Thus the Attorney General pleading that Cornier’s supposed madness–testified to by doctors but unproven–was no defence.
Countering this, Georget states that if we consider the mad to be simply wild beasts or raging dogs, society might as well go all the way and kill them off by the thousands. After all, what difference is there between a mad person who has already killed and the one who may kill? But a mad person is not a wild beast. The mad need to be cared for and can even be cured: humane attention in an asylum, not a prison, is what is needed to keep both them and society safe.
Michel Foucault has signalled Cornier’s case and 1826 as a turning point in medico-legal discourse. Crime, here, became sickness, the inexplicable monster a matter for psychological investigation. He sees Georget’s argument as leading to a double incarceration: by naming Henriette Cornier both mad and dangerous, she is being imprisoned within a classification as well as within a prison/asylum. Georget, however, believes that in championing the new medical science he is striving for a more caring and enlightened society.
The year 1826 is important in the history of psychiatry in a second way. It marks a philosophical moment in which social and environmental forces are clearly seen to produce madness, over and above biological and hereditary ones. Society engenders alienation and shapes the symptoms of derangement. The proof of this lies partly in Cornier’s much publicized case, as Georget points out. In its wake, France is prey to a series of copycat murders–a diffusion of the diagnosis of homicidal monomania. No sooner does a woman in Amiens who suffers from terrible head and stomach pains hear of the murder Cornier commits than she is seized by an irresistible desire to kill her own child, though she loves him. On the point of succumbing to this terrible temptation, she cries ‘Fire!’ When her neighbours arrive, she tells them of her plans and how she won’t be able to resist killing unless she’s hospitalized. Elsewhere a servant girl confesses to an urge to cut off her charge’s head, a desire that has incapacitated her, thrown her into depression and made her stop eating. There are more.
Citing Esquirol as his model, Georget writes:
the dominant ideas in a society, the grand conceptions and new opinions, important events, have generally influenced the character of madness. Amongst these we can count religious wars, the crusades, civil discord, magic and witchcraft, ideas about liberty and reform, the storms of our own revolution, the rise and fall of the Bonaparte family, the return of the Bourbons, and a host of other less general influences, amongst which one will soon have to place the importance of homicide trials by the mad.
The best remedy for the latter is to forgo the publicized trial, which inflames the imagination of those susceptible to copycat acts. The mad person should immediately be examined by doctors and committed to an asylum–as English procedure has it.
MONOMANIA AND CHILDBIRTH
There was general agreement amongst Pinel, Esquirol and their school that, whatever the dominance of social and psychological factors in most monomanias, the dementia of the old, ‘idiotism’, and certain kinds of madness particular to women, had a bodily base. This has been a constant from the birth of psychiatry to our own time, whatever the period’s understanding of ‘biology’, hardly yet a science.
When for a brief moment a suspicion arose that because of her low pulse rate Henriette Cornier might be pregnant, this seemed to provide a ‘sufficient’ motive for her crime and rendered it less inexplicable. Pregnant women were considered to be subject to wild and depraved whims, quite unlinked to their ‘normal’ state. Even more susceptible to madness, it was thought, were women who had just given birth, were nursing or had abruptly weaned their babies. ‘Puerperal madness’, as it came to be known, was responsible for a tenth of the intake of women at the Salpêtrière between 1811 and 1814, Esquirol notes–measuring, as the new professionalism demands.
Subtracting the third of the intake who were over fifty, the proportion of women ‘alienated’ during this phase of their lives rises even higher. And richer women were apparently equally prone to this form of madness. Given the difficulties of childbirth, the many stillbirths and dead children in all classes, this is hardly surprising. Queen Anne was pregnant eighteen times: only one child survived beyond the second year. For some women, even when the birth was a healthy one, the chances were that it might bring back the horror of a prior death. However, all that said, Esquirol and other doctors’ sense of the higher prevalence of madness in pregnancy and post partum has to be questioned. It is probable that in this historical period there were more pregnant women as a proportion of the total 16 to 40-year-olds in the population than 20 per cent, so the higher percentage in the ranks of the ‘mad’ is hardly disproportionate.
Nor does the actual character the post-partum madness takes vary greatly from that of other individuals. Of the 92 women Esquirol studied, he found 8 who suffered from dementia, 35 from lypemania, or depression, and monomania, and 49 from pure mania. Out of the fifty-eight he pronounced cured, two-thirds were returned to home and normality in the first six months after the birth. Interestingly, he notes that the recurrence rate is high if the root causes of the alienation predate childbirth. A way of avoiding the cycle of madness, Esquirol suggests in a statement which might look radical in some religious and prolife quarters even today, is to prevent pregnancy itself.
In his cohort, Esquirol notes, there were six deaths. He wonders why the number of deaths from this puerperal madness is so much lower than that amongst women who have abdominal afflictions after childbirth. Post-mortem analysis of the six women who died after relatively long periods of alienation showed nothing unusual in any of their organs. There was no evidence of a material irregularity which might have caused their madness. Certainly–and Esquirol is emphatic in countering what were long-held medical dicta which he deemed pure superstition–there was no incidence of milk having travelled to the brain either because of lactation or lack of it, or because of abrupt weaning. There was no more milk to be found in the brains of these puerperally mad, he adds, countering another long-held superstition, than there was blood to be found on the brains of those women whose menstruation had ceased. Despite his preference for environmental over physical explanations for madness, Esquirol is quick to comment that analysis of the brains of those inmates who have suffered from long-term dementia of the kind most often associated with ageing shows that they do indeed differ substantially from normal brains. But this is very rarely the case with alienated post-partum women and cannot be associated with the cause of their madness.
Throughout Esquirol’s catalogue of case histories of post-partum alienated women, his tone is the humane, ‘neutral’ one of clinical observation. Woman, as the reproductive gender, may suffer a specific kind of alienation sparked by the difficulties of her condition, but there is no attempt to generalize this specific madness in a way that stigmatizes all women. Perhaps even more radically, Georget in 1821 insisted that his research at the Salpêtrière disproved the widely held assumption of a link between the uterus and hysteria: ‘According to my observations, the action of the uterus is normal in more than three-quarters of the [hysteria] patients, even during the fit itself.’
It is worth noting that in Britain, throughout the century, medical believers in the popular reflex theory, which found correspondences along the lines of the nerves between body parts, were rather less neutral in their observations and liked to trace mental symptoms back to women’s reproductive system. They were quicker to stigmatize all women as ‘more vulnerable to insanity than men because the instability of their reproductive systems interfered with their sexual, emotional, and rational control’. George Man Burrows of the Chelsea Asylum noted in 1828: ‘The functions of the brain are so intimately connected with the uterine system, that the interruption of any one process which the latter has to perform in the human economy may implicate the former.’
Esquirol was more circumspect in his extrapolations. He was equally so in his treatments. He used purgatives, leec
hes, herbs and baths for calming or energizing, together, of course, with moral management. Kindness and time in the asylum away from the family–whether from a loving or a dictatorial husband, an abundance of children, or simply from duties and labour–seemed to be the best healers that the nascent medical science of alienism could offer.
What is innovative and far-reaching in his diagnosis of monomania is that it emphatically introduces into the new science the idea that, having come to the asylum, one may also leave it no longer mad. Madness can be both partial and, sometimes, curable.
3
ASYLUM
By 1826, the year that Georget composes his passionately argued plea for the criminally mad to be kept in special institutions, therapeutic asylums have begun to grow up across Western Europe. Managing the mad in a civilized and progressive way is a big idea. Management does not necessarily equal cure, but it is optimistic about the kinds of human rather than bestial lives the mad can lead. It is also optimistic about the possibility of treatment being found.
A year earlier, Esquirol had become chief physician at Charenton. He was turning it into a model institution much frequented by doctors from other countries. At Charenton there were separate sections for the paying and non-paying patients as well as for the women. A garden for recuperative walks and calming views, regularized activities such as sewing and military drills, and–for the paying patients–billiards and ‘a salon where they may give themselves to various sociable games, to music and to dance, among each other and members of staff’ were all part of the healing amenities. The pleasant aspect of the place as well as the kindness of the staff formed a direct part of the therapy. The general atmosphere, the abundance of staff and the zeal of the doctors all contributed to make mental illness treatable.
Charenton may have served as a model institution, but there were few equivalents in France, despite Esquirol and his followers’ efforts. Even the law of 1838 aimed at extending asylum services across the country did little to erect a Charenton in every department of France. In Germany, however, with its thirty-nine separate principalities, all competing with one another and many with their own universities, therapeutic asylums spread. Indeed, it was in Germany that the word psychiatrist was first used and that psychiatry and psychology became university sciences.
In Britain, after the early impetus given to moral management by the Tukes family and the York Retreat, therapeutic asylums burgeoned, their growth sanctioned by a series of parliamentary Acts which licensed and regulated madhouses, nudging them into a more professional and medical mould. The humanitarian impetus, a generalized wish to relieve the suffering of the poor, also expressed itself in local asylum initiatives: liberal papers like the Northampton Mercury championed the setting up of a facility which would better the condition of lunatic paupers, who suffered cruel treatment: ‘It must be borne in mind that lunacy is a disease eminently dependent for its relief upon the moral no less than the purely medical discipline to which the patient is subjected.’ The General Lunatic Asylum in Northampton, which for many years housed the poet John Clare and later became the famous St Andrew’s Hospital, was the result of public campaigning in tandem with government legislation.
Its first head, Dr Thomas Prichard, and his wife and co-worker took up the moral-management baton and went further, abolishing all mechanical restraints during their tenure from 1838. He reported that their success was echoed in the results of the ‘largest and most celebrated hospitals in the kingdom; and that unanimity of opinion on this vital question is rapidly pervading not only our own country, but also the great continents of Europe and America’. Prichard, unlike some of his fellows, did not believe that ‘moral depravity is the essential cause of madness’, nor ‘guilt and sin’, but physical malfunctions. Whatever the causes, help, however, was moral.
Kindness, a soothing relationship between doctor or carer and patient ‘to calm the agony which reminiscence often generates’, and affectionate attention, were the watchwords of George Man Burrows in Chelsea and in the Clapham Retreat and William and Mrs Ellis first at Wakefield, then at Hanwell, as well as Prichard. So, too, was orderly occupation. In 1837 there were 612 patients at Hanwell, half of them ‘paupers’, of whom 75 per cent were engaged in some kind of regular daily work. So successful was the Ellises’ combination of devoutly Methodist morning prayers, work and phrenology–which, administered by Ellis, involved a calming laying on of hands–that in 1834, three years after the Ellises had taken over the management of Hanwell, the highly popular journalist Harriet Martineau sang the praises of the asylum as a model institution.
Like many of the reforming spirits of her day, Martineau was interested in bettering the condition of the pauper lunatic. But she was also interested in the fate of the ‘lunatic rich’: the absurd secrecy their families engaged in meant that they were kept in barbarous conditions, often strait-waistcoated and chained up in the attic and bereft of any ‘occupation and the blessings which accompany it’:
Where is the right to conclude that because disorder is introduced into one department of the intellect, all the rest is to go to waste? Why, because a man can no longer act as he ought to do, is he not to act at all? Why, when energy becomes excessive, is it to be left to torment itself, instead of being more carefully directed than before? Why, because common society has become a scene of turmoil and irritation to a diseased mind, is that mind to be secluded from the tranquillizing influences of nature, and from such social engagements as do not bring turmoil and irritation?
Considered a ‘disgrace’ when it is in all likelihood no more than an ‘inflammation of the brain’, the disease of insanity may be kept secret at home. But here it is not ‘susceptible to cure’. However, if patients are placed in some public institution like Hanwell, ‘where the inmates shall compose a cheerful, busy, orderly society; where there shall be gardening, fishing, walking, and riding, drawing, music, and every variety of study, with as many kinds of manual occupation as the previous habits of the patients will admit, they will in all probability be cured’.
Martineau was alive to another important aspect of Hanwell’s management. This was Mrs Ellis’s active role in it. Pinel had already noted the importance of his caretaker Pussin’s wife. Martineau’s stress, though, has a feminist ring–Mrs Ellis is an example to all, the harbinger of a new field in which women’s dedication and moral intelligence can shine:
The grandest philanthropic experiments which have hitherto proved undoubtedly successful, have been the work of men; and it has been thought enough for women to be permitted to follow and assist. Here is an instance, unsurpassed in importance, where a woman has, at least, equally participated; an instance, too, where more was required than the spirit of love, patience, and fortitude, for which credit has always been granted to the high-minded of the sex. A strong and sound intellect was here no less necessary than a kind heart…Women who are dejectedly looking round for some opening through which they may push forth their powers of intellect as well as their moral energies, will set Mrs Ellis’s example before them, and feel that the insane are their charge. They may wait till the end of the world, for a nobler office than that of building up the ruins of a mind into its original noble structure.
Martineau’s call has today been heeded.
It is clear that the asylum as a therapeutic tool had a certain success with those conditions we would now call depression or manic depression, perhaps also with what later became known as schizophrenia. Whether it was therapy, time away from family and from the pressures of life, or simply time itself which abetted cures is in some measure irrelevant. During its heyday, under doctors such as Ellis, John Connolly and Thomas Prichard, the morally managed or humane asylum helped a significant proportion of its patients–ninety out of a hundred, Harriet Martineau enthusiastically claimed in 1834.
But the rising medical professionalism of the alienists could also lead to certain abuses in which the doctors closed ranks against patients and refused to admit mistaken di
agnoses. An understanding of madness as partial might engender therapeutic optimism. It might allow the professionals to see what the lay person was blind to. But it could also lead to diagnoses of madness where there might be none at all, or only of a passing kind; and with it a refusal to acknowledge that patients might be wiser about their state than a series of doctors, each of whom was afraid or unwilling to criticize a prior colleague’s diagnosis. Patients could well find themselves the victims of a doctor’s prejudice about what kind of behaviour constituted sanity: this could all too easily work against women who didn’t conform to the time’s norms of sexual behaviour or living habits.
Corruption–in the form of medical collusion with strict or cheating or abusive fathers and husbands–could also ensure confinement well beyond need, even if in the first instance this might have seemed necessary. Leaving the asylum in such cases became a near-impossibility, unless rescue came from family or friends on the outside. And even then, difficulties might persist. After all, insanity was so fluid a concept. When it wore the guise of lucidity, it was difficult enough for doctors to distinguish, let alone for lawyers setting out the limits of responsibility in a courtroom. Conversely, for the individual named insane, it was sanity that became all but impossible to prove. The law might want to protect the individual’s liberty and civil rights–lost when he or she was declared insane and unable to manage estate and finances. Alternatively the law might want insanity named, attested to, and the person committed, since it had a duty to protect society from danger.
Charlotte Brontë was alive to this kind of danger. In Jane Eyre (1848), Mrs Rochester growls and grovels ‘like some strange wild animal’ in the attic where she is confined. She lunges and attacks and eventually sets fire to the house, blinding her husband in the process. Brontë–whatever other interpretations one might give to Bertha’s animality–was worried by madness and alert enough, given her brother’s condition, to delirium. But when she dedicated the second edition of Jane Eyre to William Thackeray, she had no idea that his wife Isabella had broken down after the birth of their daughter, attempted to drown her and then to commit suicide. Like Mrs Rochester, Mrs Thackeray was given to ‘manic bursts of laughter’ and was at times violent, even homicidal. Thackeray had her contained in a London madhouse, where two attendants looked after her.
Mad, Bad, and Sad: A History of Women and the Mind Doctors Page 10
