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

by Lisa Appignanesi

  A prolific writer and astute observer of his patients, Weir Mitchell went on to give them fictional life in thirteen novels and countless short stories. Undoubtedly these portraits helped to fix the negative image of the neurasthenic woman in the popular imagination as a selfish, plaintive figure who manipulates those around her through her nervous disposition. Octapia Darnell, Ann Penhallow and Constance Trescott are all impatient, quasi-satirical portraits of invalids who shun the light and melodramatically enact their condition. In Roland Blake, Octapia Darnell spends her days in a darkened room, ‘on a long reclining chair, and covered with a silken down-lined coverlet’. A ‘long and attenuated figure’, she has the pale-golden complexion of a woman ‘originally dark-skinned and now lacking blood’. She complains about her weakness and chides her carer, the young Olivia, whose soothing caresses she seeks and whose life she sucks, vampire-like, to feed her own.

  Cure, for these invalid heroines, often comes–as it does for Ann Penhallow–in a call to duty, a challenge to return to a life in which they are needed: ‘Every physician of large experience must have seen cases of self-created, unresisted invalidism end with mysterious abruptness and the return of mental, moral and physical competence, under the influence of some call upon their sense of duty made by calamity, such as an acute illness in the household, financial ruin, or the death of a husband.’

  In his clinical writings, the spectrum of symptoms Weir Mitchell describes amongst his nervous women is broad. They suffer from tics and spasms, paralyses and aphonia, faints and sleeping, false pregnancies and ‘fish-flaps’, and veer between hysteria and neurasthenia, though distinguishing one from the other is rarely seen as necessary. He presents his cases with the vivid impatience of a practical misogynist:

  The patient was one of those stout, ruddy women, with good ovaries, and uterus where it should be, and yet hysterical to an exasperating degree. She weighed over two-hundred pounds, and was unhappily subject to what she called ‘fish-flaps’, which were really remarkable, because her body would be thrown up from the bed so high, and descend with such violence owing to her weight, that it was not rare to find the slats of the bed giving way. She grew better as her hysteria lessened, but is, I believe still subject at times to these unpleasant and undesired symptoms.

  While never altogether accusing his nervous women of inventing their symptoms or of being wholesale malingerers, Weir Mitchell is impatient at the intractability of illnesses which he nonetheless sees as caused by forces outside individual control. He attacks symptoms with the zeal of a terrier who doesn’t like to let go. Of a woman whose leg had for months refused to move from its rigid right angle to her body, he writes: ‘A multitude of therapeutic experiments ending always in failure, and the abandonment of the case, had been made by several physicians: nevertheless I undertook the treatment with a certain amount of hope, such in fact, as I always have, when an hysterical case is taken away from her own home and social surroundings, and subjected to new and revolutionary influences.’

  The primary features of the famous Weir Mitchell cure, his tenacity apart, were to take the patient away from familiar surroundings, to enforce rest and distance from any forms of stimulation other than those provided by doctor and nurse, to feed and to feed some more. In six weeks of isolation, the usual nervous patient was intended to gain some fifty pounds. On top of that there was massage; induction currents might be used to ‘awaken unused muscles’ sometimes, too, as in the girl with the rigid leg, there were hypodermic injections. As Mitchell describes it, the treatment consists of ‘an effort to lift the health of patients to a higher plane by the use of seclusion, which cuts off excitement and foolish sympathy; by rest [which sometimes meant immobility]…by massage…And by electrical muscular stimulation [which provided passive exercise].’

  All of this comes with goodly doses of the doctor’s willpower and an avuncular firmness, just short of threat. Symptoms, like women, were there to do Weir Mitchell’s bidding. The punishment of enforced bed rest and constant feeding, for a nervous patient who had already taken willingly to darkened rooms, could make movement and the stimulation health required at least momentarily attractive. If the patient proved obdurate, Weir Mitchell, it seems, was hardly above a little staged menacing. A story with all the force of legend has made its way into his biography. It has him telling a couch-loving patient, ‘If you’re not out of bed in five minutes, I’ll get in with you’, while slowly removing his coat, then his vest. Only when he started to take off his trousers did the angry patient leap out of bed.

  Mitchell had many women patients amongst the New England intellectual elite, including Jane Adams, Winfred Howells, Edith Wharton and Charlotte Perkins Gilman, who wrote a damning story, The Yellow Wallpaper, about the Mitchell cure. Her heroine is driven to insanity by enforced and infantilizing rest, during which she is prevented from writing. Gilman sent the story to Mitchell who, she increasingly claimed, changed his treatment of neurasthenia after reading it, though there is no substantive evidence that he did so.

  Alice James–though her symptoms were in line with his treatments–never went to Weir Mitchell. Both she and William had certainly read the man who, as a friend of theirs noted, cured ‘all the dilapidated Bostonians’. William had also met him in Connecticut, and stated in a letter that his talk was very interesting, though his intellectual and artistic nature might ‘be developed at the expense of his moral stability’. Instead, in 1883, at the height of Weir Mitchell’s fame, Alice checked into an asylum which treated ‘nervous people who are not insane,’ and stayed for three months. The Adams Nervine Asylum just outside Boston had been incorporated in 1877 by a bequest for the poor women of the state, though it also took in fee-paying patients. It had beautiful grounds overlooking an arboretum and a series of tastefully furnished Victorian Gothic buildings, all calculated to provide a fitting environment for its nervous patients and the Boston Brahmins who treated them. Places in the asylum, which prided itself, according to the Boston Globe of 18 April 1887, on ‘aesthetic’ surroundings, were in high demand.

  In a report of 1883 to his managers, Dr Frank Page provided a survey of his patients conducted since the asylum’s official opening in 1880. The results run counter to what some of his British fellow doctors might have predicted. In noting the causes of nervous illness he stated that in the 34 per cent who were housewives, their nervous condition was to do with ‘overwork, care, anxiety and sleeplessness, incident to domestic afflictions’. But worry over the care of others was more important in causing breakdown than overwork itself. Amongst the 14 per cent of patients who were teachers overwork was rarely the cause of breakdown and was, in fact, ‘productive of sound health’.

  For Alice and its other patients, the asylum offered what was a modified version of Weir Mitchell’s rest cure: time in bed, food, vapour baths, massage and faradic and galvanic currents applied to nerves and muscles to relieve pain and provide the stimulation which stood in for exercise.

  Temporarily better when she left the asylum, a few months later Alice was in search of treatment once more. As for so many nervous patients, cure was always sought and never found with any permanence. This time the instigating factor for Alice’s collapse, or fear that she would, was her companion Katherine Loring’s departure for Europe. The recommended doctor was an expensive New York specialist, a Russian who charged an exorbitant $100 a session for application of electrical currents, on the basis of a theory which had it that redirecting dormant impulses, or ones that had gone wrong, could cure fatigue and chronic nervousness. William Basil Neftel believed in exercise. It brought fresh blood and lymph to affected muscles. In 1875, he had written a book on galvano-therapeutics, which traced ‘the action and therapeutics of the galvanic current on the acoustic, optic, sympathetic and pneumo-gastric nerves’.

  Alice’s letters about her two months with Dr Neftel provide a clue to the doctor–patient relationship undoubtedly key in the treatment of ‘nervous’ illness. There is a flirtatiousness
in her tone, one she mocks, but can’t or doesn’t want to eradicate. The hope of cure produces a kind of love affair between patient and doctor which soon enough turns to disappointment and contempt for the doctor and, of course, for herself. On 5 May 1884, she writes to her old friend Sara Sedgwick, now married to Charles Darwin’s son:

  I went to test the skill of a Russian electrician…of whom I had heard great things and who certainly either in spite or because of his quackish quality has done me a great deal of good in many ways. I was charmed at first with the Slavic flavour of our intercourse but I soon found myself sighing for unadulterated Jackson. To associate with and to have to take seriously a creature with the moral substance of a monkey becomes degrading after a while, no matter how one may be seduced by his ‘shines’ at the first going off.

  Alice’s Bostonian moral sensibility may have been too refined for the mere foreign monkey, but the sexual metaphors underline that other kind of ‘electricity’ which was inevitably part of the therapeutic relationship. Doctors, in Alice’s experience, were the only men who ever laid hands on her body. The touch could be restorative, but it was also humiliating, as she made clear in a letter of 1886 to William, when she once more needed help:

  It may seem supine to you that I don’t descend into the medical arena, but I must confess my spirit quails before any more gladiatorial encounters. It requires the strength of a horse to survive the fatigue of waiting hour after hour for the great man and then the fierce struggle to recover one’s self-respect…I think the difficulty is my inability to assume the receptive attitude, that cardinal virtue in woman, the absence of which has always made me so uncharming to and uncharmed by the male sex.

  Freud, who later spoke the unspoken for so much of the period, wrote about the cure through love and underlined the vagaries of the transference between patient and doctor. For Alice, as brother Henry was to write, her tragic health was the only solution for the ‘“nervousness” engendered by (or engendering) her intense horror of life and contempt for it’. It suppressed any need for ‘equality or reciprocity’, as impossible to find with a doctor as with any other man.

  Her intense ‘horror of life’ was certainly entwined with its sexual element. But in puritanical America, diagnoses to do with that forbidden and unpalatable base matter of sex were not to arrive for some years. Before they did, that loose catch-all category of ‘nervous illness’ had to be contaminated by the dramatic proletarian atmosphere of Charcot’s Salpêtrière in republican Paris and pass through the fire of that psychological crucible which was middle-class Vienna.

  Alice was to die in London of cancer, the progress of which she met stoically and with a kind of relief that at last a real illness was the cause of her invalidism: nor did the doctors who dealt with this killing disease have any of the monkey-like quality of her prior healers. Henry James, whose books are filled with the mysterious ways in which illness, often either unnamed or unnameable, worms its way into and shapes the destiny of characters, was to survive his little sister by eighteen years.

  5

  HYSTERIA

  In France, full-blown hysteria was a condition of the poor–not, in the first instance, of the neurasthenic rich. It began its new life as the choice diagnosis of a fiercely republican belle époque. Esquirol had hardly bothered to explore it, and had classified hysteria under mania with which it shared the characteristics of ‘constant mobility, persistent agitation and inexhaustible loquacity’. The new hysteria took on prominence against the background of a society in rapid flux. Trains now sped between country and city, foreshortening geographical, if not cultural, distances. Scores of poor ‘immigrants’ and disoriented peasant travellers made their way to the capital, crowding its outskirts and slums. Their presence gave the city a sense of ungovernability. The influence of the Church was fiercely contested, as was the closeness between women and priests, which many thought only secular education and scientific medicine could rupture. In a speech in 1870, the republican politician Jules Ferry had urged: ‘Women must belong to science, or else they will belong to the church.’

  Indeed, the French battle for secularism was now waged down among the women. If the Church had Bernadette, the peasant girl who had heard the Virgin and whose cult of faith-healing miracles at Lourdes it was eager to abet, the secularists had Augustine, Geneviève, Blanche Wittman and those women who made up Jean-Martin Charcot’s remarkable panoply of hysterics at the Salpêtrière. Exhibited before a growing public not only of doctors, but of writers, artists and socialites–the chattering classes who made up le tout Paris–the extravagant St Theresa-like ecstasies and attitudes of demonic possession of these madwomen could be proved to be aspects of a disease called hysteria.

  Whatever the proclaimed battle lines, the Church’s sway over ordinary individuals went deep: the whispered orders of the confessional, the influence of invisible powers, might no longer always be cloaked in their traditional apparel, but the habit of listening to or being moved, guided, taken over by the unseen was still in place. The mind doctors would use it to bolster their new profession.

  For women, whose roles and psychosexual potential were regulated by Church and convention, the changes from a traditional to a modern society brought a double burden of difficulties. They were no longer the old version of their sex, at once cosseted and confined to the home, at least if they belonged to the middle and upper echelons of society. Nor were they yet the new: emancipation needed the First World War to take a substantive step forward. Hysteria, the most fashionable diagnosis of the latter part of the century, suited them. It described a sexualized madness full of contradictions, one which could play all feminine parts and take on a dizzying variety of symptoms, though none of them had any real, detectable base in the body. It was a partial madness which could in attacks mimic both epilepsy and ecstatic saintliness. The hysteric could be paralysed when awake, but perfectly mobile when ‘asleep’.

  Susceptible to ‘invisible’ forces such as hypnotism, easily and unknowingly swayed, emotionally labile, often young and pretty, Charcot’s hysteric sums up the period’s fears and aspirations. She is–in her hypnotized, sleeping, paralysed or mute state–a parody, an excessive, caricatural version of that Victorian vision of the feminine which would have woman passive, angelic, malleable, and utterly desirable while undesiring, her skin anaesthetic. Yet the hysteric also embodies the time’s often secret desires for a certain sexual freedom from what Freud later called ‘civilized sexual morality’–both for herself and for the fascinated men who watch and help to invent her. Hysteria, with its fluctuating symptoms, is par excellence the disorder that best expresses women’s distress at the clashing demands and no longer tenable restrictions placed on women in the fin-de-siècle.

  Augustine and the doctors

  The girl who became known as Augustine, though sometimes in the case notes she is called Louise or simply L. or X., came to the great Salpêtrière hospice, that women’s city within a city near the Gare d’Austerlitz in Paris, at the age of fifteen and a half on 21 October 1875. Just thirteen years before, in 1862, when the formidable doctor who was to become known as the ‘Napoleon of neurology’, Jean-Martin Charcot, had first taken up his post, the hospital had been a veritable hell-hole, with one doctor for every five hundred of some five thousand women, many of whom suffered from chronic neurological conditions, were geriatric or, in the case of eight hundred or so, were ‘alienated’. The vast majority were considered incurable.

  By an accident of building layout, epileptics and hysterics, having been separated out from the mad, were housed together. With a zeal for establishing a science out of neurology, Charcot, a carriage-maker’s son who had slowly risen through the medical ranks, set out to classify the contents of what he called the ‘museum of living pathology’. Working with the hospital’s resident population, he made detailed observations through time of the whole gamut of nervous and degenerative conditions–the choreas, ataxias and tabes dorsalis [a development of neurosyphil
is]–which manifested themselves in tics, shakes, loss of mobility or sensation, fits and paralyses of differing kinds. All of these could shade into mental conditions. Elevated in 1872 to the newly established Chair of Pathological Anatomy, Professor Charcot soon set up a photographic atelier in order to put the new technology to use in the work of medical documentation.

  Charcot was in the line of the great and theatrical French doctors. Like Pinel, a painting of whom he had hanging in his regular lecture theatre, and like Esquirol, he prided himself on his talent for observation, his eye for detail, his rigorous method. In the opening lecture of his Diseases of the Nervous System, he points out that unlike ‘nosographers’ who are interested in the abstract picture of a disease, ‘the task of the clinical observer…lies more especially in individual cases which almost always present themselves with peculiarities that separate them more or less from the common type’.

  Sigmund Freud, who for five months in 1885–6 sat amongst Charcot’s admiring pupils and achieved the desired honour of being invited to his famous soirées, stresses just this in his obituary of the great man.

  He was not a reflective man, not a thinker: he had the nature of an artist–he was, as he himself said, a ‘visuel’, a man who sees…He used to look again and again at the things he did not understand, to deepen his impression of them day by day, till suddenly an understanding of them dawned on him. In his mind’s eye the apparent chaos presented by the continual repetition of the same symptoms then gave way to order: the new nosological pictures emerged, characterized by the constant combination of certain groups of symptoms…He might be heard to say that the greatest satisfaction a man could have was to see something new–that is, to recognize it as new; and he remarked again and again on the difficulty and value of this kind of ‘seeing’.