Review: The Painted Bridge by Wendy Wallace

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

‘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

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

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’.

Augustine

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

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

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

Elisabeth

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

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

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 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.

 

John Kerr and the Confucian Problem

Confucius, 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)

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

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

Sarah 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

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

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

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.

Guy de Maupassant and neurosyphilis

Maupassant

In a tenuous way, this post was inspired by reading Sarah Dunant’s wonderful novel about the Borgias, ‘Blood and Beauty’, (my review for For Books Sake is here) because Cesare Borgia had syphilis. He died before it could take hold of his brain, though his brutal mood swings and outrageous behaviour may have resulted in part from his illness.

Aside from syphilis, Guy de Maupassant, a brilliant 19th century French writer widely regarded as a leading exponent of the short story, doesn’t have a lot in common with Cesare Borgia. He was born in Normandy on 5th August 1850, fought in the Franco-Prussian War of 1870-1 and then became a civil servant, spending his free time with literary luminaries like Gustav Flaubert, Emil Zola and Henry James.

Cesare Borgia

He was also, unfortunately, keen on prostitutes (which does make him a bit more like Cesare Borgia) – his first short story collection, La Maison Tellier, was unusually sympathetic in its portrayal of prostitutes – and probably contracted syphilis in a brothel during his 20s. Certainly in the 1870s he wrote to Flaubert of a ‘black depression’ that was preventing him from writing, to which Flaubert, not buying Maupassant’s diagnosis of a rheumatic complaint, responded:

“Come my dear friend you seem badly worried. You could use your time more agreeably. I’ve come to suspect you have become something of a loafer with too many whores, too much rowing and too much exercise.”

The rowing not withstanding, Flaubert’s diagnosis of ‘too many whores’ was spot on.

Illustration for La Maison Tellier, by Steinlen

Unfortunately little of Maupassant’s correspondence survives, so biographers have largely pieced together his declining mental health through his 300-odd semi-autobiographical stories. Many of them are about madness (The Inn, for example, is about two caretakers who go mad through isolation in an inn, and Le Horla, written in 1887 when Maupassant was becoming very ill, concerns the sanity of its, possibly syphilitic, protagonist), and critics have read Maupassant’s own delusions and obsessions into them.

By the late 1880s the syphilis had properly taken hold and Maupassant became increasingly fond of solitude. He was also apparently obsessed with the idea of flies eating his brain, was paranoid about death and suffered hallucinations. His despair became so great that he tried to commit suicide, first with a gun and then with a paper knife, on 2nd January 1892, and was institutionalised in an asylum in Paris. He was there until he died, from complications caused by syphilis, on 6th July 1893.

Maupassant’s entire short story collection is available for free on Project Gutenberg.

Post-partum Wallpaper

As new research indicates that post-natal depression is more common than was previously thought, now seems as good a time as any to talk about Charlotte Perkins Gilman.

Charlotte Perkins Gilman

Gilman, born in Connecticut in 1860, had a poor, fairly lonely early childhood with an unaffectionate single mother. It’s probably not unreasonable to suggest those experiences contributed to her poor mental health, which culminated in a serious bout of depression after her daughter Katharine was born in 1885.

She endured ‘continuous nervous breakdown’ for two years before seeking help from a specialist who prescribed total bed rest – a common ‘cure’ for female ‘hysteria’. She recovered physically, but then she was sent home with advice to follow what sounds like an utterly horrific treatment programme. She was supposed to live as domestic a life as she could, with a maximum two hours ‘mental stimulation’ per day, and absolutely no writing, reading or drawing. Forever.

“I went home,” wrote Gilman in 1913, “and obeyed those directions for some three months, and came so near the borderline of utter mental ruin that I could see over.”

She made those comments in a rather wonderful article explaining why she wrote her classic story “The Yellow Wallpaper”, published in 1892. The story documents her experiences, with ’embellishments and additions’; on completion, she sent it to her doctor. He never responded, but Gilman heard later that he changed the way he treated ‘neurasthenia’ after reading it.

Doctors now steer clear of prescribing deathly boredom, in favour of drugs and talking therapy.

Not content with being a prolific author, social theorist and leading feminist who advocated female economic independence, Gilman was an advocate of euthanasia. Diagnosed with inoperable breast cancer in 1932, Gilman committed suicide in August 1935. Her husband had died a year earlier. In her suicide note she explained:

“When all usefulness is over, when one is assured of unavoidable and imminent death, it is the simplest of human rights to choose a quick and easy death in place of a slow and horrible one. I have preferred chloroform to cancer.”