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

by Lisa Appignanesi

  As she nears her forties, Celia is once more thought to be pregnant. The danger of this in her delicate state causes the physician to give her apiol, commonly known as parsley camphor, to bring on her period. But Celia isn’t pregnant, is probably moving towards menopause, and the apiol in quantities has side-effects of vertigo and headaches. It is at this time that her husband is promoted and transferred to a regional posting. The move into a new community, which numbers few foreigners, is difficult for Celia, despite the comforts of the new home, the quantity of servants, the elevated social status. The new position also requires her husband to travel far more. Celia isn’t well. A French doctor prescribes more apiol, which in her later letter she links to her precarious state, at once nervous and excited.

  The local population was hostile enough in this new outpost for Arthur James to want protection for his wife when he was forced to leave her alone. An adjutant moves into their large house, to guard Celia against intruders. Instead, the young man himself becomes an intruder. He becomes her special friend, whether in bed or in fantasy isn’t clear, though she denies the first. In any event, he invades Celia’s dreams. When her husband returns, this young man begins to serve as the fantasy object who triggers her pleasure when she is with her husband. In her letter to the Edinburgh Hospital, Celia traces this change with a childish flourish: it occurred to her, she says, that it would be nicer to think of her friend than her usual ‘thought key’ when in bed. It worked: in her imagination intercourse with her husband is now accompanied by excursions with her friend.

  Arthur James grew jealous and, after a row, publicly insulted both the young man and Celia. Celia’s ‘head trouble’ followed. She protested that there had never been any impropriety, even though the man had entered her dreams. In her letter, which is both utterly cogent and has the associative tangents of a restless and troubled mind, she describes how one day at table, the young man rubbed his leg against hers. She withdrew, then reconsidered: it would be ungenerous, given how intimate they were, not to acknowledge his secret pressure. Her desire, like the affair itself, flourishes through signs both fantasized and intensely real, each of them bearing the conflict between secret desire and a doubly secret wish for exposure, which is also a fear. When the young man is sent away to another posting, Celia suffers a severe breakdown.

  She spends almost a year in a missionary hospital. During this time, she begins to communicate with her young friend in a coded and quasi-hallucinatory fashion. It seems to her that he sends her messages through other people, as well as through animals, trees, flowers and wind. Her brain grows noisy with the process.

  The missionary hospital did Celia no good. Arthur James decided she had to return to England. A nurse accompanied her on the arduous six-week journey during which her state grew worse. Celia becomes uncontrollable, running amok, throwing her suitcases into the ocean, attempting suicide, acting out with considerable violence. In England, she is committed to Bethlem, where she spends some six months. Her fantasies have become hallucinatory, her sexual practices excessive. The persecution she describes in her letter has set in. There are warring voices in her brain, an inner ‘telegraphy’ which transforms the loving messages she receives from her friend into the old, self-punishing motifs of her thought key. Neighbours, ‘others’, do this to her. They convert a coded love signal from her friend, a message embedded in the smoke of his cigarette, into a vengeful and painful whipping. ‘They take the faintest thought in my brain, even an unconscious idea sometimes–for a speech in the brain, which it isn’t.’ Her thoughts are dirty, rampant, her head like a telephone into which voices pour uncontrollably, and she cannot help listening and speaking to them aloud.

  When she is calmer, Arthur James comes to fetch her and they return once more to China, only to come back to England with the outbreak of war. It is unclear whether Celia is ever altogether stable again, or indeed whether she has ever altogether been so since her first miscarriage, late in pregnancy. Indeed, there is an amalgam of precipitating causes for her mental condition: the repeated miscarriages, the traumas of war, the death of an infant, the love affair and the subsequent mourning for what is after all a double loss of child and lover–all this compounded with her own original motherlessness and constitutional delicacy.

  Yet Celia somehow weaves all this into a narrative in which the sexual element is the one she chooses to emphasize as the salient cause and expression of her ‘peculiarity’. By the time she writes her letter of 1914 to the Edinburgh Hospital, she is begging to be institutionalized because the persecuting voices have grown rampant: she has only ‘unconsciously’ to think of her husband or friend in the most innocent way, and the voices begin, rude, insulting, unbearable. The beating fantasies have grown into vengeful embodied punishments. Only the hospital doctors might be able to provide solace. The pain in her letter is a reminder of the great contemporary psychiatrist Emil Kraepelin’s statement in his lectures to young doctors that ‘Insanity, even in its mildest forms, involves the greatest suffering that physicians ever have to meet.’

  Celia Brandon, now a small stout woman with brown hair and clear, rather yellow skin, was admitted to the Royal Edinburgh Hospital in the spring of 1915. Under the supervision of George M. Robertson, soon to be Scotland’s first Professor of Psychiatry, the Royal Edinburgh Asylum was a benign institution. Robertson had not only studied in Edinburgh and London, but in the early 1890s had visited Hippolyte Bernheim and J.M. Charcot in France to observe the use of hypnotism in the treatment of the insane. Although he was more interested in innovative practice, such as introducing the villa system with its separate small units and regular nursing into care, than in writing, two of his papers describe the findings of that early trip. By 1920 he is a convinced supporter of Freud’s, and on 7 September 1923 he writes to the London Times to distinguish between spiritual healing and the mental therapies such as ‘suggestion, auto-suggestion, or psychoanalysis, the curative effects of which are admitted by all’. It may be Robertson’s knowledge of the scientific and secular medical practices of ‘suggestion’ and ‘psychoanalysis’ that accounts for the altogether ‘modern’ classification of Celia Brandon’s problems as ‘Freudian’ in the hospital notes.

  By the First World War, Freud was already well known in the medical literature in Britain and America. He had coined the word ‘psychoanalysis’ in 1896 to describe the new talking cure which displaced the cathartic method of treatment with its use of hypnosis, such as he and Breuer had described it in Studies on Hysteria. These years were productive for Freud, his activity spurred on by his father’s death. Alongside a flood of papers, and his own self-analysis which gave him an insight into the Oedipal structure of family life, came ground-breaking books: The Interpretation of Dreams in 1900, followed in 1901 by The Psychopathology of Everyday Life, which Leonard Woolf, husband of Virginia and soon to be Freud’s major publisher in English, applauded. Then in 1905, an annus mirabilis, came Jokes and their Relation to the Unconscious, and perhaps his most influential study, The Three Essays on the Theory of Sexuality.

  With a radical coolness which had no truck with conventional morality, Freud separated out people’s sexual aims from their choice of ‘object’, often enough of the same sex; postulated a psychic bisexuality, explored fetishism, perversion and sadomasochism in terms far more subtle than any previous writer had conceived of and without a trace of the voyeurism which turned those who exemplified these conditions into freaks. He attacked the sexual morality of his own time and showed how it made people ill: ‘It is one of the obvious social injustices that the standard of civilization should demand from everyone the same conduct of sexual life–conduct which can be followed without any difficulty by some people, thanks to their organization, but which imposes the heaviest psychical sacrifices on others.’ Most dramatically, Freud transformed the supposedly innocent child of Victorian sensibility into a sexual being, and turned the idealized family into a zone of potentially tragic desires and conflicts. When it came
to patients, those sufferers from neurosis and hysteria who made up his daily practice, he once more announced that their symptoms were their sexual activity: it was only through psychoanalysis that the libidinal component of these symptoms, together with the defences which had helped to produce them, could be untangled and restored to more appropriate activity.

  In 1909 Freud and Carl Gustav Jung, still his disciple, though not for much longer, were invited to lecture in America where psychoanalysis had already taken a foothold. In Britain, too, Freud’s work was beginning to be known in medical circles, even before Ernest Jones set up the London Psychoanalytical Society in 1913. Lectures on ‘Freud’s Abnormal Psychology’ appear in such provincial institutions as Liverpool’s Medical Institute in 1912. By then his fame was also beginning to spread into the non-specialist, educated press. Four of his books had been translated, including On Sexuality. Even more importantly in terms of general reception, Bernard Hart’s The Psychology of Insanity (1912) appeared. It included fine accounts of both Freud and Janet, had a wide readership and was rapidly and repeatedly reprinted into the 1960s, making it one of the most popular books ever in the field of madness.

  As for the better journals, in January 1912 The Strand Magazine ran an article by William Brown entitled ‘Is Love a Disease?’, which talked of Freud’s success and described Jung’s early word-association experiments, noting that delayed response pointed to an unconscious emotional tendency at the root of the nervous disorder which could be cured by the psychoanalytic process of pulling this hidden matter into the light of day. By 1915 periodicals as diverse as New Age, Blackwood’s, The Cornhill and The Athenaeum had run articles and reviews on Freud, while E.S. Grew in Pall Mall named him as ‘the greatest of modern psychologists’, and accepted the existence of the unconscious and its influence. When the Psychopathology of Everyday Life appeared in English in 1914, The Saturday Review likened Freud’s investigations into the human mind to a ‘high class detective story’. Soon he was being called the ‘Sherlock Holmes of the Mind’.

  All this accounts, perhaps, for the ease with which Celia Brandon’s case is labelled ‘Freudian’ by the admitting doctor in the Edinburgh Hospital in 1915, and may go a little way towards explaining the manner in which this intelligent woman understands and writes her own plight, easily linking sexuality and symptom.

  Her admission report reveals the hospital regime as both enlightened and up-to-date. The word that is used most frequently to describe Celia’s mental state and habits is ‘peculiar’–a daily and non-medical term, but one that is free of Victorian moralizing. Under the description of her present mental state, the pre-printed categories note: Exaltation/Depression/ Excitement/Enfeeblement/Memory CoherenceDelusions and Hallucinations. However, there is no ticking of boxes for Celia. The entry statement reads:

  Patient is…oriented and fully appreciates her pains and position. She is full of delusional ideas and gives a typical Freudian History. Her present trouble takes the form of old women tormenting her, putting all sorts of unpleasant thoughts in her head and saying vile things, often of a sexual character. She suffers from ideas of a masochistic type and has dreams and thoughts of whipping and of the genital region. The old women can cause what she calls ‘sexual spasms in her vagina’.

  Celia Brandon stayed at the Edinburgh Hospital until just after the war’s end. Throughout the three years nothing much in her condition was altered. The persecutory voices in her head, the ‘filthy old ladies’ and ‘dirty devils’, retained their hallucinatory force, propelling her into outbursts, both day and night, of what the hospital considered appalling language. During such times she could also become destructive, smashing window-panes and crockery. The rest of the time she was sensitive to her environment and other people, played piano or tennis, and read. On occasion she was deeply depressed and despairing of her condition, but much of the time, when the voices didn’t attack her, she was cheerful and her physical health was good. The hospital did not seem to provide any talking therapy. Certainly there is no specific reference to this in the case notes, though there is mention of the fact that the patient tells numerous stories about what her auditory hallucinations have done and how they affect her. One imagines these are told to a doctor, and if not, to one of the professional nurses Robertson had introduced to the hospital’s management. Occasionally Veronal or sulphanol, which Celia asks for, is given to calm her.

  By April 1918, Celia Brandon has complete outside ‘parole’ and when her voices aren’t bothering her, she is permitted to leave the grounds. A year later, when her husband is back in the country, he comes to take her home. The final notes in her file state that she left ‘relieved’. The diagnosis reads ‘systematized delusional insanity’ for which the prognosis is ‘bad’. Partial relief, not cure, is what an enlightened asylum can offer.

  Sigmund Freud (1856–1939)

  Relief, not cure, is what Freud, too, most often offered. The most iconic mind doctor of the world that was to call itself modern, Sigmund Freud comes to us in many guises. Depending on the interpreter or historian, he is the heroic conquistador of the secrets of the unconscious, the great innovator whose talking cure definitively altered the treatment of madness, or the manipulative fraudster who launched a movement out of a mixture of fabrication and speculation. He is the good doctor or kind professor of some patients’ memoirs, the Jewish swindler of others. His pervasive presence in popular culture is associated with slips or sex or Oedipal struggles in the battleground that is the family. It is also synonymous with that interesting condition which is neurosis–in itself a climate of being, proper to the imaginative outsider trapped in the stultifying net of suburban norms. Finally–though with Freud nothing is ever terminable–Freud is, all other things apart, one of the twentieth century’s most fertile writers, at once the modernist who launches the discontinuities of self and dream emphatically on to the stage of literature and art, and the teller of gritty family romances replete with the narrative of childhood traumas and adult discontent.

  Before he became a great many things even to people who had never read him or experienced a supposedly Freudian psychoanalysis, Freud was a neurologist, bent on ‘understanding something of the nature of what were known as the “functional” nervous diseases, with a view to overcoming the impotence which had so far characterized their medical treatment’.

  Born in 1856 to a Jewish family in the small town of Freiberg in what was then Moravia, the Czech part of the sprawling Austro-Hungarian Empire, he was the first son in his father’s second family, a status which gave him a nephew who was older than himself, amongst other extensions common enough in a time when second families were a norm because of death rather than divorce. The Freud family moved to Vienna when little Sigmund, always his mother’s favourite of the eight children she eventually had, was four. He distinguished himself in school and gymnasium, before deciding on a medical career. These were times of growing liberalization in Austro-Hungary, and the professions were more open to Jews than they had ever previously been.

  Vienna itself was rapidly growing into the great multicultural hothouse of the new. Immigrants speaking a variety of tongues poured into the capital from the far corners of the Empire. Shtetl Jews, Slavs from Poland and the Balkans, jostled with Hungarians and Ruthenians. Poverty was rife, as was prostitution; but the economy was buoyant and the city sprouted grand new streets and embraced outlying villages. As in all times of rapid transformation, old forms and ideas–in Vienna’s case, of strict morality, religion and imperial hierarchy–coexisted with the new, that secular and scientific spirit which fed the arts, philosophy and politics. By the turn of the century, social-democratic reformers like the Adlers jostled with scientists like Boltzmann and Mach and modernist artists such as Klimt, Schiele and Mahler, their inventiveness feeding off each other through the very fact of proximity. The press for the first time felt as provocatively free as the ‘associations’ Freud drew from his patients, and fuelled reform. Writers like Schnitzl
er evoked the everyday life of the passions and sexuality with the same verve as Freud, while the radical satirist Karl Kraus simultaneously campaigned on behalf of much maligned prostitutes, attacked sexual hypocrisy and dubbed the nascent psychoanalysis ‘the disease whose cure it purports to be’.

  In 1881, Freud graduated as Doctor of Medicine from the University of Vienna. He had taken extra time over his studies, teetering as he did between interests in philosophy, a career in pure research and one in clinical medicine. He had worked under the famous Brücke at the Institute of Physiology and studied the sex life of eels in Trieste, applying the same ardour to their reproductive systems as Darwin had applied to the life of barnacles. Darwin remained his hero and first teacher in the painstaking observational skills necessary to a scientist.

  Lack of finances and a wish to marry his sweetheart, Martha Bernays, meant that Freud opted for clinical medicine over research. He worked first at the Vienna General Hospital, focusing on cerebral anatomy and later, after a research trip to France where he was much influenced by the great Charcot, at the Kassowitz Institute in Vienna, with children who suffered from cerebral palsy and other neuropathological problems. His earliest physiological papers were followed by neurological work on aphasia, and only gradually as he moved into private practice, which would allow him a living, did he focus on psychopathology, hysteria and what he defined as the neuroses.

  Like all ideas, Freud’s ground-breaking observations and the theories which grew from them hardly came ex nihilo. The existence of an unconscious, a substratum or repository of feelings and ideas not always directly within the individual’s grasp or control, the many problems of sexuality and the family, all of these had been talked and written about in various ways. What Freud gradually and magnificently added was a narrative and theories which provided pattern, motive forces and surprising explanations that did away with moralizing punishments and liberated sexuality.