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

by Lisa Appignanesi

  The argument raged, women as often as not coming out on Maudsley’s and the evolutionists’ side. They found themselves between a rock and a hard place. Boredom would drive them mad; overexertion would not only drive them mad, but doom the species they were meant to serve. With a little variation and allowing for greater freedoms, not all that much has changed in our own day. ‘Expert’ voices reinvoke old prejudices, find statistics to fill the need, carry out studies in which the terms are already trapped in outworn hypotheses. They induce conflicts in working women by bemoaning the suffering child or the less than fertile womb, all the while warning of stress, emotional depletion or worse.

  Alice James (1848–92) and the American nerve doctors

  ‘[H]er tragic health was in a manner the only solution for her of the practical problem of life.’ So wrote the novelist Henry James on 8 May 1894 to his brother William, the famous Boston psychologist, about their sister Alice, who had died two years previously.

  Perhaps James, whose fictional heroines bestride the turn of the century, had a special flair for women’s secrets and their need of them because he had so many of his own to protect. A mysterious ailment had prevented him from fighting in the Civil War, that historic testing ground of American masculinity. He seems to share women’s and particularly the childless woman’s lingering sense of ineffectuality. Better than the rest of his family, he understood the invalidism Alice had taken on from adolescence as a solution to the ‘practical problem’ of life. In part through her, one imagines, he grew attuned to that fund of ‘unused life’ a woman like Alice contained and the frustrations of an independent nature housed in a woman’s body. He imparted these in different portions to his heroines. James also understood the nature of Alice’s talent, which had only latterly found expression.

  For the last three years of her life, Alice had kept a diary. This had been sent to the brothers by the woman who had shared her life from 1879. Henry was acutely worried by the possibility of the diary’s publication and the indiscretions it would reveal about himself and friends. Even so, he was astute and generous in his assessment of his sister’s gifts: ‘the life, the power, the temper, the humour and beauty and expressiveness of the Diary…It is heroic in its individuality, in its independence–its face-to-face with the universe for and by itself–and the beauty and eloquence with which she often expresses this, let alone the rich irony and humour, constitute…a new claim for the family renown.’ The diary also provides us with an insight from the sufferer’s point of view into what constitutes her ‘nervous’ condition.

  Though distinctive in its particularities and in the soaring talents of its members, the James family shared with its social contemporaries that pattern of nervous illness which George Beard had attributed to the well educated American upper-class elite. The two elder brothers, Henry and William, as well as their father Henry Sr, a Swedenborgian philosopher, suffered from bouts of depression and a mysterious, unplaceable nervousness. But it was Alice, the single girl amongst four brothers, and the youngest, who took on the family’s neurotic duty. It is the kind of division of energy and illness that Henry James portrayed in The Sacred Fount, where an emotional vampirism fuels the relations of his hero and heroine. The trajectory of Alice’s condition, even if it is altogether her own, follows the general outlines that ‘neurasthenia’ and its sometime attendant category of ‘hysteria’ played out in many women of her time.

  Henry Sr, who had no profession to take him out of the home, was an enthusiastic parent, intent, according to his philosophical understanding, on being subordinate to his children’s sacred ‘natural instincts’. He turned their rearing, always loving but always vigilant, into an experiment in which they felt constrained to be happy. Alice was pampered by the doting Henry Sr, who happened also to believe that girls were born virtuous and capable of self-sacrifice. Faced with this vision of perfection, Alice tended to estimate any fault in herself as a fall into an abyss of badness. Much later, in her diary, she wrote, ‘how sick one gets of being “good,” how much I should respect myself if I could burst out and make every one wretched for 24 hours.’

  Henry Sr’s wife, Mary Welsh, shared little of her husband’s sense of child-rearing, nor the philosophical leanings of the family’s best-remembered members. She was the most conventional and practical of Victorian household angels. It seems she either neglected or disciplined the playful, energetic child little Alice was, though once Alice’s illnesses begin, her letters–and the James family and their friends wrote countless letters to each other–are replete with maternal care for her ailing daughter. Illness gives Alice a distinct place in the spectrum of mother love, spread as she sometimes thought rather thin over a brood in which she came last. Despite Alice’s evident intellectual abilities, she was never educated to the level of her brothers, something she regretted throughout her life. During that restless European odyssey Henry Sr insisted was a necessary preparation for life for his American children, she often found herself left behind in shabby hotel rooms, while her brothers went to school or on cultural forays.

  Back in America, Alice grew into a fraught adolescence. Love felt like a danger, something she would never be good enough to earn, even though it was women’s only apparent destiny. She was plain, better at history classes than at the courting rituals of Boston. Men’s eyes were not drawn. Mock social roles and rules as she does with all her acerbic wit, they nonetheless bear down on her and leave their mark on her sense of self. She can neither live up to feminine expectations, nor control her own unruly desires.

  Illness provides a kind of solution to a life that accosts her sensibility, while all the while filling her with guilt about the unattainability of the ideal. That lifelong ‘occupation of improving’ she talks about in her diary can then take on a double significance: bettering herself and getting better. With illness, demands grow less, even if the weight of conscience and disappointment in herself continues. Illness means she needn’t flagellate herself about her lacks, needn’t compete intellectually with her brothers: she can be both interesting in her father’s terms, and a failure, judged by outward measures.

  The particular indeterminate condition from which Alice suffers also permits her the wild outburst of occasional delirium, a kind of hysterical rebellion against the imposed constraints of her situation. Interestingly, the very first entry in her diary, begun on 31 May 1889 when she is already forty, talks about those explosives within. Alice sees the diary as an ‘outlet for that geyser of emotions, sensations, speculations, and reflections which ferment perpetually in my poor old carcass’. But before she enacted her ironic theatricals on the diary page, it was illness that gave Alice the permission to explode. Illness also allowed the opposite–a parody of a very proper feminine passivity in that enforced resting which is depression or neurasthenia. Indeed, nervous illness was an altogether useful way out.

  By the age of fourteen Alice had already assumed what Henry James’s biographer, Leon Edel, called a ‘spiritual straightjacket’. She felt useless, imprisoned in a body ‘struggling out of its swaddling clothes’ but trapped by ‘muscular circumstance’, a lack of energy, into a renunciation: ‘I had to peg away pretty hard between 12 and 24, “killing myself” as some one calls it,–absorbing into the bone that the better part is to clothe oneself in neutral tints, walk by still waters, and possess one’s soul in silence.’

  At fifteen, Alice began to suffer from the more serious breakdowns that marked the rest of her life. The family letters are full of her condition, its ups and downs, without ever precisely describing her symptoms. She lacks force. She is exhausted. She rallies, is riding or swimming, joins a sewing bee, which dwindles as the young women marry. She suffers mysterious pains and fainting spells. The pursued social life brings no necessary proposals of marriage. She wishes she were dead. She suffers from loneliness, while her brothers travel; a sense of desolation haunts her and occasionally overwhelms. She sets herself tasks of study, in keeping with her intelligence and t
he intellectual ethos of her father and the two elder Jameses, but her body, as she later says, rebels, and she is filled with thoughts of suicide or of wanting to murder her solicitous, sometimes seductive, father, who expects too much goodness from her.

  A period of recuperation, a friendship formed with Katherine Loring, a capable woman who eventually becomes her partner in a ‘Boston marriage’ but who at first has to divide her time between Alice and her own invalid sister; a troubled engagement with Boston feminism–so well captured in her brother Henry’s The Bostonians–and she is ill again, suffering from pains in her limbs, amongst much else. Her favourite brother William’s marriage brings on a more severe collapse and a sojourn in an asylum–much as Charles Lamb’s early passion helped bring on Mary’s madness. After her mother’s death, useful at last, she nurses her father. But he repudiates her usefulness by committing that slow ‘gentle suicide’ that he had once told Alice–parrying her desire to die–was the only fair way. Henry Sr’s death brings another relapse. The pattern of nervous illness continues until her final cancer, which she suffers with a kind of relief that there is at last a nameable condition.

  Neuralgia, spinal neurosis, nervous hyperaesthesia, rheumatic gout, all these were diagnosed for Alice, alongside headaches, stomach upsets, fatigue and nerves. Under neurasthenia, George Beard had listed over fifty symptoms, some of which shaded into the equally indeterminate nervous illness of hysteria: these included fainting, tooth decay, irascibility, paralysis, lack of appetite, vomiting, fits of laughing and crying, neuralgia, muscle spasms, morbid fears, constipation, insomnia and weariness. In 1866 at the age of eighteen, after the family had moved to their permanent home in Cambridge, Alice’s condition so deteriorated that she was sent away for the first of her long cures. At the New York Orthopaedic Dispensary she underwent a regimen under the care of a Dr Charles Fayette Taylor. It was not so very different from the one developed over the next decade by Weir Mitchell.

  Indeed, like Weir Mitchell in his early days, Dr Taylor conceived of a link between orthopaedics and the nervous system. His treatment regimen included rest and a fattening regime, while the patient was distanced from her family. It seems slightly less autocratic than Weir Mitchell’s in that enforced passivity was tempered with exercise. As Alice’s biographer Jean Strouse points out, Dr Taylor, under the influence of a Swedish physiologist, had developed a movement cure which consisted of physical exercises, ‘mechanical orthopaedics’ and a goodly dose of therapeutic philosophy. He postulated, like so many of his fellows on both sides of the Atlantic, that girls who had been exposed too early to too much emotional and intellectual stimulation had their nervous systems ‘perverted from tissue-making and absorbed, as it were, in the sensational life. The body is literally starved, while the nervous system is stimulated to the highest degree.’ Emotions, for Taylor, were the most exhausting of all mental attributes. Too much education in a woman made her more emotional.

  Taylor’s therapeutic aim was therefore to ‘accelerate the nutritive processes and cause muscular development, without taxing the nervous system’. He advised that the patient should be ‘impressed with the idea that she must not regard her symptoms, be they temporarily pleasant or unpleasant, but should ignore them as much as possible, taking a course to secure ultimate immunity from them’. This latter advice has much in common with the tactics of ‘moral management’. But as his paper on ‘Emotional Prodigality’ of 1879 reveals, Taylor had also taken on board evolutionary thinking and its attendant worries about the good reproductive vehicle:

  While men are calmed, women are excited by the education they receive…the woman of our modern civilisation becomes the bundle of nerves which she is–almost incapable of reasoning under the tyranny of paramount emotions; some are wholly incapable of becoming the mothers of rightly organized children…For patience, for reliability, for real judgment in carrying out directions, for self-control, give me the little woman who has not been ‘educated’ too much…Such women are capable of being the mothers of men.

  It was clear that Alice’s mother was a far better exemplar of good womanhood than her daughter.

  Alice spent longer than anyone had expected under Dr Taylor’s care, six months from November 1866 to May 1867, during which the reports were that she bloomed. But no sooner is she home in Cambridge and engaged in the turmoil of social life, the loss of friends to marriage, the recognition of her own plainness, the pressures of that hothouse which is the James family, than early in 1868, at the age of nineteen, she suffers a far more serious collapse. James Sr comments on her state that year as being ‘much of the time mostly insane’.

  In 1890, after she had read her brother William’s discussion of hysteria and the splitting of consciousness, Alice made sense of her own conflicts in his terms. She described to her diary the sheer terror of her youthful condition: she had felt morally constrained to keep herself in control, whereas some part of her, which she calls ‘body’ or ‘muscle’, had violently rebelled:

  I have passed thro’ an infinite succession of conscious abandonments and in looking back now I see how it began in my childhood, altho’ I wasn’t conscious of the necessity until ’67 or ’68 when I broke down first, acutely, and had violent turns of hysteria. As I lay prostrate after the storm with my mind luminous and active and susceptible of the clearest, strongest impressions, I saw so distinctly that it was a fight simply between my body and my will, a battle in which the former was to be triumphant to the end. Owing to some physical weakness, excess of nervous susceptibility, the moral power pauses, as it were, for a moment and refuses to maintain muscular sanity, worn out with the strain of its constabulary functions. As I tried to sit immovable reading in the library with waves of violent inclination suddenly invading my muscles taking on some of their myriad forms such as throwing myself out of the window, or knocking off the head of the benignant pater as he sat with his silver locks writing at his table, it used to seem to me that the only difference between me and the insane was that I had not only all the horrors and suffering of insanity but the duties of doctor, nurse, and straitjacket imposed upon me, too. Conceive of never being without the sense that if you let yourself go for a moment your mechanism will fall into pie and that at some given moment you must abandon it all, let the dykes break and the flood sweep in, acknowledging yourself abjectly impotent before the immutable laws. When all one’s moral and neural stock in trade is a temperament forbidding the abandonment of an inch or the relaxation of a muscle, ’tis a never-ending fight.

  In this moving description of her inner struggle written in October 1890, over twenty years after her first major attacks, Alice folds her symptoms into the time’s paradigms. She sees her sense that ‘I had to abandon my “brain”’ as being linked to her attempts at ‘conscious and continuous cerebration’. Indeed, for all her rebellion, she accepts her own time’s thinking on the limitations of women’s capability and the effects of overreaching. She also understands herself as susceptible to nervous weakness through a hereditary strain. Her attacks are outgrowths of her body’s weakness, its rebellion against the difficulties of study: her mind refuses to focus, even though she would like it to persist. There is no hint in her highly intelligent self-analysis of a description that takes her further than the American doctors around her diagnosed, even though she does note a part for the moral power of ‘the constabulary’ self in her breakdowns–that self-policing on which the Freudian mind doctors will elaborate in the next generation, when instinct and sexuality are opposed to the constraints of civilization. A quarter of a century later, a comparable woman’s analysing her condition will use very different terms.

  Meanwhile, it may not be going too far to speculate that William James’s lifelong preoccupation with the ‘principles of psychology’–the title of the two-volume work in which he explores the entire gamut of thinking in the field–owes not a little to the intricate play of consciousness in his own family and the very real problems posed by his ‘delicate’ sist
er’s health. After years of treating his little sister flirtatiously, recounting his love affairs and writing to her at length from Europe about his escapades and tastes, his engagement and marriage in 1878 precipitated a major crisis in Alice, a suicidal despair through which Henry Sr nursed her.

  The many treatments Alice underwent in her lifetime all bore the imprint of Silas Weir Mitchell (1828–1914), the pre-eminent American specialist in nervous diseases. Weir Mitchell, the son of a doctor, trained in Philadelphia before travelling to Europe where he worked with the eminent physiologist, Claude Bernard. He had a taste for both research and writing. His work on the impact of snake venom on the nerves is still considered first-rate; and his early writings on the split consciousness of an early figure in American psychological history, Mary Reynolds, were cited by many investigators in the field. But it was his ‘rest cure’ for neurasthenia and the accompanying books that brought him fame throughout America and Europe, where they were widely translated: Wear and Tear; or, Hints for the Overworked (1871), Fat and Blood: An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria (1877), and in 1881 his Lectures on the Diseases of the Nervous System, Especially in Women.