Madder than Fiction

bedlamIt’s Mental Health Awareness Week this week (12th-18th May), and For Books’ Sake has published something of mine on non-fiction female authors writing about the history of women’s mental health in the UK. You can read it here.

MHAW belongs to the UK charity the Mental Health Foundation, and this year the focus is on anxiety. Look for it on Twitter: #anxietyaware


Review: The Painted Bridge by Wendy Wallace

A woman inmate at Bethlem, 19th C

A woman inmate at Bethlem, 19th C

Twelve pages in, and Wendy Wallace has made me feel panicky. Anna Palmer, spirited heroine of The Painted Bridge, has just been locked in her tiny room at Lake House asylum, and the description – ‘...anger gave way to fear, to a feeling that she was drowning, that something fluid and dark was rising inside and choking the breath out of her…‘ – is so perfectly judged that instant claustrophobia ensues.

Early in the novel (no spoilers – if you want to know what happens you can buy the book here) we find out that Anna is at Lake House because her husband Vincent thinks she has acted irrationally in going to help the survivors of an accident at sea. Anna has no mental illness, but she is ultimately treated for ‘mania’. Wallace’s lyrical language gives a false sense of security on occasion, lulling you into thinking that hey, maybe living in a Victorian asylum wouldn’t be too bad, and then she writes about the spinning chair.

Sketch of a whirling chair, from the Oxfordshire Health archives

Sketch of a whirling chair, from the Oxfordshire Health archives

‘Anna was sitting in her own urine. She was sick, suddenly and violently, down the front of her dress…. The chair began to move again, in the other direction.’

I was fortunate enough to have a good chat with Wendy Wallace about Victorian mental health at an event in March, and her knowledge of the subject is immense. She ‘did masses of research’ for this impressive début and, like the best historical fiction, the story wears her knowledge lightly. There is nothing crowbarred in to show off, and everything is integral to the development of character and/or plot; judging by the amount of historical novelists who insist on telling their readers every single thing they’ve learned, knowing what to leave out is not an easy skill to master.

Wallace based the loveable Lucas St Clair on Dr Hugh Diamond, who believed photography could help in the diagnosis of mental illness, and she tried Victorian photographic techniques to get this vital sub-plot just right. She read people’s experiences of the spinning chair in the Wellcome Archive and familiarised herself with other tortures: the use of leeches, and freezing showers like the one that nearly kills Anna. All painfully true. Case notes from the Greater Glasgow Health Board archives show that in 1820 the ‘whirling chair’ was used to treat a woman who ‘refused to amuse herself in any way’; after an hour of the horror she still refused to sew, apparently. This treatment was meant to sort of jumble up the brain to shake it back into sanity, whereas the practices of cold showers and shaving inmates’ heads were designed to cool down ‘overheated brains’.

From West Virginia's Trans-Allegheny Lunatic Asylum

From West Virginia’s Trans-Allegheny Lunatic Asylum

Though it seems absurd to think that husbands could do away with their unwelcome wives, daughters and mothers on a whim, Sarah Wise’s Inconvenient People (see earlier post) proves it happened so regularly that Anna’s experience, rather than being far-fetched, is actually almost par for the course. A list of reasons for admitting inmates to a 19th century asylum in West Virginia shows how ludicrous the system was – though, interestingly, mania isn’t actually listed – and it was in the best interests of asylum proprietors to keep financially lucrative inmates like Anna locked up for as long as possible.

Wallace has created a fascinating cast of (primarily female) characters for The Painted Bridge, all of whom are three-dimensional and complete with desires, fears and dark sides that make them relatable today. Creating characters whom a modern readership can understand is an enduring challenge for historical novelists, and Wallace has risen to it beautifully. Anna is one of the most endearing heroines in recent reading memory, and her battles against the real-life demons of Victorian mental health ‘care’ make for a hugely satisfying read.

You can read a Wendy Wallace article about women in Victorian asylums here.

Mad, Bad and Sad: Women and the Mind Doctors (exhibition)

Mad, Bad and Sad at the Freud Museum, until 2 February 2014

Freud, drawn by Salvador Dali

Freud, drawn by Salvador Dali

The Freud Museum’s latest exhibition is inspired by Lisa Appignanesi‘s 2008 book of the same name, and focuses (unsurprisingly) on the history of female experience within psychiatric care. The exhibition also includes responsive art works by women including Tracey Emin (who has long been open about her own mental health problems), Sarah Hiller, Sarah Lucas and Jane Fradgley.

There are leading early female psychiatrists included in the exhibition, including Anna Freud, Melanie Klein and Sigmund Freud’s friend and confidante Princess Marie Bonaparte, but for the most part this is an exhibition about women looked after by men. ‘Dora’, Freud’s most famous patient because she was the only one ever to walk out of him, is featured alongside notable beneficiaries of Freud’s work such as the American writer Hilda Doolittle and the Russian psychoanalyst Lou Andreas Salomé. Freud, Dootlittle, Doolittle’s partner Bryher and her psychiatrist Hanns Sachs are pictured in a useful photographic demonstration of their relationships, though the presence of Sachs’ monkey is left unexplained.

Early psychiatry tended to treat women as some kind of alien species, so it is hardly a surprise to find a number of exhibits dedicated to that most potent of female maladies: ‘hysteria’.



The most interesting of these exhibits is a book by Jean-Martin Charcot, a 19th Century French pathologist and neurologist who developed the use of hypnosis in treating hysteria and used photography to document the condition’s physical manifestations. His methods were controversial, not least because there was cynicism surrounding his case study, a young woman called Augustine whose thrashings were distinctly sexual. The drawings make this book into a veritable karma sutra of suspect mental health research.

Charcot established a pioneering clinic at the Hospice de la Salpêtrière, France’s biggest female asylum, where he followed in the humanitarian footsteps of Philippe Pinel, an equally pioneering man whose reforms of treatment for the insane are detailed in A Treatise on Insanity (English translation 1806). One of la Salpêtrière’s inmates during Pinel’s tenure as chief physician was Théroigne de Mericourt, declared insane after a career as a French revolutionary and feminist when feminism was just pesky.

Next to Pinel’s book (which, brilliantly and unusually, visitors are encouraged to touch) is a painting of Charles and Mary Lamb, the literary brother and sister who both experienced mental illness. Mary’s was the most damaging – in 1796, aged 33, she murdered their mother and, after a spell in an asylum, stayed in Charles’s care until his death in 1834. Charles Lamb’s letters, also on display, describe his own mental health in witty detail and are a vital early insight into the realities of living with a mental illness in the early 19th century.

Sylvia Plath

Sylvia Plath

Given their famous mental illnesses you’d expect to find Virginia Woolf and Sylvia Plath featured, and both are here as recipients of the 20th century’s move towards talking therapies rather than incarceration. There are copies of both women’s works, and a transcript of Woolf’s letters, one of which describes how she was reading Freud ‘to give [her] brain a wider scope: to make it objective; to get outside.’

Other important female figures in this exhibition include English writer Anna Kavan and Austrian Bertha Pappenheim. Kavan developed a close friendship and writing partnership with her doctor Karl Theodor Bluth, who continued to prescribe Kavan heroin to feed her addiction even after her release from psychiatric hospital, and Pappenheim’s talking therapy treatment from Josef Breuer in 1880 was considered by Freud to be the beginning of psychoanalysis.

Charcot's book on hysteria

Charcot’s book on hysteria

Ultimately the contemporary artworks that superficially make this exhibition different are lost among the history, but to be honest that’s no bad thing. While Mad, Bad and Sad might not have much new to say about the history of psychiatry per se, its collation of so many important developmental figures in two small rooms means it feels fresh, and is well worth seeing.

Elisabeth of Austria



Married young into an unhappy royal life, most famous woman of her era, died violently, had an eating disorder. It sounds like Diana, Princess of Wales, and indeed there are many articles on the Internet comparing the two, but this description belongs to Elisabeth, Empress of Austria from 1854 until 1898.

Elisabeth (known from a young age as Sisi) was born on 24th December 1837, in Munich, to Ludovica, from the Bavarian House of Wittelsbach, and Duke Max of Bavaria. A shy child, she was catapulted into the limelight at 16, when she married her cousin, Emperor Franz Joseph of Austria. From the start, Vienna didn’t suit her – she referred to herself as a ‘caged bird’ in its suppressive court, under the watchful and domineering eye of Franz Joseph’s beloved mother, Sophie. Elisabeth bore three children during the 1859s, all of whom were taken away and raised by her mother-in-law. Franz Joseph was unfaithful to her and seems to have given her a venereal disease, treatment for which ruined Elisabeth’s teeth. It’s no wonder that she began to take long, restorative trips away from court.

Elisabeth's gym

Elisabeth’s gym

She was widely regarded as one of the most beautiful women in Europe, and the maintenance of her beauty certainly reads like anorexia. She had no control over her life but she could control the hell out of her food and her beauty regime. As one commenter posted on my earlier piece about nuns: “…[that] sense of control is very satisfying when you are having other issues in your life. Sometimes food is the only thing in this world that you can control”.

Elisabeth ate very little, frequently subjecting herself to starvation diets that consisted of eggs, broth and milk from the cows she took with her wherever she went. She walked for up to 10 hours a day, did rigorous gymnastic routines and went horse-riding, all to retain the (allegedly) 18 inch waist that had, ironically, attracted her husband and condemned her to her miserable life. Her fasting got worse after the death in 1857 of her toddler daughter, and starvation behaviour would reappear following periods of stress for the rest of her life.

One of Elisabeth's tiny corsets

One of Elisabeth’s tiny corsets

In obsessive pursuit of physical immortality she also concocted face masks made out of raw veal or slugs (or strawberries, which is less grim), and devoted a whole day once every three weeks to washing her knee-length hair with eggs and cognac. After the age of 32 she refused to have any more portraits made or pictures taken, so the public would always think of her as young and beautiful.

There is no doubt at all that Elisabeth was desperately unhappy, and this obsessive compulsive dedication to her appearance seems to have been the manifestation of her depression. She refused to get pregnant a fourth time, partly to maintain her waistline, until 1867, when she decided a reconciliation with her husband would help her push Hungary’s cause to become an independent nation. The Dual Monarchy of Austria-Hungary was created that same year, and in 1868 Elisabeth gave birth to Marie Valerie, insisting on bringing this child up herself. Deprived of a close relationship with her other children, she smothered Marie Valerie.

In January 1889 her only son, Crown Prince Rudolf, killed himself in a murder-suicide pact with his teenage mistress. Rudolf, then 30, had been growing increasingly frustrated with his father’s refusal to grant him any responsibility and his own unhappy marriage. Elisabeth, who had lost both her parents and her sister the previous year, was devastated, angry, and terrified that Rudolf’s depression was a family trait that Elisabeth would soon develop. Both her Wittelsbach cousins Ludwig II of Bavaria and his brother Otto had been declared insane – three days after his diagnosis of schizophrenia in 1886, Ludwig and his psychiatrist had been found drowned, officially by suicide.

Elisabeth did not die by her own hand. She was assassinated, in 1898 in Geneva, by an Italian anarchist who stabbed her because he couldn’t find his original intended aristocratic victim. Her corset was so tight that initially no blood could escape from the wound in her heart – when her bodice was loosened, she bled out.

Elisabeth and Franz Joseph

Elisabeth and Franz Joseph

Elisabeth has become an iconic figure – the original beauty in a royal fairytale gone wrong. Because of her political work she has remained especially popular in Hungary, but there are webpages and blogs all over the place dedicated to her beauty secrets and her clothes. She also has her own museum.


‘Convulsed, pitiably hideous’: Leonora Carrington

leonora-carrington-7Surrealist artist Leonora Carrington was born in Lancashire in 1917, and died in Mexico City in 2011. She had lived in Mexico City since the 1940s, becoming one of the country’s most important artists; how she ended up there is a fascinating story, absolutely worthy of Surrealism, complete with art, lust and (obviously, for the purposes of this blog) madness.

Carrington went to art school in Florence and London to indulge in what her parents thought was just a hobby. However, when she was 19 she met and fell in love with famous Surrealist painter Max Ernst (in his mid-forties and on his second marriage), and ran away with him to Paris, the heartland of Surrealism. There Carrington hung out with Man Ray, Andre Bréton, Picasso and Joan Miró, creating her own paintings and sculptures and enjoying the singular honour of being called ‘important’ by Dali. She and Ernst moved to Provence, where they both continued to work. In 1939 Carrington painted ‘A Portrait of Max Ernst’ as a tribute to their relationship, but after WWII broke out that same year Ernst was arrested: first by the French authorities for simply being German, then by the invading Nazis because his work was considered unacceptably decadent.

Portrait of Max Ernst

Portrait of Max Ernst

Ernst was locked away in an internment camp. Carrington, understandably, was distraught. She stopped eating, and was in dangerously poor health when she was rescued by some friends, fleeing the Nazis, who drove her to Madrid. She wrote later: “I’d suffered so much when Max was taken away to the camp, I entered a catatonic state, and I was no longer suffering in an ordinary human dimension.”

On the journey to Spain she saw bodies hanging from trucks and corpses on the roads – at least she thought she did, though her traumatised mind wondered if they might actually be delusions. The Spanish authorities certainly thought so when she reported them, and threw her into an asylum in Santander. According to her 1944 memoir, Down Below, she suffered there, subjected to barbiturate and Cardiazol treatment, until her family in England got sufficiently worried about her to send a nanny (or a business contact?) to rescue her and take her instead to a hospital in South Africa. In the finest traditions of Surrealist weirdness, Carrington escaped from her minders while they were waiting to board the boat, jumped into a cab and headed straight for the Mexican embassy, immediately entering into a marriage of convenience with a diplomat friend she’d known in Paris. Then they went back to wait for a boat to the USA, joined by a liberated Ernst, his new partner, his ex-wife, and his new partner’s ex-husband. Carrington and Ernst didn’t get back together – he married again, and after a few months Carrington dissolved her own marriage and moved, permanently this time, to Mexico City.

Leonora Carrington and Max Ernst

Leonora Carrington and Max Ernst

It’s an extraordinary tale, and one made more extraordinary by scholarly suggestions over the years that Carrington’s asylum memoir was more fiction than fact. (Interestingly, Amazon classes the book as fiction.) She was a surrealist, after all.

Ann Hoff at the University of Alabama wrote a paper on Down Below in 2009, concluding that Carrington’s barbaric experience could well have been entirely factual. Clinical descriptions of other people’s treatment with Cardiazol, a powerful convulsive drug that was a forerunner of ECT, suggest her recollections of seizures, hyper-sexualised thoughts post-treatment and being left to lie in her own faeces (incontinence was a common side-effect) are depressingly accurate. She was also given Luminol, a powerful anti-convulsive and sedative, side-effects of which include depression, confusion, joint pain, vomiting and nightmares.

The most galling thing about all of this is that, if you look at Carrington’s symptoms, her incarceration seems even more unjustified that most. As Hoff points out, she presented to the Spanish authorities with symptoms of paranoid schizophrenia, but her ‘delusions’ indicate an acute rather than persistent mental illness – a perfectly regular mind’s natural reaction to being 23, alone in a foreign country, scared half to death because you’re in the middle of a war and your partner has been shipped off to an internment camp for god knows how long? Her response seems pretty reasonable, looked at that way. Her ‘treatment’ probably exacerbated her symptoms – and no wonder that she described herself as completely obedient and ‘pitiably hideous’.

Self-portrait, c.1937-8

Self-portrait, c.1937-8

(And the bodies she saw on the roads were very real – that drive took in a military cemetery. Her belief that they were delusions shows how worried she was about her own mental state.)

It wasn’t unusual for trauma victims to be treated as harshly as Carrington was. Carrington wrote Down Below, she said, because she thought these awful practices in mental hospitals needed exposure, but the analysis of her account as fiction suggests her reputation got in the way of what she was trying to do. Scholar Marina Warner, in her introduction to the 1988 revision of Down Below, warns against dismissing Carrington’s facts but also recognises that Carrington’s ‘madness’ confirmed her as a Surrealist icon.

You can download Carrington’s short story The Debutante here: based on her hated experience of being presented to King George V, the story is about a reluctant debutante who swaps places with a hyena. It’s fairly disturbing.

John Kerr and the Confucian Problem

confuciusinhunanConfucius, a Chinese teacher, editor, politician and philosopher who lived between 551 and 479BC, taught that accepting one’s allotted role in society was imperative for the maximisation of personal and public harmony. He preached discipline, respect and humility, advocating for people to keep their emotions suppressed and their innermost thoughts to themselves in order to achieve harmony with others. Duty to one’s family was regarded particularly highly.

This is all well and good, but 2000 years of individual restraint for the good of the common cause has, arguably, contributed to China’s problems with owning up to and treating its mental health problems. Because mental illness is disruptive, and therefore contrary to Confucian ideals, it has traditionally been something to be hugely ashamed of, if not dismissed entirely. Behaviour deemed non-Confucian (and it’s not always easy to control feelings or actions if you’ve got a mental illness…) creates a barrier between people with mental illnesses and people without. So there’s long been a huge stigma, compounded by the idea that the pressures of Chinese society are responsible for some of the country’s mental health problems.

There is a serious dearth of psychiatrists in China, and little education (this article, for example, while generally positive, perpetuates the idea that people with severe psychiatric disorders are likely to be violent towards others).

John Glasgow Kerr (1824-1901)

John Glasgow Kerr (1824-1901)

This lack of knowledge is understandable to an extent, because during the Cultural Revolution psychiatry was actually made illegal; Maoist thought dictated that mental health problems were simply a lack of appreciation of the class struggle. People with mental illnesses were denounced as ‘counterrevolutionary’, and incarcerated in labour camps. So the mental health sector has had a lot of catching up to do.

Traditional family culture means people who would be treated with medication or in hospital in the UK are kept at home, ‘looked after’ by relatives whose knowledge of mental illness is shaky at best; this seems a step back to the 19th Century, when families kept their mentally ill relatives in dark rooms at home, neglected and abused. This isn’t entirely dissimilar to how the UK treated some of its mentally ill citizens, actually, but there were no others options in China, except prison. Until American medical missionary John Glasgow Kerr established China’s first psychiatric hospital in 1898 there was no dedicated psychiatric care in the country at all.

The invisibility of mental illness in Chinese society led some Christian missionaries to assume mental illness was less of a problem than in their own countries, but Kerr disagreed. Initially his proposal for a hospital in Canton received little support from either his fellow missionaries or local people in Canton, but his plan was agreed by the Medical Missionary Association on the basis that though China didn’t necessarily want a hospital, it needed one. Kerr bought land for the hospital with his own money, and built a 24-room facility – the Kerr Refuge for the Insane.

Kerr's Refuge for the Insane

Kerr’s Refuge for the Insane

He began admitting patients in 1898, facing up to the grim realities of Chinese mental health ‘care’ as families starting bringing people to him in chains; his first patient had been chained in such a way that he could no longer walk. Kerr’s treatment was founded on the understanding that his patients were ill, and needed an environment where they were not blamed for their actions but given the best possible chance of recovery: freedom, relaxation, employment if possible, kindness and, slightly more left-field, warm baths.

The hospital flourished as local families, policemen and government officials referred patients to Kerr, paying him an annual sum to look after them. Kerr died in 1901, but his Refuge, which grew to accommodate 500 people, survived until 1937. The hospital paved the way for further psychiatric care in China but the reluctance Kerr encountered at first suggests that, had it been left to people growing up with Chinese cultural norms, such an institution might never have existed.

Review: Inconvenient People by Sarah Wise

Inconvenient PeopleSarah Wise begins her epic exploration of 19th century mental health ‘care’ with the story of Edward Davies, an eccentric, nervy young man whose loving mother had him declared insane and locked up in an asylum so she could gain control of his business interests. Davies was exonerated and declared of ‘perfectly sound mind’ in a jury trial at the end of 1829, only a year after the passing of the Act to Regulate the Care and Treatment of Insane Persons in England, which specified that:

  • Two certificates of lunacy were required for each private patient (those who could afford to pay for their care);
  • Each certificate must be signed by a different doctor, following two separate interviews no more than fourteen days apart;
  • No physician could sign a certificate if he was an owner, co-owner or regular attendant at a madhouse;
  • A lunacy order was to be completed by the person who had first alerted doctors to the lunatic.

Wise’s far-reaching, comprehensively researched book utilises twelve shocking case studies to indicate how this Act (known colloquially as the Madhouse Act) was manipulated by relatives and friends to dispose of their inconvenient people. It’s a brilliant achievement, and deserves reading by anyone with an interest in the history of mental health care.

The Agapemone village in Somerset

The Agapemone village in Somerset

Starting with poor Edward Davies we move through the decades, focusing on such characters as John Perceval, whose own incarceration led him to start the Alleged Lunatics’ Friend Society; elderly, wealthy Mrs Cumming, declared insane by her own estranged children; Louisa Nottidge, who joined the Agapemone ‘Abode of Love’ cult; spiritualist and eventual campaigner Louisa Lowe; and William Windham, whose wild behaviour resulted in one of the century’s most expensive lunacy trials and his natural death at the age of 25.

Wise tells these sad stories with panache and great humour – there is plenty of ridiculousness here, not least the idea, held by early ‘alienist’ (mad doctor) Dr George Man Burrows, that insane persons could be diagnosed by the way they smelled. Her language is beautiful and her sketches read like Victorian novels; the plots are equally intricate and far-fetched. She is sympathetic to an extent to the medical professionals, recognising that they were operating at a time when understanding of mental health conditions was in its infancy and largely experimental, saving her harshest words for the often venal, corrupt asylum proprietors.

As well as detailing the progress made in legislation (her style is sufficiently entertaining that the legal bits, while dense, are not boring or dry. We also meet some weird and wonderful characters, including the famously social reforming Lord Shaftesbury) and in public sympathy for victims of the system, Wise provides a cracking literary analysis.

Rosina Lytton

Rosina Lytton

Perhaps the most shocking stories in the book are those that deal with single-patient care – where a lunatic boards in someone else’s home, or stays with their own family. There are cases here of a girl who would now be diagnosed with learning difficulties being murdered by her relatives and of men left to rot in windowless rooms in their own excrement because their families have no idea how to deal with them. Wise looks at Bertha Mason‘s character in Jane Eyre in this context, defending Mr Rochester for actually looking after his wife significantly better than he was really obliged to do – keeping her from the asylum, where she might have been subject to all sorts of inhumane punishment, was in a sense a mark of his nobility.

Wise also, understandably, references Wilkie Collins’ The Woman in White, and devotes a chapter to the ‘mad’ wife of Edward Bulwer-Lytton, whose most enduring contribution to literature was giving us ‘It was a dark and stormy night’. The incarceration of his estranged wife Rosina, herself a writer, who believed Dickens and her husband grew facial hair to hide their evil features, caused a huge scandal in the 1850s and drew public attention to the issue of women’s rights in marriage for perhaps the first time.

Dr Forbes Benignus Winslow, a leading Victorian authority on lunacy

Dr Forbes Benignus Winslow, a leading Victorian authority on lunacy

In her epilogue, Wise points out ‘the stubborn unchangeability of many aspects of the lunacy issue’, and draws our attention to the horrific treatment of people declared mentally ill up until the mid-20th century and beyond. In some ways we’re actually going backwards. While we might think how ridiculous it is that Victorians could declare people insane and have them locked away forever because of their religious views, or (in the case of actress Elsa Lanchester‘s mother Edith in the 1890s) because they didn’t want to get married, it’s worth remembering that in the latest version of the Diagnostic and Statistical Manual, disagreeing with authority is considered to be a diagnosable mental health issue.