Women on the verge

<strong>Mad, Bad and Sad: a History of Women and the Mind Doctors from 1800 to the Present</strong>

One evening, as they were preparing for dinner, a young woman seized a knife and stabbed her mother to death. She had suffered, said her brother, the essayist Charles Lamb, "a fit of insanity". It was 1796 and Mary Lamb was never brought to trial: she was admitted to an asylum in Islington during her periods of lunacy; otherwise she was looked after in the home she shared with her beloved Charles. She had committed murder and been designated mad, and yet was able to live a free life. It was an extraordinary verdict for an age that sent people to the gallows for stealing a handkerchief, and it marked, Lisa Appignanesi argues in this colossus of a book, "a key transitional moment in the understanding of madness and the institutions and legislation which surround it".

Women and madness go together like mums and Mothers Pride, and it is largely through the study of women's madness, badness and sadness that the treatment of mental illness has evolved over the past 200 years. Mad, Bad and Sad, which is about the ways in which "mind doctors", from "alienists" and psychoanalysts to neuroscientists and psychopharmacologists, have understood extreme emotional states in women, begins with the case of Mary Lamb. It ends, after an often perilous but always well-navigated journey through storms of "frenzies, possessions, manias, melancholy, nerves, delusions, aberrant acts, dramatic tics, passionate loves and hates, sex, visual and auditory hallucinations, fears, phobias, fantasies, disturbances of sleep, dissociations, communication with spirits and imaginary friends, addiction, self-harm, self-starvation, depression . . . monomania, melancholia, hysteria, dementia praecox, schizophrenia, anorexia . . . multiple personality disorder, attention deficit disorder [and] obsessive compulsive disorder", with a discussion of cognitive behavioural therapy. CBT, as it is known, is the treatment most doctors now recommend for the mad, bad and sad because of its quick-fix approach and box-ticking efficiency. It suits perfectly the current climate of league tables and spread charts.

Appignanesi's argument is that the expression and interpretation of madness are culturally specific, changing with each generation. Today middle-class girls are more likely to suffer from anorexia nervosa than attacks of the vapours. Anorexics, as Appignanesi puts it, are "the suicide bombers inside the bourgeois family. Their refusal of appetite and consumption mark them out as the perfect anti-capitalists." The century that began with the birth of psychoanalysis ended with the age of Oprah: Sigmund Freud's case studies have been replaced with victim autobiographies written by "survivors" of incest or abuse. Appignanesi suggests that the present definition of a woman is to be a "survivor" of some variety of trauma; women's lives have become therapeutic tales.

There is some wonderful writing here and plenty of sharp insights, which make the volume and weight of the study easier to digest. Historical data and careful analysis are accompanied by gripping accounts of the addictions of Zelda Fitzgerald and Marilyn Monroe, the depressions of Virginia Woolf and Sylvia Plath, the eating disorders of Jane Fonda and the sexual abuse of Roseanne Barr, as well as many other curious cases, such as that of the Papin sisters, French servants who pulled out the eyes of their mistress and her sister and murdered both women, and Henriette Cornier, who cut off the head of a neighbour's baby for no apparent reason.

Some of the women are more heroic in their suffering than others, but it is the mind doctors themselves who emerge as the heroes - and sometimes heroines - of the story. This is a pleasant surprise. The tale of female madness as it is usually told is one of medical insensitivity and entrenched misogyny, but for every dreary doctor such as Charles Fayette Taylor, who claimed that education is the reason women go mad, there is a compassionate Philippe Pinel, who during the French Revolution famously ordered that inmates of the Paris madhouses be liberated from their chains. He then set up the study of madness as a medical science at the Salpêtrière hospital.

Freud famously asked the question, "What do women want?" Lisa Appignanesi might answer that she wants to know everything there is to know about women. If there is a problem with Mad, Bad and Sad, it is that it wants too much, is too ambitious and asks too many questions of its own. In her exploration of "the dark continent" (another of Freud's phrases) of femininity and madness, Appignanesi goes further than any of her precursors - such as Elaine Showalter in The Female Malady - and her up-to-the-minute analysis of the rules and roles of women's mental health makes earlier studies seem dated. Mad, Bad and Sad is, Appignanesi says, the book she has been writing all her life. It is also, in many ways, the book we have been waiting for.