Sad, Mad and Bad: Women and the Mind-Doctors

This Review appeared in the Toronto Globe and Mail.
%%AMAZON=0393066630 MAD, BAD AND SAD%%
Women and the Mind-Doctors from 1800
By Lisa Appignanesi
McArthur & Company,
532 pages, $34.95

This book is beautifully written and carefully, even lovingly, researched. The author prides herself on the fact that she is primarily a writer and is neither a patient nor a mind-doctor.

Thus, Lisa Appignanesi, who is also a respected novelist, views the literary arts as almost interchangeable with, or superior to, the psychoanalytic arts. In her view, “sad, mad, bad” women may be best analyzed, not psychoanalytically, but in a literary way.

Literary analysts may have compelling, even brilliant intellectual and historical insights but they do not view themselves as obligated to comfort, help or save a particular sorely afflicted soul. Indeed, Appignanesi views herself as an “outsider” who has “faith” in the writer’s point of view.

The power struggle that may be at the heart of this book reveals itself in Appignanesi’s description of Virginia Woolf as adamant that “the turf of the inner life and the imagination rightly belongs to novelists and artists and needs protecting from the reductionist inanities of … psychological interlopers.”

Permit me a brief psychoanalytic interpretation. To compensate for Woolf’s view, which Appignanesi may share, the author tells us far too much about far too many mind-doctors, theories, asylums, cases, patients. Her textbook-like reach is sometimes overwhelming. Perhaps unconsciously guilty about her own bias, and in an effort to be “fair,” she feels honour-bound to present a very long, if nevertheless informative, account of the history of female patients and their mind-doctors.

Appignanesi does not take sides; she has the luxury of understanding each approach without having to “do” anything. Therefore, she does not choose one school of thought over another, she simply presents them all. I wanted her to make a judgment about what helps: psychotherapy, psychopharmacology, political liberation movements, trauma theory, divorce, bed rest, cold showers – but she does not do so. Literature – and the long view – are redemptive solutions for Appignanesi.

I would, however, recommend this book for every abnormal psychology class in the world, since Appignanesi has really mastered the territory. She provides a sophisticated and nuanced history of how madness has been viewed and treated. She delves not just into the atrocities of confinement and of so-called treatment, but also the respite, safety and “tenderness” some asylums, keepers and mind-doctors have provided.

Historically, in Appignanesi’s view, how we conceived of madness actually changed from male to female. She writes: “In 1815 the two writhing, brutish and chained male personifications of madness in front of Bedlam were replaced by figures of women – a youthful, beautiful, female insanity. Madness, at least in representation, it would seem, was becoming feminized and tamed, no longer wild, raving and dangerous, but pathetic.”

Appignanesi does not deny that madness exists, nor does she romanticize it. She understands that madness was more acceptable in European society before the condition became medicalized, that madness may not be permanent, and that “cures are rarely absolute or forever.”

She condemns asylum abuse, beginning with the practice of chaining, brutally force-feeding, blood-letting and straitjacketing those who are already in torment. Of the many examples of psychiatric abuse she offers, let me share one especially chilling account. The American psychiatric system tortured one poor woman for 54 years before she mercifully died. Martha Hurwitz lived in New Jersey in the 20th century. Superintendent Henry Cotton of the Trenton State Asylum “carried out an obscene campaign of surgery on the tonsils, stomach, colon, and uterus of (female psychiatric) patients alongside removal of teeth. In the process he maimed and killed thousands” – including Martha Hurwitz, whom he also diabolically, perhaps psychotically, overmedicated and in whom he induced more than 50 insulin comas.

Appignanesi is as much at home in European salon society as she is in Bedlam, Paris’s Salpêtrière or in Freud’s office. Reading this book was a way to learn new things about some old friends: Freud’s Anna O (Bertha Pappenheim), the orthodox Jewish woman who co-invented the “talking cure” and who became a major feminist leader; Jung’s Sabina Spielrein, a patient with whom he had a love affair during treatment – and who went on to become the first woman psychoanalyst; Charlotte Perkins Gilman, the writer and feminist, for whom S. Mitchell Weir prescribed bed rest and a domestic routine; Zelda Fitzgerald, the talented writer envied by her writer-husband Scott; the great Virginia Woolf, whose husband Leonard adored and protected her; the sublime but haunted Sylvia Plath, whose husband, Ted Hughes, left her. I also met some people here for the first time.

Appignanesi is at her best when she slows down and spends time with a woman, a doctor, a “case.” Thus, her more extensive discussions of Mary Lamb, Théroigne de Méricourt, Celia Branden, Alice James, Virginia Woolf, Sabina Spielrein, Zelda Fitzgerald, Sylvia Plath and Marilyn Monroe are excellent.

Sad, Mad and Bad also provides us with literary gossip at a high level. In a sense, this book is a social history of madness among intellectuals, poets and revolutionaries. Thus, we learn about Mary Lamb, who, in a fit of madness, killed her mother and who was, thereafter, both periodically confined and at liberty. This is the same Mary Lamb who, together with her brother, Charles, wrote Tales From Shakespeare and was a social intimate of Coleridge and Wordsworth. According to Appignanesi, William Hazlitt described Mary Lamb as “the only truly sensible woman I’ve ever met.” Mary Lamb’s alcoholic brother depended upon her totally and they lived together as adults.

We learn about George Cheyne, who himself had a “breakdown,” but who went on to become a popular holistic healer whom Samuel Johnson praised.

Asylum reformer Phillipe Pinel (1745-1826), sometimes considered the father of psychiatry, was a member of a salon run by Madame Helvetius, who admired Stendhal; this was same Pinel who ran the asylum where the Marquis de Sade was imprisoned. Théroigne de Méricourt was rescued by none other than the revolutionary Marat; an all-female mob had stripped her naked and was publicly flogging her. William Makepeace Thackeray’s wife broke down after childbirth and tried to drown her newborn and kill herself. Jung’s former patient and lover, Sabina Spielrein, was Jean Piaget’s analyst.

Alice James, the sister of William and Henry, once checked into an asylum that “treated nervous people who are not insane.” James Joyce’s daughter Lucia saw one of Zelda Fitzgerald’s mind-doctors and consulted with Jung, who, as it happened, “hated Joyce’s Ulysses.”

There are many more such anecdotes and asides that will delight any student or teacher of literature.

Because Appignanesi is so comprehensive, I am surprised that she does not cite the excellent work of Dr. Paula Caplan about the psychiatric pathologizing of women – or that of author and therapist Kim Chernin, who has written a great deal about women’s eating disorders. (Appignanesi is exceptionally eloquent about anorexia and characterizes those who suffer from it as “hunger artists” and “suicide bombers inside the bourgeois family.”)

Early on, Appignanesi theorizes that her “interest in madness” is a “form of survival” since her family “fled the Holocaust.” I do not entirely understand what she is saying here, but to the extent to which madness or evil may be narcissistically appeased, Appignanesi has “survived” in very high style indeed.