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“It's true that the women are worse than the men”, as the old Irish ballad has it. That madness has long been seen as a female province is the thrust of Lisa Appignanesi's detailed history of psychiatry over the past 200 years.
Appignanesi, prolific writer, co-author of Freud's Women and holder of the Chevalier de l'Ordre des Arts et des Lettres, places the first doctor to concentrate on the workings of the mind as Philippe Pinel (1745-1826). In charge of Parisian madhouses during the French Revolution, Pinel ordered women patients at the notorious Salpêtrière hospital to be freed from their chains. He listened to them, observed their symptoms and classified their “mental alienation” into four categories: mania, melancholy, dementia and imbecility.
Later Sigmund Freud (1856-1939), as a young neurologist, studied in Paris and watched Jean-Martin Charcot demonstrate the use of hypnotism to treat female “hysteria” (symptom: anaesthesia of the right side). The famed photograph of Charcot standing before a rapt audience of male doctors with his beautiful patient leaning back limp and unconscious on the arms of his associates, was, says Appignanesi, “part of the Republic's love affair with boulevard spectacle”.
Freud went back to Vienna, invented the “talking cure”, mythologising patients, mainly women, in beautifully written, sometimes over-artful, case histories such as “Dora” and “Anna O”. His assertion that sexuality was at the heart of neurosis was a liberating force for women.
Psychosis is another story. The Swiss Emil Kraepelin (1856-1926), utterly rejecting Freud's technique, identified three separate categories of severe mental disturbance: manic depression; paranoia; and “dementia praecox”, marked by indifference to life and to others. In 1911 Eugen Bleuler of the Burghölzli clinic in Zurich offered the word “schizophrenia” to describe what he saw as a splitting of soul and mind. Bleuler at least encouraged his doctors to live among their patients and to talk to them.
For the mentally ill the more usual treatment was to be shunted off - to luxury villas if they were rich, to crowded asylums if they were not - where they underwent traumatic treatments such as insulin coma, electric shock, lobotomy, prolonged bed rest and forced feeding. Under such a regime Virginia Woolf gained 3st (19kg) in a year.
Appignanesi's strength is her mastery of the sweep of history. She elucidates the “battle of the Titans” (Freud vs Jung); Jacques Lacan, the 1960s “French Freud”, who linked women, language and psychosis, and the anti-psychiatry movement inspired by R.D. Laing in the 1960s. Laing, a Glaswegian doctor, horrified at the treatment he saw in the wards, maintained that schizophrenia was an “intelligible response to harrowing existential conditions”. His philosophy, combined with the new drugs available to keep psychotic mania under control, led to the shutting of asylums and the release of patients “into the community”.
Feminism fuelled the anti-psychiatry movement. The mere mention of “penis envy” - the female's alleged anger at her anatomical deprivation - put psychoanalysis beyond the pale for many women. Juliet Mitchell, in Psychoanalysis and Feminism in 1974, reclaimed the field for women; one result was that group therapy and family therapy caught on. However, the liberated female developed new diseases such as anorexia and bulimia, and a new cadre of mind doctors sprang up to treat her.
Appignanesi's scholarly work is weakened by the laboured re-telling of the stories of famous neurotics such as Woolf, Zelda Fitzgerald, Marilyn Monroe and Sylvia (yawn) Plath. It also weaves uncertainly between its emphasis on women and the necessary discussion of mental illness in men. During the First World War, “war psychosis”, or shell shock, gave a big impetus to psychotherapy but it was hardly a woman's disease.
Observing that “mind doctors” seem to have more success in treating women than men, the author asks if it is possible that women, who made up so talented a portion of Freud's early patients, have a gift for the talking therapies?
Or is it possible, the onlooker might ask, that troubled women go to therapists while troubled men go to jail?
Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the
Present, by Lisa Appignanesi
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