Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present
by Lisa Appignanesi
Virago £20, pp560
This is a book with a broad scope and a bold aim: to look at the history of the study of the female mind over the past two centuries. It asks whether the contents of a woman's head need be regarded as any different to those of a man. The premise from the outset is clear: Appignanesi does not see women as inherently mad, bad or sad but is fascinated as to why, over the years, we have continued to classify them in these categories far more often than we do men.
As philosopher Ian Hacking puts it: 'In every generation, there are quite firm rules on how to behave when you are crazy.' But why have women been particularly subject to these rules? And in the past 50 years, has one important promise of the feminist project come true - that being able to have a profession and a less restricted life mean that women are less prone to mental illness? Or are there life events unique to the female experience that make women more susceptible to mental health problems?
The early chapters on the birth of the mental health professions are fascinating and addictive. It is astonishing to think that only a few hundred years ago, doctors did not imagine that their interaction with the patient had any effect or importance; neither did they regard anything the patient told them about their condition as being especially relevant. Philippe Pinel, the doctor in charge of the Parisian madhouses during the French Revolution, invented the bedside manner and was the first to look for patterns in the patient's life story that might explain what he called their 'mental alienation'.
The view of female patients throughout the 1800s would be hilarious were it not so disturbing. Breast-feeding women were seen as having 'lactational insanity' (it was thought, quite literally, that they had milk on the brain). In 1825, in Paris came the first instance of a doctor testifying that if a patient insisted she was not mad, this proved that she must be. This was part of the extraordinary case of Henriette Cornier, a nursemaid who calmly sliced off the head of her 19-month-old charge and threw it out of the window because 'the idea presented itself'. She refused to accept the charge of insanity and was sentenced to hard labour 'in perpetuity'.
One of the most striking cases is that of Celia Brandon, a 'small, stout woman with brown hair and clear, rather yellow skin' admitted for observation to the Royal Edinburgh Hospital in 1915. Brandon showed an extraordinary understanding of her own condition and of her sexuality; she was one of the first British patients whose case notes diagnosed her as having 'Freudian' problems. Brandon was brought up by a brutal aunt who subjected her to beatings from the age of three: these began to form the basis for her childhood fantasies. Later in life, this abuse surfaced as a problem when she married a diplomat who was largely absent. After she had a miscarriage, she became plagued by memories of her childhood and voices started to speak to her, castigating her for the 'dirty' fantasies in her memory. When stable, she could describe her conflicted mental state in great detail to her doctors. It's possible she had knowledge of Freud: 'She seems to know that dreams are an expression of wishes and fears.' She was diagnosed with 'systematised delusional insanity' and treated for three years. After a while, the voices in her head abated and she left the hospital 'relieved'. Partial relief, not cure, Appignanesi concludes, is all an enlightened asylum can offer a woman like Celia Brandon.
The triumph of Mad, Bad and Sad is to mix these evocative case studies with potted histories of the great and good of psychology and psychiatry. Without wanting to sound too glib about an intelligent and academically rigorous study, this book is an excellent one-stop shop for those wanting to find Freud, Lacan and Melanie Klein among the same pages as Marilyn Monroe and Elizabeth Wurtzel. There is an attractive mix of the everyday and the clinical. The chapter on 'Mother and Child' is particularly useful for anyone eager to read an overview of the dauntingly extensive works of John Bowlby ('attachment parenting') and Donald Winnicott ('the good-enough mother').
This book is also excellent fodder for anyone prone to hypochondria of the mental rather than the physical variety. You find yourself scrutinising the diagnoses of the 18th-century 'furious lunatics' to see how far you match them. As Pinel put it, hatred, envy, jealousy, grief and remorse are all capable of driving an individual mad; which of us has not experienced these emotions, sometimes all at once? Likewise, who can say they are safe from the factors he considers predictive of mental alienation: irregularities in the environment; sudden, oppressive or excessive passions; a melancholic constitution?
There are ample examples from literature (Woolf, Proust, Plath) and fascinating historical tabloid cases of extreme hysteria and so-called madness. Appignanesi tirelessly explores causes, symptoms and back histories to find answers, refusing to believe that madness comes out of nowhere. Like Freud, she is at her best when trying to untangle our preconceptions about sanity.
Her reading of 'the most iconic mind doctor' is generous, although she examines in detail why Freud has been portrayed as sexist. Freud believed that women were at risk of neurosis when 'idealisations of the family were at odds with lived experience'. But this, as Appignanesi seems to imply, is surely true for most people. Life is often at odds with our expectations. She concludes that Freud's perceived sexism is less relevant than his legacy: he underscored the 'shallowness of sanity' which helped to destigmatise mental illness.
The book returns repeatedly to the most awkward questions. Why do women still seem to be more prone to mental illness than men? Is this caused by something innate? Or by 'female' life events like childbirth and menopause? Or because of the way we have viewed and treated women for centuries? Why do women seem to respond better than men to talking cures? These questions are timely. A 2004 study is quoted in which girls' suicide attempts in the UK outnumber boys' by nine to one. We may have moved beyond 19th-century practice of observing and cataloguing 'female hysteria', but we have not lessened the incidence of mental illness in women.
The author treads carefully here, weighing up every approach objectively. Her own view is eventually revealed - mental illness and depression are far more likely to be caused by poverty than by gender: 'The greatest percentage of both men and women who consult doctors, old age apart, are those who have no regular work or those engaged in manual labour.' Prolonged impoverishment of potential, she notes, is a near certain predictor of a brush either with the mental health authorities or the prison system.
With this in mind, Appignanesi does not reach a table-thumping conclusion; she prefers analysis and exploration to blame and political point-scoring. The thread running through this work is that all women - and all men - are mad, bad and sad at times, and that we must be wary of classifying those who seem excessively so, because, in labelling them, we are simply labelling the human condition. 'Narrowing or medicalising definitions too much limits the boundaries not only of so-called normality, but of human possibility.'
Girl crazy: madwomen in books
The Bacchae by Euripides, 405BC
The women of Thebes are driven into a frenzy by Dionysus.
Macbeth by William Shakespeare, c1605
Lady Macbeth's ambitions are fulfilled at the price of her sanity.
Jane Eyre by Charlotte Brontë, 1847
The original madwoman in the attic, Bertha is confined by her husband, Mr Rochester.
Great Expectations by Charles Dickens, 1861
Jilted at the altar, Miss Havisham becomes a bitter recluse.
The Yellow Wallpaper by Charlotte Perkins Gilman, 1891
Diagnosed with 'nervous depression', the narrator is prescribed a terrible rest cure.
The Bell Jar by Sylvia Plath, 1963
Semi-autobiographical account of 20-year-old Esther's battle with depression.
Poppy Shakespeare by Clare Allan, 2006 Poppy reports from a psychiatric hospital.
Jean Hannah Edelstein
