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

by Lisa Appignanesi

  The Sheppard and Enoch Pratt Hospital was a leading site for the use of psychoanalysis. Harry Stack Sullivan, the pre-eminent American psychiatrist to apply psychoanalytic treatment to the psychoses, came to the hospital in December 1922. Though he left in 1930 for private practice in New York and Washington, the hospital was already imbued with his methods. Hardly an orthodox Freudian, Sullivan had trained with the feminist Clara Thompson, close colleague and analysand of Sandor Ferenczi, and a follower of Karen Horney’s. Horney had challenged Freud on his concept of penis-envy, regrounding it as a biologically ordained attraction between the sexes and positing an equal and opposite womb-envy, an envy of women’s natural creativity, as a structural principle in the male. This was an idea Zelda might not have been unfamiliar with.

  What is clear from both Scott’s and Zelda’s writings, as well as their letters, is that whatever Zelda’s prognosis and current state, the understanding of herself in relation to Scott and her parents shifted through the course of her various treatments. Both learned from the doctors, in that continual redescription of illness which seems to be part not only of the history of mental medicine but of the patient’s own experience and interpretation of symptoms. In certain respects Scott and Zelda’s changing perspective keeps pace with the changes in psychoanalytic and psychiatric theory themselves. At first, in France and Switzerland, Zelda is concerned primarily with sexuality; by the time she is through with the Phipps and in the Pratt, she and Scott are talking about relations with each other and with parents, about strengths and fears, competition and security. The developing American psychodynamic psychiatry privileged ‘interpersonal relations’ and that ‘anxiety’ which mounted to a veritable panic in the dreams and delusions of schizophrenics. It was ‘anxiety’ that was said to characterize the sick patient’s early relation to a family which, though Oedipal in its power relations, was not understood as sexual. This same anxiety was replayed in the social world and again in the doctor–patient couple.

  Frieda Fromm-Reichmann, a leading German-trained American analyst who worked with extreme or psychotic patients just after the Second World War, explained this shift in an attempt to bring different kinds of practitioners together, while all the time heeding Freud:

  Among the reasons for this shift in therapeutic emphasis among analysts, the historical fact should be mentioned that Freud’s original concepts of analytic therapy and theory were gained from his experience with the psychoneuroses, mainly hysteria, whereas the majority of the patients with whom we work now, are character disorders [sic], obsessionals, and also many borderline cases and outright psychotics. The repressed and dissociated material of these patients is somewhat more easily available to consciousness than that of the hysteric. Their anxieties are greater than those of the hysteric and in the borderline cases and the psychotics not infrequently nearer to the surface. These facts, I believe, explain in part the psychoanalytic shift in therapeutic emphasis from unearthing repressed material and investigating its meaning, to the investigation of its dynamics. This includes, above all, therapeutic concern with the manifestations of the anxiety which is aroused by the resolution of repressed material, and in the patients’ operations with the therapist. At this point, then, the theoretical and therapeutic conceptions of classical psychoanalysts and other dynamic psychiatrists run in close dynamic confluence…

  Sullivan…shares with Freud the concept of the anxiety-arousing power of unacceptable thoughts, feelings, wishes and drives. But in the framework of his interpersonal conception, he sees the expected punishment for these forbidden inner experiences as entailed in the anticipated disapproval of the significant people of an anxious person’s early life and of their emotional successors in his present life…it seems that the feeling of powerlessness, of helplessness in the presence of inner dangers, which the individual cannot control, constitutes in the last analysis the common background of all further elaborations on the theory of anxiety.

  For Sullivan, repressive religious educators and overbearing, moralizing mothers featured prominently as anxiety producers. Their penalizing prohibitions against masturbation were part of the picture that produced schizophrenia. ‘A hand on the penis is a hand against God’ was an all too prevalent sentiment that needed to be fought by sexual education. Sullivan’s patients were taught that sexual experience was a good. Sullivan himself was known for his marked personal success with patients he diagnosed as schizophrenic, in particular the men amongst them. One of the reasons he took on an analysis with Clara Thompson was that he failed with women. He thought of schizophrenics as singularly gifted and socially significant people, and understood their condition as an unsuccessful reaction to anxiety. Everyone needed safety, security, let alone that attribute of ‘self-esteem’ that was later to dominate so much American psychological thinking. Sullivan’s patients were given hours of close attention. Drugs, often ethyl alcohol, were also widely used in the period to put patients into a curative state of sleep, or to make them amenable to talk therapy by dismantling their defences. Though, given Scott’s objections to Zelda having anything with an alcoholic content, since it tipped her over the edge, it is unlikely that it would have been used in her case.

  By July 1935, in any event, the doctors had concluded that talk about her illness in her present serious state was futile. Zelda swung between violence and an uncooperative, inaccessible apathy in which she would have nothing to do with the other patients or the doctors. Scott, who visited regularly, had suggested that he help her pull together a collection of her stories, but the timing wasn’t right. Zelda was incapable. She talked of suicide to her doctors and tried to harm herself in whatever way she could, once racing towards the railway tracks so that Scott caught her only moments before the onrush of a train. She wrote only to Scott, who was also unwell, sometimes calling up the good times they had had together. But even if he was her ‘dream’, the only ‘pleasant thing in her life’, her tone, for herself, was now without hope:

  My dearest Sweetheart:

  There is no way to ask you to forgive me for the misery and pain which I have caused you. I can only ask you to believe that I have done the best I could and that since we first met I have loved you with whatever I had to love you with…Please get well and love Scottie and find something to fill up your life…

  By April 1936, though she wanted to leave the hospital, Zelda was no better. As Scott noted in a letter to mutual friends, she was claiming to be in direct contact with ‘Christ, William the conqueror, Mary Stuart, Apollo and all the stock paraphernalia of insane-asylum jokes…I was her great reality, often the only liaison agent who could make the world tangible to her.’ But in his own precarious state, he was seeing her less and less.

  He had her moved to Highland Hospital in North Carolina, since he was temporarily in the state for his health. Zelda was to be in and out of the institution for the rest of her days. The Dr Carroll who had founded the hospital was an eccentric in contemporary psychiatric circles: a throwback, a believer in the therapeutic value of diet and exercise. But something in the treatment helped. In July, Scott was reporting to Scottie that Zelda ‘looked five years younger’ and had stopped her ‘silly praying in public’. They met for lunch and walks. Dr Carroll, in 1937, was saying that Zelda was ‘quite charming’ while a fellow staff member underlined:

  We were careful with Zelda; we never stirred her up. She could be helped, but we never gave her deep psychotherapy. One doesn’t do that with patients if they are too schizophrenic. We tried to get Zelda to see reality; tried to get her to distinguish between her fantasies, illusion and reality…We let her talk about things which bothered her. Discussed her reading and what things meant to her. Explained the ‘why’ of her orders and routine. She often rebelled against the authority, the discipline…She didn’t like discipline, but she would fall into it.

  There was no simple or single treatment method or cure, and Scott was having difficulty paying hospital and school bills. He took up an offer in Hollywo
od where he met the English-born Hollywood columnist, Sheila Graham, who would be with him till the end a mere year later. Scott wanted to continue to care for Zelda. For Easter 1939 he arranged a Cuban family holiday for the two of them and Scottie, but it proved a disaster, partly because of his drinking and brawling. It was the last time Scott and Zelda were to meet.

  Back at the hospital Zelda had town privileges and helped with gym classes. She was particularly good with patients who were far worse off than herself. In return for her help, her expenses were reduced. At Christmas that year she was permitted to go home to her mother in Montgomery, as long as she kept to the advised routine. She did so well that Carroll, in March 1940, wrote to Fitzgerald signalling that she was ready for release. Her mental health would always be precarious and she was incapable of mature judgement, he said, and though she might again become irresponsible and suicidal, for the time being she was ‘gentle and reasonable’.

  Four years and one week had passed since her admission. Approaching her fortieth birthday, Zelda was now to live with her mother in the straitened circumstances which were all that Scott could afford. She would spend her last years between her mother’s home and the Highland Hospital.

  On 20 December 1940 Scott Fitzgerald’s heart, already weakened by a first attack, gave up. Zelda wasn’t well enough to attend the funeral. When his unfinished novel The Last Tycoon was published in 1942, it triggered the repetition of a pattern. She started to write her own once more: Caesar’s Things occupied her through her six last years. The book reworks the terrain of her childhood and youth, her sense of rejection by her father, her lost great love. But its incoherence is a testimonial to the debilitating effect of her illness. Delusions and religious fantasies have overtaken her, as has a sense of utter solitude. Her hold on the real slipped unpredictably.

  At the beginning of 1948, she was given insulin treatment–a course of injections to reduce blood-sugar level, which eventually induced hypoglycaemic shock and attendant convulsions or coma. The treatment had been pioneered in Berlin by Vienna University-trained Manfred Sakel. Before long, it travelled through Europe and America. At the Maudsley in London, it was a favourite of that stern advocate of the physical therapies, including ECT and leucotomy, William Sargent. Insulin-induced coma was administered when schizophrenic or depressed patients were restless and agitated, grew violent or suicidal. When they emerged from their deathlike sleep, the patients were transformed, reborn into a new calmer self, or so the treatment story went. In fact, this chemical version of ECT–based on a notion that epileptic convulsions were the biological antagonists of schizophrenia–often came with memory loss, physical and mental disorientation and a substantial weight gain of twenty to sixty pounds. With its sugar and starch diet it also infantilized patients, and in this respect resembled the nineteenth-century rest cures for women. Adolf Meyer, ever eclectic, had given the therapy his blessing in 1937 and from then on it became common in American custodial hospitals, particularly with intractable patients.

  After her treatment, Zelda was recovering on the top floor of the hospital with the other insulin-coma patients. She had just written to her daughter, who had given birth to her second child, to say that maternity clothes would probably do very well for Zelda, so much weight had she put on. But she was buoyant, indeed reborn. She noted the promise of spring in the air and how she longed to see the new baby. It was not to be. During the night of 10 March 1948 a fire leapt from the kitchen of the building in which she was housed. Zelda Fitzgerald died along with nine other women. She was just under forty-eight years old.

  Virginia Woolf had committed herself to a watery grave seven years before, on 28 March 1941. Between them, the two women had been through the span of treatments the twentieth century thus far offered. None of them worked, if permanent cure acts as the main criterion.

  The schizophrenia that Zelda had on occasion been diagnosed with would, in the fifties and sixties, become America’s most common diagnosis. Shortened to ‘schizzy’, it grew into an everyday synonym for crazy, or odd, or weird, or peculiar. Marilyn Monroe, amongst many others, was called ‘schizzy’. Committed into the asylums, however, those labelled schizophrenic could easily enough develop a career path of craziness. Learning the illness behaviours that got attention from doctors and formed a bond with other patients was, as Erving Goffman convincingly argued in his Asylums (1961), an inevitable part of life in a ‘total institution’. While the governing principle of the asylum is that treatment should lead to ‘cure’, the compliance it generates in patients, even when treated by well-meaning doctors, can lead to entrapment in a schizophrenic role and a pattern of recurrent institutionalization.

  Being schizzy could all too easily become a way of life.

  9

  DISTURBANCES OF LOVE

  In France after the First World War, a new kind of woman was born. She wore some of the clothes of the liberated flapper and was a sister in spirit if not in arms to bluestocking and suffragette. But her closest kin was the convulsive hysteric, marked in body and mind by the conflicts of her condition, her social place and her rampant desires. Unafraid, unabashed, utterly reasonable in the excesses of her erotic logic, she was nonetheless mad, often criminally so. The Surrealists, those postwar artists who grouped themselves under the banner of a rebellion against a reason that had ended in the madness of the trenches, where war was fought in the name of what kings called peace, sang the praises of this new woman and helped to invent her and spread her fame.

  Hysteria, for the Surrealists, as their Révolution Surréaliste of 1927 proclaimed, was a ‘supreme vehicle of expression’. Young Augustine, who had entered Charcot’s service back in the 1880s, was delectable in her excess, a subject for poetry and emulation rather than for pathological dissection and psychiatric classification. In his novel Nadja, structured as a case history, Nadja, the case, becomes Surrealist supremo, André Breton’s seductive model of the artist as a charter of new frontiers of the mind and of metaphorical possibility. For the first time, madness, a Rimbaldian derangement of the senses, became a glamorous cultural property, a barometer of the new, particularly where female desire itself was concerned.

  The Surrealists were inspired by mind doctors like Freud and Janet. They also took not a little from Gaëtan Gatian de Clérambault (1872–1934), medical head of the Sainte-Anne Hospital’s Special Infirmary for the Insane attached to the Paris Préfecture de Police, who reinvented the condition of erotomania and entered the annals of psychiatric diagnosis with a syndrome named after him. In turn, they inspired readers and a new generation of mind doctors–Jacques Lacan, their friend and contemporary, principal amongst them. In the sixties Lacan, the French Freud, would become one of France’s most celebrated intellectuals, a kind of philosopher of excess, the excesses of meaning and desire. Early anti-psychiatrists, the Surrealists both learned from the profession and the patients and attacked its more disciplinary side, as well as the underpinnings of its laws on insanity.

  Elisabeth Roudinesco, the historian of French psychoanalysis, reports how in November 1929, when Nadja was the subject of a meeting of the Medico-Psychological Society, Breton was accused of inciting inmates to murder their psychiatrists: a dangerous maniac had underlined in blue the poet’s insults against psychiatry and caused a commotion in the asylum. Heavyweights of the older generation, Janet and Clérambault, attacked the upstart Surrealists, and the proceedings found their way into the press. Breton counterattacked, accusing the mind doctors of being jailers and executioners who abused their power, rather than true physicians. The following year, those who had targeted the Surrealists figured prominently in the Second Surrealist Manifesto as prime agents in society’s ‘system of degradation and cretinization’, part of the sterile crowd at whom the Surrealist revolver was aimed. Virginia Woolf had put it more decorously and with English irony, but the criticism was the same. Though culturally they were inextricably linked, artists and the mind doctors now stood ranked against each other across
the terrain of the human soul. And that terrain was often symbolically, as well as actually, signposted feminine.

  Little enough had changed for French women despite the greater need for their labour during wartime. If the right to spend their own earnings had recently been won, many of their civil and property rights were still in question. Values might now be more openly disputed; customs were challenged; but for every question the left put, the Catholic and moralizing right had an answer. The Surrealists’ invocation to a free sexuality, a rebellion that could be deemed criminal, a seeing afresh of the world, coexisted, for women, with this standard school textbook call to tradition:

  What is a woman’s greatest duty? To have children, then to have more children, always to have children! A woman who refuses, who seeks to control or to suppress her maternal destiny, no longer deserves any rights. That woman becomes nothing.

  Way back in the revolutionary year of 1791, the radical Olympe de Gouges in her Declaration of the Rights of Women had stated that if women had the right to mount the scaffold, they should also have the right to mount the hustings. In the interwar years the scaffold was still in place, although out of chivalry it was rarely used for the weaker sex. The hustings had to wait until 1944. In terms of crime, not all that much had altered since the days of Henriette Cornier. Clemency, in the form of a lifetime of penal servitude, might be granted murdering women, but the war of the lawyers and psychiatrists over badness or madness was to be waged all over again in the cases of ‘criminal’ women that galvanized the early thirties.

  It is hardly surprising if the conflict between new liberties and old laws played itself out in both symptoms and diagnoses. Erotomania had already been noted as a condition by Esquirol. In its newly amplified guise, compounded with persecutory delusions, it reflected some of the disorder of the times, the contradictory liberties, demands and prohibitions which tugged at women’s minds and emotions, as well as a fraying class system and its attendant resentments. With a Kraepelinian zeal, Clérambault detailed erotomania in his police infirmary as a madness, a ‘mental automatism’ of the ambitious, often sexually wayward and most usually female, imagination. With an admixture of paranoid delusions, erotomania frequently carried its own punishment for any excessive overreaching. It also often came with a glossolalia, a fervid verbal outpouring and flagrant mixing of metaphors, syntax and literary registers. The Surrealists found this as inspiring as the more conservative literary critics found their ‘modernist’ outpourings mad.