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

by Lisa Appignanesi

  Writing about the serious bout of illness when she was thirty-three which lasted for about nine months and was the second since their marriage, Leonard noted: ‘She talked almost without stopping for 2 or 3 days, paying no attention to anyone in the room or anything said to her. For about a day what she said was coherent, the sentences meant something, though it was nearly all wildly insane. Then gradually it became completely incoherent, a mere jumble of dissociated words.’ Virginia’s incoherence, her total absorption in the world of her madness, parallels Zelda’s–despite the different nomenclature for their condition. Both women also had ‘nerves’ and eccentricity in their closest family. Both at points blamed their husbands for their condition, complained about the doctors they had chosen for them, but largely felt guilty about the trouble their condition caused. Zelda often and Virginia before her suicide wrote tender letters to their partners thanking them for creating the only true happiness in their lives.

  Virginia’s breakdowns began in 1895 when she was thirteen, shortly after her mother’s death, the grief over which her formidable, if histrionic, father manifestly took over, stealing it from the children. Irritable, increasingly engulfed in morbid self-flagellation, subject to her stepbrother’s sexual molestation, Virginia entered a world from which suicide seemed the only escape. There were further attacks, of varying intensity: a difficult one after the death of her father, whom, like Anna O and so many other women in the period, she had nursed; one after Leonard proposed; a grave one, involving a suicide attempt, a year into their marriage and lasting really until 1915, perhaps in part occasioned by her less than happy sexual experience and then Leonard’s decision, on the advice of their new and more modern doctor–a eugenicist in the spirit of the times–that children should be avoided. Later breakdowns were milder, one imagines partly because of Leonard’s watchfulness. If her early breakdowns had been sparked by deaths–her mother’s, her favourite brother Toby’s, her father’s–the later ones tended to come after she had sent off the manuscript of a novel. The last ‘breakdown’ came in 1941 after she had completed Between the Acts. This time it was so bad, so much a replay of the most difficult crack, that she took her life.

  In the midst of all this, Virginia wrote a brilliant array of fiction and criticism, not to mention the most riveting journals, diaries and letters of her era. Two principal doctors, each of a status equal to the doctors who treated Zelda Fitzgerald, in turn oversaw Virginia’s illness. The treatment she received was, however, very different, at least in the way it was theorized. Early on there was certainly no question of talk therapy–not that Virginia’s attitude to it, despite Bloomsbury’s adamant modernism, was ever less than ambivalent. She and her husband may have become the English publisher of Freud’s Collected Papers, but Virginia remained sceptical of the whole psychoanalytic enterprise, perhaps coming closer to Freud only once she had read him and realized that the inner life he had set out to chart was rather more darkly textured and marked by the irrational than that which the philosopher G.E. Moore, so important to the pre-war Bloomsbury Group, had evoked.

  The doctor who oversaw Virginia Stephen’s serious illness following her father’s death when she was twenty-two was George Savage (1842–1921), President of the Medico-Psychological Association and of the Neurological Society, and the editor of the Journal of Mental Science. He was an alienist of the old school, who wrote his major work, Insanity and Allied Neurosis, in 1884. Though he had resigned as head of Bethlem in 1888–because under his aegis deaths there had occurred at twice the rate of other asylums–he remained a bastion of the British medical profession. The Stephens family doctor, he was first consulted directly about Virginia in 1904. He promptly diagnosed a general ‘neurasthenia’ and sent her off to a Twickenham nursing home where treatments were largely benign: rest, quiet and not too much sedation, though in the course of her life Virginia was given everything from chloral to the veronal on which she overdosed in 1913.

  Savage, like all the members of the family, knew that George Duckworth, Virginia’s stepbrother, her mother’s son by a former marriage and fourteen years older than her, had sexually molested Virginia, beginning at the time of her mother’s death and continuing until her breakdown of 1904, when she had flung herself out of the window. George, who ‘prowled by night’, had also abused her sister Vanessa and poor, mad Laura, abnormal from birth and long incarcerated, their father’s daughter from his first marriage to Thackeray’s child, Minnie, the very child whose birth had precipitated the older writer’s wife into puerperal madness. Savage apparently lectured George over his sexual misconduct, but any direct sympathy for Virginia is more likely to have come from the kindly Violet Dickenson, who nursed her back to health after her suicide attempt.

  It is clear that the early incestuous activity had a disturbing effect on Virginia’s sexuality: from all reports, sex was to prove perennially problematic for her, though not, it seems, for her artist sister, Vanessa. After Leonard Woolf proposed to Virginia on 11 January 1912 she went through a period of turmoil, and over the next two months Dr Savage had her in and out of nursing homes. Then, as recent historical digging has revealed, Virginia herself went to see a doctor who only a year later was to become a founding member of the London Psychoanalytical Society. On 9 March 1912, independently of Leonard, who was waiting for her response, she consulted Dr Maurice Wright, whom she called a ‘psychologist’. What they talked of is not known, but it would not be implausible to imagine her sexuality might have been on the agenda. In any event, something turned, for on 29 May she accepted Leonard’s proposal. She returned to Wright probably only once more. Virginia and Leonard’s honeymoon proved, sexually at least, less than satisfactory, though their sexual relations persisted and there was talk, at least at first, of having children. The marriage was one that buoyed them both up.

  Whether it was the sexual disturbance that made Virginia wary of Freud, as some have claimed, is unclear. Like all the members of bohemian Bloomsbury, Virginia was altogether forthright in her use of sexual language, alert to and experienced in homosexuality, and seemed to relish the shock of ‘dirty’ words. It is more likely that what kept her from a talking cure was what became the twentieth-century artist’s perennial fear that the insights garnered during ‘madness’ were somehow related to literary talent and might be disturbed by psychoanalysis–a therapy as potentially penetrative as sex itself. To the composer Ethyl Smith, Virginia noted in 1930: ‘As an experience, madness is terrific I can assure you, and not to be sniffed at; and in its lava I still find most of the things I write about. It shoots out of one everything shaped, final, not in mere driblets as sanity does. And the six months–not three–that I lay in bed taught me a good deal about what is called oneself.’

  In a 1920 review entitled ‘Freudian Fiction’, Virginia scoffed at the reductionist simplicities of the new science: ‘A patient who has never heard a canary sing without falling down in a fit can now walk through an avenue of cages without a twinge of emotion since he has faced the fact that his mother kissed him in the cradle. The triumphs of science are beautifully positive.’ The patient, here, is more than likely Woolf herself, and her irony points to the fact that no ‘psychologist’s’ revelation has lessened the intensity of the singing birds for her. She will not be turned into a ‘case’–any more than Nabokov, ever scathing about the ‘Viennese witch-doctor’, would later be. Her own experience aside, she is adamant that the turf of the inner life and the imagination rightly belongs to novelists and artists and needs protecting from the reductionist inanities of these psychological interlopers. Yet Virginia’s husband thought of himself as an out-and-out Freudian. He reviewed Freud early, had read The Interpretation of Dreams by 1914, and he and Virginia certainly discussed dreams. Her brother, Adrian Stephen, became one of Britain’s first psychoanalysts.

  Later, her own views towards Freud, if not the efficacy of his practice, changed with reading. In her notes on the writing of To the Lighthouse she tellingly states: ‘I wrot
e my book very quickly; and when it was written, I ceased to be obsessed with my mother. I no longer heard her voice; I do not see her. I suppose I did for myself what psychoanalysts do for their patients. I expressed some very long felt and deeply felt emotion. And in expressing it I explained it and then laid it to rest.’

  Woolf’s diary note, after meeting Freud on 28 January 1939, is amenable enough for a woman who was known for her tart verdicts on the people she met: ‘Dr. Freud gave me a narcissus…A screwed up shrunken very old man: with a monkey’s light eyes, paralysed spasmodic movements, inarticulate: but alert…Difficult talk. An interview…Immense potential, I mean an old fire now flickering…’ The following day, she added: ‘Freud said, It would have been worse if you had not won the war. I said we often felt guilty–if we had failed, perhaps Hitler would not have been. No, he said, with great emphasis; he would have been infinitely worse.’

  As Robert Hinshelwood has argued, it is likely that for Virginia and many of her circle Freud was acceptable culturally, but not therapeutically. In the first half of the twentieth century Freud equalled the modern, the emphatically new, the sexually open and unrepressed. The package included a toppling of the securities of the Victorian era. The very hypothesizing of an unconscious meant that the individual’s grip on reason, on a controlled self, was undermined, by slips, by laughter, by desires. For writers, the erratic stream of the inner life, rather than the character in action, became the subject of fiction.

  The cultural Freud, as Virginia gradually read him, might be fine, but that hardly equalled Freud as a mind doctor. Alix Strachey, a close friend, analyst and James Strachey’s wife, noted in her reminiscences about Virginia that she didn’t agree with James that analysis would be of help to Virginia: ‘Leonard, I think, might well have considered the proposition and decided not to let her be psychoanalysed…Virginia’s imagination, apart from her artistic creativity, was so interwoven with fantasies–and indeed with her madness–that if you stopped the madness you might have stopped the creativeness, too.’

  Alix Strachey was probably right. Virginia recognized that psychoanalysis had as its object the individual’s unconscious processes and not just clinical symptoms: hers had uses apart from illness.

  Freud aside, Virginia had little time for mind doctors in general. It is unlikely that she would have felt any more friendly to the posthumous uses of her supposed manic-depressive cycle and its relationship to her artistic productivity than she did to contemporary experts. The fact that after the span of serious illness at the start of her marriage all that the detailed charts of her illness can show is that there was no significant decrease in literary output, whatever the ups and downs of mood, might have induced one of her usual hoots of laughter.

  Woolf’s second principal doctor, whom Leonard, always well informed and progressive in his views, decided to consult rather than the ageing Victorian Savage during Virginia’s prolonged bout of illness of 1913–15, was Dr Maurice Craig. A Cambridge graduate like so many of the Bloomsburys, and in his later career thoroughly integrated into the elite circle of Cambridge medical psychologists, Craig had worked as an assistant at Bethlem. He had written a textbook on Psychological Medicine (1905) and had succeeded Savage at Guy’s Hospital. He also ran a nursing home, played a crucial role, when part of the War Office’s group on shell shock, in securing pensions for many thousands of ‘nervous’ soldiers, and was the doctor Leonard Woolf himself consulted about the tremor in his hand. Craig certified in 1914 that Leonard was unfit for ‘military service’. He eventually became the President of the Psychiatric Section of the Royal Society. For all his modern dislike of Savage’s older designations of ‘moral insanity’, and his move into a more Kraepelinian nomenclature, Craig’s handbook on Nerve Exhaustion of 1922 offers little that is new. Cautious about Freudian therapy, since the ‘distressing ideas’ it revealed might threaten the ‘mental stability’ of patients who couldn’t stand the strain, Craig thought of breakdowns as ‘nervous’ and therefore requiring primarily physical treatment rather than the Freudians’ ‘clearing up of amnesias’.

  Virginia’s early biographer, Quentin Bell, describes the breakdown which brought her to Craig thus:

  She thought people were laughing at her; she was the cause of everyone’s troubles; she felt overwhelmed with a sense of guilt for which she should be punished. She became convinced that her body was in some way monstrous, the sordid mouth and sordid belly demanding food–repulsive matter which must then be excreted in a disgusting fashion; the only course was to refuse to eat. Material things assumed sinister and unpredictable aspects, beastly and terrifying or–sometimes–of fearful beauty.

  During this prolonged bout of madness, which also brought with it violence, hallucinations and a refusal of food, Craig had little more to offer than a dose of foul-smelling and sedating paraldehyde and the Weir Mitchell regime of bed rest, quiet inactivity and regular intensive feeding. Writing–when it once more became possible–was to be kept to a minimum, a maximum of one hour daily. Craig was a conservative when it came to women’s abilities. Under his care, Virginia put on over three stone in a year, sixty pounds over the two years of her illness. She was not averse to the treatment. Ever after, as she wrote to a friend in 1922, she associated plumpness with health: ‘I’m glad you are fat; for then you are warm and mellow and generous and creative. I find that unless I weigh 9 stones I hear voices and see visions and can neither write nor sleep.’

  That said, Virginia was hardly complimentary about Craig. He was the doctor who had advised, unlike the buoyant Savage, against her and Leonard’s having children.

  In Mrs Dalloway, a novel which is in part about the competing languages of mental illness, the sufferer’s and the doctor’s, Woolf’s principal male character, the suicidal war veteran Septimus, feels ‘exasperation’ in his encounters with the various branches of the medical profession. His general practitioner can only offer ‘no nonsense common sense and recommend porridge, golf and three grains of Veronal’ for his ‘nerve symptoms’. As for Sir William Bradshaw, the smug Harley Street psychiatrist who is an amalgamated portrait in which both Craig and Savage figure, Woolf describes him in the most scathing terms. Indeed, her contempt for the disciplinary regime doctors impose on patients rivals that of Michel Foucault. Her portrait of Bradshaw suggests a conspiracy between social engineering, the restraint of the mentally ill and the patriarchal self-protection of the Establishment. Bradshaw shuts up his lunatics in ‘nice’ homes in the interests of the ‘goddess of Proportion’ and of his ever-growing bank balance:

  To his patients he gave three-quarters of an hour; and if in this exacting science which has to do with what, after all, we know nothing about–the nervous system, the human brain–a doctor loses his sense of proportion, as a doctor he fails. Health we must have; and health is proportion, so that when a man comes into your room and says he is Christ (a common delusion), and has a message, as they mostly have, and threatens, as they often do, to kill himself, you invoke proportion; order rest in bed, rest in solitude, silence and rest, rest without friends, without books, without messages, six months’ rest until a man who went in weighing seven stone six comes out weighing twelve…Worshipping proportion, Sir William not only prospered himself, but made England prosper, secluded her lunatics, forbade childbirth, penalised despair, made it impossible for the unfit to propagate their views until they, too, shared his sense of proportion.

  Zelda’s last years

  Like Virginia, Zelda Fitzgerald rebelled against her doctors’ discipline. Talk may have been part of her treatment, but it was talk of a kind which was intended to make her comply with the doctor’s or husband’s view of the world–though even had it been otherwise, there is no guarantee that it would have been more palatable, or served her. Unlike Virginia, however, Zelda’s control over her own talents was never great enough to result in more than one book.

  At the Phipps, through the winter of 1934, Zelda grew worse. She wanted to leave the hospita
l, go to Europe. Instead, Scott found her a place at the sumptuous Craig House, located on 350 acres adjacent to the Hudson River some two hours from New York. Here patients were free to roam: there were swimming pools, tennis courts and a golf course–all for a handsome fee. The hospital’s assessment of Zelda was that she was madly confused, emotionally unstable and, oddly, mentally retarded. She continued to write from her plush new quarters to Dr Rennie. Scott, ever guilty and assiduous in bursts, arranged for an exhibition of her paintings at a gallery in New York. The reception of the work was not what either of them might have hoped. Zelda’s letters to Dr Rennie begin to show more confusion. To Scott she says she wants to start on a new novel, if he will allow it. But things quickly became too serious for her to begin. On 19 May 1934, Zelda was transferred to the Sheppard and Enoch Pratt Hospital just outside Baltimore in what was described as a ‘catatonic’ state, a term which probably refers to her listless apathy, a lack of expression and affect, which signalled a serious relapse.

  Auditory hallucinations of the persecutory kind she had experienced at Prangins had returned. This time the voice was Scott’s and it terrified her in its repetition of her name, or of her own words. ‘I have killed her,’ the voice also said. ‘I have lost the woman I put into my book.’ She told the doctors that despite the tricks her eyes were playing on her, the doublings of things, the distortions, she wasn’t thinking of killing herself, but death was the only way out.