Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present
by Lisa Appignanesi
560pp, Virago, £20
Lisa Appignanesi has a notable track record as a novelist and a sophisticated commentator on ideas. Freud's Women, which she wrote with John Forrester, engaged with the theme that is explored more deeply and fully in this book: the puzzling and often disquieting place of women in the understanding and treatment of mental affliction.
Let me begin with a hearty cheer. Mad, Bad and Sad is an ambitious, sobering and often entertaining account of a contentious subject. At the same time it is scholarly, acute and written with judgment. Appignanesi's prose is lucid and unpretentious, free of the portentousness and jargon that can encumber writing in this genre. It is a long book but never a tedious one, and I went to bed each night looking forward to learning more.
The book has two avowed aims: to give a historical survey of the evolution of "mind doctoring" and to consider what, if anything, distinguishes the female mind from the male - is it society or something inherent in the feminine psyche that causes it to be perceived and treated differently from the male? Thus, at the heart of the book is a feminist inquiry, but this is conducted without shrillness - indeed, with a balance that admits contradictory evidence and gives due weight to the fact that all report is culturally influenced and partial. Most tellingly, Appignanesi seeks to disinter and illuminate the hidden assumptions that conflate moral and mental health, and confuse natural affections and sentiments with pathology. Is madness bad or sad? Is sadness madness, or madness mere sadness? Is it badder to be mad or sad? Or is it better to be simply bad?
The evidence cited in the book is wide, drawing from historical records, many of them literary. The book begins with one of literary history's most famous instances of mental aberration: the sudden, violent and uncharacteristic behaviour of Mary Lamb, sister of the better known Charles, which led to the murder of their mother. This story is a paradigm for the book's whole enterprise: Mary, the intellectually precocious and emotionally neglected daughter of a crippled mother who favoured her firstborn son, and intimate of a bright but fragile younger brother, Charles - himself prone to melancholia - became the chief support of her beleaguered family through her industry as a needlewoman. A punishing workload, leading to extreme physical exhaustion, together with a history of emotional privation, seems to have provoked a fit of matricide at odds with Mary's known public character.
The story of "serene" and "sensible" Mary's murderous - yet entirely understandable - outburst and her eventual return to the community is instructive. Thanks to the swift action of Charles, she was confined in an institution, which served as an immediate protection and, by ensuring that her insanity was established, as a safeguard against any judicial punishment. As Appignanesi points out, the case was treated with a leniency that later eras, including our own, would not have condoned. Mary, while ever after affected by her descent into madness, was released back into a life of patchy equilibrium. She lived with her brother and produced creative work, which allowed her imagination a scope beyond the limits of needlework.
Three factors seem especially relevant in Mary's initial breakdown and tentative recovery. The degree of strain to her constitution, brought about by her responsibilities and long hours of unrewarding labour; the disparaging treatment she had received since childhood from her mother; and the crucial intervention of her brother. That her chief tormentor and victim of her "madness" was removed - by her own action - and that she received the attention and concern of her beloved brother may have been enough to restore her "sanity", if only temporarily. It seems likely that childhood damage was the main factor in her malaise. For the rest of her life she was subject to agitating "distempers", and she and her brother kept a straitjacket permanently to hand. There is a touching vignette of them weeping as they walked to the institution where Mary was to be confined, carrying between them the restraining garment.
Appignanesi describes numerous shocking brutalities to which those designated insane have been subjected. She is especially chilling on the techniques of force feeding, which led to loss of teeth and, frequently, broken jaws. There are dreadful examples of surgical assaults performed in the name of cure. One diabolical "care giver", Superintendent Henry Cotton of the Trenton state asylum in the US, "carried out an obscene campaign of surgery on the tonsils, stomach, colon and uterus of [female psychiatric] patients alongside removal of teeth. In the process, he maimed and killed thousands."
But Mary Lamb's is not the only case where kindness and escape from the pressures of the world proved modestly efficacious. Mary herself offers this wise advice to a friend whose mother has become demented: "Let your whole care be to be certain that she is treated with tenderness ... it is a thing of which people in her state are uncommonly susceptible." One of her physicians prescribed an effective therapy in the form of water, peace and bed rest.
One of the pleasures of Appignanesi's approach is her willingness to entertain the possibility that such simple restoratives may have their virtue. The old saying "nature cures and the physician takes the fee" is not sheer cynicism. The provision of a safe haven, a respite from quotidian strains, calm and kindness may be more remedial, ultimately, than drugs or more focused human intervention. One fact shines clearly throughout the book: the concerned and sensitive attention of another human soul is the single consistent feature in any successful treatment. And there is also the recognition, inimical to our fix-it age, that "cures are rarely absolute or for ever".
Appignanesi also makes the point that the deracinated and deranged were more socially acceptable before becoming medical subjects and thus liable to be stigmatised. And with this shift occurs the strange and well-documented phenomenon of the accord, rarely recognised or addressed at the time, between any prevailing theory and the nature of symptoms manifested. Thus we have the glut of hysterical paralysis in the late 19th and early 20th century, a condition unusual today but commonplace to Freud and his contemporaries; in the late 60s, with the prophet Laing, conflicted states of mind were represented by an upsurge of disembodied "voices"; more recently, there has been the march of multiple personalities, allegedly taking their origin from sexual abuse (though Appignanesi usefully presents historical cases where this was never a factor); and now we are beset with the attention disorders of our children, which plague distracted teachers and parents.
The example of Mary Lamb is but one among many cruelly captivating stories. The latter part of the book contains clear and comprehensible accounts of the major psychological contributions of the last century. But the white-hot core of the book lies in the compelling readings of the disturbed lives of Théroigne de Méricourt (the French revolutionary rescued by the Marquis de Sade from a coterie of screaming women), Alice James (sister of Henry and William), Virginia Woolf, Sabina Spielrein (Jung's patient, lover and early analyst), Zelda Fitzgerald, Sylvia Plath and Marilyn Monroe. Appignanesi resists the temptation to romanticise insanity, but examples such as these demonstrate a correlation between an unusual talent, or sensibility, and a susceptibility to being destabilised.
The case of Celia Branden is particularly fascinating, partly because like Rousseau she illustrates how the child is father to the wo/man. Branden's experience of physical correction as a child became the demonic ruling fantasy of her later sexual preference (the book shows why loving kindness to children is essential for the individual adult's wellbeing and for the general welfare of society). Branden provided her own highly intelligent confessions, revealing a Freudian perspicacity. Plainly, she had read and grasped Freud and was able to apply his theories even if, incarcerated against her own sexual demons, she never received the potential benefits of his "talking cure".
Appignanesi is too canny to attempt any one theory of the place of the feminine in the history of mental illness but she intimates that, both by upbringing and for procreative genetic reasons, women are generally more adaptive. They are better at picking up clues both as to what is being asked of them and what is acceptable (and what is "acceptable" is also whatever it is the current fashion to disown). It figures, then, that women may conceive and deliver whatever strategy gives their inchoate dissatisfactions the shape to fit the theories that are abroad in the collective consciousness. Appignanesi is not a sexist feminist - but the book slyly suggests that women are often the dramatic, if tragic, harbingers of men's radical "new" theories.
· Salley Vickers's Where Three Roads Meet is published by Canongate
