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

by Lisa Appignanesi

  Thinking back over the lives that have punctuated this history–from Mary Lamb, Théroigne de Méricourt, Henriette Cornier, through Alice James, Zelda Fitzgerald, Virginia Woolf to our contemporary sufferers from anorexia or depression–and putting them side by side with their times’ understanding of the mad, bad and sad, certain features come into relief. It is clear that symptoms and diagnoses play into each other and cluster to create cultural fashions in illness and cure. Whatever the sophistication of the diagnosis, however, and its attendant treatment, this may not alter the recurrent or chronic nature of an individual’s suffering. Pinel, in that sense, was as effective or ineffective a medic as the most ‘scientific’ of psychopharmacologists.

  What is clear is that as we have moved through the twentieth century and into the twenty-first, an ever wider set of behaviours and emotions have become ‘symptomatic’ and fallen under the aegis of the mind doctors. A vast range of eccentricities or discomforts that seem too hard to bear shape suitable cases for treatment. But if what is understood as illness grows, symptoms have been attributed to an ever narrowing set of ‘chemical’ factors. It is as if the greater the terrain of possible malaise, the more ‘scientifically’ and organically precise we would want the cause and cure to be. There is a contradiction here, which may serve a drug industry rather better than it serves those who have become designated as patients or indeed the social sphere as a whole. Our times may need ‘cures’ that are broader and other than those that can be found in therapy alone, whether of the talking or the pharmaceutical kind.

  Meanwhile, the mind doctors–whether they’re GPs on the front line, therapists of an increasing number of varieties, psychoanalysts, psychiatrists or psychopharmacologists–trudge along, doing what they can, which is sometimes all that can be done. The danger, perhaps, comes when we ask them to do too much.

  NOTES

  Abbreviations

  CW

  The Collected Works of C.G. Jung, ed. Sir Herbert Read, Michael Fordham and Gerhard Adler, trans. R.F.C. Hull (London: Routledge & Kegan Paul, 1944–78)

  FJ

  The Complete Correspondence of Sigmund Freud and Ernest Jones, 1908–1939, ed. by R. Andrew Paskauskas (Harvard: Harvard University Press, 1995)

  FJung

  The Freud–Jung Letters, ed. Wiliam McGuire, trans. R. Manheim and R.F.C. Hull (Princeton: Princeton University Press, 1974)

  IJP

  International Journal of Psychoanalysis

  SE

  The Standard Edition of the Complete Psychological Works of Sigmund Freud, 24 vols, ed. James Strachey in collaboration with Anna Freud, assisted by Alix Strachey and Alan Tyson (London: Hogarth Press and Institute of Psychoanalysis, 1953–74)

  Introduction

  up by 234 per cent Rufus May, ‘Britain on the Couch’, Independent, 8 Oct. 2006, p. 12, available at http://news.independent.co.uk/uk/ health_medical/ article1819643.ece

  mental health problems Nigel Mossis, ‘Suicidal, Sexually Abused, Scarred’, Independent, 2 Aug. 2006, p. 12, available at http://news.independent.co.uk/ uk/crime/article1209749.ece

  high blood pressure Our World, BBC World, 14 Nov. 2006

  specific hormones Ray Moynihan, ‘The Marketing of a Disease: Female Sexual Dysfunction’, British Medical Journal 326 (2003), pp. 45–7, available at: http://www.bmj.com/cgi/content/full/326/7379/45

  anxiety and depression See website for the ADD Health Centre: http://www.add-adhd-help-center.com/Depression/statistics.htm. See also the website for the National Institute of Mental Health, National Statistics Online (UK), the WHO document The Global Burden of Disease, 2000

  majority are women ‘Mental Illness Benefit Claims Up’, BBC News, 1 Feb. 2007, available at http://news.bbc.co.uk/1/hi/uk/6319593.stm

  Service are women Cambridge University Newsletter, Apr./May 2007, p. 4

  PART 1

  1 Mad and Bad

  frilly bonnet Mary and Charles’s portrait was painted by Francis Stephen Cary and is in the London National Portrait Gallery Collection

  too much business Morning Chronicle, 26 Sept. 1796, in Sarah Burton, A Double Life (London: Penguin Books, 2004), p. ix

  holy infant’s head ‘To a Friend’, in Samuel Taylor Coleridge, Poems, ed. John Beer (London: Dent, 1974), p. 43

  she is mad Richard Hunter and Ida Macalpine, Three Hundred Years of Psychiatry 1535–1860 (Oxford: OUP, 1963), pp. 310–11

  until 1948 Edward Shorter, A History of Psychiatry (New York: John Wiley & Sons, 1997), p. 5

  they administered William Battie, A Treatise on Madness, and Remarks on Dr Battie’s Treatise on Madness by John Monro, reprinted from the 1758 edition with an introduction by Richard Hunter and Ida Macalpine (London: Dawsons of Pall Mall, 1962)

  Earth and Heaven defies Anonymous, in Roy Porter, Mind-Forg’d Manacles (London: Penguin Books, 1990), p. 123

  as a lunatic Burton, A Double Life, p. 91

  paroxysms of insanity State Trials, 1800, vol. 27, columns 1307–30, quoted in Valerie Argent, ‘Counter-Revolutionary Panic and the Treatment of the Insane’, available at Andrew Roberts’s website: http://www.mdx.ac.uk/www/study/index.htm

  under five thousand Shorter, A History of Psychiatry, p. 5

  was 74,000 See Roberts’s website http://www.mdx.ac.uk/www/study/mhhtim.htm#1800

  use of violence Porter, Mind-Forg’d Manacles, pp. 131, 137

  wrong principles John Locke, An Essay Concerning Human Understanding (London: Everyman, 1961), book 2, ch. 11, p. 127

  melancholy to hypochondria George Cheyne, The English Malady: Or, a Treatise of Nervous Diseases of All Kinds (London: Stratham & Leake, 1733), ed. and with an introduction by Roy Porter (London: Routledge/Tavistock, 1991), p. 262, passim 260–74 for following material

  nervous minds Letter to Moxon’s, Sept. 1833; letters to Thomas Manning, 24 Feb. 1805, 10 May 1806

  Resource of Ignorance Cheyne, The English Malady

  associations and judgement Dr William Cullen, First Lines of the Practice of Physik (Edinburgh, 1778–84), vol. 2, pp. 121–2, quoted by Porter in Mind-Forg’d Manacles; see also Clinical lectures, delivered in the years 1765 and 1766, by William Cullen, M.D.…Taken in shorthand by a gentleman who attended (London: 1797), available at ‘Eighteenth Century Collections Online’, Gale Group, http://galenet.galegroup.com/servlet/ECCO

  society is afflicted Thomas Trotter, A View of the Nervous Temperament (London: Longman, 1807), p. xvii, quoted by W.F. Bynum, ‘The Nervous Patient in Eighteenth-and Nineteenth-Century Britain’, in W.F. Bynum, Roy Porter and Michael Shepherd (eds), Anatomy of Madness, vol. 1 (London: Tavistock, 1985), pp. 89–102

  Roy Porter Porter, Mind-Forg’d Manacles, esp. pp. 89–110

  newly invented types Michel Foucault, Interviews and Other Writings, 1977–1984 (London: Routledge, 1988), pp. 125–51. Foucault argues in his essay on ‘The Dangerous Individual’ that in consolidating itself as a specialized branch of medicine, psychiatry invented a new human type, the homicidal maniac, and turned murderers into mad people, the madness calling out for expert witness from specialists in court, since it was often visible only to them, the specialized readers of its signs, and the increasingly trained custodians of their treatment. The period in which this new human type emerges runs alongside the consolidation of the specialization of psychiatry in the first half of the nineteenth century. Mary Lamb’s life coincides with its development, though her homicide just predates it. Whereas the arguments put in pleading Hadfield’s assassination attempt on George III could have been spoken by later psychiatrists, in 1800 there were no expert witnesses for Erskine to call. His arguments, however, were familiar to Pinel and Esquirol, the founding fathers of French psychiatry

  his last years Porter, Mind-Forg’d Manacles, pp. 88–9

  to escape It is telling that Charles writes an essay entitled ‘The Sanity of True Genius’ in which he emphatically states that genius, the greatest wit, is always to be found in the ‘sanest writers’. ‘It is impossible for the min
d to conceive of a mad Shakespeare.’ Poetic talent, for Charles, who was always unsure of his own and worried over Coleridge’s excesses, manifests itself in the ‘admirable balance of all the faculties’

  report of 1825 Burton, A Double Life, pp. 294ff. See also Anon. [John Mitford], A description of the Crimes and Horrors in the Interiors of Warburton’s Private MadHouse (London: Benbow, 1822); and J.W. Rogers, A statement of the Cruelties, Abuses and Frauds, which are practised in MadHouses (London: printed by E. Justins, 1815)

  asylums in Britain See Andrew Roberts’s biographical resource on Mary and Charles Lamb, available at http://www.mdx.ac.uk/www/study/yLamb.htm

  that was necessary W.W. Webb, rev. Patrick Wallis, ‘Tuthill, Sir George Leman (1772–1835)’, Oxford Dictionary of National Biography (Oxford: OUP, 2004), available at http://www.oxforddnb.com/view/article/27900

  most valuable asylum W.L. Parry-Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries (London: Routledge & Kegan Paul, 1972), pp. 183–4

  good citizenship See Samuel Tuke, A Description of the Retreat, 1813 (reprinted London: Dawson’s, 1964); Michel Foucault, Madness and Civilization, trans. Richard Howard (London: Random House, 1965), pp. 241–7, provides what has become the classic critique of moral management

  female insanity Elaine Showalter, The Female Malady (London: Virago, 1985), p. 10

  of a kaleidoscope Thomas Noon Talfourd, Final Memorials of Charles Lamb (London: Moxon, 1850), pp. 351–2, quoted in Burton, A Double Life, pp. 241–2

  bear this out See, for example, Andrew Scull, Social Order, Mental Disorder (Berkeley: University of California Press, 1989), p. 270; and Nancy Tomes, various articles including ‘Feminist Histories of Psychiatry’, in S. Micale and Roy Porter (eds), Discovering the History of Psychiatry (Oxford: OUP, 1994), pp. 348–83, 364–6

  ever met with See Burton, A Double Life, pp. 164–5

  those of women Porter, Mind-Forg’d Manacles, p. 163

  30 per cent Parry-Jones, The Trade in Lunacy, pp. 49–50

  1056 to 1000 Figures quoted by Showalter, The Female Malady, pp. 52, 259

  nineteenth-century asylum Jonathan Andrews and Anne Digby (eds), Sex and Seduction, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry (Amsterdam: Rodopi, 2004); see, esp. the editor’s introduction

  in either jaw John Haslam, Observations on Madness and Melancholy, first published 1798, 2nd revised edn (London: Callow, 1809), p. 317, quoted in Shorter, A History of Psychiatry, p. 5

  Scabs dried up William Black, ‘Dissertation on Insanity’, in Hunter and Macalpine, Three Hundred Years of Psychiatry, p. 646

  category of masturbation Arthur Foss and Kerith Trick, St Andrew’s Hospital, Northampton: The First 150 Years (Cambridge: Granta Editions, 1989), pp. 193–4

  PART 2

  2 Passions

  the medical gaze Michel Foucault, The Birth of the Clinic, trans. A.M. Sheridan Smith (New York: Vintage, 1994); see, for example, preface, pp. ix–xix and 71–2. Foucault’s definition of the gaze is far-reaching: it includes an ocular probing which, translated into speech, renders the patient’s disease visible in a series of signs which become a subject both for natural history and for the education of students in the new medical technology of la clinique

  of his volition J.E.D. Esquirol, délire, in Dictionnaire des Sciences Médicales, par une Société de Médecins et de Chirugiens, Paris, p. 251, quoted in German Berrios and Roy Porter (eds), A History of Clinical Psychiatry (London: Athlone Press, 1995), p. 31

  or faith cures Jan Goldstein, Console and Classify (Cambridge: CUP, 1987), pp. 72–7

  the Paris police Ibid., pp. 47–8

  machine à guérir Jacques Tenon, in Mémoires sur les hôpitaux de Paris (1788), quoted by Goldstein, Console and Classify

  of the passions G.-F. Etock-Demazy, ‘Statistique médicale de l’asile de la Sarthe’, Bulletin de la Société d’agriculture, sciences et arts du Mans 2 (1837), quoted in Goldstein, Console and Classify, p. 160

  from their chains Sigmund Freud, ‘Charcot’, SE, vol. 3, p. 18

  brain disease Ibid.

  reassuring words Quoted in Goldstein, Console and Classify, p. 79

  in their capitals Quoted in Dora Weiner, ‘Le geste de Pinel: Psychiatric Myth’, in Mark S. Micale and Roy Porter (eds), Discovering the History of Psychiatry (Oxford: OUP, 1994), pp. 232–47. The description comes from a report Esquirol undertook for the Minister of the Interior in 1817, when he travelled across France investigating the conditions in which the mad were kept

  virtually vanished Goldstein, Console and Classify, p. 155

  buoyant [gaies] passions J.E.D. Esquirol, monomanie, in Dictionnaire des Sciences Médicales, Adelon, Alibert, Barbier, et al. (eds), vol. 34 (Paris: 1819), p. 115; and below, passim to p. 122

  despair and suicide J.E.D. Esquirol, Des Maladies Mentales (Paris: Ballière, 1838), vol. 1, pp. 399–401, for an introduction to the condition

  roller-coaster-like excesses See, for example, Elisabeth Roudinesco, Théroigne de Méricourt, trans. Martin Thom (London: Verso, 1991)

  to the soldiers Esquirol, Des Maladies Mentales, vol. 1, p. 447

  this monstrous crime Etienne-Jean Georget, Discussions médico-légales sur la folie ou l’aliénation mentale (Paris: 1826), pp. 71–9

  was no defence Quoted in ibid., p. 94. Georget’s contemporary text is the main source of material for the trials which laid the foundations of French law in this sphere

  trials by the mad Ibid., p. 116

  form of madness Esquirol, Des Maladies Mentales, pp. 252–3. Later figures cited by Elaine Showalter in The Female Malady, p. 54, show that the balance for post-partum madness was greater amongst the poor–though none of these comparisons are altogether reliable. Poverty could breed what was called ‘lactational insanity’, a condition caused by anaemia and malnutrition in mothers who nursed their babies for long periods for lack of other food and as a means of contraception

  the fit itself Etienne-Jean Georget, De la physiologie du système nerveux (Paris: 1821), vol. 2, p. 279, quoted in Edward Shorter, From Paralysis to Fatigue (New York: Free Press, 1992), p. 202

  rational control Showalter, The Female Malady, p. 55

  implicate the former Ibid., p. 56

  3 Asylum

  mental illness treatable Esquirol, Des Maladies Mentales, vol. 2; see pp. 695, 701–2

  patient is subjected Northampton Mercury, Oct. 1834, quoted in Foss and Trick, St Andrew’s Hospital, Northampton, p. 17

  Europe and America Report by Dr Thomas O. Prichard in 1838, cited in ibid. pp. 30–1

  often generates George Man Burrows, Commentaries on the Causes, Forms, Symptoms and Treatment, Moral and Medical, of Insanity (London: Underwood, 1828), p. 667

  laying on of hands Shorter, A History of Psychiatry, p. 43

  original noble structure Harriet Martineau, ‘The Hanwell Lunatic Asylum’, Tait’s Edinburgh Magazine, June 1834, quoted in Roberts and Andrew, The Lunacy Commission (1981) available at http://www.mdx.ac.uk/www/study/01.htm

  mercifully to control Wilkie Collins, The Woman in White (Oxford: OUP, 1991), p. 22

  she said, whispering Ibid., p. 91

  contradictions of a dream Ibid., p. 25

  put in place English novelists of ‘sensation’ continued to be preoccupied by madness and confinement. The bestselling Lady Audley’s Secret ends with the heroine’s confession that she murdered her husband because she was mad, a gloss of sorts on its author Mary Braddon’s relationship with the man she couldn’t marry because his wife was insane and confined in an asylum. Charles Reade’s Hard Cash provides a thin disguise for John Connolly, head of Hanwell, and accuses him of confining a man after receiving payment from his father: in fact, Connolly admitted taking money from a wife in order to inter her husband

  had told him Hersilie Rouy, Mémoires d’une aliénée (Paris: Paul Ollendorff, 1883), pp. 92–3, trans. by and qu
oted in Jeffrey Masson, Against Therapy (London: Collins, 1989)

  unemployed symptoms Goldstein, Console and Classify, pp. 324, 328

  officially anonymous Rouy, Mémoires d’une aliénée, p. 216, quoted by Masson, Against Therapy, p. 56

  of her reason Rouy, Mémoires d’une aliénée, p. 133, quoted in ibid., p. 54

  buried alive Ibid., p. 257, quoted in ibid., p. 57

  demonstrate sanity David Rosenhan, ‘On Being Sane in Insane Places’, Science 179 (1973), pp. 250–8

  number was 1072 Shorter, A History of Psychiatry, p. 47

  total of 30,538 E. Fuller Torrey, MD, and Judith Miller, The Invisible Plague (New Jersey: Rutgers University Press, 2001), p. 74

  the present day Ibid., p. 75, quoted from the Journal of Psychological Medicine and Mental Pathology 10 (1857), pp. 508–21

  alcohol-related madness Shorter, A History of Psychiatry, gives astonishing statistics on the rise of alcohol consumption throughout Europe: for example, in France the production of alcohol rose fourteen-fold between the end of the eighteenth and the beginning of the twentieth centuries. The result was a huge rise in alcohol-related conditions which fell under the category of madness–hallucination, memory loss, confusion–and resulted in confinement.

  was called for Emil Kraepelin, Lectures on Clinical Psychiatry, facsimile of the 1904 edn, revised and ed. by Thomas Johnstone, with a new introduction by Oskar Diethelm (New York: Hafner Publishing Co., 1968)

  the century progressed See Showalter, The Female Malady, passim, esp. ch. 3.

  moral insanity ‘Moral insanity’ was in fact first introduced in 1835 by the physician J. C. Prichard. He–and the courts after him–applied it to ‘insanity without delusions’, a Scots, then English, equivalent of Pinel and Esquirol’s ‘partial insanity’. See G.E. Berrios, ‘Délire’, History of Psychiatry, vol. 10, part 1, no. 37 (Mar. 1999)

  alone can live Henry Maudsley, Body and Will (London: Kegan Paul, Trench, 1883), p. 237, quoted in Showalter, The Female Malady, p. 119