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

by Lisa Appignanesi

  THE GOOD-ENOUGH SHRINK

  According to some statistics in the 1950s and 1960s twice as many women in America suffered from depression and anxiety disorders as men. Whether increasing psychologization of the nation augmented the numbers of sufferers, or demand for psychological medicine increased the supply of mind doctors, is unclear. Undoubtedly a conjuncture of forces came into play and popular culture both reflected and propagandized the symmetries of illness and cure. Leading women’s magazines, like Mademoiselle in October 1953, ran attractively illustrated spreads with the headline question ‘Should you be psychoanalyzed?’, while the confessional answer below ran ‘Illness, worry, deep depression brought me to the analyst…I stayed to work the puzzle to the end.’ Moss Hart’s Lady in the Dark had moved from enormous success on Broadway to Hollywood. Ginger Rogers, the star who played more psychiatric patients than any other, enacted a career woman on the edge of a nervous breakdown whose sessions on the couch bring deep Oedipal knowledge and a release into love and marriage.

  While popular culture educated America in the ways of analysis and the slips of the unconscious, New York’s and California’s intellectual and artistic elites used analysts in the way that the rich in the past had used personal spiritual advisers and father confessors. The church of the self, after all, had its painful stations of the cross, and a personal analytic adviser could help on the journey through life. Daily sessions on the couch, advice from the analyst on how to lead your life and cope with its intimate problems, as well as your children, while all the while achieving some insight, some inner truth and maturity, were part of a covetable and glamorous lifestyle.

  Chris Mankiewicz remembers that his director father (Joseph Mankiewicz) made sure that his children, as well as his wife, were seen by psychiatrists:

  My father used to say to me, ‘You obviously have a lot of problems and a lot of hostility. You and I could never relate, so you need to talk to someone impartial.’ Just as English families consigned their kids to private school so they didn’t have to deal with them until they knew Greek and Latin, people like my father used psychiatry for one-on-one dealings…Most of us progressed from nannies to nurses to housekeepers to psychiatrists. There was always a surrogate parent around…the shrinks were always there.

  Brenda Webster in her memoir The Last Good Freudian depicts her artist mother’s reliance on her analysts through mourning, breakdowns and suicide attempts. The support such well known analysts as Muriel Gardiner and Marianne Kris gave her extended to help with the children. The advice the young Brenda Webster received on sex, on contraception, on men and on life paths came from them too. There was an implicit double bind here: if mothers couldn’t cope with their children and had to send them to shrinks, they had obviously failed in their primary calling and could only be resented by the children.

  Increasingly conservative as they became part of the medical establishment, America’s supposedly Freudian analysts were by the mid-sixties to find themselves attacked either because they had betrayed Freud’s legacy or because the whole psychoanalytical package was retrograde and ineffectual. Happiness was neither a penis, nor the child it helped to produce. Nor was the envy of it–so often interpreted as everything that a woman might want that didn’t include the attached man–a sufficient explanation or a good-enough put down for women’s growing desire for a wider sphere of activity.

  But if the generation of women who came to young adulthood in the late sixties and early seventies and made up ‘women’s liberation’ attacked Freudian patriarchy, they also and inevitably criticized the Moms who had been suborned by it. In fact, often enough they endowed them with the same all-influencing power that the culture as a whole popularly attributed to Moms. With intimate resentment, when it came to their own psychological ills, daughters blamed mothers for loving them not enough or suffocating them with too much love. Cold or fawning, always and inevitably sensed as controlling since they were the all-important centre of love or attachment in the family–its keepers and makers–these mothers also inevitably emerged as responsible for their daughters’ breakdowns. They had failed to safeguard the rites of passage into womanhood. In the spate of fictions describing women’s mental illness–from Sylvia Plath’s The Bell Jar, to Susanna Kaysen’s Girl, Interrupted, to Hannah Green’s I Never Promised You a Rose Garden, to Marie Cardinale’s The Words to Say It–it is the mother who in an uncannily Oedipal scenario becomes the focus of the daughter’s illness, the bearer of her inability to come to terms with self, men or world.

  Mother-analysts, transferential doubles–reliable and, it is hoped, not ultimately controlling–stand in for mothers and allow the girls to separate from their childhood Moms. They can also stand in the way of getting to or at the fathers. Meanwhile, they oversee the girl’s growth into woman.

  I never promised you a rose garden

  Hannah Green is the pseudonym of Joanne Greenberg, the author of some twelve fictions. Her bestselling novel, I Never Promised You a Rose Garden (1964), which became a Hollywood film, is a fictionalized account of her three-year experience as a patient in the famous Chestnut Lodge, one of the United States’ finest private mental hospitals. Greenberg, or Deborah Blau, as she is in the book, is sixteen, and has made a suicide attempt. This has led to a diagnosis of schizophrenia and the parents’ difficult decision to have her institutionalized.

  The girl, the book gradually reveals, has increasingly lived in isolated torment in a symbolic world, the Kingdom of Yr, which has its own language and demanding, persecutory gods. The real of her parents, a precise, emotionally controlling mother and a lonely father, confused by her illness, is available only with effort. Arriving at the asylum, ‘Deborah Blau smashed headlong into the collision of the two worlds…where she was most alive, the sun split in the sky, the earth erupted, her body was torn to pieces, her teeth and bones crazed and broken to fragments. In the other place where the ghosts and shadows lived…an old red-brick building stood…There were bars on all the windows.’

  During a time when electro-shock, insulin and early forms of drug treatment were common, Chestnut Lodge was one of the elite asylums to specialize in psychoanalytic therapy with severely disturbed patients. Run primarily by highly trained psychoanalysts, it took between forty-five and fifty-eight patients at a time, who were looked after by a staff of some 165. Treatment revolved around intensive therapy, not only the four-times-weekly hour with the psychiatrist, but life within an ethos in which each staff member saw mental illness as a condition potentially common to all, and listened carefully to what patients said since it might give a symbolic lead to the inner world they inhabited. Frankness was a watchword. Parents, particularly mothers, were to be kept away since their presence affected patients badly.

  That said, the picture Greenberg gives of asylum life is hardly rosy: warders can be frightening and insensitive; other patients violent as well as suffering. What is acutely portrayed is the solidarity and understanding that exist between patients, their nervous gossip about those who leave and may return, their knowledge that acts of violence are unintended or find mistaken objects. For all its travails, this asylum emerges as a place of refuge from a world which fears and fails to understand the motors of insanity and the overwhelming pain it brings.

  The Dr Fried (or Furii), who treats Deborah, is based on Frieda Fromm-Reichmann, a pioneer of analytic treatment with schizophrenics. One of the first women doctors in Germany, she had worked with neurologically damaged soldiers during the First World War and had run an asylum along Orthodox Jewish lines with her then husband, Erich Fromm. Both had trained as psychoanalysts at the Berlin Institute in the twenties. He went on to become one of the cultural theorists of the influential Frankfurt School and moved to the United States in the mid-thirties. Frieda, a medic, became a leading practitioner. Four foot ten, apparently straight-talking and charismatic, she was an advocate of Harry Stack Sullivan’s interpersonal psychiatry and by all accounts a formidable clinician. She is one of the �
��mothers’ Greenberg’s book is dedicated to. Persistent and sensitive, her long experience with the most intractable of mental patients leads to Deborah/Joanne’s cure after three gruelling years as an inpatient between 1948 and 1951, and then, until 1955, as an outpatient while she completes her education.

  Greenberg evokes a psychoanalyst whose treatment methods are far more interventionist than the norm, who prods her patient into response until she uncovers the secrets that won’t be divulged, in Deborah’s case a humiliating and disturbing uterine operation when she was five, which the child feels poisoned her: ‘They had gone in with their probes and needles as if the entire reality of her body were concentrated in the secret evil inside that forbidden place.’ The analyst communicates her anger. Her voice is ‘full of indignation’ for the five-year-old who stood before them both:

  ‘Those damn fools. When will they learn not to lie to children!…’

  ‘Then you’re not going to be indifferent…’

  ‘You’re damn right I’m not!’

  Fromm-Reichmann, like the various doctors who worked with schizophrenics and the severely disturbed, doesn’t rely on what had become the standard technique of detachment, silence and rare interpretation of the patient’s free associations–the norm of the profession in America. Instead, she is talkative, asks questions and answers them, intervenes actively and builds up trust. She offers support and is wise. As her last paper makes clear, she understood the profound, incommunicable loneliness–like the ‘helpless loneliness of a child whose cry is never answered’–which underlay her patients’ condition and against which their madness was a defence. The trust built up in the novel between Dr Fried and Deborah is one of the cords that tugs her back into the world as they do battle together against Yr, its persecutory authorities and its buried meanings. The doctor is a responsible guide through and out of the depths.

  Deborah’s ‘poisoning’ operation, one of the points of origin of Yr, leads her to believe that she poisons everyone she meets, including the ugly new baby sister she is certain she has tried to fling from the window. The attendant guilt is given symbolic shape in Yr. So, too, is her Jewishness, and the fate of the European Jews in the war that her grandfather evokes. Then there is her father, who constantly warns her against the filthy world of men’s desires, so much so that she palpably feels his and her own. As the therapy digs backwards, she sees a place without colour where a child is utterly alone, cold, far from love, her mother gone. She gradually recognizes that her sense of abandonment was triggered by her mother’s miscarriage. Locating the real and reasonable event is not enough to dispel the madness. We are made to see that this underlying aloneness has been reinforced time and again by each subsequent abandonment in the child’s life, has accrued in terror so that escape to her secret world becomes a habit and then a parallel universe which takes over.

  Yr is both the expression of Deborah’s illness and the illness itself: the once compassionate idealized world she could flee to has turned on her, and now threatens to destroy her altogether. Let into the secret, Dr Fried’s task is in part to interpret this world and then to wean her away from it by allowing her patient to experience her ability to live without its ambiguous protection. Deborah’s first active step away from her symbolic world is the assumption of responsibility for a fellow inmate who has been beaten. She acts on her roommate’s behalf by coming out of the lethargy which her struggles in Yr impose and complaining to one of the doctors. She comes to Dr Fried, too, who talks tough and pragmatically underlines that neither justice nor happiness is necessarily part of the ‘real’ world they are working together to usher her back into. There is no rose garden, only the ability to fight for it.

  ‘Look here…I never promised you a rose garden. I never promised you perfect justice. And I never promised you peace or happiness. My help is so that you can be free to fight for all of these things. The only reality I offer is a challenge and being well is being free to accept it or not at whatever level you are capable.’

  The fight takes time. Deborah gets worse, recedes, self-harms, burning herself time and again. Coming into the real is not easy, as all patients’ narratives testify. The doctor’s belief that there is a core of strength in her, however, is one of the forces that can pull the patient through.

  In her own writing, Fromm-Reichmann talked of the stormy therapeutic interviews, the severe persecutory ideas of her patient, as well as her hostility towards her and the dependence that had been built up. Not unlike Winnicott, though her language is different, she understood schizophrenia to come from a failure of early mothering at a time when it was essential to the child’s survival. In terms resonant with the force of splitting into good and bad, Fromm-Reichmann elaborated the conflict between dependence and hostility in the child, a split which produced intense anxiety. The fear of her destructive impulses, her fury and violence, made the child resort to hiding in her own self-enclosed world. The analyst’s task was to clarify the causes of these impulses as they were reinvoked through the defences–in Deborah’s case, through the symbolic world of Yr. Gradually the patient could recognize the irrationality of those defences, relinquish them and be tugged back into reality.

  Chestnut Lodge had more success than most in dealing with schizophrenia. From a group of seventy-seven paranoid schizophrenics treated by psychotherapy, 17 per cent were much improved, while 49 per cent were improved. Thirteen per cent remained unchanged, got worse, or died. For patients often considered incurable these are good figures; though the attendant costs in staff and time were such that only the wealthiest could afford them. Another elite institution known for its famous patients and for its mix of treatments from ECT to psychotherapy was McLean’s in Belmont, Massachusetts. It was here that another talented young woman was sent on 14 August 1953, after she had taken an overdose of sleeping pills and almost died.

  Sylvia Plath (1932–63)

  Sylvia Plath’s case is well known. Part of its iconic status comes from her ‘fiction’ The Bell Jar, where she evokes the downward spiral of a young woman, hungry for both creative work and experience, but vaulted by the limiting choices of her time into depression and the suicide attempt that take her to McLean’s. Plath’s own ultimate suicide at the age of thirty propelled the poet into an iconic stardom. For the women’s movement, particularly in America, she grew into a saint of female victimization, her madness and suicide themselves signals of what patriarchy did to talented women who dared to aspire, and dared doubly by also loving passionately. Sylvia Plath’s graduating class at Smith in 1955 were exhorted by the presidential candidate, Adlai Stevenson, to write ‘laundry lists’ rather than poems.

  Almost ten years passed between Plath’s first suicide attempt, her hospitalization, and the writing of The Bell Jar, which appeared pseudonymously in Britain in 1963–the year The Feminine Mystique came out–and just months before her death. Plath had been worried about her mother’s reaction and the book, though circulated in its British edition, didn’t come to America until eight years after her death. In the years between her first breakdown and the writing of The Bell Jar, Plath had moved to Britain on a Fulbright fellowship, met and married and was arguably on the point of divorcing the British poet Ted Hughes, had had two children, published The Colossus, and composed amongst others the great poems of Ariel.

  The Bell Jar is Plath’s only novel. It was written with the hope of making much-needed money. Provoked by ‘mental health articles’ in Cosmopolitan, she notes in her Journals on 13 June 1959 that she wants to write ‘a college girl suicide’ story, ‘THE DAY I DIED’…a novel even, since there is an increasing market for ‘mental health stuff’. She has, she says, Mary Jane Ward’s The Snake Pit in mind, the gripping asylum exposé made into a film with Olivia de Havilland.

  Plath produced something quite different. In the tough unsentimental idiom of an urban thriller, she explored the question of what being a productive woman might entail–one who can write, love and have children, not to mentio
n relate to the world. The question harries her heroine, Esther Greenwood, into a suicide attempt. Becoming a woman in the fifties, when the choices are restricted to suburban motherhood or a spinsterish professional life, entails a descent into madness, a symbolic death by ECT, followed by a reawakening, a birth into rebellious womanhood. This last is signalled by the ritual bloodletting, which is her heroine’s triumphal stage-managed sacrifice of her virginity. Greenwood’s is not the ‘schizophrenic’ symbolization and splitting into parallel worlds that Deborah Blau suffered from, but a far more common adolescent picture of depression, or of what Plath later called the ‘disintegration’ of her mind.

  Like her heroine, Plath had, in a writing competition, won a highly coveted month guest-editing the annual college edition of Mademoiselle in that capital of life and glamour, New York. That very month, on 19 June 1953, Ethel and Julius Rosenberg, allegedly Soviet spies, were electrocuted–and ‘goggle-eyed headlines’ blared–a chilling event that Sylvia both recorded in her journal and used in the opening of her novel, where the heroine talks of feeling ‘very still and very empty, the way the eye of a tornado must feel, moving dully along in the middle of the surrounding hullabaloo’.

  The month passed in an agitated whirl of activity, unfulfilled sexual exploration and self-doubt. At the end of it Sylvia was torn between taking a summer writing course at Harvard, the expense of it, and spending the next months before her senior year at Smith at home, learning shorthand, meeting the challenge of writing alone, and making her mother’s vacation ‘happy and good’. In July her Journals record the self-laceration of an ambitious and highly achieving young woman who drives herself with a frenzy, drives herself to love and work so hard that a paralysis of indecision and inertia takes her over. Plath’s vivid notes capture a spiral of self-hatred and confusion, a hothouse emotional excess made up of ardent desire, fear, lack of confidence and injections to bolster it. Her inner life is reminiscent of many a troubled young woman’s. On 6 July, she chastises herself: ‘why blind yourself by taking course after course’ when you should be able to think and not ‘retreat into a masochistic mental hell where jealousy and fear make you stop eating?’ She orders herself to stop thinking selfishly ‘of razors & self-wounds & ending it all’ and at the same time of ‘noise, names, dances’. She should be getting a job, or learning shorthand. ‘Nothing ever remains the same,’ she tells herself.