Mad, Bad and Sad, by Lisa Appignanesi

From chains to couches
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The Independent Culture

Lisa Appignanesi's richly reflective new "history of women and the mind doctors from 1800 to the present" opens with an emblematic moment in the history of madness. One evening in 1796, Mary Lamb, overwrought by the unmitigated toil of caring and earning for needy parents and siblings, picked up a "fatal knife" and murdered her invalid mother. Not many years later, and the institutional doors of the 19th century would have clanged shut on Mary for life; but, owing to a verdict of temporary lunacy which meant that she was deemed neither criminally responsible nor a long-term danger, she went on to lead a productive, perhaps even a happy life.

There were recurrent spells of disturbance, with time in hospital – one of the private "madhouses" of the day. Mostly, Mary lived alongside her brother Charles, participating in a lively social and intellectual world and collaborating with him on the Tales from Shakespeare. Theirs is also a fascinating tale of brother-and-sister fidelity and co-dependency, as Charles remained his sister's devoted carer, while her more dramatic derangement may have kept at bay troubles on his side which manifested themselves in the commoner symptoms of drinking and depression.

Appignanesi is careful not to idealise the culture which gave Mary Lamb a lifelong loophole. But she does endorse the Rousseauian and Romantic discovery of the significance of childhood experience in the formation, and malformation, of the adult, looking at Mary's own writings about childhood. The belief that the child's first emotional world is all-important is taken for granted today across mental-health care, social work and psychological theory, even though ideas about what kinds of harm a bad childhood inflicts and how, or if, it can be helped may be radically contested.

If Appignanesi evokes the late 18th-century stress on the special character of childhood, the "mad, bad and sad" of her title also stand out as childish words. They are deliberately simple in their opposition to the abstractions of the many technical vocabularies that have been mustered since in attempts to explain, or to heal, the manifold human sufferings that they evoke. Of these three unfortunate graces or disgraces, brought together by rhyme if not reason, the book's focus is most on the mad, and to a lesser extent the sad, with the prevalence of modern depression. Appignanesi is interested in female criminality only at the point, as with Mary, where it seems to intersect with the involuntary acts associated with a loss of ordinary reasoning – although the lesser, more lovable badness of the wild girl comes into play with rebellious figures like Marilyn Monroe.

The simplicity of "mad, bad and sad" is also a call for clarity in a field where competing technical languages may make it almost impossible to distinguish woods from trees or even elephants from rooms. The last, most polemical part of Appignanesi's book sets out to untwist the arguments about cures and causes for the madnesses that beset women (and men) today, from eating disorders to child abuse to depression in all its forms.

An ongoing argument shows how clinical definitions of illnesses may themselves have the effect of creating as much as curing them: a bulimic, as participatory websites show, is something to be, while GPs provided with checklists of questions and the pills to prescribe are bound to find patients suffering from newly identified subspecies of depression. This is not, as Appignanesi emphasises, to deny that the diagnoses usually respond to real distresses; but to highlight an intractably self-perpetuating process, amplified today by the hugely profitable pharmaceuticals industry.

Much of Mad, Bad and Sad consists of superbly lucid accounts of the clinical and theoretical contributions of leading psychiatric thinkers of the past two centuries, during which both the disciplines and practices of "mind doctoring" have grown into vast and complex fields. Many innovative practitioners emerge as mad in their own ways - as perhaps, in their empathy with those whom they treat, they needed to be. They are also, more mundanely, presented as men (and women) who honestly do or did their best to make sense of the minefields of mental illness. Appignanesi will protest in passing against the megabucks earned by "Big Pharma", or the barbarity of ECT, or the tendency of professionals to ignore poverty and inequality as factors in disturbance. But there is no conspiracy theory here, whether of patriarchal control or repressive institutionalisation. Understated though this argument is, it is crucial to the book's subtle remapping of the field of women and madness.

For Appignanesi, there is no symbolic madwoman shut in the bourgeois attic awaiting her feminist release. In fact, the real women she highlights tend to have lived much in the public eye. The Mary Lamb story is the first of a number of spectacular exhibits of iconic women: Virginia Woolf, Sylvia Plath, Zelda Fitzgerald and Marilyn are famous as well as famously unsane. But despite her focus on these stars, Appignanesi is not interested in the old question of possible links between madness and art; instead, she tells these women's stories in relation to their encounters with hospitals, treatments, doctors or psychoanalysts. This enables her both to place much-discussed figures in a fresh context, that of the history of psychiatry, and also to offer pill-sugaringly vivid frames for telling that history. The same strategy is applied to the stories of patients famous for their connections with celebrity mind doctors: Charcot's Augustine, Breuer's Anna O., Jung's Sabina Spielrein.

These starry women bring the theory and institutional histories to life. Mad, Bad and Sad is constantly interesting. But perhaps what has to be left out of a bearable account of madness is the sheer deadening monotony of much of it, for helpers as well as sufferers. Think of the hopeless and doped-down condition of the women and men confined in big state "bins", or private "homes" where the wealthier disposed of their misfits. These non-lives would not, I suspect, have made for such a wonderfully enlightening and engaging book as this one.



Rachel Bowlby is professor of English at University College London

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