By Lisa Appignanesi
‘I’m always running into people’s unconscious,” remarked Marilyn Monroe, only months before she died, an empty bottle of Nembutal sleeping pills by her side. An emblem of femininity and cultural icon, in death Marilyn is also nailed as a typically unstable female, dependent on women’s drugs and beset by feminine struggles over self-image.
From Jane Eyre’s “madwoman in the attic” to Victorian ladies prostrated by “nerves” and Freud’s hysterics, through to today’s Valium-poppers, women especially have seemed affected by mental illnesses and have been theorised and experimented on by generations of would-be curers. Lisa Appignanesi here brings together 200 years of the treatment of mental illness and an analysis of women’s experiences to shed light on why we treat women’s madness as we do, and why we still don’t fully understand it.
Appignanesi recounts a series of “cases”, beginning with Mary Lamb —who killed her mother and was in and out of madhouses all her life, yet managed to write much-admired stories and essays with her brother Charles — and ending with proto-misery memoirists Elizabeth Wurtzel and Lauren Slater, authors of Prozac Nation and Prozac Diaries respectively. In between, we are treated to original angles on the madness of famous women including Zelda Fitzgerald, Virginia Woolf and Sylvia Plath, who speak through extracts from their published writings, their diaries and letters.
This pulls Mad, Bad and Sad almost into the realm of literary biography, yet it is the forgotten or ordinary cases that are arguably the most interesting and moving. Celia Brandon, for example, was one of the first women to describe and thus diagnose her own disorder in modern terms, writing to doctors about her childhood, sexual fantasies and the dislocation of her adult life — she was among those besieged in China’s Boxer Rebellion.
The doctors, too, make up a gallery of fascinating characters, from the eccentric French pioneers Charcot and Pinel; the dominant figure of Freud in Vienna and London; and the influential American shrinks from Weir Mitchell through to their caricatures in the films of Woody Allen — for Appignanesi draws not only on literature high and low (Plath’s The Bell Jar was originally written to take advantage of the “increasing market for ‘mental health stuff’”!) but also on Hitchcock, Arthur Miller and the Rolling Stones, whose 1966 track Mother’s Little Helper assured Valium its place in pop history.
Ultimately, “Big Pharma” emerges as villain. In this admirably even-handed history, which includes generous accounts of noted misogynists like Dr Henry Maudsley, Appignanesi reserves her sharpest criticism for the faceless medics harnessed to the promotion of contemporary anti-depressant medications. Their crime is to forget the shallow scientific basis for their treatments: they thrive on fashions for new disorders, each defined by the treatment that is tagged to it.
Medical treatments now seem to lead to diagnoses, rather than the other way round. Appignanesi produces impressive and disturbing statistics, but most impressive is her comparison between the few, random, emotion-based categories of disorder used by Bethlem Hospital in 1810 and the 900 pages of apparently precise definitions enshrined in the Diagnostic and Statistical Manual of Mental Disorders today. We have multiplied our classifications, but are no nearer to a cure.
Sophie Lewis is a writer, editor and translator