Mad, Bad & Sad: History Of Female Mental Illness Turns Into Indictment Of PsychotherapyS

From force-feeding to tooth removal to stomach surgery, mental patients throughout history — many of them women — have endured some pretty horrific therapies. In Mad, Bad & Sad, Lisa Appignanesi questions whether modern treatments are much better.

Subtitled A History of Women and the Mind Doctors, Appignanesi's book aims to trace the relationship between women's "madness, badness, and sadness" and their treatment by (usually male) professionals from the late 18th century to the present day. The book does a good job of describing the connection early physicians saw between physical and mental ailments — the "moving womb" theory of hysteria, the fits of numbness and paralysis supposedly brought on by a frightening sight or memory. The "mind doctors" of the 18th and 19th centuries were of course wrong about the specifics of these connections (breast milk, for instance, does not travel into the brain and cause insanity), but it's interesting to note that they understood what we sometimes forget — that the mind and body can influence each other, for good and ill.

Unfortunately, this awareness often led to sexism. Appignanesi notes that doctors in the second half of the 19th century believed that problems with the female reproductive system caused "nervous afflictions," and that,

Throughout this period, doctors and scientists seemed determined to raise the existing division of labor in the middle class to a universal given, and to transform women's place in the domestic sphere into a biological inevitability from which deviation of any kind would bring breakdown, not only of the mind but of the species. Women were understood as being fashioned by evolution for the home and maternity, nervously fragile, intellectually inferior. Moving away from that lesser birthright, allowing energies to be drained by intellectual or imaginative exertion would lead to nervous collapse or to that capacious list of symptoms which most often went under the catch-all diagnosis of neurasthenia or its near-neighbour hysteria.

Prejudicial theory was often matched by brutal practice. Pelvic surgery and force-feeding were common treatments, and Appignanesi tells the story of one woman fed so violently in an asylum that all her teeth were broken. Especially gruesome was early 20th-century hospital superintendent Henry Cotton, who believed psychosis was caused by "chronic pus infections" and who "treated" sufferers not only with tooth removal but with surgery on the stomach, tonsils, uterus, and colon.

There's an interesting book to be written about how fads in mental treatment have harmed and helped women's bodies and minds over the past two centuries. Mad, Bad & Sad is not that book. Appignanesi offers overlong and sometimes jumbled case histories in lieu of any real tracking of trends. Instead of a full picture of how culture has shaped women's diagnosis and treatment, we get scattershot portraits of such ailments as hysteria, neurasthenia, eating disorders, and borderline personality disorder without a coherent explanation of what brought each of these conditions to the fore. It's clear that aspects of mental illness are culturally determined — there's a reason why the diagnosis and even the symptoms of hysteria were prevalent in one century, BPD in another, but Appignanesi doesn't really examine what that reason is.

She does say that "therapies [...] can create their own best patients," and she seemed nearly as skeptical of modern SSRIs and cognitive-behavioral therapy as she does of tooth removal and pelvic surgery. Despite her graphic descriptions of blood-vomiting hysterics, she sometimes seems to think that mental illness is largely illusory, something imposed by doctors on women going through normal life phases like adolescence and childbirth. The only therapies she seems to support are journaling, psychoanalysis (with some reservations), and just growing out of your problems.

Appignanesi makes good points at the beginning of her book about the inherent sexism of early psychiatric theories. She might have used these insights to examine how modern-day therapists might transcend gender stereotypes and treatment fads to give their patients the best possible care. Instead, she seems to consider almost all mental health treatments to be forms of insidious social programming. Of course, psychotherapy does tend to reinforce social norms even as it helps patients deal with their very real pain. Whether the two necessarily go hand in hand is an interesting question. It's too bad Appignanesi doesn't make a serious effort to answer it.

Mad, Bad, And Sad: A History Of Women And The Mind Doctors