XIV

It was not accidental then that treatises on madness began to appear in numbers at the historical moment that resistance set in to the monolithic theories of "the nerve doctors," especially their hysteria diagnosis. This overlap is a complex phenomenon involving theory and practice, as well as social conditions in Western European societies that were becoming more repressive of their poor classes after approximately the mid-eighteenth century. Given the degree to which nerves had earlier been held to account for everything pathological in body and mind the gamut from affections and passions to the wildest imagination—some doctors began to doubt whether this could be so. I refer, of course, to the well-known treatises by the Batties and Monros, the Perfects and Pargeters in the second half of the eighteenth century, who in varying degrees felt ambivalent about nervous diagnosis in relation to perceived lunacy and derangement; in brief, the company discussed by the late Richard Hunter and Ida Macalpine.^[295]

Their collective position permits us to understand how the rival theory of madness developed in relation to the hysteria diagnosis, as well as to comprehend to what degree the hysteria diagnosis had become a barometer of social conditions lorded over by notions of gender—surely a mental zone embracing more than a medical category. The spaces of confinement—madhouses public and private, the clinic, the hospital, prisons of one type or another, attics and closets—are as revealing here as the theory of madness itself. The line between so-called hysterics, female and male, and other types of lunatics was not finely drawn. Incarceration could be ordered for one type as easily as another. There were no specially ordained "hysteria hospitals" (although there were dedicated wards by late century such as the one in Edinburgh). Treatment and therapy for incarcerated hysterics were usually identical to that for other derangements. Furthermore, if the late eighteenth-century madhouse had not yet become the nineteenth-century nervous clinic, there were nevertheless structural similarities in both their methods of diagnosis and applied therapies. But there was one other difference between the diagnoses of madness and hysteria. Unlike the broad base of Enlightenment nervous conditions, madness was not then (in the age of William Battie and A. Monro) a stigma-free organic illness. It was closer to our polluted view of those afflicted with AIDS.^[296]

Stigma was nothing new. It had attached to diagnoses of derangement for centuries. What differentiated it now, in the medical realm of the late eighteenth century, was its new gender lines, often drawn with rank and social class as firmly in mind as any gender base. As Baglivi had pro-

nounced at the turn of the century: "Women are more subject than Men to Diseases arising from the Passions of the Mind."^[297] He and other physicians continued to stress that madness especially afflicted "poor women." Not so hysteria, a female condition said to afflict as many of the rich as the poor and perhaps more.^[298] Nor was madness gendered along the lines it would later be in the nineteenth century, in the decadent world of such subsequent "nerve doctors" as Charcot and Weir Mitchell, nor believed to imitate other diseases (Whytt's "Proteus and the chameleon"). Thus hysteria and madness drifted sharply apart in this dimension: the former deemed by medical professionals to be stigma-free, the latter tarnished by it. But in most other considerations the margins between madness and hysteria were irreparably blurred, and there was as much disagreement as agreement about which of the two diseases was more chronic and lingering. Nor was there much lucidity about, or significant differentiation of, somatic pain in relation to the two conditions. The patients' pain was often thought to be identical in both conditions, affirmed in either state to have been explicitly lodged in an organic site. So in these often contradictory conceptualizations of the late eighteenth century we are actually not far from the radical positivism of late nineteenth-century science and medicine.

One other contrast between lunacy and hysteria cannot be omitted before making the central point about their difference. This is the lunacy that did not announce its pathology through the explicitly acceptable language of organic nervous obstruction but which was said to be something else: hysteria masquerading as lunacy . Hysteria could present both ways—this was one of the features of its protean ability to imitate. And it may have been one reason the proprietors of Bedlam could open its doors to the public "to view the lunatics for a penny," without considering that they were inflicting pain upon patients. This "lunacy that was something else" leads us, moreover, to interrogate the rise of madness in the clear light of the hysteria diagnosis. Fortunately, the point is not so simple as a somatic (bodily) versus psychogenic (mental) hysteria.^[299]

A broad gaze over the eighteenth century buttressd by a cursory bibliographical column makes the point loud and plain. When Thomas Tryon, the neo-Pythagorean guru of health and diet, commented on lunacy in his 1703 Discourse of the Causes of Madness , he was persuaded that madness was still supernaturally induced through possession of devils and spirits, and he harbored no sense of a medicalized, let alone secularized, condition or category. Only one generation later Charles Perry, a licensed physician who traveled widely in the Orient and compiled massive treatises on the Levant, published a treatise On the Causes and

Nature of Madness (1723) claiming that lunacy was a mechanical defect in the nervous constitution, a position echoed for years to come in other works of "mechanical medicine," as in Giovanni Battista Morgagni's Seats and Causes of Diseases . . . (English version 1769). A few years later Andrew Wilson tried to refine the classification of all these conditions, but shortly thereafter William Rowley, another English physician who specialized in "female diseases," jumbled the categories together again in A treatise on female, nervous, hysterical, hypochondriacal, bilious, convulsive disease; apoplexy & palsy with thoughts on madness & suicide, etc .^[300] Rowley's classifications were weak, to say the least. Had he been a student at Edinburgh and listened to the lectures of Cullen and the other professors stressing the importance of classification in medicine, he would not have written as he did, but Rowley was a practitioner, not a theorist, and the intricacies of the female constitution and its maladies were beyond him.^[301] Not a year went by, it seems, without the appearance of some medical treatise aiming to distinguish among these conditions. Over these decades writing continued about the dangers of religious melancholy leading to madness and hysteria, as in John Langhorne's Letters on Religious Retirement, Melancholy, and Enthusiasm (London, 1762) or in the real-life cases of poets such as Christopher Smart, William Cowper, and (some would later say) William Blake.

Wordsworth performed something of a poetic amalgam of these traditions linking religion and hysteria, especially in the strange medical case of Susan Gale, the lonely mother whose intense passion he describes in "The Idiot Boy." Susan's "solitary imagination" lies at the base of her undiagnosed medical condition, just as the medicalized imagination did for so many hysterics examined by Wordsworth's contemporary physicians. Alan Bewell discussed the figure of Susan and "maternal passion" and claimed that the theory of hysteria plays a central role in the poetry of this great Romantic poet. "As a major figure in Wordsworth's mythology of origins," he wrote, "the lonely witch/hysteric provided him with a figural and empirical means for imagining in palpable terms the genesis of language and culture."^[302] These are large claims, but substantiated, I think, by the sweeping role the theory of hysteria played in the European Enlightenment.

But why, one asks, was there a need for a madness diagnosis in the first place if hysteria had been so broad and protean a category since the time of Sydenham that it could embrace most "mad" symptoms? This is the question that must be put if we are to make entry to the world of the nineteenth century, the milieu expounded in chapter 3, by Roy Porter. To restate the matter, where did hysteria and its rival, madness,

stand in relation to gender and the mind/body dilemma (considered separately and in tandem) if there was need for a new condition called madness in the eighteenth century?

There is no simple answer to this all-important question, in itself bound to provoke debate. On one hand, it may be argued that madness was not new in the eighteenth century, and yet even a cursory glance at its discursive representations from 1600 forward shows a sudden outburst of writing in this century. More crucially on the question about gender and the mind/body split, there is no clear-cut division in the late eighteenth century, as I have been stressing, between madness and the hysteria diagnosis. On the other hand—and the adversative is as weighty—the doctors and even their patients clearly have something in mind when they point to the condition of the one or the other. And many readers today will be struck by the fact that Battie's important discussion of madness never refers to hysteria or ever uses the word. No one can read these treatises on madness—by Battie, Monro, and their cohorts—and come away believing one has read a treatise on hysteria. At the same time, and equally paradoxically, the patients' symptoms often presented identically and were described in the same language for both conditions. These are the inconsistencies that must be faced if we are to move into the world of nineteenth-century "nervousness."

When the artist Joseph Farington recorded that his friend, Hone, had "been in a very nervous Hysterical state, the effect of anxiety of mind,"^[303] did he mean hysteria or madness? Across the channel, when French physician Pierre Pomme, who interested himself in few diseases more than nervous ones, published his treatise on "Hysterical Affections in Both Sexes,"^[304] did he mean hysteria or insanity or both? Pomme's boundaries are not drawn. Likewise for other medical writers of varying ranks and abilities. William Falconer's work on hysteria and madness was geared to strengthen the psychogenic bases of derangement by showing how fierce is "the Influence of the Passions upon Disorders of the Body."^[305] So too John Haygarth's treatise Of the Imagination, as a Cause and as a Cure of Disorders of the Body , written only a few years later.^[306] But at the same time Benjamin Faulkner, who owned and operated a private madhouse in Little Chelsea in London, complained that both hysteria and madness had "given birth to endless conjecture and perpetual error."^[307] He was doubtless right, and John Haslam, for two decades an official at Bethlehem, who wrote from long experience in the prison-houses of madness, found himself writing treatises on insanity without invoking hysteria.^[308] Paradoxically, it is as if the two conditions were

identical, yet oceans apart. The lists could be extended many times. Yet the matter is not lists but definition, categories, classification, and—from the patient's point of view—appropriate therapies for each condition.

What then was madness if it was taxonomically bred in the heyday of the hysteria diagnosis? From what need was it sprung? And what had the thousand-year-old hysteria ultimately become if it required the birth of a new malady—madness—to assuage its philosophical and practical defects? Foucault provided no answers in his classic works on madness, and the fault may not be his. Or is it that the late eighteenth-century doctors generating this welter of theory really believed they had discovered some intrinsic difference now lost to time? Can the crux be the massive amount—perhaps too massive—f extant evidence? Anyone can study these early treatises on madness—from Battie to Haslam; in France, from Pomme to Pinel—and explicate them page by page. It is more difficult to pronounce authoritatively on the silences of these discourses, such as the categorical lacuna discovered when William Battie's paradigmatic Treatise on Madness defines madness by refraining from glancing at the concept of hysteria. I am therefore suggesting that we need to study these works, both on hysteria and madness, for their silences as well as their revelations.

In conclusion, there is plenty of evidence to suggest that the Enlightenment nerve doctors conceptualized hysteria as light years away from lunacy, the latter normally conceptualized as a "diseased passion of the mind" often occurring without pathological nervous involvement and without a lingering and chronic madness. Lunacy, madness, insanity: the three are interchangeable terms in their conceptualization—but not so hysteria . Here then is the categorical imperative once again.^[309] For them, hysteria was not a malingering malefactor, but a curable condition of the body's nervous apparatus thrown into convulsion. Hysteria was thus not essentially the inflammation of the reproductive organs unduly excited, as it would again be in the nineteenth century with its retaliative clitoridectomies and antimasturbation techniques, but the nerves laboring under some extraordinary local distress, lesion, or fever.

Still, approximately by the turn of the nineteenth century hysteria was thought to be the more baffling of the two diseases—hysteria and madness—if also the less chronic condition, and now apparently losing ground to a more treatable "insanity." As Whytt had emphasized in Edinburgh a generation earlier with characteristic humility and wisdom, the body's nervous organization, following the laws of sympathy and sensibility, regulates all mind/body traffic. Even so, Whytt had to claim

(following Sydenham who had seen so profoundly into the mysteries of hysteria) that hysteria is entirely unpredictable whereas insanity was not.^[310]

But the discourses on madness, committed as they were to medical materialism, also built mystery into the essence of secularized modern man.^[311] Down through the eighteenth century the Enlightenment nerve doctors had constructed their theoretical edifices on the dualistic model they inherited from a post-Cartesian legacy; as well, they wrote in an intellectual milieu desperate to construct an infallible "science of man"—one as predictable for his or her frail states as strong states. Nevertheless, in generating their versions of hysteria, and then later of madness, they carved out space for man's mystery, enigma, anomaly. The endeavor demonstrated a philosophical tolerance that would serve the nineteenth century well. It also helped to legitimate anomalous, irrational, and enigmatic creatures of both genders as the victims of a medical condition still requiring medical research and authentic classification.

By the turn of the nineteenth century the male nerve doctors had palpably defeminized and dehumanized their female lunatics, often recording their case histories as if these mad patients were "unisex": conflating female and male discourse into a new version. Pinel, for all his well-deserved reforms in Paris, was the odd man out. "Ur-Enlightenment" and humanitarian figure that he was, he also displayed the most unusual versions of compassion and sympathy for his patients. But even Pinel could not resolve the definitional disputes on the boundaries of the two conditions, hysteria and madness, nor did he try.^[312] In the flow of theory, female lunacy was said to imitate male, a position as old as genesis itself, and just as female voices were recorded in the terms and tropes of the male, no different from the protean imitations hysteria had performed.

As hysteria had imitated virtually every other disease, according to Sydenham and Whytt, now, at the end of the eighteenth century, the case histories of women's derangement resembled those of men. It was an odd form of representation, no less baffling than all philosophical mimesis.^[313] But women not only lost their sexual identity, they even lost the voice—the expressive voice—presiding over their collective discourse. The reason and control of the "mad doctors" burned feminine unreason out of the medical annals of the late eighteenth century, so much did the doctors fear it. Instead, they replaced it with a logic and language of their own: a male grammar and syntax that prevailed up to the time of Josef Breuer and Freud. Our contemporary American feminists have enlightened us here—as Mary Jacobus and Juliet Mitchell

have so convincingly written—when cautioning that "women's writing can never be anything other than hysterical."^[314] We can almost reconstruct the position from the social vantage of the last two centuries by gleaning how inevitable it was that women would eventually retrieve the pathetic voices they had lost. No wonder that in our own time hysteria's "his-story" (history) has been transformed into "her-story": the retrieval of a grammar and syntax long suppressed as much as any set of diagnoses and therapies.

To return to the world of Enlightenment hysteria as it approached the turn of the century, not until William Cullen, near century's end, did the womb reappear, and then just momentarily, only to be discredited once again. Cullen's bizarre implication of the womb clung firmly to a somatic etiology, and in this sense it may be said to have had a temporary retarding effect. He not only invoked the hysterical womb but linked it to nervous conditions and the class he called "neuroses," claiming in First Lines of the Practice of Physic (1777), as had Sydenham and others before him, that hysteria was the most "protean of all diseases." "The many and various symptoms," he wrote, "which have been supposed to belong to a disease under this appellation, render it extremely difficult to give a general character or definition of it." But Cullen's explanation retains some of the mystery of hysteria in ways that had been lost on his less enlightened colleagues in Edinburgh and elsewhere. He gazed deeply into women; he understood their anatomies as well as neuroses (a word he virtually coined and made his own).^[315] He somehow gathered that the constant redefinition of hysteria's cause from the Renaissance to his own time was ultimately consistent with the socioeconomic developments he witnessed around him: in rank, class, and economic means. His version of hysteria was as sociological as Sydenham's, and it captured the age-old counterpoint of endorsing and rejecting the womb etiology that had been in vogue from the time of Hippocrates.

Au fond there is something unique to women and implicitly powerful, if destructively so, in the idea of the raging womb compared to the much tamer and vaguer notion that women have "inherently weak" nervous systems merely because of inferior "inner spaces."^[316] But even at that time, in the 1770s and 1780s, Cullen's strong paradigm about hysteria and neurosis took shape within the contexts of a developing rival theory of madness. Another chapter would be necessary to chart with clarity and precision its overlaps with hysteria. Yet rank and class never lurked very far behind these considerations of the role of gender in hysteria and madness. Now, in a European world that would soon be plunged into the night of chaos and political anarchy, both medicine and culture

conspired to rob the middle nouveau riche of its newest and most fashionable garb: nervous affliction. If the poor could be hysterical, as they were in Edinburgh, what was left for the "mad rich in London and Paris"? The pattern appeared to be global and local at once—as paradoxical in this sense as the gender-bound nature of the actual hysteria. Throughout Europe, nerves signified one thing preeminently: rank and class. What differed from place to place, locale to locale, were the forms of social control and patriarchal expression of the nerves. To these disparities, the medicine of the time was almost entirely oblivious and insensitive, and nothing proved it more than the prolific treatises on hysteria and madness. Meanwhile, the doctors churned out their vast collective annals of hysteria diagnoses, one of the largest in the medico-historical literature.