Kylie Valentine

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Psychoanalysis, Psychiatry and Modernist Literature

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Psychoanalysis, Psychiatry and Modernist Literature

10.1057/9781403919366preview - Psychoanalysis, Psychiatry and Modernist Literature, Kylie Valentine

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Kylie Valentine

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© Kylie Valentine 2003 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission.

Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted her right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2003 by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York, N.Y. 10010 Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin’s Press, LLC and of Palgrave Macmillan Ltd. Macmillan® is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries. ISBN 1–4039–0061–2 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Valentine, Kylie, 1970– Psychoanalysis, psychiatry and modernist literature / Kylie Valentine. p. cm. Revision of the author’s thesis (Ph.D.)—University of Sydney. Includes bibliographical references and index. ISBN 1–4039–0061–2 1. English literature—20th century—History and criticism. 2. Modernism (Literature)—Great Britain. 3. Psychoanalysis and literature—Great Britain—History—20th century. 4. Literature— Psychological aspects. 5. Literature—Psychology. 6. Psychiatry in literature. 7. Psychology in literature. I. Title. PR478.M6 V35 2003 820.9′112—dc21 2002035535 10 12

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No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP.

Contents vii

Acknowledgements

1

1 Modernism

31

2 Psychiatry

63

3 Madness

91

4 Virginia Woolf

113

5 Hayford Hall

149

6 Beyond the Glass and The Shutter of Snow

171

Conclusion

199

Notes

203

Index

223

v

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Introduction

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This book is a revision of my PhD thesis, completed in the Department of Gender Studies at the University of Sydney. My thanks to examiners Rita Felski, Elizabeth Young-Bruehl and Moira Gatens, and to my supervisors Denise Russell and Melissa Hardie. To Denise especially I owe the best of this book, and the thesis that preceded it. Thanks also to Alison Bashford, Gail Mason and Elspeth Probyn in Gender Studies and Kate Lilley in the Department of English. Elizabeth Wilson’s encouragement has been generous, thoughtful, and greatly needed. Postdoctoral research was supported by a travel grant from the Wellcome Trust. The assistance of staff at the Wellcome Institute for the History of Medicine and at the Special Collections Department, University of Delaware Library is gratefully acknowledged. Unofficial, occasionally haphazard postgraduate reading groups listened to drafts of this material well beyond the point of it being any fun for them. I am grateful to Louise Gyler, Megan Jones, Natalya Lusty and Kerry Sanders. In a book about Bloomsbury and Freud it feels right to acknowledge the following people, some of whom care little for either. They each have a talent for friendship, and they make a difference to the ways I think about, and practise, love and work. Gilly Dempsey, Monica Dux, Suzanne Fraser, Gina Laurie, Celia Roberts and Noni Rummery helped me through the paranoid impoverishment that is postgraduate study. Outside university they continue to provide support, and so do my friends Diane Aw Yong, Karen Burke, Luke Chess, Martha Chess-Phelps, Buzz Coleman, Jam Dickson, Tim Fabry, Robin Flynn, Adam Goc, Elisabeth van der Wetering and staff of the FlexSIS project at the University of Sydney, Nancy Griffiths, Nathan Hollier, Kurt Iveson, John Jacobs, Hugh Kennedy, Lachlan and Winona Kennedy, Adrian Mackenzie, Trisha Pender, Trudy Phelps, Nikki Potent, Kevin, Joan and Simone Scalmer, Hannah Sharp, Jon Smart, Eris Smyth, Ian Syson, Harry and Dan Syson, Patrick Tanoi, Dave Tomley, Damian Totman; and my family Bruce, Roselyn, Shelley and Pip Valentine. I am especially grateful for Jon Smart’s hospitality and heart. Three of the people whose friendship means most have also made some of vii

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Acknowledgements

the most important material contributions to this book. Pat Flynn has negotiated and organised me into the kind of paid work that leaves room for writing. Judith Smart and Rick Short shared their house and brought London to life. They will recognise tidied-up versions of late night conversations, and I am more grateful for their patience and faith than I can say. My greatest debt is to Sean Scalmer. He read every word at least twice, provided the domestic and emotional space I needed, encouraged me unceasingly and filled my life with love. Without him this book would not have been written, and it is for him.

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viii Acknowledgements

In January 1939 Virginia and Leonard Woolf visited Sigmund Freud at his house at 20 Maresfield Gardens in north London. The Woolfs’ Hogarth Press had been publishing Freud and other psychoanalytic work since 1924, along with pamphlets on imperialism and economics, Fabian didactics, a swag of Russians and more typical Bloomsbury fare. Everyone who knows of the meeting also knows that Freud gave Virginia Woolf a narcissus, a presentation that inspires many, but not me, to pursue arguments about Freud’s insights into Woolf’s personality. The meeting was genial if awkward. Freud had had little to do with Hogarth’s publishing of the International Psychoanalytic Library, but was grateful to the Woolfs, occasional disagreements about book titles notwithstanding. For her part, Virginia Woolf had changed her mind about the pernicious effects of psychoanalysis, to the extent that in 1936 she had assisted in collecting the signatures of 350 writers and artists which were presented to Freud as an eightieth birthday gift. She records the event in her diary and in characteristically caustic fashion: [Freud] was sitting in a great library with little statues at a large scrupulously tidy shiny table. We like patients on chairs. A screwed up shrunk very old man: with a monkeys [sic] light eyes, paralysed spasmodic movements, inarticulate: but alert. On Hitler. Generation before the poison will be worked out. About his books. Fame? I was infamous rather than famous . . . Difficult talk. An interview. Daughter and Martin helped. Immense potential, I mean an old fire now flickering.1 1

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Introduction

Freud sent Leonard Woolf a letter three days later indicating his pleasure at meeting them and insisting that his English was terrible, as he always did, in courtly and perfectly competent English: ‘Handicapped in the use of your language I think I could not give full expression to my satisfaction at having met you and your lady.’2 The house at Maresfield Gardens is now a museum, with most of Freud’s collection of ‘little statues’, and his couch, displayed. Freud lived in the house for only fifteen months, although the museum dedicates at least as much curatorial energy to him as it does to his daughter Anna, who lived and worked in the neighbourhood for over forty years. There is also a Freud museum in Vienna, and the existence of both testify to the flight of Freud’s family from a city to which they could no longer belong. Home movies of the time are introduced by Anna Freud, who apologises for their quality, and show Freud as looking likeable and self-conscious whenever the camera is turned on him. His eyes, so far as it’s possible to tell, don’t look much like those of a monkey. Woolf’s diary has been read as published, public literature and as testament to madness by critics both sympathetic and hostile to her work. I have no intention of undertaking either kind of reading myself, although the anti-Semitism that dots much of her private correspondence, and her relationship with Leonard, may have influenced her assessment of Freud. That Woolf never underwent analysis herself, despite experiencing enough kinds of psychiatric treatment to fill a book, 3 has been the subject of both regret and relief. Notable in both attitudes is the assumption that psychoanalysis would have had some kind of effect on Woolf, and on her bouts of mental distress, despite the widely acknowledged failure of psychoanalysis to have much of an impact on the kind of severe distress Woolf suffered. Leonard and Virginia have strikingly similar recollections of the visit, and it is Leonard’s autobiography that makes clear that the fame or infamy discussed belongs to Freud, not to Virginia. 4 This visit would be the one occasion on which Freud and the Woolfs would meet, and whatever the three of them thought of each other beyond these formal courtesies must remain speculative. Eight months after the meeting with the Woolfs, Freud was dead. He escaped the concentration camps as two of his sisters did not, to die in pain but at peace in England, a country he had always admired. The International Journal of Psycho-Analysis issued after his death in

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2 Psychoanalysis, Psychiatry and Modernist Literature

1939 is unrestrained in its elegies, predicting, rightly, that psychoanalysis would go on but never be the same. With typical narrowness of vision, the start of the second World War goes all but unacknowledged in the journal.5 Two years after her meeting with Freud, Virginia Woolf was also dead. Quentin Bell’s biography reports that the ‘voices of insanity spoke to her [and] she took the only remedy that remained, the cure of death’. 6 Her suicide notes to Leonard contain despair at her inability to write and urge him to continue working. Freud was eighty-three, Woolf fifty-nine. I begin then with an ending. Perry Anderson argues that the Second World War ‘cut off the vitality of modernism’. 7 The meeting between Freud and Woolf instantiates the convergence of my central concerns: modernism, psychoanalysis, psychiatry, madness. The Second World War marks off the modernist era, and ends other eras also. Psychoanalysis, which had been in contest with physicalist psychiatry since the First World War, would be defeated by the work of men like William Walters Sargant, who inaugurated the English era of electroconvulsive therapy and psychosurgery in the late 1930s and early 1940s. Sargant was opposed to psychoanalysis, and most ‘psychological’ theories of mental distress, arguing in 1936; ‘We forget that the brain is a complicated chemical factory, and thought the product of chemical and electrical processes.’ 8 Of course, the ascendancy of psychoanalysis as a critical tool of the academic humanities would not begin in earnest until the 1950s: I intend to explore the institutional locations of psychoanalysis, not to write yet another version of its death certificate. Psychiatry’s interwar institutional and discursive struggles, which include but are not exhausted by its encounters with psychoanalysis, reveal also a conversation with modernism, shedding light on the forces that produced the biological model dominating psychiatry today. The history of psychiatry and psychoanalysis that I will pursue discloses the volatile and sometimes incoherent models of madness that the two interconnected fields produced. Their versions of madness are not the only ones, however, and the conflict between these versions and those of others, such as modernist writers and artists, and those suffering mental distress, will also be explored. This is a history of modernism, psychoanalysis, psychiatry and madness that argues that each one of them needs to be understood in relation to the others. The meeting between Freud and Woolf can

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Introduction 3

be read as a moment when the connectedness of the four is made visible: the ‘founder’ of psychoanalysis, trained in medicine, greatly interested in literature and increasingly recognised as a writer of literature, encounters one of the central figures of British modernism, a writer and publisher of literature who stands at the centre of one of the most important intellectual networks of the time, who was subject to psychiatric scrutiny and directives, and who is often identified as mad. Woolf’s putative madness has been scrutinised and questioned by feminist critics, and their work informs my own arguments about madness. The argument that the processes by which modern madness was made were those of interdisciplinary contest and struggle, at the sites of texts, institutions and individual experiences, is central to this work. This modern madness, as we shall see, is not one single entity. Rather, it is itself a series of processes and productions that circulate between clinical texts, cultural discourses and embodied experience. I am also concerned with documenting the processes by which the discipline of psychiatry came to assume its contemporary form: an established medical speciality with a domain that encompasses the delusion and derangement long recognised as madness, but also other behaviours and ideas only recently brought into psychiatric purview. I aim to analyse the role of psychoanalysis in forming modern psychiatry, without neglecting the impact of psychoanalysis on other, non-medical, histories. Too many histories of psychoanalysis, I will argue, construct psychoanalysis as a primarily non-medical field which, for good or ill, was appropriated by medicine. This approach does not stand up to scrutiny – the history of psychiatry and psychoanalysis is one of interaction and mutual influence. Psychiatry may look on psychoanalysis these days with something like professional contempt, and on the historical importance of psychoanalysis to psychiatry with something like professional embarrassment; while psychoanalysis may want to say little about its institutional psychiatric history. Nevertheless, as we need to understand psychiatry’s history in order to make sense of its current status, so the importance of psychoanalysis to the humanities warrants a recognition of its institutional history. Finally, the broad, rich and ill-defined field of modernism is a productive site to locate such a project. Modernism is a field that makes available both rich textual criticism and sustained intellectual histories,

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4 Psychoanalysis, Psychiatry and Modernist Literature

and so presents an opportunity to pursue an investigation that sacrifices neither the complexity of texts nor the significance of institutions. Modernism is historically coincident with the emergence of psychoanalysis; a moment when the troubled profession of psychiatry was finally consolidated; when significant and historically unprecedented creative interest was invested in madness; and a large number of artists and intellectuals were recognised as mad. This project is in part a synthetic one, and brings together literature from a wide variety of theoretical and disciplinary fields – fields which seem to resist speaking to each other. Modernist scholarship is varied, complex and interdisciplinary, but pays little attention to psychiatry, although a great deal to psychoanalysis. Historiography of psychiatry makes use of literary texts often enough, but often enough in narrow and uninteresting ways. Analysis of madness, whether connected with historiography of psychiatry or not, has a tendency to privilege clinical understandings of it, to the neglect of experiential and literary accounts. Histories of psychoanalysis are often unhelpfully partisan and increasingly emphasise psychoanalysis as a discourse concerned with sex, to the neglect of the place of psychoanalysis in psychiatry, and, indeed, the impact of psychoanalysis on psychiatric understandings of sex. These lacunae represent the points at which this work will intervene.

Historicising psychiatry: disciplining madness Study of interwar English psychiatry reveals fragmentation, struggle and conflict. Study of any profession at any time reveals all of these characteristics to a greater or lesser extent, of course, but psychiatry has been subject to more than most. The opposing tendencies of most professions have not been subject to the dramatic account found in Pat Barker’s 1991 novel Regeneration. A sympathetic portrait of doctors treating and soldiers suffering war neuroses (‘shell shock’) at Craiglockhart military hospital in Edinburgh during and after World War I, the novel’s central figure is anthropologist and psychologist W.H.R. Rivers. Barker’s Rivers is a humane and ethical man with sense enough to be impressed by Siegfried Sassoon who adopts, as Rivers actually did, some of the main tenets of psychoanalysis and rejects others. The narrative rendering of trauma is crucial, for instance, but dreams probably have nothing to do with wish fulfilment.

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Introduction 5

Towards the novel’s close, Rivers visits the National Hospital in London to witness a very different, physicalist treatment of war neuroses by Lewis Yealland. Yealland treats the symptoms and causes of his patients’ ailments as without content and without interest, and effectively tortures cures out of his patients with the application of electric shocks. What Yealland says to a patient struck mute is almost as horrifying to Rivers as his attaching electrodes to the patient’s tongue: ‘You must speak, but I shall not listen to anything you have to say.’ 9 Barker’s novel, like Foucault’s studies of psychiatry, have become well known to scholars and readers uninterested in institutional histories of psychiatry, to the understandable annoyance of the authors of such histories. Sometimes psychiatrists themselves, these writers focus on the development of psychiatry as a contemporary medical profession and examine the institutions, practices and theories that go to constitute this: schools and training, diagnostic categories, professional bodies and associations, management of hospitals and clinics, therapeutic models and etiological frameworks. The picture of psychiatry revealed by those less dramatic and Manichaean histories is of a medical speciality caught between the enormous asylums and expanding legislation of the nineteenth century and the increasingly complex medical techniques of the twentieth. The struggles and anachronisms of psychiatry until the 1920s are relatively easy to detect. Specialist training in the mental sciences was brief and unpopular. Leading figures in the field, such as Henry Maudsley, fought to register insanity as a medical term, and institutions for the insane as hospitals. ‘Lunacy’ would not be superseded as the official term for madness until 1930, and drugs would not become dominant in treatment until after World War II. The nineteenth century saw an exponential growth in the numbers of people subject to psychiatric scrutiny and management. In 1827, 1046 people were resident in county asylums, by 1930 this had grown to 140,000. 10 More and more people became psychiatric patients, but the numbers of those ‘cured’ remained low. Therapeutic regimes remained much less successful than in most other areas of medicine, and medical ‘breakthroughs’ of uncertain effect. For example, the discovery that certain ailments did indeed, as had been claimed by some nineteenth-century doctors, have a basis in the nerves was an important step in the changing understanding of madness from

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6 Psychoanalysis, Psychiatry and Modernist Literature

a disorder of reason to a disorder of the physical body. This discovery was concomitant with the development of English neurology as a distinct speciality, and with the transfer of ‘ownership’ of these ailments to that distinct speciality.11 ‘Nervous’ patients, whose recovery rates were unpredictable and who suffered symptoms that could not be identified as originating in the nerves or anywhere else, remained within the purview of psychiatry. As increasing types of mental disorders were identified and increasing numbers of patients suffered from them – hysterical complaints increasingly associated with women, a significant proportion of soldiers disabled by the war neuroses – the demands on doctors working in the mental sciences became increasingly complex and fraught. Yet if the challenges and difficulties of psychiatry in the first decades of the twentieth century are evident, so too are developments in the field and the incipient characteristics of a contemporary medical speciality. A number of psychiatric theories and approaches emerging in France and Germany seemed to give cause for therapeutic optimism. New ways of viewing and understanding populations were forming that seemed relevant to the challenges of psychiatry – a relevance that in turn bolstered the confidence of those claiming that psychiatry deserved a role larger than simply keeping the deranged from intruding into civil society. While it was true in the interwar years that the mental sciences were less prestigious than other branches of medicine, it was also true that the status of psychiatry as a medical profession commensurate with other medical specialities had been effectively established. A number of journals and professional organisations were active, and a number of debates around the direction of the profession were in full swing. The most basic of these debates was not new to the period, although the terminology and theoretical frameworks were. Mark Micale and Roy Porter argue that psychiatry has always been made up in part of competing schools and that since the eighteenth century it has been convulsed by a deep, dichotomous debate between the somatic and mentalist philosophies of mind.12 This is an important argument: that psychiatry’s history is characterised by struggles between psychiatry and other fields, and also by struggles between different schools within psychiatry. However, the historical novelty of psychiatry as a field, especially in Britain, needs to be foregrounded here. While contests between somatic (crudely, madness is located in

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Introduction 7

the brain, and the brain is an organ like any other: a disease of the body) and mentalist (madness is the result of psychological problems, or a combination of psychological and physical problems: a disease of the mind) have obviously been important to the history of psychiatry, these contests also pre-date psychiatry. In Britain and elsewhere psychiatry was established as a discipline only in the nineteenth century, and its development through that century was precarious and contested. Before that time, the somatic–mentalist debate was carried out elsewhere, in the domains of philosophy and literature. John Locke’s 1690 Essay Concerning Human Understanding is a contribution to the ‘mentalist’ tradition of interpreting madness, for instance, while Kant’s 1764 ‘Essays on the Maladies of the Mind’ argues for somatic explanations. Debates about the causes and significance of madness have never been of interest only to medical practitioners. By the interwar years, psychoanalysis was probably the most significant mentalist school. The British Psycho-Analytic Association was founded in 1913 and the London-based International Journal of Psycho-Analysis published from 1920. Freud’s work was translated into English and published in Britain at an increasing rate in the ten years before the Journal started, which featured in its first volume a ‘Bibliography of Psycho-Analytical Literature in English’, running to 346 monographs and articles. As I will argue in Chapter 2, psychoanalysis was regarded with scorn and disapproval by many within and outside the medical professions, but it was also an influential force in the development of modern psychiatry. Other chapters will be attentive to the non-clinical, non-psychiatric theories and practices of psychoanalysis. It is not possible to do justice to the complexity of the psychoanalytic field by referring only to theories of mental distress and personality. Neither is it possible to make an assessment of psychoanalysis without reference to its impact on psychiatry: whatever else psychoanalysis has done, it has added to a long tradition of complex philosophical systems numbering madness among their concerns. I will be representing much of the terrain of English psychiatry during the period under study as polarised over the broad approaches of somatic and mentalist. This is of course a simplification: very few of even the most ardent somaticist psychiatrists rejected altogether any psychological factors; most psychoanalysts, including Freud, noted the primacy of physical processes in certain kinds of

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8 Psychoanalysis, Psychiatry and Modernist Literature

mental distress. But during this period the struggle for dominance between somaticist and mentalist approaches was important to the formation of modern psychiatry, and psychoanalysis played an important role in this struggle. I will also be making use of a similarly simplified, and similarly productive, struggle over the writing of psychiatry’s history. Micale and Porter write about a battle over psychiatric historiography that parallels division within the field. In a presumably deliberate echoing of Foucault’s Great Confinement, they argue that a Great Revision can be detected from the 1950s, when relatively optimistic accounts were challenged by sociological and feminist interventions. And if these interventions were concerned with the structure of modern professions and societies, and the ascendancy of science as a dominant ideology, they were often equally concerned with the history of psychiatry from the other side – with madness, those identified as mad, and the precarious connections and separations between madness and sanity. It would be possible to write a history of psychiatry that refers only glancingly to the deep and powerful place of madness within cultural artefacts and imagination, a place that pre-exists the quite young discipline of psychiatry and continues to hold even in our era, when the genetic foundations of schizophrenia and depression are routinely proclaimed. This history has been written, more than once. It is not my intention to contribute another of these. As those both most and least sympathetic to psychiatry have often pointed out, the proximity of psychiatrists to the mad contributed to the lack of medical recognition of the early profession. Psychiatry has never been simply one medical branch among many, precisely because of the meanings invested in the sufferings of its patients. It would also be possible to write a history of psychiatry that treats the changing numbers and kinds of people subject to psychiatric scrutiny as evidence of improvements in diagnosis or therapy over time. Again, I don’t intend to write such a history. This work is based on the critical assumption that symptoms of mental distress reflect and inflect the social and political environments in which they are found. I am indebted to a diverse scholarship that unpacks the sexual and racial ideology responsible for many historical and contemporary psychiatric practices, and the ways in which psychic distress may be interpreted and understood. Psychiatry and mental distress are not unique in this. I am not interested in arguing that oncology, say, or an increase

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Introduction 9

in the diagnosis of arthritis, is culturally or politically empty. But psychiatry and madness are especially productive sites for analysis of the connections between scientific and artistic understandings of personality and behaviour, and of the ways in which social and political norms are lived at an embodied, individual level. They are especially productive sites for reading, in other words, the narratives circulating across fields often understood as disconnected from each other. Such an analysis, and such a reading, will inevitably be formed at sites of contention and disagreement. Inevitably, arguments about the practices of psychiatry and the ideologies behind those practices become arguments as well about what madness is and what it means. There are few agreed truths that form the foundation of such accounts; it is not possible to begin from such truths. In Britain during the interwar years there was no consensus on what psychiatrists, let alone the mad, should be called. It is nonetheless possible to detect some trends in the histories of madness and psychiatry, and to note that an analytic focus on one has often meant neglect or distortion of the other. To schematise, histories of psychiatry tend to neglect the ideological and political history of madness. Analysis of the ideological and political histories of madness, on the other hand, neglect the fractious, fractured history of psychiatry. Sociological histories of English psychiatry, such as Andrew Scull’s Museums of Madness, emphasise the importance of economic and political forces in the formation of psychiatry, but often ignore the ways in which madness was formed during this time. Scull argues that the increase in numbers of the incarcerated insane during the nineteenth century can be explained in terms of professional expansion: The general relationship between the construction of asylums and the increase in insanity again suggests that on the whole it was the existence and expansion of the asylum system which created the increased demand for its own services, rather than the other way around.13 During the nineteenth century, he writes, madness changed from being something well known but relatively rare to something that, because of the changing nature of family relations under capitalism and the growth in asylums, was defined as pretty much whatever

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10 Psychoanalysis, Psychiatry and Modernist Literature

people were unprepared to tolerate in their homes. His focus, though, is on the reasons why ‘an institutional approach to madness emerged in the first place’, 14 rather than on the volatile nature of madness. He has little interest in this, remarking that ‘Madness seems to attract more than its share of myths’, an argument which does little to advance our understanding of the importance of madness to myth-making, its role in representing alterity throughout history. Other histories of psychiatry that take account of the changing cultural investments in madness also treat these changes as of incidental, rather than crucial, importance. 15 In contrast, feminist investigations into the history of madness emphasise the metaphorical and symbolic impact of madness, but tend to neglect the professional and institutional history of psychiatry. Textual analysis that mobilises madness as a metaphor for rebellion or oppression often erases changes over time in the experience and treatment of madness, while analysis of the ideological productions of madness can be institutionally ahistorical, seeing continuity between witch-hunts in the thirteenth century and ECT in the twentieth. 16 However, there are ways to bring together sociological, nonfeminist psychiatric historiography and feminist investigations into the nature of madness. Histories of psychiatry have much to offer feminist analysis of the changing relationships between women and psychiatry, and the changing meanings of the madness produced by psychiatry. Feminist analysis of the long-standing, but historically volatile, meanings given madness outside psychiatry sheds light on the institutional history of psychiatry. In order for this synthesis to be possible, though, we need to question the assumed point of disagreement between feminist and non-feminist accounts: that of arithmetic. Feminist investigation into the relationship between women, psychiatry and madness has been misunderstood as based solely on the argument that women are affected by mental distress and psychiatry in far greater numbers than men. This misreading can then lead to an imagined corrective: if it can be established that men and women were affected in equal numbers then no feminist critique can stand. Even some writers who argue that feminist critiques of psychiatry are needed simplify the basis of existing critiques. Nancy Tomes, for example, disputes the argument ‘that the mental hospital bore some unique relationship, as symbol or actual punishment, to nineteenth-century women’. Instead, she argues, ‘although mental illness

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Introduction 11

manifested itself in somewhat different ways, mental illness afflicted roughly equal numbers of men and women’. 17 Tomes is referring here to two important arguments of feminist writing on madness and psychiatry. The first is the argument that women are affected in greater numbers by psychiatry than men. The second is that this disproportionate effect is not accidental or apolitically epidemiological: that women are subject to psychiatric scrutiny because of the way both women and madness are produced in psychiatric taxonomies. Her own argument is instead that women and men were more or less equally affected by the changing therapeutic and institutional regimes of the nineteenth century, and that these regimes emerged from the changing nature of capitalism during that time. However, Tomes is also being disingenuous when she argues that ‘mental illness afflicted roughly equal numbers of men and women’, implying as this does that feminist writing on the subject argues simply that women experience ‘mental illness’ in greater numbers than men. In fact, most feminist writing on this subject makes a distinction between psychiatric scrutiny and mental distress, and disputes the clinical interpretation of mental distress as mental illness. Feminist work on madness and psychiatry does more than argue that women experience mental distress in greater numbers than men. It also argues that clinical frameworks of mental health are sexed and that women have little chance within these frameworks of ever being seen as mentally healthy, that the mental distress experienced by women is interpretable and comprehensible outside the paradigm of illness, and that psychiatric regimes not only mirror gender roles and patriarchal relations, but actually reproduce them. Tomes concludes that the argument between feminist and nonfeminist critical histories of psychiatry can be resolved through an investigation of psychiatry’s history that is attentive to the gendered construction of science and professions as well as to the gendered construction of madness. 18 This is a fair point, but I think there are other ways in which the non-feminist historiography of psychiatry and madness can be linked with feminist writing on madness and psychiatry. Most critical histories of psychiatry and madness share a number of important arguments, the most important of which is that psychiatry does more than simply interpret a pre-existing ‘madness’, but actually produces madness. This clinical madness is historically volatile and contested, connects with the experience of

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12 Psychoanalysis, Psychiatry and Modernist Literature

individuals in limited ways, and is parasitic on other productions of madness, such as the artistic and philosophical. This does not mean it is somehow unreal. On the contrary, clinical constructions of madness dominate other types, such as the experiential, and have done so for some time: this is probably the most important effect of the establishment of psychiatry as a medical profession. Madness is understood by most people, not just psychiatrists, as mental illness, an understanding that testifies to the hegemonic power of clinical productions of madness. Such hegemony was attained not only through the construction of new interpretative frameworks that replaced older ones, but also through the production of entirely new kinds of madness. Throughout the late nineteenth century, evolution and attendant theories of degeneration became influential as a framework for understanding both individuals and populations. This influence can be readily detected in changing models of etiology, and in the increase in the kinds of people subject to psychiatric scrutiny. No longer simply the deranged and delusional, populations of interest to psychiatry now included those that threatened the march of progress: those in slums and those from poor eugenic stock who insisted on reproducing. 19 Also included were those who weren’t mad yet but could be in the future: those with ‘mild’ emotional and behavioural disturbance and those who had previously been recognised as odd but not crazy. Nikolas Rose has argued that twentieth-century psychiatry is a powerful discipline not only because of its control over damaged individuals but because of the proliferation of the sites in which psychiatry operates. It is not possible to understand psychiatry through focusing only on the interventions made into the lives of individuals, it is necessary to examine the extent to which populations are understood and managed within psychiatric frameworks. 20 In other words, to argue that most people locked up in the nineteenth century were ‘actually’ sane, or that most people under psychiatric scrutiny shouldn’t be, may be strategically useful but will also be limited. Institutions and discourses have material effects on social and political practices, but also on the ways in which individuals experience the world and themselves. Institutions and discourses, to invoke what has become a cliché, do more than describe the world; they make it.

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Introduction 13

14 Psychoanalysis, Psychiatry and Modernist Literature

The emphasis of feminist works on psychiatric productions of madness has been on the sexed nature of this production. Beyond an investigation of the formation of institutions, feminist histories also examine the ideological uses and ideological flexibility of madness. While a number of these works also argue that women are numerically over-represented in terms of psychiatric diagnosis, this kind of argument is never the extent of their analysis. The emphasis of feminist works on the sexed constitution of madness is an expansion of the analytic power of the field of psychiatric historiography, but they also have their problems. Tomes argues that these problems are ‘misconceptions and exaggerations’ of the numbers of women and men affected by psychiatry,21 but I want to argue that they are something different – an eliding of different types of madness. Feminist writing on madness and psychiatry emerged early in second-wave feminism, and, depending on where you place de Beauvoir, arguably pre-dates it. Critiques of psychology, psychiatry, psychoanalysis, or all three, can be found in some of the most popular and influential feminist texts, including de Beauvoir’s The Second Sex, Friedan’s The Feminine Mystique, Millett’s Sexual Politics and Greer’s The Female Eunuch.22 Phyllis Chesler’s 1972 Women and Madness was one of the earliest, and most important, monographs on the subject. Praised by newspapers and feminists from Susan Sontag to Adrienne Rich, the text was a publishing event, and has remained influential in both its arguments and structure. An eclectic collection of biographical studies, psychological theories, interviews and statistical analysis, Women and Madness is complex and ambitious, but primarily concerned with the experience of women, especially women who undergo psychiatric incarceration. Three of its arguments have been particularly influential. First, what is usually recognised as madness, whether of men or women, is in each individual case either the acting out of the female role or a rejection of, or alienation from, that individual’s sex role stereotype. The female role is so devalued that performing this role comprehensively will lead to a diagnosis of depression or anxiety neuroses for women, of homosexuality or schizophrenia for men. On the other hand, if women reject the prescribed behaviours and attitudes of our ‘own’ sex we will also be in trouble, landing a diagnosis of schizophrenia, homosexuality

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Feminist readings of madness

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