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

by Lisa Appignanesi

  In his general description of the condition Pinel underlines, as predisposing factors for hysteria, a great physical and moral sensitivity, an abuse of sexual pleasure, lively emotions, voluptuous reading and conversation; deprivation of the pleasures of love after having experienced long satisfaction in that domain, and nursing. Flaubert’s Madame Bovary may well have gone to school in hysteria and helped to spread that version of the ‘condition’. Pinel notes that symptoms can be minimal–over-paleness or ruddiness, loss of breath–or, when severe, fainting, fits and loss of sensation can take place. He also notes that the condition can be complicated by melancholy, hypochondria, even epilepsy. Indeed, throughout this time what we might call depression features as a symptom of hysteria. The best kind of treatment, Pinel suggests, is hearty exercise, various palliatives; and in the case of young, ardent women he recommends, like his precursor Hippocrates, marriage.

  By the time Charcot arrived on the scene of hysteria, this knowledge had something of the status of an old wives’ tale to which the harder truths of neuropathology, drugs, the newly scientific hypnotism, and anatomy were preferred. It is to Charcot’s credit that he did not treat the young women who came to him with a wide range of florid symptoms either as malingerers or as posturers. He understood hysteria as a genuine illness which had a neurological basis in a hereditary degeneration of the nervous system. Its status as a disease was provable by the very fact that it had a clinical pattern, the four stages, and could be relieved–by pressing on one of the hysterogenic zones, the ovarie, for instance–if not cured, which was the case for most neurological illnesses. It was the degeneration of the nervous system that made hysterics so susceptible to hypnotism, part and parcel of their illness. Environmental factors, traumas, sexual disturbances–all these for him were simply agents provocateurs.

  If hysteria flourished under his aegis into a particular set of theatrical symptoms, it was perhaps not due only to malleable patients and the suggestive powers of hypnosis. In the naming of an illness, power relations between doctor and patient can be a delicate set of negotiations with mutual benefits. Hysteria burgeoned because it served as a useful tool in the armoury of fin-de-siècle republican anticlericalism, of which Charcot was such a champion. That anticlericalism went hand in hand with defining a new, more independent, status for women.

  Nonetheless, we may not be surprised to find feminists in Charcot’s very own time criticizing his condescension towards women, his ‘sort of vivisection of women under the pretext of studying a disease for which he knows neither the cause nor the treatment’. But neither should we be surprised that working-class women may have found some liberation in becoming his highly visible patients; and, indeed, to find middle-class women influenced by his patients into a greater openness of behaviour than their families might have approved. Freud’s genius, perhaps, was to underline the wider cultural ramifications of hysteria, the collective features of conditions which so distinctly embodied the psychosexual conflicts of their time. One could say that Freud ‘medicalized’ the twentieth century by locating and naming sexuality as a problem; one could equally say the opposite. By underscoring the shallowness of sanity, our common thrall to the unconscious, Freud helped to destigmatize hysteria and the madnesses in which we all share.

  6

  SLEEP

  Looking back at the last decades of the nineteenth century and the period up until the First World War, what strikes the eye is the peculiar and frequent emphasis on kinds of sleep. Sleep, indeed, is associated with a veritable boom in activity amongst mind doctors, whether they train as neurologists, alienists or psychologists, and whether their patients are poor and come to them in hospitals or more affluent and consult them in clinics or private practice.

  There is the sleep which indicates illness–fatigue, exhaustion, hypnotizability. There is the sleep which is linked to therapy, whether as rest cure or the healing kinds of hypnosis. There is also sleep as mediumistic trance which is interpreted as either spiritualism, a communion with the dead, or hysteria. As illness, the medium’s sleep, with its array of voices and characters, paves the way for a diagnosis of multiple personality, as explanations move inward, away from the metaphysical and the soul is ‘scientized’.

  It is as if the period itself, with all its overt emphasis on work and achievement, on new speeds of travel and instant communication across distances–by telephone, telegram, telepathy–both deeply feared and passionately wished for nothing other than sleep. Nervous breakdown, collapse, exhaustion, fatigue, melancholia, punctuate the letters, diaries and case notes of the time, particularly for the growing number of nerve doctors in private practice in Britain and the USA, but also in Germany. The ardour of industrialization and commerce gives way to the world of neurotic, aestheticized torpor that Thomas Mann evokes so well, first in the family saga of the rise and fall of the German bourgeoisie which is Buddenbrooks, and then in Death in Venice.

  To unpack the term ‘decadence’, so often associated with the period, is in fact to arrive at just this: heightened senses, tautly strung and attuned to the finest and subtlest, also need and long for rest, a dying sleep, the obverse of the call to rigid duty and discipline. The will, that backbone of character and action in the latter half of the nineteenth century, the very sign of Empire and industry, is weakening, even as it calls for power. It is worth noting that with Morton Prince and his famous ‘multiple’ Miss Beauchamp, the will itself becomes the will to sleep, to enter the hypnotized state. Aboulia, that Greek term which became part of the diagnostic apparatus of the time and was attributed (mostly) to hysterics and neurasthenic women, means simply ‘loss of will’. If this sleep of dissociation, for the woman, becomes the more radical will to open her eyes and become another–a spunky, smoking, rebellious gender-crossing Sally, in the case of the prim, timid Miss Beauchamp, say–then this is precisely because what women want is liberation from the indeterminate, hypnotized state into which the customs and morality of the times have penned them. Out of the end of the century’s sleep, that waning of the disciplinary will, comes the Freudian dream with its double-edged wish at once for pleasure and for death. Indeed, one way of thinking about the shift is to note that with Freud, all the more rigid, determining and Victorian attributes of ‘will’ slip into the softer, murkier, and sexier, ‘wish’.

  Sleep, like wish, is, of course, most often culturally gendered feminine. And when the turn of the century researchers into the mind–whether psychiatrists, neurologists, psychologists, eventually the new century’s psychoanalysts or simply philosophers and artists–begin to explore all the ramifications of sleep, their subjects more often than not are women. Sleep is a passive, feminine state, after all. But increasingly it is clear that activity takes place within it. That activity–whether it is dream, somnambulism, the emergence of different personalities or selves or aspects of the self, visitations, or just the nightly work of an unconscious mind–is distinctly other, altered, and seems to share not a little with the hallucinatory, non-rational spheres of madness. When sleep states intrude on waking, as in post-hypnotic suggestion, this is understood as ‘pathological’ so too, the other way round, when the sleeper, rather than simply sleeping, walks or talks. The twentieth century is born with Freud’s investigation into a sleep state: The Interpretation of Dreams, published in 1900. Just a few years later Marcel Proust, who hadn’t read the Viennese, begins the novel that marks the modernist century with the words ‘Longtemps je me suis couché de bonne heure’ (for a long time I went to bed early), and proceeds to move fitfully in and out of sleep for the next fifty pages.

  If the hysterics of the Salpêtrière with their dramatic fits and star turns in lecture theatres hardly seem to be sleepers, this is to forget what Charcot thought of as their propensity for hypnosis, the ease of falling into sleep, into a state of somnambulism, which for him was intrinsic to their condition. In fact, part of the attraction of the Charcotian model of hysteria for the public may well have been that, like music-
hall performance, it allows a dominant male to look into a woman’s eyes and put her into a trance. In that sleep, like Trilby’s Svengali, that great bestselling creation of George du Maurier’s which had fin-de-siècle England enthralled, Charcot has the woman utterly in his control, even to the point where a mere touch supposedly brings on orgasm. Charcot is no exploitative Svengali, but he is part of the time’s mounting fascination with sleep states, that other consciousness which escapes reason and duty.

  Towards the end of the book Svengali’s assistant, Gecko, evokes Trilby’s double consciousness:

  ‘I will tell you a secret. There were two Trilbys. There was the Trilby you knew…But all at once—pr-r-r-out! presto! augenblick!…with one wave of his hand over her–with one look of his eye–with a word–Svengali could turn her into the other Trilby, his Trilby, and make her do whatever he liked…you might have run a red-hot needle into her and she would not have felt it…

  ‘He had but to say “Dors!” and she suddenly became an unconscious Trilby of marble, who could…think his thoughts and wish his wishes–and love him at his bidding with a strange unreal factitious love…When Svengali’s Trilby was singing–or seemed to you as if she were singing–our Trilby was fast asleep…in fact, our Trilby was dead…and then, suddenly, our Trilby woke up and wondered what it was all about.’

  Svengali’s use of the French command ‘Dors!’ for sleep is no accident, nor is the smattering of Italian and German. Hypnotism was a Europe-wide phenomenon. The papers and popular magazines were filled with stories about it and about trials concerning crimes committed under hypnosis. Performances of hypnotism were widely advertised. Nor was the gendered nature of the relationship between the male hypnotist and the female sleeper or patient something new. Ever since Franz Mesmer had travelled Europe at the end of the previous century and used animal magnetism and trance for various forms of healing, men had taken on the active role and deployed women as patient or subject. In the 1840s, the Scottish surgeon James Braid had medicalized the process he had first witnessed on the stage and had given it a new name, ‘hypnosis’, because he then assumed the trance state of the mesmerized was physiologically a kind of sleep. By the 1880s, when women had begun to clamour for greater freedoms and power over their own lives, controlling them by putting them to sleep might have felt even more apposite and expedient. Putting them to sleep for their own good, as the doctors did, adopting popular performers’ means for experimental use, had a double advantage.

  While there might have been some visible gains for working-class women in the ‘performance’ of sleep or trance on theatrical and hospital stage, or as mediums for the growing number of spiritualist séances, particularly in the Protestant countries, the immediate benefits of sleep for middle-and upper-class women are often less clear. The attractions of the invalid role with its sanctioned excuse from duty whether familial or sexual when no other possibilities are on offer, however, must not be underestimated. In a society such as the English, where fragility was a feminine attribute, the sickroom also wore associations with refinement and spirituality. The various anaesthesias–the lack of sensation–that so many of those with hysteria suffered on various parts of their bodies also seem to hold up a mirror to the times: the body, the skin, is not that through which the late-nineteenth-century woman, so well wrapped in her clothes, petticoats and corsets, is meant to feel.

  Exploring the uses of hypnotism, trance and double consciousness as a key to an unknown province of the mind was high on the agenda for the leading clinicians of the 1890s, whether they called themselves neurologists, alienists, psychologists or eventually, after 1896, psychoanalysts, as well as for philosophers and criminologists. In Paris, during the Great Exhibition of 1889, while the Eiffel Tower displayed the feats and conquest of the skies of which modern engineering was capable, from 8 to 12 August adventurers in the mind sciences gathered at the First International Congress for Experimental and Therapeutic Hypnotism, which followed on from the International Congress on Physiological Psychology.

  The congress on hypnotism brought together famous names from America as well as Europe. The philosopher and psychologist William James came from Boston, seedbed of the new psychology. The most famous medical user of hypnotism apart from Charcot, Hippolyte Bernheim, spoke. An opponent of Charcot’s and an expert in internal medicine who had become head of what became known as the Nancy School–where hypnotism, which he saw as a purely psychological phenomenon, was used to treat ‘organic’ diseases of the nervous system–Bernheim had influenced amongst many others the young Freud, who came to Nancy for a month in 1889 just before attending the Paris congress. Bernheim’s hypnosis was intended ‘therapeutically’, unlike Charcot’s, which was simply understood as a test for a susceptibility to hysteria. August Forel, doyen of Swiss psychiatry, represented the famous Burghölzli Hospital, where the hypnotism he had learned from Bernheim in Nancy was regularly practised on nurses seeking quiet, as well as on the agitated patients they attempted to tend.

  From England came Frederick Myers, founder of the Society for Psychical Research, which had an impact not only on Bloomsbury and English psychoanalysis, but on William James at Harvard and various researchers around Europe. Cesare Lombroso, another pioneer in a new field, came from Italy. A positivist and a progressive in terms of punishment, Lombroso’s work in criminology had nonetheless attempted to establish the hereditary nature of deviance, and posited an atavistic ‘born criminal’ whose degeneracy was identifiable through physical features such as fleshy lips, large jaw, pitcher-shaped ears and high cheekbones. 1889 was the year in which Lombroso published his Man of Genius, which argued a close link between genius and insanity.

  The fame of the conference participants and the popularity of hypnotism as a subject meant that the conference attracted a host of journalists from some thirty publications around the world. They would spread the word, along with the gestures and behaviours of the hypnotized. The altered minds and altered states that hypnotism could engender became not only clinical tools or psychological experiment for a growing cohort of specialists and researchers, but a subject that fascinated the masses just as monomania had before.

  Amongst the conference participants that summer was Pierre Janet, then a doctoral student whose experiments with long-distance hypnosis and the sleep states of hysteria had captured the attention of professionals. A philosopher who was soon to be a doctor, Janet had been invited by Charcot to oversee the psychological laboratory of the Salpêtrière that very year. Janet’s findings, his many books, his influence particularly on American practitioners, have been largely overshadowed by Freud. They have only come into prominent view again, after a century, with the rise of the multiple-personality movement in the United States, which needed a non-psychoanalytic precursor to give credibility to their ever more prevalent diagnosis.

  DOUBLES, DISSOCIATION AND HYPNOSIS

  Addressing the special centenary meeting of the Bloomingdale Asylum in New York in May 1921, Pierre Janet reminisced about his days with Charcot and underlined the strangeness of the divisions in the world of mind-doctoring.

  During the whole of the nineteenth century the radical division of neuroses and psychoses was accepted as a dogma; on the one side, one described epilepsies, hysterias, neurasthenias; on the other, one studied manias, melancholias, paranoias, dementias, without preoccupying oneself in the least with the connections those very ill-defined disorders might have. This division was accentuated by the organization of the studies and the treatment of the patients…

  This complete division did not fail to bring about singular and unfortunate consequences. In a hospital such as La Salpêtrière the tic sufferers, the impulsive, those beset with obsessions, the hysterical with fits and delirium were placed near the organic hemiplegics and the tabetics who did not resemble them in the least, and completely separated from the melancholic, the confused, the systematically raving, notwithstanding evident analogies…This distinction between the neurotic sufferer a
nd the mental sufferer was mostly arbitrary and depended more than was believed on the patient’s social position and fortune. Important and rich families could not be resigned to see one of their members blemished by the name of lunatic, and the physician very often qualified him as neurasthenic to please the family.

  Janet’s comments underscore the sense of the old adage that what is madness in the poor is mere eccentricity in the rich. They also look back with the wisdom of hindsight on what seem to be the aberrant classifications and odd mind/body divisions of the turn of the nineteenth century, a generational pattern which will repeat itself throughout the history of the mind sciences. As if trapped in the swing of a vast pendulum, the mind doctors focused their attention on physical or biological explanations only to be corrected by their followers, who emphasized the psychological and mental, and then back again.

  Janet’s criticism of his old master Charcot is, however, tempered. His work with hysterics pointed the way for those with a more psychological orientation, such as Janet himself. Born into a prosperous intellectual family, son of a Parisian legal editor, Janet began his academic career by studying philosophy at the elite Ecole Normale during 1879–82, where his contemporaries were Emile Durkheim, the founder of the new field of sociology, and Henri Bergson, the philosopher who was so to influence Proust with his work on memory–a major question for the epoch. Janet’s interests were soon to move from a philosophical reflection on the self and memory to a more practical investigation of the problem.