History: Mad, Bad and Sad: A History of Women and the Mind Doctors, from 1800 to the Present By Lisa Appignanesi Virago, 540pp. £20A fascinating account of approaches to female mental disorders from the 18th century.
'He went up to the attics when all was burning above and below, and got the servants out of their beds and helped them down himself, and went back to get his mad wife out of her cell. And then they called out to him that she was on the roof, where she was standing, waving her arms, above the battlements, and shouting out till they could hear her a mile off . . . She was a big woman, and had long black hair: we could see it streaming against the flames as she stood . . . Mr Rochester ascended through the sky-light on to the roof; we heard him call 'Bertha!'. We saw him approach her; and then, ma'am, she yelled and gave a spring, and the next minute she lay smashed on the pavement."
Bertha Rochester is the iconic figure of 19th-century female madness, as well as a repository for all kinds of forbidden female behaviours and longings. Susan Gubar and Sandra Gilbert, authors of The Madwoman in the Attic, the landmark piece of feminist literary criticism published in 1979, argued that women writers of the 19th century used female madness as a metaphor for their own suppressed anxiety and rage at the restrictive gender categories they were forced to endure.
What drives women mad? Right through the period covered by Lisa Appignanesi's absorbing book, mostly male doctors connected female mental disorder to the spectrum of menstruation, childbirth, motherhood and menopause, and current practitioners also place these events and processes centre-stage, but with far less misogyny and quite different aims to their predecessors. Early male doctors considered education likely to drive women mad, and these attitudes persist in the idiots who shouted "Iron my shirt!" at Hillary Clinton recently. And, of course, mothers are deemed by some psychoanalysts to drive everyone mad, particularly their daughters. Second-wave feminism said inequality, enforced domesticity and misogyny drove women mad.
Appignanesi is concerned to provide a guide to the various theories that governed approaches to mental disorder from the late 18th century to date, and to illustrate how changing approaches to the classification of disorders, diagnosis and treatment affected women. She singles out exemplary participants in the ongoing saga, ranging from Mary Lamb in the late 18th century to Elizabeth Wurtzel in the late 20th. What she requires from her exemplars is a capacity to articulate their situation and feelings, or a detailed record of their illness provided by someone else. The book is therefore heavily focused on writers, including obvious ones like Lamb, Alice James, Virginia Woolf and Sylvia Plath. The great mass of female mental patients (women have always slightly outnumbered men in this respect) are glimpsed only through the accounts of their more articulate and better-educated sisters.
MARY LAMB, SISTER of Charles and an author herself, murdered her mother with a kitchen knife in 1796. Next day in the coroner's court she was declared a lunatic. Her brother Charles had already placed her in a private asylum in Islington, thus pre-empting any incarceration order that might have been made. Six months later, she was released into the care of her brother, in accordance with the prevailing legislation. Had she killed her mother after 1800, she would have probably been incarcerated for life, as a new law had been introduced due to an assassination attempt on George III. Her case is on the cusp of the transition from meagre and brutal public and private provision for the mentally ill, to the creation of the large modern asylum and the professionalisation of therapists.
This enormous change, which mirrored the transformation of versions of mental illness from demonic possession and witchcraft to a more secular and humanist approach, was largely commenced in the famous Salpêtrière asylum in Paris during the revolutionary period, by Philippe Pinel and Jean-Etienne-Dominique Esquirol. The Salpêtrière was an exclusively female asylum, with thousands of inmates, many of whom were released from actual chains by Pinel in 1795. Both Pinel and Esquirol were interested in the effect of environment as well as biology on mental disorder. Pinel began the process of classification that has now reached its apogee in the American Diagnostic and Statistical Manual, the bible for psychiatrists, which lists more than 1,000 different disorders.
Pinel and Esquirol were the first "alienists", precursors of the modern psychoanalysts and psychiatrists. While the professionalisation of such pursuits was welcome in many ways, it also had its drawbacks, not least doctors' disinclination to question colleagues' diagnoses, and the possibility of perfectly sane people being confined against their will. One such was Hersilie Rouy, who was committed by her half-brother to an asylum in Paris in 1854, and remained there for 24 years, all the while battling for her release. She wrote memoirs that outline the stubborn professional resistance she encountered to her claims of sanity, one doctor marvellously rebuking her: "Your delusion is total, and all the more dangerous and incurable in that you speak just like a person who is fully in possession of her reason."
"Was will das Weib?" (What do women want?), Sigmund Freud disconsolately asked Marie Bonaparte, one of his patients and pupils. As we know, the daft conclusion he came to is that we want a penis, thus reinforcing women's second-sex status for many years after this most gifted of thinkers transformed our idea of human consciousness. Surprisingly, many of Freud's female followers (he had no problem with women psychoanalysts) unquestioningly accepted this nonsense, until Karen Horney, herself a Freudian, posited the idea of male womb-envy, a far more plausible idea, thus evening up the score. Feminist theorists like Simone de Beauvoir and Phyllis Chesler attacked Freud head-on, and did much to discredit his version of woman.
One thing that remains admirable about Freud, however, is his belief that ordinary human unhappiness is our normal condition. The prevailing pharmacological delusion that all human problems can be solved by Prozac or some other drug seems particularly infantile when placed beside the Freudian apprehension of the intricacy and complexity of the personality. The "talking cure", which he invented, is still probably the most effective mechanism for helping people in distress.
MOTHERS HAVE HAD a bad time of it from psychoanalysis. Just when we begin to survive childbirth and vicious child mortality, along comes Melanie Klein, one of Freud's followers, and pours a huge burden of guilt on mothers as the almost certain ruination of their infants, even if they think they are acting in their best interests. They are blamed for under-attachment to their children, causing autism, and over-attachment, causing unhealthy dependencies. How can you win?
From chains to purges to bedrest and overfeeding to lobotomies, ECT, psychotherapy and lithium; from demonic possession and witchcraft to melancholia to dementia praecox to manic depression to bipolar disorder; from small private madhouses to huge institutions to so-called care in the community, the history of women's diagnosis and treatment when mentally ill is largely a story of progress and amelioration, with significant gaps due to misogyny, inequality and a too-great reliance on the latest "cure". Appignanesi builds on earlier work by Elaine Showalter, Phyllis Chesler and others to give us a fascinating account of an important and illuminating subject.
Catriona Crowe is former president of the Women's History Association of Ireland