Could it be that imprisoned inside every sane woman is a Mrs. Rochester the madwoman in the attic whose untamed presence, like that of "some strange wild animal," haunts "Jane Eyre" yowling to get out? Are we women now, as in the 19th and 20th centuries, in danger of coming down, sooner or later, with some configuration of what Elaine Showalter described as "the female malady"? Some culturally constructed and fashionably diagnosed form of emotional instability, that is, ranging from "weak" nerves to full-blown Britney Spears meltdown?
Ever since the latter part of the 18th century, when madness came into its own as a disorder worthy of scientific scrutiny instead of denial and punishment, it has been women including some of the most talented, such as Virginia Woolf, Zelda Fitzgerald, Sylvia Plath, and Marilyn Monroe whose unhappiness or erratic behavior has been most often "medicalized." These, among others, are the cast of characters who have ended up as passive patients of what Lisa Appignanesi, in her book "Mad, Bad, and Sad" (W.W. Norton, 540 pages, $29.95), euphemistically refers to as "mind doctors." Call them "empiricks" (better known as quacks), alienists, mesmerists, psychiatrists, or therapists, these are the men and they are almost always men summoned to render judgment and prescribe the treatment du jour: bed rest, exercise, cold baths, hot baths, purgings and bleedings, insulin injections, forced feedings, dietary moderation, doses of opium, the talking cure, and pills by the dozen. From the 18th century to the present day, women have been essentially conceived of as little more than the sum total of their symptoms whether homicidal, suicidal, neurasthetnic, hysterical, borderline, or merely troublesome. What, one wonders, does this say about a society intent on viewing them in such reductionist terms?
This is among the slew of questions that cascade, one after the other, in the course of Ms. Appignanesi's dauntingly ambitious, occasionally brilliant, and almost always compelling account. "Mad, Bad, and Sad," which was published to wide acclaim in England earlier this year, takes on everything in its path and then some its author seemingly driven to follow every tendril of a thought or sprig of a fact in her exploration of the "protean process of symptom-shaping." The result is a powerhouse of a book, although one that is stalled by so many local stops, and sends out so many diffuse sparks, that it loses rather than gains steam as it proceeds. (One might wonder at the laxness of the British editor, who has done this prolific writer Ms. Appignanesi has written 10 novels and a clutch of nonfiction books, including a biography of Simone de Beauvoir no service by letting her amble every which way, without paying much heed to order or context.) But betwixt and between the 540 pages of lengthy and not always germane digressions into the factionalism within British psychoanalysis, the creation of the door-stopper diagnostic bible known as the DSM, and the recent emphasis on psychic trauma and the attendant rise of multiple personality disorder, and of the numbers of victims of sexual abuse is a riveting description of the etiology and trajectory of female mental illness.
"In every generation, there are quite firm rules on how to behave when you are crazy," Ms. Appignanesi quotes the philosopher Ian Hacking. Her story begins in 1796 before the rules were clearly inscribed and the infractions less marshaled into neat cubbyholes than they were even a century later with a Gothic matricide. The act was committed by the widely loved (both before and after the murder) Mary Lamb, the older sister of the essayist Charles Lamb. This was a form of insanity avant la lettre, so to speak. It was too violent Mary had stabbed her paralyzed mother several times, wounding her senile father in the process to be contained wholly within the family, although Mary's liberation from lifelong incarceration was based on Charles's assurances that he would take full responsibility for his sister's welfare. It was also too exotic in its criminal madness to be dealt with in the usual manner: throwing the perpetrator into the brutal atmosphere of Bethlem Hospital (more commonly referred to as Bedlam), or one of several lunatic asylums that had come into being by the end of the 18th century.
Luckily for Mary Lamb, who was never brought to trial, just a decade earlier one Margaret Nicholson had tried to stab George III with a butter knife. The king unexpectedly responded with sympathy instead of outrage, cautioning his guards, "Take care of the woman do not hurt her, for she is mad." One of Ms. Appignanesi's intriguing suggestions is that, despite our assumptions about pre-modern medicine, there was at the time a "certain sophistication about what madness meant and the patterns it took" helped by the emergence a few decades earlier of a Romantic sensibility that led Byron in "Child Harolde's Pilgrimage" to describe Rousseau as a writer who knew "How to make madness beautiful." Although Mary spent some time in private madhouses, ranging from informal (and lucrative) boarding arrangements to settings that could house 200 patients, she set up house with Charles less than three years after the murder, though there were intermittent bouts of "violent agitation" during which Charles placed her in a madhouse; eventually her breakdowns degenerated into longer and more frequent periods of manic depression such that he moved into a private asylum with her. Notwithstanding the "cycle of illness and care," Mary went on to live a productive and sociable existence, considered an engaging conversationalist and a "calm," "rational" creature. Although none of her writings could appear under her own name because of the murder, she collaborated with Charles on "Tales from Shakespeare" and a collection of children's stories. Mary lived on 12 years after the death of her brother, who had given up hopes of marriage and lurched into alcoholism in part under the burden of looking after his sister; she died in May 1847 at 82.
In her essay, "On Needlework," Lamb noted that "Needle-work and intellectual improvement are naturally in a state of war." If one of the things that drove Mary Lamb nuts was the way in which her presumed societal usefulness lay in false busywork, it was only a hop, skip, and a jump to declaring war on this consignment to pious duty by making sure to keep one's hands very, very idle. And indeed, as Ms. Appignanesi observes, "Throughout the nineteenth century, talented, middle-class women were to shake off the chains of their socially restricted forms of usefulness by unconsciously choosing invalidism as a preferable form of life."
This velvet revolution usually took the form of amorphous physical discomforts, which defied the mind doctors' best efforts at diagnosis and required sustained application of couch or bed rest. This unconsciously willed withdrawal from society into a kind of private sanctuary was, in its way, an ingenious solution not so different in its dulling effect than the stampede during the 1950s and '60s to Valium and the like (Mick Jagger called them "mother's little helpers") by housewives who suffered from a sense of malaise that went unexamined and unnamed before the publication of Betty Friedan's "The Feminine Mystique" in 1963.
The poet Elizabeth Barrett Browning chose the supine way out of the drudgery of caretaking 11 siblings and an autocratic father, developing an unspecified "ailment" that allowed her to write and study, only to shove aside her bedclothes when the poet Robert Browning, with whom she had a child at the age of 43, came calling. A more cautionary case is that of Alice James, the younger sister of William and Henry, whose considerable intellectual and literary abilities her diary and letters are a sheer delight to read were thwarted by social expectations, her class, and the particular Boston Brahmin family in which she was raised; when Henry Sr. took his children to Europe in search of a more deep-rooted culture than America could provide, Alice was mostly left behind in shabby hotel rooms. Unable to make use of her gifts, negligibly educated, and little-understood by her practical mother, whom Ms. Appignanesi describes as "the most conventional and practical of Victorian household angels," Alice retreated early on into a series of illnesses, beginning with a nervous breakdown at 15. In a family shot through with tensions and conflicts, she was the designated patient, the one who took on its "neurotic duty." Two years after her death at the age of 43, her piercingly astute brother Henry summarized her plight to William: "[H]er tragic health was in a manner the only solution for her of the practical problem of life."
"Mad, Bad, and Sad" documents, too, the restrictive manner in which solutions to that central problem have been arrived at not by those who suffer, but, increasingly over the last two centuries, by those who don't the ways that the "inner experience of madness, madness from the point of view of the sufferer" comes up against "what Michel Foucault calls the medical gaze." Subjective input, objective data, medical observation, speculative inference: The possibilities for getting it wrong are terrifying, but none of this has stopped the forward march of the mind doctors who are determined to make what can't be seen "a sickness of the soul," or, as it may be, a biochemical tangle into something concrete that can be wedged into a taxonomy of disorder, with its "imperializing diagnoses."
In surveying the history of misdiagnoses and miscures, Ms. Appignanesi is pulled this way and that by intriguing case studies, historical developments, and gleaming pieces of information: that the word "psychiatrist," for instance, was first used in Germany; that attitudes differed toward the "pauper lunatic" and "lunatic rich"; that the term "neurasthenia" was coined by an American physician, George Beard, in 1869, and that a degenerative theory of insanity ceded to a more developmental theory, followed by a biochemical one. (The bibliography alone is worth cherry-picking for one's own periods of invalidism when nothing will avail but reading.)
It can make for a dizzying mixture of a bird's-eye view and microscopic perspective, but the archives Ms. Appignanesi has sifted through have turned up some pearls: Especially striking is the 1825 example of "Henriette Cornier and Homocidal Mania," which involved what seemed to be the cold-blooded, even lethargic murder of a 19-month-old little girl by a 27-year-old French servant girl and mother of two who lived next door to the girls' parents. Ms. Appignanesi compares Cornier "to Freud's Dora, who refuses the interpretation he gives her and flees." Except in Cornier's case, given her station, the nature of her crime, and her utter refusal to display signs of emotion much less repentance there was no fleeing.
One of the main arguments in this sometimes maddeningly discursive book is that we learn to cut our psychic clothes to fit this year's diagnostic style (latterly the floor models have been OCD, ADD, and PTSD) and that, as Ms. Appignanesi ruefully points out, "Life, it seems, causes madness." Her approach to her au courant subject is both psychoanalytic and feminist. What could be more intellectually chic than combining Juliet Mitchell-like gender theory with Foucaultian sound bites on mental illness as a cultural trope, a means of disempowering that which we fear in ourselves by labeling it and marginalizing it? (At times, she veers perilously close to simply parroting the French theoretician: "Society engenders alienation and shapes the symptoms of derangement.") Yet one of the more impressive aspects of Ms. Appignanesi's use of the massive amount of high-low research she has done which includes unearthing a 1758 treatise on madness and a study of private madhouses in the 18th and 19th centuries, as well as dipping into Freud's correspondence with Jung, Elizabeth Wurtzel's "Prozac Nation," and Web sites galore is that she so rarely stoops to facile summary or jargon-riddled theories.
Admittedly, the exhaustiveness of the inquiry some of Ms. Appignanesi's questions are never properly formulated, others left unanswered, and yet others a bit tired can wear on the reader. There will undoubtedly be some who, in search of an underlying thesis that pulls all the divergent threads together, will be frustrated and put down the book midway through.
The more patient reader, however, will be well rewarded for sticking with it to the end. Ultimately, "Mad, Bad, and Sad," unconventionally and steadfastly psychoanalytic, offers a complex and subtle account of the way a patriarchially confining narrative shapes and misshapes the female self. The fact that William Hazlitt, the great critic and friend of Charles Lamb, considered Mary Lamb to be "the only truly sensible woman I ever met with" is cause for either laughter or tears and great unease.
Ms. Merkin is a contributing writer to the New York Times Magazine and the author of a novel, "Enchantment," and a collection of essays, "Dreaming of Hitler."