Mad, Bad and Sad: A history of women and the mind doctors from 1800 to the present
By Lisa Appignanesi
Published by Virago
KEY POINTS:
This is a book with a broad scope and a bold aim: to look at the history of the study of the female mind over the past two centuries.
It asks whether the contents of a woman's head need be regarded as any different to those of a
man.
The premise from the outset is clear: Appignanesi does not see women as inherently mad, bad or sad but is fascinated as to why, over the years, we have continued to classify them in these categories far more often than we do men.
As philosopher Ian Hacking puts it: "In every generation, there are quite firm rules on how to behave when you are crazy."
But why have women been particularly subject to these rules? And in the past 50 years, has one important promise of the feminist project come true - that being able to have a less restricted life means women are less prone to mental illness?
Or are there life events unique to the female experience that make women more susceptible to mental health problems?
The early chapters on the birth of the mental health professions are fascinating and addictive. It is astonishing to think that only a few hundred years ago, doctors did not imagine that their interaction with the patient had any effect or importance, neither did they regard anything the patient told them about their condition as being especially relevant.
Philippe Pinel, the doctor in charge of the Parisian madhouses during the French Revolution, invented the bedside manner and was the first to look for patterns in the patient's life story that might explain what he called their "mental alienation".
The view of female patients throughout the 1800s would be hilarious were it not so disturbing.
Breast-feeding women were seen as having "lactational insanity". It was thought, quite literally, that they had milk on the brain.
In 1825, in Paris, came the first instance of a doctor testifying that if a patient insisted she was not mad, this proved that she must be.
This was part of the bizarre case of Henriette Cornier, a nursemaid who calmly sliced off the head of her 19-month-old charge and threw it out of the window because "the idea presented itself". She refused the charge of insanity and was sentenced to hard labour "in perpetuity".
The triumph of Mad, Bad and Sad is to mix evocative case studies with potted histories of the great and good of psychology and psychiatry.
Without wanting to sound too glib about an intelligent and academically rigorous study, this book is an excellent one-stop shop for those wanting to find Freud, Jacques Lacan and Melanie Klein among the same pages as Marilyn Monroe and Elizabeth Wurtzel. There is an attractive mix of the everyday and the clinical.
The chapter on "Mother and Child" is particularly useful for anyone eager to read an overview of the dauntingly extensive works of John Bowlby ("attachment parenting") and Donald Winnicott ("the good-enough mother").
This book is also excellent fodder for anyone prone to hypochondria of the mental variety. You find yourself scrutinising the diagnoses of the 18th-century "furious lunatics" to see how far you match them.
As Pinel put it, hatred, envy, jealousy, grief and remorse are all capable of driving an individual mad. Which of us has not experienced these emotions, sometimes all at once?
There are ample examples from literature (Woolf, Proust, Plath) and fascinating historical tabloid cases of extreme hysteria and so-called madness. Appignanesi tirelessly explores causes, symptoms and back histories to find answers, refusing to believe that madness comes out of nowhere. Like Freud, she is at her best when trying to untangle our preconceptions about sanity.
Her reading of "the most iconic mind doctor" is generous, although she examines in detail why Freud has been portrayed as sexist. Freud believed that women were at risk of neurosis when "idealisations of the family were at odds with lived experience". But this, as Appignanesi seems to imply, is surely true for most people. Life is often at odds with our expectations.
The book returns repeatedly to the most awkward questions. Why do women still seem to be more prone to mental illness than men? Is this caused by something innate, or by "female" life events like childbirth and menopause? Or because of the way we have viewed and treated women for centuries?
The thread running through this work is that all women - and all men - are mad, bad and sad at times, and that we must be wary of classifying those who seem excessively so, because, in labelling them, we are simply labelling the human condition. "Narrowing or medicalising definitions too much limits the boundaries not only of so-called normality, but of human possibility."
- OBSERVER
