Mad, Bad and Sad


Lisa Appignanesi

Reviewed by Mira de Vries

Does a novelist have something new to add to the history of psychiatry? It is certainly an eye-opener that, according to Appignanesi, the term "depression" was introduced not by a psychiatrist but by the novelist George Eliot in her last publication, Daniel Deronda.

Appignanesi does not mention why she focuses on women in psychiatry. Perhaps it is because in some though not all sectors of psychiatry women are disproportionately present?

Early psychiatrists associated perceived diseases of the mind with malfunction of the internal female reproductive organs, hence the word "hysteria." Depression was originally the disease of middle class housewives condemned to spending their days with nothing more fulfilling to do than needlepoint. Borderline is the disease of women who were sexually abused in childhood. There are the hormonal swings of menstruation, pregnancy, and childbirth. Even some psycho-drugs target women, such as Valium, famously called "mother's little helper" by the Rolling Stones. Later when women themselves entered the fields of psychoanalysis and psychotherapy, research found they were better at it than men, thus contends Appignanesi.

A large part of the book is devoted to famous "patients" such as Mary Lamb, Anna O., Virginia Woolf, and Kay Redfield Jamison, to name but a few.

The book is well researched as evidenced by the references provided in an appendix. As she avoids cluttering the main body of the text with footnotes or end-notes, it is sometimes difficult to distinguish her own viewpoints from her summery of other people's viewpoints.

The last chapter before the epilogue is a discussion about psychiatric drugs, which, she illustrates, were always a part of psychiatry, from the now abandoned chloral hydrate on. Curiously, she chooses this chapter to discuss the DSM which has stamped its pseudo-authority on so much of psychiatry the past half century.

With nearly 600 pages of small type one might expect this history to be thorough, yet there is no mention at all anywhere in the book of the T-4 program. Imagine a book subtitled "A History of the World and Europeans from 1800 to the Present" not containing any mention of WWII. True, the T-4 program did not target specifically women, but neither did Teen Screen. She does mention degenerationist theories in connection with Kraepelin and Maudsley but not the mass murder of between 80,000 and 400,000 (depending on who counts and how) perceived mad people to which those theories led.

Another subject about which she says little, is deprivation of liberty. "He saw me for only a minute or two ... and he sentences me on the strength of Doctor Calmeil, who sentenced me on the strength of a doctor who had never seen me at all, who took me away as a favor to somebody else, on the strength of what they had told him." This quote is from Hersilie Rouy in 1854. No mention is made of coercion in our modern times.

Although Appignanesi recognizes psychiatry's inefficacy and records different forms of psychiatric abuse (medical experimentation, social control, etc.) she doesn't condemn psychiatry outright.

All in all it is an interesting book, but devoid of new insights, including regarding the role of women in psychiatry.

Copyright MeTZelf