As part of researching literary references to lived experience of psychiatric hospital I recently re-read Elaine Showalter’s The Female Malady. My research is chiefly concerned with looking at the social construct of ‘madness’ through the eyes of writers giving accounts of just how society defines sanity and insanity. We have this idea that mental illness is a scientific given, when the reality is that Psychiatry is as much a Science as Humoral Theory – originally associated with Hippocrates – could be regarded a Science.
Both Psychiatric diagnoses and medicine based on the four humours rely on subjective categorisations of an individuals temperament. And it is the context within which an individual is observed and judged that determines whether or not a person is deemed sane or insane. Yet habitually we talk about someone being clinically ’mentally ill’ as if the Science that determines insanity is a given.
Showalter gives a rigorous account of how through the medicalisation of madness in the 19th century ‘mental illness’ came to be deemed as chiefly a woman’s prognosis, primarily used as a form of social control – a way for men to keep women in their place. She gives a detailed account of how with the advent of the First World War – when so many men were returning from the Front in states of distress – that males were first associated with ‘mental illness’. Even then, the ‘illness’ was categorised as ‘shell shock’ rather than ‘hysteria’ or labels associated with the feminine:
“Built on an ideology of absolute and natural differences between women and men, English psychiatry found its categories undermined by the evidence of male war neurosis.”
The names for psychiatric diagnoses are as much in flux as the pre-determinants. According to Charles Myers an English physician who wrote the first paper on shell shock in 1915: “‘shellshock’ won out over ‘anxiety neurosis’, ‘war strain’ or ‘soldier’s heart’.” [Female Malady p.167]
The fickle world of the alienist has always been in a state of reinvention. Myers had inherited his definitions from the attitudes of Victorian psychiatrists who more clearly defined insanity as a moral issue – and, as such, saw ‘madness’ as a female malady… with female sexuality at its’ root.
Showalter writes: “The regulation of Women’s Cycles in Victorian psychiatry often seems like an effort to postpone or extirpate female sexuality. Dr Edward Tilt argued menstruation was so destructive to the female brain that it should not be hastened but rather be retarded as long as possible and he advised mothers to prevent menarche by ensuring that their teenage daughter’s remained in the nursery, took cold shower baths, avoided feather beds and novels, eliminated meat from their diets and wore drawers. Delayed menstruation he insisted was “the principal cause of the pre-eminence of English women, in vigour of constitution, soundness of judgement, and rectitude of moral principle.” On the Preservation of the Health of Women at the Critical Periods of Life. p. 31” [The Female Malady p. 75]
Showalter goes on to describe the treatments invented by male psychiatrists for their female patients: “W. Tyler Smith for example recommended injections of ice water into the rectum, the introduction of ice inside vagina and leeching of the labia and the cervix. “The suddenness with which leeches applied to this part, fill themselves,” he wrote admiringly “considerably increases the good effects of their application and for some hours after their removal there is an oozing of blood from the leech bites.”
The most extreme and nightmarish effort to manage women’s minds by regulating their bodies evolved out of beliefs expounded by the Obstetrical Society of London that masturbation was the singular cause of madness and led to Dr Isaac Baker Brown’s surgical practice of clitoridectomy as a cure for female insanity…
Brown carried out his sexual surgery in his private clinic in London for 7 years between 1859 and 1866. In the 1860s he went beyond clitoridectomy to the removal of the labia as he became more confident he operated on patients as young as 10, and even on women with eye problems. He operated on women whose madness consisted of their wish to take advantage of the New Divorce Act of 1857 and found in each case that his patient returned humbly to her husband.
In 1867 Brown was expelled from the Obstetrical Society not so much because his colleagues disagreed with his methods, but because patients had complained of being tricked and coerced into the treatment. Some had been threatened that if they refused to have surgery their condition would worsen and they would become hopelessly insane.
The decision for expulsion came after a speech by Dr Seymour Haden, secretary of the society giving a forceful if intentional description of the sexual power relationships in Victorian medicine.
We have constituted ourselves as it were the Guardians of their [women’s] interests and in many cases… the custodians of their honour. We are in fact the stronger and they the weaker. They are obliged to believe all that we tell them. They are not in a position to dispute anything we say to them, and we therefore may be said to have them at our mercy… Under these circumstances if we should depart from the strictest principles of honour, if we should cheat or victimize them in any shape or way we would be unworthy of the profession of which we are members.” Obstetrical Society Meeting, British Medical Journal 1867, p.396.
[The Female Malady p.75-p.78]
Psychiatric practices have changed enormously since those dark days of torture and meticulously argued subjugation of women, body and soul. Showalter remarks on the changes in power relations that began to emerge towards the end of the 19th century:
“At the same time that new opportunities for self-cultivation and self fulfilment in education and work were offered to women, doctors warned them that pursuit of such opportunities would lead to sickness, sterility and race suicide. They explicitly linked the epidemic of nervous disorders – anorexia nervosa, hysteria and neurasthenia – which marked the fin de siecle to women’s ambition.” [The Female Malady p.121]
Providing a detailed feminist critique of a range of novels from the mid-1800s onwards, reflecting understanding of the ‘mad’, Showalter alights on Janet Frame’s autobiographical novel Faces in the Water, citing it as one of three novels, published at the beginning of the 1960’s, which marked a new precedent in attitude: “While earlier novels did not question the idea that madness was the woman’s own fault, these novels [including Jennifer Dawson’s The HaHaHa and Sylvia Plath’s The Bell Jar] place the blame for women’s schizophrenic breakdowns on the limited and oppressive roles offered to women in modern society, and deal very specifically with institutionalisation and shock treatment as metaphors for the social control of women. [The Female Malady p.213]
The parallel between schizophrenia as a social construct and female identity runs through Faces in the Water. It is intrinsic to Frame’s poetic evocation of the rites of passage endured by a teenager at the hands of psychiatry, located in a mental hospital in Christchurch, New Zealand in the 1950’s.
Electric Shock Treatment is at its height, deemed the new wonder cure at the forefront of what Frame jokingly calls ‘The New Attitude’. Frame knows she is caught in a spiders web of cruel judgements and desperately at every twist and turn seeks resolution and an attempt to hold on to her sanity, in the face of punishment dressed up as cure. Written with a razor-sharp sense of irony Faces in the Water conveys the atmosphere, the smell of urine and defeat, the taste and feel of the 1950s asylum. Her Cliffhaven and Treecroft could be located in the UK or the US. With the advent of Chlorpromazine – the first of the chemical interventions introduced globally in 1951, Electro Convulsive Therapy and leucotomy – there was a new optimism about the treatment of the ‘mad’.
The Victorian asylums were being modernised bringing in clean showcase wards that contrasted distinctly with the long stay ward and the secure unit. My memories of Banstead, Belmont and Netherne where I volunteered briefly were of oppressive institutions dedicated to disabling people ‘for their own good’ – another theme repeated in Frame’s recollections. Decisions were made about peoples’ lives – transferred from ward to ward and from hospital to hospital, without any sense of responsibility for letting the person know what the consequences of a transfer was likely to be.
It seems everything was done to ensure any transition was done to produce as much anxiety as possible. Frame recalls her anxieties over threats of ECT and leucotomy… she recalls promises of release and steps towards release from hospital that disappeared into thin air. In my own experience I was taken alone into my bedroom by my mum’s psychiatrist aged ten and was guilt-tripped into telling him a long list of things she had been saying and to whom, so that he could get his ‘proof’ of her insanity. I was taken in to see her after she’d been given large doses of ECT and she couldn’t remember who her children were. The impact of what I’d done felt like falling through the centre of the earth. And yet I was meant to believe that her memory-loss was the result of her ‘mental illness’ not systematic torture.
The history of Psychiatry reveals a history of reinvention with new labels, and new freedoms at every turn of the wheel. It is only with hindsight that we look back at these developments as new forms of oppression. Frame recalls this in Faces in the Water through bitter experience.
We are currently in the throes of yet another ‘new attitude’ towards mental distress, but we’ve heard that one before…