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Summary
Summary
This is the story of how we have understood extreme states of mind over the last two hundred years and how we conceive of them today, from the depression suffered by Virginia Woolf and Sylvia Plath to the mental anguish and addictions of iconic beauties Zelda Fitzgerald and Marilyn Monroe. From Mary Lamb, sister of Charles, who in the throes of a nervous breakdown turned on her mother with a kitchen knife, to Freud, Jung, and Lacan, who developed the new women-centered therapies, Lisa Appignanesi's research traces how more and more of the inner lives and emotions of women have become a matter for medics and therapists. Here too is the story of how over the years symptoms and diagnoses have developed together to create fashions in illness and how treatments have succeeded or sometimes failed. Mad, Bad, and Sad takes us on a fascinating journey through the fragile, extraordinary human mind.
Reviews (3)
Publisher's Weekly Review
Award-winning British novelist Appignanesi (The Memory Man) has written a fascinating if somewhat diffuse study of how, over the past two centuries, women's ability to live creative lives has been controlled by culture, and how their unsuccessful attempts to rebel frequently lead to mental illness--itself a slippery, ever-evolving cultural concept. Appignanesi's sources are wide-ranging but largely literary, based upon letters, diaries, articles and fiction from feminist writers such as Betty Friedan, historians like R.D. Laing and Jacque Lacan, psychologists such as Melanie Klein, and troubled subjects like Zelda Fitzgerald and Marilyn Monroe. Beginning with the lives of mentally ill women in the 19th century, Appignanesi moves chronologically through the history of psychology--as ideas like schizophrenia replace earlier notions of hysteria--and its relationship to the creative woman, using in-depth profiles of Virginia Woolf, Alice James and others. Looking at the complex cultural, political and familial circumstances under which mental illness emerges, and their implications for the present (in which depression and eating disorders have become major problems), Appignanesi convincingly asserts that "symptoms and diagnoses... cluster to create cultural fashions in illness and cure," suggesting provocatively that "[w]hat is at issue here is not psychic disorder so much as social deterioration of a radical kind." (Apr.) Copyright 2008 Reed Business Information.
Guardian Review
Exhilaratingly covering two centuries of developments on both sides of the Atlantic, this ambitious study deftly combines a series of profiles of leading mind doctors - from Pinel, who pioneered talking therapy during the French Revolution, to Lacan and Laing - with tracing how particular mental disorders (hysteria for Charcot and Freud, for example) preoccupied theorists as cultural fashions and definitions of madness, normality and appropriate female behaviour shifted. Starting with Mary Lamb, the patients considered are often either authors themselves or the inspiration for plays or novels; and Appignanesi, who writes fiction as well as non-fiction, excels in depicting such figures as Virginia Woolf, Zelda Fitzgerald, Sylvia Plath and Marilyn Monroe. After the 1960s, however, the book, still assured in analysing trends, lacks the celebrity case studies and potted lives of shrinks that have previously made it so riveting. The final attack on the increasing reliance on drug-based treatments would arguably work better as a separate, more polemical book. Caption: article-houses6.1 Exhilaratingly covering two centuries of developments on both sides of the Atlantic, this ambitious study deftly combines a series of profiles of leading mind doctors - from Pinel, who pioneered talking therapy during the French Revolution, to Lacan and Laing - with tracing how particular mental disorders (hysteria for Charcot and Freud, for example) preoccupied theorists... - John Dugdale.
New York Review of Books Review
Lisa Appignanesi reviews two centuries of volatility in the treatment of supposedly mentally ill women. BACK when Zelda Fitzgerald, her skirts wet from diving into public fountains, was accelerating from madcap toward outright madness, a Wharton School economist named George Taylor made the seemingly fey observation that hemlines rose and fell with the stock market, proposing a causal connection between two presumably separate spheres of human enterprise. Fashion, as the now familiar "hemline index" suggested, is socially determined. With prosperity come optimism and tolerance for risk; women are emboldened to show off a more daring length of leg. But what of more empirical, utilitarian domains? Surely doctors hypothesize independently of whatever forces drive style. Take, for example, the diagnosis and treatment of mental illness. Most of us trust psychiatry to remain immune to fads. And it does, doesn't it? One of the consistently fascinating and disturbing aspects of "Mad, Bad and Sad: Women and the Mind Doctors" is Lisa Appignanesi's assiduous tracking of the modishness of what might be mistaken for a sui generis discipline. Of course, as anyone who has visited a psychiatric hospital - or ridden the subway - can attest, crazy is what we call people who refuse to conform to accepted norms of behavior. And the definition of nonconformity must change in step with styles of conforming. "Mad, Bad and Sad" is, Appignanesi tells her readers, not only "the story of madness, badness and sadness and the ways in which we have understood them over the last 200 years," but also a survey of the mad, bad and sad themselves, the particular women, including Zelda Fitzgerald, Lucia Joyce, Virginia Woolf and many less famous patients, who suffered "frenzies, possessions, mania, melancholy, nerves, delusions, aberrant acts, dramatic tics, passionate loves and hates, sex, visual and auditory hallucinations, fears, phobias, fantasies, disturbances of sleep, dissociations, communion with spirits and imaginary friends, addictions, self-harm, self-starvation, depression" and so on. Phew. A list like this makes a girl grateful that Freud even bothered to ask what such desperate, deluded creatures might want No wonder the 19th century couldn't build enough asylums to house them. It seems that as soon as society relinquished witchcraft as the crime for which to punish an overtly liberated woman, it settled on madness as the reason to incarcerate her. As Appignanesi observes, "Patients could well find themselves the victims of a doctor's prejudice about what kind of behavior constituted sanity: this could all too easily work against women who didn't conform to the time's norms of sexual behavior or living habits." That diagnoses conceived by male doctors would be subject to men's changeable views of women - romantic, patronizing, idealistic, misogynistic: the choices are limited only by the imagination - comes as no surprise; it's the meticulous and exhaustive account of these theories offered in "Mad, Bad and Sad" that is sobering. Victorian women who weren't locked up for falling victim to lypemania (melancholy), monomania, homicidal monomania or "moral insanity" were at risk of neurasthenia, a "mirror image of rebellion" in which their "nervous depletion" was explained as the result of their "incursion into the masculine sphere of intellectual labor," a strain that constitutions formed for tender sentiment couldn't be expected to support. And then came hysteria, which "best expresses women's distress at the clashing demands and no longer tenable restrictions placed on women in the fin de siècle." Karen Horney (1885-1952), a pioneer in "feminine psychology." If male doctors conspired to define madness, responding to behaviors that flouted the social conventions of their culture, female patients, in the attempt to understand themselves and their context, and maybe even to create or bolster identity, colluded with those same doctors to satisfy the changing definitions of madness. "Often enough," Appignanesi notes, "extreme expressions of the culture's malaise, symptoms and disorders mirrored the time's order." Anorexia, she writes, "is usually an illness of plenty not of famine, as depression is one of times of peace and prosperity, not of war." Having wept, raved, trembled and hallucinated our way into the 21st century, when "the sum of information available in any given minute is larger than it has ever been in history," we've conceived "a condition in which attention is at a deficit." Among all the doctors whose diagnoses and treatments have proved provocative, none have enjoyed the tenaciously divisive stature of Sigmund Freud. Appignanesi, who (with John Forrester) documented the early years of the psychoanalytic movement in "Freud's Women," examines the new order ushered in by Freud's delving "with a radical coolness which had no truck with conventional morality" into "something mysterious and perhaps threatening, constantly in need of investigation, attention or control." That "something" was, of course, sex. To her credit, Appignanesi herself assesses Freud with a kind of radical coolness. She neither monumentalizes his influence nor engages in a perfunctory, reflexive attack on his pioneering work. Instead she tidily summarizes how Freud, having lifted the lid of consciousness off the tenebrous realm of unconscious desires, hostilities, conflicts and Oedipal struggles, begat countless intellectual heirs - his child and analysand Anna Freud, as well as Melanie Klein, Karen Horney and others - who leapt into the postwar baby boom and focused on women "in relation to their biological destiny - menstruation, pregnancy, menopause." These female pioneers ushered in a cult of childhood and its inevitable corollary, the demonization of mothers, at whose feet piled up responsibilities for all manner of diseases and dysfunctions, from stuttering to schizophrenia, now understood to be neurochemical and decidedly outside the influence of fads. While "Mad, Bad and Sad" echoes and enlarges upon Elaine Showalter's book "The Female Malady: Women, Madness, and English Culture, 1830-1980," Showalter's perspective is more exclusively feminist, arguing that psychiatry as practiced on women is a history of their subjugation and control by men. But as Appignanesi makes clear, women have had no little role in creating and fulfilling the definitions of their madness. The spreading and treatment-resistant phenomena of anorexia and bulimia are owned largely by women, who account for some 90 percent of patients with eating disorders and who are counseled and treated by an industry of specialists whose attempts to raise consciousness about these diseases have helped also to spread them, in much the same way that neurasthenia so captured the Victorian imagination. It would be hard to imagine a mental illness that better evinces the slippery interplay among fashion, delusion, diagnosis and treatment than anorexia, which announces itself with the appearance of following rather than defying social directives and which women embrace, as they did neurasthenia, as a mode of femininity, in this case to be slim rather than morbidly sensitive and enervated. Only after the obsessive pursuit of emaciation betrays a subversive refusal to play by the rules of normality does anorexia reveal itself as flagrantly unstylish, an indictment of the very norms it pretended to satisfy. "Anorectics perennially sabotage therapy," Appignanesi writes, because it isn't only food they refuse but "any form of intrusion," even - perhaps especially - that of a mind doctor intent on curing them. Kathryn Harrison's "While They Slept: An Inquiry Into the Murder of a Family" will be published in June.
