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

by Lisa Appignanesi

  There is nothing necessarily suspect in any of this. It is intrinsic to an extended doctor–patient relationship and can often help engender ‘cure’, or at least an improvement of symptoms, whether the treatment comes by hypnosis, talk or pills. As for what both doctors are interested in and patients produce as symptoms, that does seem to bear the weight of a historical moment. Janet, Freud, William James, Flournoy, Morton Prince were all fascinated by and trying to find evidence for the existence of an unconscious or subconscious mind, however they then described its workings. Alternating personalities, or la condition seconde, were proof of this. During the decades of widespread multiple personality disorder in the USA, what the doctors were interested in was the link between childhood sexual abuse–the collective anxiety of the epoch–and dissociated selves in the adult: they found it everywhere, and symptoms grew to fit the diagnosis the greater the notoriety that attended them.

  It was certainly the malleability of symptoms as he saw them in his patients, particularly those he called hysterics, that led Freud to pay less attention to their external manifestation than to the underlying nature of his patients’ lives–the trigger that had determined or precipitated symptoms. And it was when Freud went in search of motivation, the inner emotional turmoil that engendered the splitting that took place in a state akin to sleep, that he came upon sex.

  PART THREE

  THE CENTURY TURNS

  7

  SEX

  Late in 1914, just as the First World War was digging its trenches, a forty-five-year-old woman wrote to the Royal Edinburgh Hospital, then an asylum known for its outstanding and innovative psychiatric services, and asked to be admitted. Her letter is a riveting document from the inside of disorder: at once a gruelling depiction of the psychic pain she is in, a plea for help, and a searing attempt to make sense of her condition.

  The sense she does make catapults us into a new epoch of psychological understanding. Somewhere along the line, and mysteriously, this woman has picked up a terminology to describe her disordered state and give it an explanatory narrative which is quite different from what has come before. With Celia Brandon and far from Freud’s Vienna, we somehow find ourselves in the midst of a Freudian case: one which emphasizes that the roots of a disorder lie in childhood and are linked to sexuality, to the tangled trajectory of desire, punishment and inhibition, much of it expressed through dream and fantasy. Celia is an indication that the Freudian paradigms, though of course still enmeshed with the language of the nerves and heredity, travelled quickly to Britain and informed not only local practice, but the patient’s own narrative of psychic ills.

  Throughout the nineteenth century, various prohibitions about sex and masturbation had increasingly combined with a medical and psychiatric discourse to make sex far more than an experience of the body. Sexuality as a ‘possession of sexual powers, or capability of sexual feelings’–in other words as a complex of psychic features which carry with them abilities and lacks, a too-muchness or too-littleness–makes its first appearance in the OED in 1879. It is already manifestly a problem: the attendant quotation defining usage is from J.M. Duncan’s Diseases of Women of the same year: ‘In removing the ovaries, you do not necessarily destroy sexuality in a woman.’

  Sexuality is other than anatomical. It is not simply a matter of physical parts, but something mysterious and perhaps threatening, constantly in need of investigation, attention, or control. It is fundamental to the make-up of the person, and in particular of the female person. ‘Upon the nature of sexual sensibility, the mental individuality in greater part depends,’ writes Dr Krafft-Ebing, the noted Viennese psychiatrist, in his Textbook of Insanity. One of the period’s growing number of sexologists, he readily constitutes humans by their perversions–whether masochist or sadist, fetishist or homosexual, nymphomaniac or frigid. In an article of 1894 on the sexual functioning of women, he clearly hypothesizes that the sexual centre in the brain is as important as any sexual organ. Like Freud, as the century moves towards its close, he sees illnesses such as hysteria arising from a psychological factor. Drawing not only on patients but on his many informants who over the years write letters to him on any number of sexual dysfunctions, he notes that coitus can be ‘unsatisfactory’ even if on a physical level it takes place altogether satisfactorily. That ejaculation into the vagina constitutes only one part of a man’s sexual pleasure is ‘proven by so many husbands’ confidential complaints to the doctor of the frigidity of their wives’.

  As the century turns, sexuality increasingly and openly becomes implicated in the way the Western world makes sense of health and happiness, identity and destiny. It becomes a key indicator of the kind of individual one is, normal or perverted, sane or mad. The focus on sexuality, as Foucault underlined, particularly problematized women and homosexuals, masturbation, and children.

  The bathetic nadir of views on women is perhaps best represented by Otto Weininger in Sex and Character, the book that in 1903 took the German-speaking world by storm, was quickly translated and went into numerous editions. Weininger begins with a radical principle of human bisexuality. His feminine, however, is incapable of morality, voraciously desiring and ‘organically deceitful’. Emancipated women were, for Weininger, sexual deviants, only one step above homosexuals and Jews (of which he was one) in the hierarchy of value.

  Other commentators, less interested in apocalyptic evocation, stressed the need for reform: in a world where marriage for men, the only breadwinners, came late, since they had first to establish themselves, prostitution was rife alongside debilitating venereal disease. In Munich one-third of all children were born to single mothers. (Another third, it was thought, though born in wedlock were not the children of their putative fathers.) The principle of monogamous marriage was both a hypocrisy and destructive, as that ‘polygamist’ and wild psychoanalyst Otto Gross, who for a while deeply marked the young Carl Gustav Jung, pointed out. In more academic circles, similar views took hold. The anthroposociologist Ivan Bloch, in The Sexual Life of Our Times (1906), points out how modern society simultaneously ridicules the ‘old maid’ and ‘condemns the unmarried mother to infamy’. ‘This double-faced putrescent “morality” is profoundly “immoral” it is radically evil. It is moral and good to contest it with all our energy, to enter the lists on behalf of the right to free love, to “unmarried” motherhood.’

  Thus, while problematizing sexuality, the new reforming discourse also had a liberatory force, especially for women who had been consigned to roles and rules, a double standard which severely restricted their human potential. The new attention paid to sexuality brought desire out of the depths that respectability, ignorance and oppression had forced it into.

  Celia Brandon provides an example of the way a patient might have internalized the old punishing sexual order while acquiring some of the language of the new psychosexuality, a language which had become so commonplace by the end of the twentieth century that it is difficult to see it afresh and recognize it as a cornerstone in the making of a particular kind of human.

  Celia Brandon

  Celia Brandon had an extraordinary history, though in her own time its general trajectory was not untypical of women in families engaged in the colonial service. Her case underlines the difficulties the wives of those who worked in distant outposts faced as they negotiated the dangers of childbirth, the loneliness of a world where there was little mingling with natives, and the hothouse of damaging rumour produced in this closed society. Born in Shanghai in 1870 to a mother who died two weeks later, leaving the tiny infant and her older brothers in the care of a father in the British Chinese colonial service, baby Celia was sent home, first to relatives in Scotland, then to an aunt in England. Here she lived under the strict and self-righteous tutelage of a taciturn woman who could ill cope with the precocious child Celia was. The older Celia, already an adept of asylums, describes this aunt as ‘cataleptic’ and prone to periods of ‘unconsciousness’.

  In the letter to
the Edinburgh Hospital in which she narrates her own ‘case’, Celia writes of terrifying punishments, too severe for the delicate child she was–one whom the doctor had thought might be stillborn. When she is three or four, she begins to have vivid dreams in which she is crouched on all fours and smacked from behind, ‘which gave me a sexual pleasure in front…forgotten at the time, but remembered later’. Her formulation wonderfully parallels the Freudian understanding of child development from the early anal, oral and phallic stages, which are forgotten and then reinvoked during the sexual awakening of puberty–so that early sexuality is already always in part a created memory. Celia talks of remembering how her aunt told her to take a hairbrush to bed at night and punish herself behind–an injunction she names as the cause of her ‘performing on her person in all manner of ways’, including riding banisters. Discovered by her governess, little Celia learns to lie and carries on her activities, only to stop when she is returned ‘home’.

  At the age of twelve, Celia was shipped back to China to live with her father and brothers, one of whom worked as an engineer, the other as a teacher of navigation. Her mother, it was rumoured, had had a drinking problem; one of the brothers was unstable, and Celia’s father described his own daughter as ‘weak’, referring to her nervous temperament as well as her physical delicacy. Celia’s education may have been erratic but she was bright, as her own writing testifies, and her finishing school commented on her talents. She had a good singing voice and her liveliness made her popular in the fair-sized colonial community. So did her amateur theatrical performances, which were commented on in the local newspaper.

  At the age of twenty, Celia met an ambitious functionary in the Chinese Office. Ten years older than her, Arthur James was a widower who had two children by a previous marriage. There is the sense of an exciting courtship filled with dance and music, so exciting that it over-stimulates Celia and her father takes her home, away from her fiancé, for something of an enforced rest. She talks in her letter of being in a nervous state during which excitement pulls her down again. The excitement is also evidently sexual and worrying.

  Once married, the couple move to Peking where Arthur James rises through the service. The family live in the foreign compound, a small but active community housing a mix of European and American nationals, a lively society of diplomats, teachers, entrepreneurs and their staff. The compound has its own shops, library and entertainment, and is situated at the centre of Peking, just outside the walls of the Forbidden City. The James children live with Celia and her husband for a few years, before they are old enough to be shipped to boarding school in England. Meanwhile, Celia herself is pregnant, but the child is lost in a difficult miscarriage which takes its toll on both her health and her stability. Her accompanying illness just precedes the Boxer Rebellion. Sparked by growing resentment and nascent nationalism, fuelled by drought, this violent uprising against the foreign powers and their commercial interests, but also against the Empress who had sanctioned them, marks Celia profoundly, as it does the other inhabitants of the compound.

  Barricades are built. A small military force faces some twenty thousand Boxers, as the members of the Society of Righteous Fists are nicknamed. They have marched from the countryside and want nothing less than to expel the ‘foreign devils’ by any means to hand. For nearly two months, the entire foreign compound is kept under siege and subject to daily incursions and bombardments. Captives are tortured. Houses are burned. Food grows scarce, along with medical supplies and ammunition. Over seventy foreigners die and many are wounded. Only when an international force is raised and finally marches on Peking are the inhabitants of the compound at last freed.

  Soon after the Boxer Rebellion, Arthur James left Peking–partly, one imagines, on account of Celia. She was pregnant again and this time the birth of the child would be secured by a delivery in England. But even England couldn’t guarantee the baby’s safety, nor the mother’s precarious mental and physical state. The child died just two weeks after birth. Eclampsia may have been the cause. Celia cites this frightening condition in her later letter to the Edinburgh Hospital. Eclampsia, literally ‘a bolt from the blue’, consists of a series of epileptic-like convulsions, jerky, repetitive, sometimes violent, involving muscles in the jaw, neck, limbs and eyes, leading to loss of consciousness and sometimes a stop in breathing. It is unclear when exactly the eclampsia occurred and whether Celia’s baby died from asphyxia as a result of her convulsions, or had already been weakened by the lack of oxygen which is common to eclampsia. Whatever the actual medical cause of death, Celia’s own puerperal fever and resulting condition were serious enough for her to be confined to an asylum, St Andrew’s Hospital in Northampton. She stayed there for some six months.

  St Andrew’s Hospital was founded in 1838, as a belated result of the County Asylums Act of 1808 which empowered local justices of the peace to raise rates for asylums for paupers and criminal lunatics. Home for twenty-three years to the poet John Clare, St Andrew’s had always, however, had a link to the middle classes. The great architect Gilbert Scott, who built St Pancras Station in London, designed its chapel. By the 1870s pauper lunatics had been moved to a separate asylum, and St Andrew’s pushed ahead, becoming one of the most advanced of institutions in terms of patient comfort, offering gardens and grounds, a working farm, theatrical recreation and holidays in the Welsh hills. New technologies–first a telephone in 1881, then in 1898 an electrical generator–were installed.

  This technological modernity hardly extended, it seems, to treatment and diagnosis. What the hospital provided was a rest home with all modern comforts. Its superintendent, Dr Joseph Bayley, had been there since 1865, and accounts of the hospital’s history show him as far more interested in the management of the premises than in any new theories or treatments. It is unlikely that when Celia Brandon went home after six months, she had picked up from the hospital’s two resident doctors either the terminology or the structural narrative of madness which permeates her letter of 1914. Something else, perhaps other patients, perhaps her own later reading and conversation in the cosmopolitan hub that was China’s foreign community, must have influenced the narrative she makes of her life and ‘peculiarity’.

  Celia tells her story as if she knows that the beating fantasies which charged her sexual pleasure in childhood structured her adult sexuality. She seems to know that dreams–the human activity Freud described in 1900 in The Interpretation of Dreams as the royal road to the unconscious–are an expression of her wishes and fears. She also underlines the difference between fantasy and the real, and how masturbation is converted by shame into fantasy scenes foisting responsibility on to others, noting that on her marriage bed she struggled to tell her husband of the kind of masturbatory scenario she engaged in, but instead ended up telling him only that her aunt acted out the beatings which gave her pleasure. In fact, the thought of being beaten ‘as in her dream’ was enough to trigger pleasure for Celia. She names this beating fantasy her ‘thought key’, and she uses it during intercourse when her husband doesn’t satisfy, the more especially so after her baby’s death and the spell in the asylum. She also on occasion takes the ‘whip’ to herself, dutifully reporting this to her husband, who chides her and tells her never to do it again. Clearly she is ambivalent about her husband, who, she says, is worried about his own health, and doesn’t give her all she wants. Her cravings, her need for self-punishment, shadow her marriage.

  Celia’s frankness to the doctors about her sexuality is astonishing: Freud’s turn-of-the-century hysterics were hardly so well educated in their own conflicting desires, and manifested far more resistance to his sexual interpretations. What is even more startling is the way that in telling her story she openly links sexual needs and habits, formed in childhood, to her mental disarray–to the persecuting voices she now hears and wishes the doctors could rid her of–as if the masturbatory dream scenario and its eventual merging with the longed-for messages from a possible lover were known to be a se
xual aberration that precipitated illness, and demanded both punishment and cure. There is far more in play here than a Victorian governess’s punitive edict to a masturbating child, who is, unusually in this instance, a girl. What Celia gives us is the construction of a narrative of developing female sexuality and the conflicts on which it founders to produce illness.

  Narratives such as hers are also the basis for Freud’s understanding of the human and emphatically women’s predicament. Freud listened, perhaps for the first time, to what women told him; made speech, rather than the clinical gaze of the Charcotian kind, a privileged part of treatment. It was out of what he heard in the consulting room, no matter how bizarre or against the grain of conventional beliefs, that he diagnosed the wrongs of his time’s repressive sexual mores and built his theories of the formation of the human mind and its progress from infancy into adulthood.

  When she leaves St Andrew’s, Celia, still delicate after the horror of the birth and death of her child, returns to her ‘thought key’ for sexual solace. She has sought help, or perhaps understanding, from her husband, wanting to ‘change her thought key’ since it isn’t very ‘nice’. But he won’t or can’t take any of this in, simply repeating, as he did on their wedding night, that she must put all this behind her. Celia’s hold on the real grows tenuous once more. She talks of what she calls her ‘black magic’, her ability to predict and foresee the future, her refusal of it; but it is precisely this ‘visionary’ quality, this permeability of mind that she experiences, which comes back to persecute her later.