form of sin in the public economic domain, so in the private sphere excessive expenditure which led to breakdown of the nervous system or to madness was tainted, and understood not only as physically depleting but as morally reprehensible. Sexual activity without a procreative aim was bad and incapacitating, doubly so masturbation. Excess was an abandonment of willpower–a faculty which, according to the public moralists and doctors, was already weaker in women. Duty was sacred, and for women it lay in marriage and the purity of motherhood.

  With greater or lesser emphasis on such Protestant notions of willpower and duty, the language of the nerves was used throughout Europe and America. The resulting nervous illnesses–neuroses, breakdowns, neurasthenia–were conceived of as organic. Though the turn of the century swung the medical pendulum towards psychic explanations which had no proven physical base, this language of nerves and neuroses continued.

  In 1895, the German psychiatrist Krafft-Ebing wrote in his Psychopathia Sexualis:

  The mode of life of countless civilized people exhibits nowadays an abundance of anti-hygienic factors which make it easy to understand the fateful increase of nervous illness; for those injurious factors take effect first and foremost on the brain. In the course of the last decades changes have taken place in the political and social–and especially in the mercantile, industrial and agricultural–conditions of civilized nations which have brought about great changes in people’s occupations, social position and property, and this at the cost of the nervous system, which is called upon to meet the increased social and economic demands by a greater expenditure of energy, often with quite inadequate opportunity for recuperation.

  Since nerves fed the entire bodily system, overwork in one area, for example the brain, could result in a weakening elsewhere. Most usually for women, the link was with the vitality of the reproductive organs. Indeed, during the last part of the nineteenth century woman’s reproductive system seemed to grow an intimate link with her frail, unstable nerves. Periodicity–the impact of menstruation on woman’s body–childbirth and menopause had always played a part in the assessment of mental health, but not until the 1860s did these specifically sexual characteristics take on quite so prominent a public place in the interpretation of the ‘nervous’ symptoms that women might present.

  The ‘reflex theory’ of the nerves had laid the ground for such thinking back in the 1830s. It proposed that nervous connections running via the spine regulated all organs, without any intervention from consciousness. If this ‘message network’ became weakened or was broken, the mind failed in its function. Breakdown could also lead to failures of internal and external sensation such as those anaesthesias suffered by hysterics, and of the motor system, such as spasms, jerks and palsies. Pioneered by the society doctor Marshall Hall in England, the reflex theory was extended to include the cerebral hemispheres by the prolific Edinburgh physician, Thomas Laycock, in a publication of 1845. Because of the continental fame of Laycock’s earlier Nervous Diseases of Women, his speculations on the way in which reflex worked proved highly influential throughout Europe. Indeed, it was possibly Laycock’s intervention that was the deciding one in making the reflex theory an early model for the links between the physiological and the psychological. ‘Woman, as compared with man,’ Laycock proclaimed, ‘is of the nervous temperament…Her nervous system is therefore more easily acted upon by all impressions, and more liable to all diseases of excitement.’

  Since the notion of reflex action could link organs far from the site of a symptom, the theory helped to provide a ‘scientific’ basis for implicating the uterus in a large variety of nervous afflictions. As Weir Mitchell emphasized, ‘organic diseases of the ovaries and tubes in women react profoundly upon the nervous system’. Reflex action also had the disastrous effect of introducing a fashion for pelvic surgery and any number of other interventions in women’s reproductive system as a cure for ailments as disparate as fatigue, headaches and vomiting. This impulse towards surgical intervention continued until the century turned.

  Throughout this period, doctors and scientists seemed determined to raise the existing division of labour in the middle class to a universal given, and to transform women’s place in the domestic sphere into a biological inevitability from which deviation of any kind would bring breakdown, not only of the mind but of the species. Women were understood as being fashioned by evolution for the home and maternity, nervously fragile, intellectually inferior. Moving away from that lesser birthright, allowing energies to be drained by intellectual or imaginative exertion would lead to nervous collapse or to that capacious list of symptoms which most often went under the catch-all diagnosis of neurasthenia or its near-neighbour hysteria. ‘What a weak barrier is truth when it stands in the way of any hypothesis,’ Mary Wollstonecraft had acutely observed in the 1790s, railing against Rousseau wanting to make woman a coquette by nature.

  By the 1870s, women’s growing and concerted demands not only for the vote and for equality within marriage, but for education and greater freedom of activity, met with the newly mobilized strength of a scientific and medical establishment, specializing in nervous and mental illness. The medical warnings against any activity that might change women’s domestic status, seen as a fact of God and nature, were deafening. They needed to block out not only women’s voices, but advocates of the calibre of John Stuart Mill.

  Mill stresses that women’s subjection has everything to do with political will. Only in relations between the sexes, he points out, does it still seem just for the ‘law of the stronger’ to prevail. Where arguments for women’s inferiority are concerned, the only thing that has changed since the last century is the move from social explanations to a call on innate, physical causes:

  The reason given in those days was not women’s unfitness, but the interest of society, by which was meant the interest of men: just as the raison d’état, meaning the convenience of the government, and the support of existing authority, was deemed a sufficient explanation and excuse for the most flagitious crimes. In the present day, p
ower holds a smoother language, and whomsoever it oppresses, always pretends to do so for their own good: accordingly, when anything is forbidden to women, it is thought necessary to say, and desirable to believe, that they are incapable of doing it, and that they depart from their real path of success and happiness when they aspire to it. But to make this reason plausible (I do not say valid), those by whom it is urged must be prepared to carry it to a much greater length than anyone ventures to do in the face of present experience. It is not sufficient to maintain that women on the average are less gifted than men on the average, with certain of the higher mental faculties, or that a smaller number of women than of men are fit for occupations and functions of the highest intellectual character. It is necessary to maintain that no women at all are fit for them, and that the most eminent women are inferior in mental faculties to the most mediocre of the men on whom those functions at present devolve.

  Mill called for a proper psychological assessment which would show that the differences between men and women are only the differences of their education and indicate no inferiority given by nature. He wittily underscored that the size of the brain (is an elephant cleverer than a man?) might be less important in determining intelligence than its activity. He noted that men had cunningly and selfishly enslaved women ‘by representing to them meekness, submissiveness and resignation of all individual will…as an essential part of sexual attractiveness’. He also pointed out that all arguments from ‘nature’ were undermined by cultural comparison: ‘An oriental thinks that women are by nature peculiarly voluptuous; see the violent abuse of them on this ground in Hindoo writings. An Englishman usually thinks that they are by nature cold. The sayings about women’s fickleness are mostly of French origin.’ As far as medical practitioners were concerned, since almost none of them were psychologists, when they talked about women their comments were of no more use than any ‘“common” man’s. It is a subject on which nothing final can be known, so long as those who alone can really know it, women themselves, have given but little testimony, and that little, mostly suborned.’

  For Mill ‘the principle which regulates the existing social relations between the two sexes–the legal subordination of one sex to the other–is wrong itself, and now one of the chief hindrances to human improvement…it ought to be replaced by a principle of perfect equality, admitting no power or privilege on the one side, nor disability on the other.’ The greater nervous susceptibility of women, he contended, was in fact a feature of the ‘higher classes’ brought up as hothouse plants, physically inactive, yet unnaturally active where the emotions were concerned: ‘It is no wonder if those of them who do not die of consumption, grow up with constitutions liable to derangement from slight causes both internal and external, and without stamina to support any task, physical or mental, requiring continuity of effort.’

  One of Mill’s intellectual opponents most popular with the Victorian public was Herbert Spencer, whose writings on evolution, science and society incorporated Darwin’s theories as well as those of the French naturalist Lamarck and his evolutionary model of acquired characteristics. It was Spencer, a prolific journalist and autodidact, who served, certainly in part, as the model for George Eliot’s Casaubon in Middlemarch–a cold, sexless man whom Eliot had once wanted to marry and who was forever in search of a complete system of knowledge. It was Spencer, not Darwin, who coined the phrase ‘survival of the fittest’. For Spencer, armed with a belief in the ever increasing ‘specialization of functions’, women were made for domesticity. From the beginning of time, they had perfected their intuition, submissiveness and skills in deception: hence their proper and natural place was in the home. Indeed, the patriarchal family was the model favoured by nature. Only within such an environment could healthy offspring be reared. Anything else would lead to the decline of the species.

  As nature would have it, the theorists who most warned against women’s straying from their natural sphere in reproduction, those who saw intellectual aspiration as a path towards a variety of nervous and physical disorders, were men who themselves suffered from any number of ‘nervous’ ills. Depression and a variety of physical symptoms with no physical cause shadowed Darwin. Spencer’s ‘neurasthenia’ plagued him throughout his life and he suffered from severe breakdowns. Indeed, that ‘nature’ which underpinned Victorian domestic arrangements did not extend to his own. He never married, nor fathered a child.

  Such ironies hardly seemed to impinge on the pronouncements of the fin-de-siècle’s alienists and neurologists.

  Reacting against a nascent women’s movement and John Stuart Mill’s call for women’s education, Maudsley, the most influential of Victorian alienists, wrote an essay in 1874 on ‘Sex in Mind and Education’. Here he made an emphatic case for the damaging effects on women’s ‘vital energy’ of intellectual work combined with the bodily changes of adolescence. Women’s physiology, unlike the male’s, was simply not up to the nervous energy required. Menstruation was the bogey.

  This is a matter of physiology, not a matter of sentiment; it is not a mere question of larger or smaller muscles, but of the energy and power of endurance, of the nerve force which drives the intellectual and muscular machinery; not a question of two bodies and minds that are in equal physical condition, but of one body and mind capable of sustained and regular hard labour, and of another body and mind which for one quarter of each month, during the best years of life, is more or less sick and unfit for hard work.

  Education, therefore, was an ‘excessive mental drain’ on the young woman’s mind and, using the bank as a model of human resources, Maudsley argued ‘What Nature spends in one direction, she must economise in another direction.’ Woman’s nerve centres, already unstable because of the energy needs of bodily change at puberty, would become deranged with the double effort of mental work and the kind of competition on which young men thrived. Menstruation would become irregular or cease altogether. The injuries to the menstrual cycle might lead, in some, merely to headache, fatigue or insomnia. In others the effects were graver: mental breakdown, epilepsy or chorea–which was the name the period gave to all kinds of fits. Worst of all, the young woman’s reproductive system might fail.

  Describing this failure, Maudsley fully exposes the prejudices and degenerationist sexual fears underlying his science. Mendacity is a key feature of the woman he evokes, a low creature determined to hoodwink the male: ’Those in whom the organs are wasted invoke the dressmaker’s aid in order to gain the appearance of them; they are not satisfied unless they wear the show of perfect womanhood.’ His description of the sagging breasts and loss of pelvic power of the unsexed, sterile woman, a freak who ‘having ceased to be woman is yet not man’, betrays a visceral disgust. Out of the girl grown nervously depleted through education, Maudsley brings forth the cataclysm of a sexless dystopia. It seems that all of Victorian civilization, structured around the family unit, topples with a young woman’s education.

  Maudsley’s much quoted article was written in response to Harvard’s Edward Clarke, whose Sex in Education argued that education would render women unfit for childbearing. In Britain both had a ready following. The slightly younger alienist James Crichton-Browne (1840–1938), medical director of the large West Riding Wakefield Lunatic Asylum, where he established one of the few hospital-based neuroanatomical laboratories, shared Maudsley’s views. (It was Maudsley who introduced Darwin to him, when the latter wanted help with photographs of the mad, so that he could study their facial expressions for his work on the emotions in man and animals.)

  Crichton-Browne’s asylum provided him with ready and legally sanctioned access to the brains of dead patients unclaimed by their families. Measuring these and comparing his results with colleagues in two other asylums, he wrote a series of articles on the smallness of women’s brains in comparison to men’s and their comparative physiology. From this information he extrapolated a series of prejudices which gained influence because of their purported links with science.
Women’s smaller brains, the shallowness of the grey matter, the numbers of convolutions, all proved that women were intellectually inferior and childlike in their nature: they were over-emotional, had a deep sense of dependence, craved sympathy and were able mimics. Girls had ‘sensitive and highly-strung nerve centres apt to be damaged by pressure’, whereas boys were ‘more obdurate and resistant’.

  Supposed expert facts breed more facts in the world. Just as contemporary ‘expert’ research linking women’s infertility to the fact of work rather than to a thousand and one other potential causes helps to nurture panics about fertility, so the late nineteenth century stoked up a moral panic which envisaged that middle-class women’s attempt to change their lives would result in madness and the decline of the species. The medical consensus about women’s inferior intelligence and nervous frailty all linked to the vagaries of her reproductive functions did indeed, in turn, breed nervous illness and its over-diagnosis. Expert agreement led women to fear their periods and pregnancies, which apart from any impact on the ‘nervous system’ already had the dire side-effect of often enough resulting in death, either of mother or of child. Deprived of activity, warned off exercise and work, freedom of mind and movement, fin-de-siècle women with their ‘mimic’ capacity developed nervous troubles which the doctors then linked to their specifically female functions rather than to the overall conditions of their lives.

  Elizabeth Garrett Anderson (1836–1917) struggled against great institutional odds, not to mention prejudice, to become the first woman doctor in Britain and the founder in 1871 of the New Hospital for Women in London, which had only women on its medical staff. She also married, had three children and engaged in numerous political activities. Her response to Maudsley and his cohort was not–though it might have been–that she was living proof of the fact that education did nothing to hinder women’s reproductive abilities. Rather, she tactfully pointed out that working women were a fine example of the way women disregarded their ‘special physiological functions’. The ‘facts of their organization’ did not stop them from working. Her patients had shown her that it was often the other way round. ‘The breakdown of nervous and physical health seems at any rate to be distinctly traceable to want of adequate mental interest and education in the years immediately succeeding school life. Thousands of young women, strong and blooming at eighteen, become gradually languid and feeble under the depressing influence of dulness.’